Sexually Transmitted Diseases (STDs)
Dr. Shaikh Ubedulla Iqbal, Asst Professor, Department Of Pharmacology, Mamatha Medical College, Khammam.
October 3, 2012
Sexually Transmitted Diseases (STDs)
Gonorrhea
Syphilis
Genital Herpes Chancroid Lymphogranuloma Venereum Granuloma inguinale or donovanosis Vaginal discharge
October 3, 2012
GONORRHEA
N. gonorrhoeae is a gram-
negative diplococcus.
Individuals infected with
gonorrhea can be symptomatic or asymptomatic
Complicated or
uncomplicated infections, and have infections involving several anatomic sites.
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Presentation of Gonorrhea Infections
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Males
General Incubation period 114 days Symptom onset in 28 days
Most commonurethra Most common endocervical canal Othersrectum,oropharynx, eye Can be asymptomatic or minimally symptomatic Urethral infectiondysuria and urinary frequency Anorectal infectionasymptomatic to severe rectal pain Pharyngeal infectionasymptomatic to mild pharyngitis Purulent urethral or rectal discharge Anorectalpruritus, mucopurulent discharge, bleeding
Females
Incubation period 114 days Symptom onset in 10 days
Most commonendocervical canal Othersurethra, rectum,eye, oropharynx Can be asymptomatic or minimally symptomatic Urethral infectiondysuria and urinary frequency Anorectal infection same as in men
Site of infection
Symptoms
Signs
Abnormal vaginal discharge or uterine bleeding; purulent urethral or rectal discharge can be scant to profuse Pelvic inflammatory disease and associated complications Disseminated gonorrhea 2012 October 3,
Complication Rare (epididymitis, prostatitis, inguinal s lymphadenopathy, urethral stricture) Disseminated gonorrhea
Treatment of Gonorrhea in adult
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TYPE OF INFECTION
DRUG OF CHOICE
ALTERNATIVE
Uncomplicated NG of cervix,urethra and rectum
Ceftriaxone 250 mg IM in a single dose
Cefixime 400 mg orally in a single dose Azithromycin 1g orally in a single dose
Spectinomycin 2 g IM once Cefotaxim 500 mg IM once Azithromycin 2 g orally
Doxycycline 100 mg orally twice a day for 7 days
Uncomplicated Gonococcal Infections of the Pharynx
Ceftriaxone 250 mg IM in a single dose Azithromycin 1g orally in a single dose Doxycycline 100 mg orally twice a day for 7 days Ceftriaxone 1 g IM in a single dose
Gonococcal Conjunctivitis Disseminated Gonococcal Infection (DGI)
Ceftriaxone 1 g IM or IV every 24 hours
Cefotaxime 1 g IV every 8 hours Ceftizoxime 1 g IV every 8 hours
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Gonococcal Meningitis
Ceftriaxone 12 g IV every 12 hours
TYPE OF INFECTION
DRUG OF CHOICE
Ophthalmia Neonatorum
Ceftriaxone 2550 mg/kg IV or IM in a single dose, not to exceed 125 mg
DGI and Gonococcal Scalp Abscesses in Newborns
Ceftriaxone 2550 mg/kg/day IV or IM in a single daily dose for 7 days, with a duration of 1014 days, if meningitis is documented
Cefotaxime 25 mg/kg IV or IM every 12 hours for 7 days, with a duration of 1014 days, if meningitis is documented
Prophylactic Treatment for Infants Whose Mothers Have Gonococcal Infection Ceftriaxone 2550 mg/kg IV or IM, not to exceed 125 mg, in a single dose Erythromycin (0.5%) ophthalmic ointment in each eye in a single application (opthalmia neonatorum prophylaxis)
October 3, 2012
Syphilis
Syphilis usually is acquired by sexual contact with
infected mucous membranes or cutaneous lesions.
Although on rare occasions it can be acquired by
nonsexual personal contact, accidental inoculation, or blood transfusion.
The causative organism of syphilis is Treponema
pallidum
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Genital Herpes
Genital herpes is a chronic, life-long viral infection. Two types of HSV have been identified, HSV-1 and HSV-2. The majority of cases of recurrent genital herpes are caused by HSV-2
Genital Herpes in Men This picture shows
typical herpes lesions on the penis, including vesicles and ulcerations. Because the number of lesions is extensive this may be a first outbreak of genital herpes for this person.
Genital Herpes Penis This picture shows herpes lesions in the later stages of healing. The ulcerations are starting to fill in. Because the genital area is warm and moist, crusting may not develop as the lesions heal. Herpes on the penis last stage of the blisters
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First Clinical Episode of Genital Herpes
Recommended Regimens* Acyclovir 400 mg orally three times a day for 7 10 days OR Acyclovir 200 mg orally five times a day for 710 days OR Famciclovir 250 mg orally three times a day for 710 days OR Valacyclovir 1 g orally twice a day for 710 days * Treatment might be extended if healing October 3, 2012 is incomplete after 10 days of therapy.
Recurrent infection Episodic therapy
Recommended Regimens
Acyclovir 400 mg orally three times a day for 5 days OR Acyclovir 800 mg orally twice a day for 5 days OR Acyclovir 800 mg orally three times a day for 2 days OR Famciclovir 125 mg orally twice daily for 5 days OR Famciclovir 1000 mg orally twice daily for 1 day OR Valacyclovir 500 mg orally twice a day for 3 days OR Valacyclovir 1.0 g orally once a day for 5 days
October 3, 2012
Suppressive Therapy for Recurrent Genital Herpes
Recommended Regimens Acyclovir 400 mg orally twice a day OR Famiciclovir 250 mg orally twice a day OR Valacyclovir 500 mg orally once a day OR Valacyclovir 1.0 g orally once a day
October 3, 2012
Chancroid
Causative organism is H. ducreyi
.
The combination of a painful
genital ulcer and tender suppurative inguinal adenopathy.
This painful ulcer can measure
from 1/8 of an inch to two inches across. It can be recognized by its sharply defined, though sometimes irregular, borders.
Some men only have one ulcer,
while some have more, and women often have four or more ulcers.
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Chancroid
Recommended Regimens*
Azithromycin 1 g orally in a single dose OR Ceftriaxone 250 mg intramuscularly (IM) in a single dose OR Ciprofloxacin 500 mg orally twice a day for 3 days OR Erythromycin base 500 mg orally three times a day for 7 days
October 3, 2012
Lymphogranuloma Venereum
Lymphogranuloma venereum (LGV) is
caused by C. trachomatis.
The primary stage of the disease is
characterized by a single genital ulcer that is hard to spot for both men and women with inguinal or femoral lymphadenopathy.
Second stage of the disease, seen
within 10 to 30 days after the primary stage, includes a range of clinical symptoms: abnormal discharges, pain, swelling and a range of other
October 3, 2012
Lymphogranuloma Venereum
Recommended Regimen
Doxycycline 100 mg orally twice a day for 21 days
Alternative Regimen
Erythromycin base 500 mg orally four times a day for 21 days
October 3, 2012
Granuloma inguinale or donovanosis
Granuloma inguinale or donovanosis on a man is a
chronic ulcerative debilitating disease that mainly affects the genital organs.
Caused by the intracellular gram-negative bacterium
Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis)
Painless, progressive ulcerative lesions without regional
lymphadenopathy. The lesions are highly vascular (i.e., beefy red appearance) and bleed easily on contact.
Granuloma inguinale in men. Clinically, a papule followed by a painless ulcer develops after a variable incubation period of from one to eight weeks. The ulcer can extend with a serpiginous edge. Vegetations may be present
October 3, 2012
Granuloma inguinale or donovanosis
Recommended Regimen
Doxycycline 100 mg orally twice a day for at least 3 weeks and until all lesions have completely healed
Alternative Regimens
Azithromycin 1 g orally once per week for at least 3 weeks and until all lesions have completely healed OR Ciprofloxacin 750 mg orally twice a day for at least 3 weeks and until all lesions have completely healed OR Erythromycin base 500 mg orally four times a day for at least 3 weeks and until all lesions have completely healed OR Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 weeks and until all lesions have completely healed October 3, 2012
Vaginal discharge
Three diseases most commonly associated with vaginal discharge are
Bacterial Vaginosis Trichomoniasis Vulvovaginal Candidiasis
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Bacterial Vaginosis
Caused by the replacement of the vaginal flora by an
overgrowth of anaerobic bacteria including Prevotella sp., Mobiluncus sp., G. vaginalis, Ureaplasma, Mycoplasma, and numerous fastidious or uncultivated anaerobes.
Abnormal homogeneous off-white vaginal discharge with an
unpleasant smell.
Discharge coats the walls of the vagina, and is usually
without irritation, pain or erythema.
Recommended Regimens
Metronidazole 500 mg orally twice a day for 7 days* OR Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days OR Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
October 3, 2012
Trichomoniasis
Trichomoniasis is caused by the protozoan T. vaginalis. Clinical FeaturesThere is profuse, offensive vaginal discharge ( usually following menstruation) Itching and Irritation mild to severe around the genitalia Urinary symptoms like dysurea ( painful urination), frequency of urination can occur History of similar attacks in past may be derieved Up to one-third of infected women have no symptoms.
Men
The majority of infected men have no symptoms Urethral discharge,Pain with urination dysurea Pain and swelling in the scrotum October 3, 2012
Trichomoniasis
Recommended Regimens
Metronidazole 2 g orally in a single dose. OR Tinidazole 2 g orally in a single dose.
Alternative Regimen
Metronidazole 500 mg orally twice a day for 7 days.
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Vulvovaginal Candidiasis
o VVC usually is caused by C. albicans,
but occasionally is caused by other Candida sp. or yeasts.
o Typical symptoms of VVC include o pruritus, vaginal soreness, dyspareunia,
external dysuria, and thick, curdy vaginal discharge.
o An estimated 75% of women will have at
least one episode of VVC, and 40% 45% will have two or more episodes within their lifetime.
October 3, 2012
Vulvovaginal Candidiasis
Recommended Regimens
Butoconazole 2% cream 5 g intravaginally for 3 days OR Clotrimazole 1% cream 5 g intravaginally for 714 days OR Miconazole 2% cream 5 g intravaginally for 7 days OR Miconazole 100 mg vaginal suppository, one suppository for 7 days OR Nystatin 100,000-unit vaginal tablet, one tablet for 14 days OR Terconazole 0.4% cream 5 g intravaginally for 7 days
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