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OP - Treatment of Sexually Transmitted Infections (STIs) or Genital Infections Delegation Protocol - Adult/Pediatric - Ambulatory [5264] Smart Set

OP - Treatment of Sexually Transmitted Infections (STIs) or Genital Infections Delegation Protocol - Adult/Pediatric - Ambulatory [5264] Smart Set - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols, Related


OP - Treatment of Sexually Transmitted Infections (STIs) or Genital Infections
Delegation Protocol - Adult/Pediatric - Ambulatory [5264]
Treatment of Sexually Transmitted Infections
(STIs) or Genital Infections Delegation Protocol
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/delegationpractice-
protocols/ambulatory-delegation-protocols/name-
97379-en.cckm
Documentation
Progress Note [193521]
RN Assessment - STI SEXUALLY TRANSMITTED INFECTIONS FEMALE
Progress Note [193087]
RN Assessment - STI SEXUALLY TRANSMITTED INFECTIONS MALE
Chlamydia
First line for males and non-pregnant females [193536]
Azithromycin, 1 gram today [57023] 1,000 mg, 4 tab, 0, starting 12/21/17 until 12/22/17,
Normal
Males and non-pregnant females allergic to azithromycin or other macrolide antibiotics (including
erythromycin, clarithromycin) [193537]
doxycycline (VIBRAMYCIN) 100 MG cap -
2x/d-7d [36917]
100 mg, 14 cap, 0, starting 12/21/17 until 12/28/17,
Normal
Pregnant females [193090]
erythromycin, clarithromycin), allergic to azithromycin or other macrolide antibiotics (including If
consult provider.
Azithromycin, 1 gram today [57023] 1,000 mg, 4 tab, 0, starting 12/21/17 until 12/22/17,
Normal
Expedited Partner Therapy [187958]
EXPEDITED PARTNER THERAPY -
CHLAMYDIA [EPTCHL0001]
Local Printer, Routine, Qty-1
Gonococcal Infection
First line for males and non-pregnant females [182851]
allergy.provider if patient has penicillin or cephalosporin Contact
Azithromycin + Ceftriaxone [193512]
Azithromycin, 1 gram today [57023] 1,000 mg, 4 tab, 0, starting 12/21/17 until 12/22/17,
Normal
ceftriaxone (ROCEPHIN) 250 MG injection
[44583]
250 mg, 1 each, 0, starting 12/21/17, Print for Fax
lidocaine 1 % injection given IM mixed with
antibiotic [39034]
0.9-4.2 mL, 1 Syringe, 0, starting 12/21/17, Local
Printer
Ceftriaxone - Medication Fee (Charged per 250
mg) [J0696]
No Print, Routine
Administration Fee [96372] No Print, Routine
Males and non-pregnant females with allergy to azithromycin or other macrolide antibiotic (including
erythromycin, clarithromycin) [187918]
allergy.provider if patient has penicillin or cephalosporin Contact
Doxycycline + Ceftriaxone [193577]
doxycycline (VIBRAMYCIN) 100 MG cap -
2x/d-7d [36917]
100 mg, 14 cap, 0, starting 12/21/17 until 12/28/17,
Normal
ceftriaxone (ROCEPHIN) 250 MG injection
[44583]
250 mg, 1 each, 0, starting 12/21/17, Print for Fax
lidocaine 1 % injection given IM mixed with
antibiotic [39034]
0.9-4.2 mL, 1 Syringe, 0, starting 12/21/17, Local
Printer
Ceftriaxone - Medication Fee (Charged per 250
mg) [J0696]
No Print, Routine
Administration Fee [96372] No Print, Routine
Page 1 of 3
Printed by SPENCER, LINDSEY M [LMS033] at 12/21/2017 5:21:05 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Pregnant females [193557]
erythromycin, clarithromycin), allergic to azithromycin or other macrolide antibiotics (including If
providerpenicillin, or cephalosporins, consult
Azithromycin + Ceftriaxone [193512]
Azithromycin, 1 gram today [57023] 1,000 mg, 4 tab, 0, starting 12/21/17 until 12/22/17,
Normal
ceftriaxone (ROCEPHIN) 250 MG injection
[44583]
250 mg, 1 each, 0, starting 12/21/17, Print for Fax
lidocaine 1 % injection given IM mixed with
antibiotic [39034]
0.9-4.2 mL, 1 Syringe, 0, starting 12/21/17, Local
Printer
Ceftriaxone - Medication Fee (Charged per 250
mg) [J0696]
No Print, Routine
Administration Fee [96372] No Print, Routine
Expedited Partner Therapy [193558]
EXPEDITED PARTNER THERAPY -
GONORRHEA [EPTGON0001]
Local Printer, Routine, Qty-1
Bacterial Vaginosis
First line for non-pregnant females (Single Response) [193093]
administered -Oral 1st choice. Use metronidazole gel if the patient would prefer a vaginally
medication. Contact provider before ordering metronidazole if patient is taking warfarin.
metRONIDazole 500 MG - 2x/d-7d [39640] 500 mg, 14 tab, 0, starting 12/21/17 until 12/28/17,
Normal
metRONIDazole (METROGEL) 0.75% gel -
1x/d-5d [45741]
1 applicatorful, 1 Tube, 0, starting 12/21/17, Normal
Non-pregnant females with allergies or unable to avoid alcohol (Single Response) [193559]
administered -vaginally1st choice. Use vaginal cream if the patient would prefer a Oral
medication.
Clindamycin (CLEOCIN) 300 MG cap - 2x/d-7d
[44723]
300 mg, 14 cap, 0, starting 12/21/17 until 12/28/17,
Normal
Clindamycin 2% Vaginal Cream - 1x/d-5d [44726] 1 applicatorful, 1 Tube, 0, starting 12/21/17 until
12/26/17, Normal
Pregnant females [193560]
provider if patient is allergic to clindamycin. Contact
clindamycin (CLEOCIN) 300 MG cap - 2x/d-7d
[44723]
300 mg, 14 cap, 0, starting 12/21/17 until 12/28/17,
Normal
Trichomoniasis
Males and non-pregnant females [182847]
alcohol consumption or provider if patient is allergic to metronidazole, is unable to avoid Contact
is taking warfarin.
metRONIDazole (FLAGYL), 2 g today [39640] 2,000 mg, 4 tab, 0, starting 12/21/17, Normal
Pregnant females [182848]
alcohol consumption or provider if patient is allergic to metronidazole, is unable to avoid Contact
is taking warfarin.
metRONIDazole (FLAGYL), 2 g today [39640] 2,000 mg, 4 tab, 0, starting 12/21/17, Normal
Expedited Partner Therapy [182849]
EXPEDITED PARTNER THERAPY -
TRICHOMONIASIS [EPTTRI0001]
Local Printer, Routine, Qty-1
Genital Herpes (HSV)
Males and non-pregnant females [193096]
provider if patient is allergic to acyclovir. Contact
acyclovir (ZOVIRAX) 400 MG tab - 3x/d-5d
[44027]
400 mg, 15 tab, 0, starting 12/21/17 until 12/26/17,
Normal
Pregnant females [193556]
provider if patient is allergic to acyclovir. Contact
Page 2 of 3
Printed by SPENCER, LINDSEY M [LMS033] at 12/21/2017 5:21:05 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

acyclovir (ZOVIRAX) 400 MG tab - 3x/d-5d
[44027]
400 mg, 15 tab, 0, starting 12/21/17 until 12/26/17,
Normal
Page 3 of 3
Printed by SPENCER, LINDSEY M [LMS033] at 12/21/2017 5:21:05 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org