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Sexually Trasmitted Disease  

Sexually Transmitted Disease             

Diseases Characterized by Genital Ulcers

     

Diseases Characterized by Urethritis and Cervicitis
  1. Chlamydial Infections - Chlamydia    (Chlamydia trachomatis)
  2. Gonococcal Infections -  Gonorrhea  (Neisseria gonorrhoeae)
  • Management of Male Patients Who Have Urethritis
  • Etiology
  • Confirmed Urethritis
  • Management of Patients Who Have Nongonococcal Urethritis
  • Management of Patients Who Have Mucopurulent Cervicitis (MPC)

Urethritis can result from infectious and noninfectious conditions.

Symptoms: discharge of mucopurulent or purulent material, dysuria, or urethral pruritis.
Asymptomatic infections are common.

N. gonorrhoeae and C. trachomatis are clinically important infectious causes of urethritis.

If clinic-based diagnostic tools (Gram stain microscopy) are not available, patients should be treated for both gonorrhea and chlamydia.

Diseases Characterized by Vaginal Discharge -  Vaginitis  
  • Management of Patients Who Have Vaginal Infections
  • Bacterial Vaginosis
  • Trichomoniasis
  • Vulvovaginal Candidiasis

Pelvic Inflammatory Disease

  • Diagnostic Considerations
  • Treatment
  • Follow-Up
  • Management of Sex Partners
  • Prevention
  • Special Considerations

Chancroid
Azithromycin 1 gm PO x1  or
Cipro 500 mg bid PO x3days  or
Erythromycin 500 mg PO QID x1 week
Ceftriaxone 250 mg IM x1

Genital Herpes
For first episode:
Acyclovir 400 mg tid x 7-10 days
Famciclovir 250 mg tid x 7-10 days
Valacyclovir 1 gm bid x 7-10 days

For recurrent episodes:
Acyclovir 400 mg tid x 5days or 800 mg bid x 5 days
Famcyclovir 125 mg bid x 5 days
Valacyclovir 500 mg bid x 5 days

For suppressive Rx:
Acyclovir 400 mg bid
Famciclovir 250 mg bid
Valacyclovir 250 mg bid or 500 mg daily

Gonorrhea
Cipro 500 mg PO x 1 dose
Cefixine (Supra)  400 mg PO x 1 dose - may be discontinued by manufacture soon!
Ceftriaxone (Rocephin) 125-250 mg IM x 1 (can be reconstituted with 1% lidocaine soln to reduce injection pain)
Spectinomycin 2 gm IM x 1
Plus Azithromycin 1 gm PO x 1 or Doxycycline 100 mg bid x 7 days for Chlamydia Rx also. 

Chlamydia  
Azithromycin  (Zithromax) 1 gm  (4 tab of 250 mg tablet) PO x 1 , or
Doxycycline 100 mg bid x 7 days

* Evaluate, test, and treat all sexual partners within the last two months if possible.

Treatment of Patients Who Have Nongonococcal Urethritis 
Azithromycin 1 g orally in a single dose, OR
Doxycycline 100 mg orally twice a day for 7 days. or
Erythromycin base 500 mg orally qid for 7 days
Erythromycin ethylsuccinate 800 mg orally qid for 7 days,

Ofloxacin 300 mg twice a day for 7 days.

Granuloma-Inguinale
Trimethoprim-sulfamethoxazole one double-strength tablet orally twice a day for a minimum of 3 weeks
, or
Doxycycline 100 mg orally twice a day for a minimum of 3 weeks.
Therapy should be continued until all lesions have healed completely.

Alternative Regimens
Ciprofloxacin 750 mg orally twice a day for a minimum of 3 weeks, OR
Erythromycin base 500 mg orally four times a day for a minimum of 3 weeks.

Syphilis
 
Benzathin Penicillin G 2.4 million units IM x 1 dose, or
Doxycycline/Vibramycin 100 mg PO bid x 2 weeks, or
Tetracycline 500 mg PO qid x 2 weeks


For Early Latent Syphilis
Penicllin G 2.4 million units IM x1 dose

For Late Latent Syphilis
Benzathin Penicllin G 2.4 million units IM x 3 consecutive weeks

       

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2010