hottie99
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peter90036 wrote:
i cant seem to remember how to treat chlam/gonococcal ... need your help:
if woman sex active + discharge = what pathogen #1 ? DISCHARGE = neisseria
if woman cystitis = what pathogen #1 E.Coli/Proteus/Klebsiella; e.coli is most common
if man sex active +discharge = likely what pathogen? neisseria
if man asymptomatic = carrier of which ? was gono the asympt in man? asx is always chlamydia
if woman has chalmydia
--> treat for what? chlam+gono or just chlam --> only chlamydia, so Doxy or Azithro
--> treat just woman or also partner partner will have also, but u must treat her
if woman has gonococcccal
--> treat for what? chlam+gono or just chlam --> treat for both, so Ceftriaxone + Doxy
--> treat just woman or also partner partner will have too, but again treat pt who is there first
what if she has trichomonas? this is self standing, they will talk about strawberry cervix or motility of bug; tx is Metronidazole
--> tx tricho or +chlam & gono?
--> woman & partner?
what if its a man? what is what is a man??? not sure wat u asking here!
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| peter90036
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thank you, ok...
G -> CD ... NCD...
GC = Gonococcus+Chlamydia .
.. gonocd... gonoboth,
...neissboth
Gonna treat both
GOTB ...
trichomonly 
Edited by peter90036 on 04/14/08 - 04:14 PM
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| hottie99
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yes, hope that helps!
think of it this way, since gonorrhea is usually has discharge, thy treat it presumptively for chlamydia b/c that usually presents asymptomatically, so it's 'assumed' they have both; chlamydia is most common std, and they say that b/c in most ppl it's asymptomatic.. so if someone comes in with burning urination and sexually active and descirbes chlamydia bug, then u know it's that, but a lot dont present with symptoms until much later.. i know this isn't any 'official' definitions from any book, it's just what i've picked up over reading this stuff for so long, hahaa.. hope it helped!! 
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| DrVirgo
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hottie99 wrote:yes, hope that helps! think of it this way, since gonorrhea is usually has discharge, thy treat it presumptively for chlamydia b/c that usually presents asymptomatically, so it's 'assumed' they have both; chlamydia is most common std, and they say that b/c in most ppl it's asymptomatic.. so if someone comes in with burning urination and sexually active and descirbes chlamydia bug, then u know it's that, but a lot dont present with symptoms until much later.. i know this isn't any 'official' definitions from any book, it's just what i've picked up over reading this stuff for so long, hahaa.. hope it helped!!
You are right -Chlamydia is very common... way more common than Gonorrhea.. about 5 times more!. And if a person has gonorrhea, you must treat for both gono and chlam because of the high frequency of coinfection.
Give a cephalosporin (cefixime 1 dose PO) AND Azithromycin (1 dose PO)
However I would like to make a small correction:
#1 Most common STD is HPV (also the most common VIRAL STD) -around 80% of women have been exposed to HPV!
#2 is Trichomonas -(also the most common PARASITIC STD)
#3 is Chlamydia -(also the most common BACTERIAL STD)
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| arlete
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Only wanna add, since we are talking about it:
# 2 cause of cystitis in women: Staphylococcus saprophiticus.
DrVirgo: I thought we were supposed to treat gonorrhea with Ceftriaxone, did that change? (Cardiologist here asking...  ).
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| DrVirgo
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arlete wrote:Only wanna add, since we are talking about it: # 2 cause of cystitis in women: Staphylococcus saprophiticus. DrVirgo: I thought we were supposed to treat gonorrhea with Ceftriaxone, did that change? (Cardiologist here asking... ).
you're right... It IS ceftriaxone according to Kap ID. for some reason I have written cefixime in my ob/gyn notes from lecture under where it says cephalosporin. Safe to just say cephalosporin? or do we have to know which class to be more specific?
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| hottie99
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3rd generation ceph covers neisseria
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| arlete
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So both will work. Thanks, guys!
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| inkspot
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let me add something here:
if the women is pregnant then you dont give doxycyline (teratogenic) for chlymydia give erythromycine base.
for trichomonas and all other stds treat partner as well. BUT the exception to this rule is:
bacterial vaginosis ( gardnerlla vaginalis = the one of with clue cells ) and candidia
gonorrhea: ceftrixone is given as IM so you can give cefixime which is available as oral ( only 3rd generation which is oral ) --- single dose
Chlamydia: doxy (single dose) or erythro base (days???) - and yes treat both gonna treat both 
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