Silverbook.health.wa.gov.au

Bacterial
Incubation period
Vaginosis
Metronidazole 400 mg orally, 12-hourly with food for five days OR metronidazole 2 g orally, as a single dose (less effective) OR metronidazole gel 0.75% gel 5 g, nocte for five nights (not on PBS) Requires notification
OR tinidazole 2 g orally, as a single dose with food OR clindamycin 2% vaginal cream 5 g, daily for seven days (not on PBS) Usual testing method
OR clindamycin 300 mg orally, 12-hourly for seven days (not on PBS). Candidiasis
Any of the available imidazole preparations are effective, either as cream or pessaries. Quick Reference
Incubation period
Various preparations are available for either single dose therapy, or three to seven Indefinite. C. albicans is usually normal flora
How far back to contact trace
to STI Management
recurrent symptoms
Requires notification No
Usual testing method
Genital Herpes
Valaciclovir 500 mg orally, 12-hourly for five to ten days Incubation period
OR aciclovir 200 mg orally five times daily for five to ten days Often unknown
How far back to contact trace
Genital Herpes
Episodic
Episodic treatment is indicated for infrequent recurrences (i.e. intervals of more than six to eight weeks). Short courses of three to five days duration of valaciclovir, famciclovir or aciclovir should be initiated early on by the patient at the first sign of Requires notification No
Usual testing method
Suppressive
Suppressive therapy is indicated in significant, frequent disease. Valaciclovir, famciclovir, aciclovir on a daily basis can reduce severity and frequency of outbreaks.
Genital Warts
Not pregnant
Incubation period
Podophyllotoxin paint (0.5%) (not on PBS) or cream (0.15%) topically twice daily for three days, do not treat for four days. Repeat for up to four weeks.
OR Imiquimod 5% cream topical y, three times a week for up to 16 weeks (not on PBS).
How far back to contact trace
Pregnant
Cryotherapy: apply liquid nitrogen to visible warts weekly until resolution occurs Requires notification No
OR surgical ablative therapy for large or extensive lesions.
Usual testing method
Trichomoniasis
Metronidazole 2 g orally, as a single dose Incubation period
OR tinidazole 2 g orally, as a single dose with food OR metronidazole 400 mg orally, 12-hourly for five days.
asymptomatic indefinitely
How far back to contact trace
partners only
Requires notification No
Usual testing method
Microscopy or specific culture of vaginal * NAAT = Nucleic Acid Amplification Test (e.g. PCR)
**First void urine to detect STIs is first 20 mL of urine passed, collected at any time of the day
*** The standard treatment for uncomplicated chlamydia and gonorrhoea in endemic regions is a ZAP pack, which contains azithromycin 1 g, amoxycillin 3 g,
probenecid 1 g and a patient advice sheet. Please see the WA Endemic Regions STI/HIV Control Supplement: Goldfields, Kimberley and Pilbara Regions and
check with regional standing orders in regard to use of a ZAP pack.
For more information on contact tracing recommendations order the Australasian Contact Tracing Guidelines 4th Edition (2010)
at http://www.ashm.org.au/publications
For more information go to
http:/ silverbook.health.wa.gov.au OR phone:
Fremantle Hospital Sexual Health Clinic - (08) 9431 2149
Royal Perth Hospital Sexual Health Clinic - (08) 9224 2178
Chlamydia
Incubation period
Chancroid
Azithromycin 1 g orally, as a single dose (preferred treatment) > 2 days–2 months for male urethral Incubation period
Azithromycin 1 g orally, as a single dose OR doxycycline 100 mg oral y, 12-hourly for seven days (LGV see Silver Book, section 2.6.4). OR ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly How far back to contact trace
Children 0-8 years
OR ciprofloxacin 500 mg orally, 12-hourly for three days.
Azithromycin 10 mg/kg (to a maximum of 1 g) orally, daily for five days OR erythromycin 10 mg/kg per day orally, in four doses for 10-14 days. How far back to contact trace
Requires notification
Children > 8 years
Usual testing method
Azithromycin 20 mg/kg (to a maximum of 1 g) orally, as a single dose Requires notification
OR doxycycline 100 mg orally, 12-hourly for seven days. Pregnant women
Usual testing method
Azithromycin 1 g orally, as a single dose (category B1) (preferred option) OR erythromycin ethyl succinate 800 mg orally, 12-hourly for 10 days (category A) Incubation period
OR erythromycin base 250 mg orally, six-hourly for 14 days (category A). Hepatitis A
Post-exposure prophylaxis: Within two weeks of sexual exposure, use normal
Use ZAP pack for empirical treatment in WA endemic areas *** How far back to contact trace
Under 25 kg - 0.5 mL intramuscularly as a single dose
Treating uncomplicated gonorrhoea contracted in the Perth metropolitan area or
Gonorrhoea
Incubation period
Requires notification
interstate/overseas
2 –10 days for male urethral infection; 25–50 kg - 1 mL intramuscularly as a single dose
Adults - Ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly, as a single dose
Over 50 kg - 2 mL intramuscularly as a single dose
Usual testing method
If vaccination is to be given, it can be started at the same time but at a dif erent injection site.
Children - Ceftriaxone 50 mg/kg (maximum 500 mg in 2 mL 1% lignocaine)
How far back to contact trace
Treating uncomplicated gonorrhoea contracted outside the Perth metropolitan
Acute infection does not usually require treatment. Incubation period
area but within WA. Single dose directly observed therapy (DOT) is preferred.
Hepatitis B
Post-exposure prophylaxis
Requires notification
Adults - Amoxycillin 3 g orally, as a single dose
Percutaneous contacts should be given hepatitis B immunoglobulin (HBIG) 400 IU How far back to contact trace
PLUS probenecid 1 g orally, as a single dose. intramuscularly, as a single dose within seventy-two hours of exposure.
Usual testing method
Children weighing < 45 kg
Individuals sexually exposed should be given HBIG 400 IU intramuscularly and vaccine Amoxycillin 50 mg/kg orally, as a single dose within two weeks of sexual contact for maximum protection. If more than two weeks PLUS probenecid 25 mg/kg orally, as a single dose. vaccination should still be commenced.
Requires notification
Care should be taken to follow-up these patients as empirical treatment will sometimes Hepatitis B vaccination and immunoglobulin can be given at the same time, but at fail due to the rise in penicillin-resistance.
Usual testing method
This treatment is not adequate for rectal or pharyngeal gonorrhoea, where ceftriaxone Use ZAP pack for empirical treatment in WA endemic areas *** Treatable using pegylated interferon and ribavirin.
Incubation period
Hepatitis C
No specific prophylaxis or vaccine is available for HCV.
Urethritis/
Manage as for chlamydia and also gonorrhoea in areas where this is common. Cervicitis
How far back to contact trace
Donovanosis
Azithromycin 1 g orally (DOT), weekly for four weeks or until healing occurs Incubation period
Requires notification
(whichever is longer) (preferred treatment because of much greater compliance) OR azithromycin 500 mg orally (DOT), daily for seven days only. How far back to contact trace
Usual testing method
Requires notification Yes
Usual testing method
Clinical, histology of a shave biopsy, or Begin treatment early. Delayed treatment is associated with a significantly increased Incubation period
Inflammatory
risk of tubal infertility or ectopic pregnancy. Rest. Use non-steroidal anti-inflammatory for pain relief. How far back to contact trace
Prevent any Candida infection with pessaries during the treatment period. Syphilis
Penicillin remains the drug of choice. If there is any doubt about the clinical stage
Incubation period
of the patient’s infection, treat as for late latent syphilis.
Sexually acquired PID - Immediate treatment Requires notification
Primary, secondary and early latent syphilis (up to 24 months)
Azithromycin 1 g orally, as a single dose secondary syphilis; usually 5–35 years Benzathine penicillin 1.8 g intramuscularly, as a single dose PLUS ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly, as a single dose Usual testing method
OR procaine penicillin 1 g for patients less than 60 kg Clinical diagnosis, may be reinforced by bodyweight and 1.5 g for patients over 60 kg How far back to contact trace
For mild to moderate infection (outpatient treatment) bodyweight, intramuscularly, daily for 10 consecutive days. After the immediate treatment above, continue with:
If allergic to penicillin - doxycycline 100 mg orally, 12-hourly for 14 days.
doxycycline 100 mg orally, 12-hourly for two weeks OR a second dose of azithromycin 1 g seven days later (where compliance is thought RULE OUT Pregnancy
Late latent syphilis (more than 24 months)
Benzathine penicillin 1.8 g intramuscularly, once weekly for three doses. If treatment is PLUS either metronidazole 400 mg orally, 12-hourly for two weeks missed for more than two weeks, must restart OR tinidazole 500 mg orally, daily for two weeks. OR procaine penicillin 1 g for patients less than 60 kg bodyweight and 1.5 g for patients over 60 kg Requires notification Yes
bodyweight, intramuscularly, daily for 15 days. Usual testing method
If allergic to penicillin - doxycycline 100 mg orally, 12-hourly for 28 days. Patient to avoid sexual intercourse until they are non-infectious and HIV - Initial assessment and staging should be done by an HIV / Sexual Health specialist ideal y involving shared care with the General Practitioner.
Contact Clinical Immunology (HIV only), Royal Perth Hospital (08) 9224 2899 Or Infectious Diseases Department, Fremantle Hospital (08) 9431 2149 in the first instance For pregnant/breastfeeding women or inpatient management see Silver Book, How far back to contact trace: can be years, seek expert advice

Source: http://silverbook.health.wa.gov.au/images/ASHMPublications/pdf/ASH3786_Ready%20Reference_A3-6DEC.pdf