STD prophylaxis?

[AREID]

I work in an area where chlamydia is very prevalent.  When someone comes in saying they might have been exposed, ill usually give the Azithro 1gram at the same time im sending off the urine.  Is there such a thing as treating someone too soon after exposure? Say giving antibiotics the following day from unprotected intercourse? What about with gonorrhea?  Iv searched, but I really couldn't find an answer. Thanks

 

 

[Gaijyn]

From what I have seen/read if there is a possible exposure, or if a exposure is suspected you treat.  Also, if I recall correctly, the CDC recommends treating both Gonorrhea and Chlamydia together even in the abscence of a positive result for one of them.  I think it is the 2010 or so CDC guidlines.  So you could give the 250mg Rocephin IM with the 1gm Azithro and be okay and within CDC guidlines to my knowledge.  

 

 

 

Not to hijack but I know the CDC recommends 2gm of Azithro for PCN allergic pts to tx for Gonorrhea, but does this also cover for Chlamydia at the same time?  In the past (as a student yes but the decision to tx was mine) I added Doxy 100mg BID x7days to cover for Chlamydia.  Is this something that is acceptable or is the 2gm Azithro enough to cover both?

[AREID]

2 grams is an option but not 1st or 2nd line. If they are PCn allergic it shouldn't matter because the treatment is 250 of rocephin. Now if there is anaphylaxis then yes. If pos for chlamydia treat chlamydia. If pos for gonorrhea you treat both

 

 

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[rcdavis]

Teaching and pondering point.

 

Back in "the day" gc was tx'd with penicillin or spectinomycin, which would also kill syphilis

 

Until, of course, resistance, and the emergence of rocephin..

 

Now standard tx is rocephin for gc and Zithromax for chlamydia.

 

Unlike penicillin, neither rocephin nor Zithromax is spirochetal..

 

Doxycycline is.

 

I routinely add a 14 day course doxycycline ( picking the less expensive salt) to the rocephin and the Zithromax in order to

 

---1. Assure complete chlamydial treatment, especially in potential salpingitis

 

---and, IMHO 2. more importantly, to treat the very potential comorbid infection: syphilis.

 

In many parts of the states we are seeing a resurgence of syphilis, and most of us in the ED are NOT Screening for this disease when we are doing the NGC/chly screens.

 

Just my opinion

 

Oh btw, I would also add the warning, that if the patient has true anaphylactic penicillin reaction, I would hesitate to use even third gen cephalosporins

[cinntsp]

Oh btw, I would also add the warning, that if the patient has true anaphylactic penicillin reaction, I would hesitate to use even third gen cephalosporins

 

http://academiclifeinem.com/busting-the-myth-the-10-cephalosporin-penicillin-cross-reactivity-risk/

 

 

HOT OFF THE PRESS

A new review article of 27 articles on this very topic just came out reporting:

• Overall cross-reactivity rate between cephalosporins and penicillins in patients reporting a penicillin allergy = 1%. 
• Overall cross-reactivity rate in patients with a confirmed penicillin allergy = 2.5%. 

OTHER KEY FINDINGS TO NOTE

1. The true incidence of an allergy to penicillin in patients believed to have such allergy is <10% (it’s like we have a built in 10-fold safety factor).
2. Cross-reactivity between penicillins and MOST 1st and 2nd generation cephalosporins is negligible.
3. Cross-reactivity between penicillins and ALL 3rd and 4th generation cephalosporins is negligible.
4. If a patient has an allergy to amoxicillin or ampicillin, avoid cefadroxil, cefaclor, cefatrizine, cefprozil, cephalexin, and cephradine.

[cupojava]

 

---and, IMHO 2. more importantly, to treat the very potential comorbid infection: syphilis.

 

In many parts of the states we are seeing a resurgence of syphilis, and most of us in the ED are NOT Screening for this disease when we are doing the NGC/chly screens.

 

 

I'm very glad you posted this.  I receive the state epidemiology report every quarter and the incidence of syphilis keeps rising.  Not only does it appear as co-infection with other STDs, there is also an increasing incidence of congenital syphilis (so sad).

Sorry for thread hijack but I just thought I'd reiterate.

Carry on....

[AREID]

I appreciate the responses. But really my question was if there is a window of time where treating a patient too soon after exposure will make the treatment worthless?

 

 

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[d2305]

Penicillin is still the treatment for syphilis. Spectinomycin did not treat syphilis, and it used to be that one got 2.4 MU Wyclillin in one cheek and 2 gms of Spectinomycin in the other after PI liberty. Not much Chlamydia back them.