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1.1. Gonorrhea

1.1.1. Ceftriaxone 250mg IM AND azithromycin 1g OR Doxycycline 100mg BID x 7 days COVERS CHLAMYDIA

1.1.2. If cephalosporin allergy gemifloxacin 320mg PO + AZ Gentamycin 240mg IM + AZ

1.1.3. Pharyngeal Ceftriaxone 250mg IM AND azithromycin 1g PO

1.1.4. Conjunctivitis ceftriaxone 1g IM AND azithromycin 1g PO

1.1.5. Kids Ceftriaxone 25-50mg/kg IV or IM

1.2. Chlamydia

1.2.1. Azithromycin 1g PO

1.2.2. OR doxycycline 100mg PO BID x 7 days

1.2.3. Alternatives Erythromycin base 500mg PO QID x 7 days OR ofloxacin 300mg PO BID x 7 days OR levofloxacin 500mg PO x 7 days

1.2.4. Pregnancy Azithromycin 1g PO

1.2.5. Infants and kids erythromycin 50mg/kg/day PO x 14 days

1.3. Syphilis

1.3.1. primary, secondary, or early latent <1 year Benzathine PCN G 2.4 million U IM in a single dose If PCN allergy Doxycycline 100mg BID x 14 days OR tetracycline 500mg QID for 14 days Latent > 1 year or unknown duration Benzathine PCN G - 2.4 million U IM in 3 doses eac at 1 week intervals PCN allergy

1.3.2. Neurosyphilis PCN G- 18-24 million U per day, administered as 3-4 million U IV every 4 hours or continuous infusion for 10-14 days Procaine PCN G 2.4 million U IM 1x/day PLUS probenecid 500 mg QID both for 10-14 days

1.3.3. Children Primary, secondary or early latent Benzathine PCN G- 50,000 units/kg IM in single dose (maximum 2.4 million units) Latent Benzathine PCN G- 50,000 units/kg IM for 3 doses at 1 week intervals (max total 7.2 MU)

1.4. Trichomonas

1.4.1. Metronidazole or Tinidazole 2g PO single dose avoid ETOH for 36 hours

1.4.2. OR Metronidazole 500mg BID x 7 days

1.4.3. Failure: Metronidazole or Tinidazole 2g PO x 7 days

1.4.4. Treat partners

1.4.5. Caution with treating in early pregnancy

1.5. Epididymitis

1.5.1. Acute Ceftriaxone - 250mg IM in single dose AND Doxy 100mg BID x 10 days Acute + Anal intercourse Ceftriaxone 250mg IM single dose AND levofloxacin 500mg 1x/day for 10 days OR ofloxacin 300mg PO 2x day for 10 days

1.6. PID

1.6.1. Ceftriaxone 250mg IM AND doxycycline 100mg PO 2x for 14 days WITH OR WITHOUT Metronidazole 500mg pO 2x day x 14 days

1.6.2. Cefotetan 2g IV Q12 hrs AND doxyclycline 100mg PO or IV q12 hours

1.6.3. Cefoxitin 2g IV q6 hrs AND doxyclycline 100mg PO or IV q12 hrs

1.7. Vaginosis

1.7.1. Metronidazole gel .75% 1 5g applicator full at bedtime for 4 days

1.7.2. Metronidazole 500mg BID x 7 days CANNOT DRINK WHILE ON ORAL METRONIDAZOLE

1.7.3. Multiple recurrences - metronidazole gel x 6 months

1.7.4. Alternatives Tinidazole 2g PO x 2 days Tinidazole 1g PO 1x day for 5 days Clindamycin 300mg PO 2x day for 7 days

1.8. Chancroid

1.8.1. Azithromycin 1g

1.8.2. OR IM ceftriaxone

1.8.3. OR PO erhythromycin x 7 days

1.9. HSV

1.9.1. higher doses with concurrent HIV

1.9.2. Valcyclovir Best bioavailability less frequent dosing initial: 1g BID x 7-10 days Recurrent 500mg BID x 3 days Acyclovir Cheap Short half life initial Recurrant

1.9.3. Famcyclovir increased bioavailability less frequent dosing initial 250mg TID x 7 days Recurrant 125mg 2x day x 5 days

1.10. Candidal (Yeast infections)

1.10.1. Fluconazole 150 mg - 1 tablet only

1.10.2. Topical/Intravaginal - butoconazole, clotrimazole, miconazole, nystatin, terconazole

1.10.3. Pregnancy Intravaginal clotrimazole or miconazole x 7 days Women will present with first yeast infection in pregnancy

1.10.4. Recurrance Flucaonazole + 2nd/3rd dose 3 & 6 days later probiotics

1.11. Genital Warts

1.11.1. Aldara cream imiquimod 3.75% - 5% 3x week & wash off 6-10 hours later max 16 weeks

1.11.2. Podofilox .5% gel BID x 3 days discontinue for 4 days & repeat PRN Max 4 treatment cycles

1.12. Lymphogranuloma vereum

1.12.1. Doxycycline 100mg BID x 21 days

1.12.2. OR erythromycin 500mg QID PO for 21 days

1.13. Nongonoccocal Urethritis

1.13.1. Azithromycin 1g PO

1.13.2. OR doxycycline 100mg BID x 7 days

1.13.3. OR erythromycin 500mg QID x 7 days

1.14. Crabs

1.14.1. Permetrhin 1% cream rinse

1.14.2. OR pyrethrins with piperonyl butoxide

1.14.3. OR malation .5% lotion

1.15. Scabies

1.15.1. Permethrin 5% cream

1.15.2. Ivermectin 200mcg/kg PO repeated in 2 weeks

2. MEN


2.1.1. AE: HA, dyspepsia, back pain, nasal congenstion, flushing, sudden vision or hearing loss, priapism, HYPOTENSION

2.1.2. PDE5i - inc cGMP, relax smooth muscle

2.1.3. C/I nitroglycerine, severe renal/hepatic impairment

2.1.4. Sildenafil (Viagra) 50mg PO 1 hr before sexual activity Increase to 100mg or reduced to 25mg PRN 25mg for hepatic/renal/>65 MAX 100mg/day tx ED, pulmonary arterial HTN,

2.1.5. Tadalafil (Cialis) 10mg PO before sexual activity OR 2.5mg/day PO daily dose 5-20mg dose adjustments renal/hepatic  do not exceed 5mg/day Tx BPH, pulm art. HTN, ED,

2.1.6. Vardenafil (Levitra) film coated - 10mg PO 1hr before sex 5-20mg dose increase/decrease decrease dose with azoles/avirs/mycin PO disintegrating - 10mg PO placed on tongue 1 hr before sex do not exceed 1 dose/day


2.2.1. AE: men with carcinoma of the breast or prostate or women who are or may become pregnant, can cause virilization in females

2.2.2. Methyltestosterone (Android) SYNTHETIC PO 10-50mg/day Buccal 5-25mg/day 2x activity of PO tx delayed puberty tx breast cancer that has spread PO 50-200mg/day

2.2.3. Fluoxymesterone (Androxy, Japetestom) SYNTHETIC replacement therapy for testosterone deficiency 5-20mg PO qD Metastatic Breast CA females 10-40mg/day PO x 3 months

2.2.4. Testosterone Tesosterone cypionate (Depo) 50-400mg IM q 2-4 weeks testosterone enanthate (Delatestryl) 50-400 mg q 2-4 weeks testosterone patch (Androderm) 2.5-5mg/day testosterone gels (Androgel, testim) 5-10 g of gel /day

2.3. BPH Treatment

2.3.1. SELECTIVE - α1A blocker MOA: block adrenoreceptors in prostate C/I: -avir, -conazole AE: abdominal pain, back pain, bronchitis, dizziness, HA, impotence, liver impairment Alfuzosin (uroxatral) 10mg PO qD after food Tamsulosin (flomax) .4 PO qD 30min after same meal each day Tx BPH, bladder outlet obstruction, ureteral stones OK for renal/hepatic

2.3.2. NONSELECTIVE - α1 blocker hypotension, dizziness, fatigue take at bedtime to avoid syncope C/I: -evir, -afil, -osin, yohimbe liver disease, CVA, MOA: vessel dilation, decrease TPR Can treat HTN Doxazosin (Cardura) IR - 1-8mg/day PO ER - 4mg/day PO Terazosin (Hytrin) 1mg PO qHS Prazosin (Minipress) can treat PTSD .5mg PO q12hrs



3.1.1. NO VTE, migraine, smokers > 35, history of DVT

3.1.2. TX menopausal sx, hypogonadism, osteoporosis, prostate CA, abnormal uterine bleeding,

3.1.3. AE: abdominal pain, breast enlargement, HA, arthralgia, sinusitis, diarrhea, endometrial CA, breast CA, CV risk,

3.1.4. C/I: ospemifene

3.1.5. Premarin Conjugated equine oral/Topical/Vaginal .3mg PO once daily continuous or cyclic

3.1.6. Estradiol (Alora) Patch estroderm 1-2mg PO once daily x 3 weeks, with 1 week off


3.2.1. breastfeeding or contraindication to progesterone

3.2.2. C/I: breast cancer, liver dx, HTN, DM,

3.2.3. Norethindrone 350 mcg (Micronor) Estrogen sensitive patients severe nausea, enlarged uterus, uterine fibroids, large/painful breasts, heavy menstruation, dysmenorrhea 1 tablet .35mg PO qDay, continuous administration

3.2.4. Norgestrel 75 mcg (Ovrette) .075mg PO qDay at same time each day

3.2.5. ANTIPROGESTINS Mifepristone (Mifeprex) Abortion C/I: anything with increased bleeding, steroids, lovastatin AE: abd pain, cramping, N/V/D, HA, MOA: stimulates uterine contractility, increases postaglandins


3.3.1. Biphasic delvier the same amount of estrogen but progesterone is increased halfway through the cycle Norethindrone/EE (ortho-novum 10/11) Norethindrone acetate/EE/Iron (Estrostep FE) Desogestrel/EE (Mircette) irregular menses with no underlying PCOS

3.3.2. Triphasic have 3 different doses of progesterone and estrogen that change q 7 days Levongestrel/EE (Trivora) Norgestimate/EE (Ortho Tricyclen) Norethindrone/EE (Ortho-novum 7/7/7) For moderate flow and average cramps


3.4.1. Contain a constant amount of estrogen and progesterone in each pill

3.4.2. For estrogen deficient

3.4.3. For moderate flow and average cramps

3.4.4. 35/0.25 EE/norgestimate (Ortho-Cyclen)

3.4.5. 35/1 EE/Norethindrone (Ortho-Novum)

3.4.6. 35/0.5 EE/norethindrone (Modicon)


3.5.1. Constant amount of estrogen and progesterone throughout cycle

3.5.2. for short term tx of BTB (initial)

3.5.3. For heavy flow and severe cramps (Decrease dose once stable)

3.5.4. 50/1 EE/ethynodiol diacetate (Zovia 1/50)

3.5.5. 50/1 EE/norethindrone (Ortho-Novum)


3.6.1. Constant amount of estrogen and progesterone throughout cycle

3.6.2. More likely to have BTB

3.6.3. For perimenopausal women with irregular cycles Relieve hot flashes

3.6.4. For light flow and mild cramps

3.6.5. 20/1 EE & NORETHINDRONE ACETATE & IRON (Loestrein Fe 1/20) For progesterone deficient

3.6.6. 20/.01 EE & LEVONGESTREL (Aviane)

3.6.7. 20/1 EE/norethindrone acetate (Loestrine)

3.6.8. 30/1.5 EE/norethindrone acetate/iron (Loestrine Fe 1.5/30) Menorrhagia

3.6.9. 30/0.3 EE/norgestrel (Low-Ogestrel)

3.6.10. 30/3 EE/drospirenone (Yasmin, YAZ) Drospirenone has no androgenic activity First line PCOS Progesterone senstivie PMS symptoms, edema, abominal bloating, HA, depression

3.6.11. 30/0.15 EE/levonorgestrel (Levora)

3.6.12. 30/1.5EE/norethindrone acetate (Loestrin 1.5/30)

3.6.13. 30/0.15 EE/desogestrel (Ortho-Cept)