Narrated STD (94)

Chapter 94: 

Chapter 94 Drug Therapy of Sexually Transmitted Diseases

Sexually Transmitted Diseases: 

Sexually Transmitted Diseases Sexually transmitted diseases (STDs) Infections or parasitic diseases transmitted primarily through sexual contact Types of STDs Chlamydia trachomatis Gonococcal infections Pelvic inflammatory disease Acute epididymitis Syphilis

Sexually Transmitted Diseases: 

Sexually Transmitted Diseases Types of STDs (cont ’ d) AIDS Trichomoniasis Herpes simplex Bacterial vaginosis Condyloma acuminata Proctitis Pediculosis pubis and scabies

PowerPoint Presentation: 

Fig. 94-1. Incidence of sexually transmitted diseases.

Chlamydia trachomatis : 

Chlamydia trachomatis Most common bacterial STD in the U.S. Can cause: Genital tract infections Proctitis Conjunctivitis Lymphogranuloma venereum Ophthalmia and pneumonia in infants Pelvic inflammatory disease (PID) if untreated in women Sterility (often asymptomatic infection)

Chlamydia trachomatis: 

Chlamydia trachomatis Treatment for uncomplicated infections Adults and adolescents Azithromycin (Zithromax) Doxycycline (Vibramycin) Infection in pregnancy Infants Preadolescent children Lymphogranuloma venereum

Gonococcal Infections: 

Gonococcal Infections Neisseria gonorrhoeae Gram-negative diplococcus 720,000 new cases each year (2nd to chlamydia) Transmitted almost exclusively by sexual contact Symptoms Men – complaints of burning sensation with urination and pus draining from penis Women – often asymptomatic or mild cervicitis; serious infection may result in sterility

Gonococcal Infections: 

Gonococcal Infections Neisseria gonorrhoeae (cont ’ d) Causes Urethral, cervical, and rectal infection Pharyngeal infection Conjunctivitis Treatment (cephalosporins preferred) Cefixime (Suprax) Ceftriaxone (Rocephin) Ciprofloxacin (Cipro) 2007 CDC – recommends not using fluoroquinolones for gonorrhea

Nongonococcal Urethritis (NGU): 

Nongonococcal Urethritis (NGU) Caused by any organism other than Neisseria gonorrhoeae Prevalent among sexually active adolescent girls Treatment Azithromycin (Zithromax) Doxycycline (Vibramycin)

Pelvic Inflammatory Disease: 

Pelvic Inflammatory Disease PID – syndrome that includes endometritis, pelvic peritonitis, tubo-ovarian abscess, and inflammation of the fallopian tubes Causes Neisseria gonorrhoeae Chlamydia trachomatis Treatment Caused by multiple organisms, so necessitates broad coverage and combination therapy

Pelvic Inflammatory Disease: 

Pelvic Inflammatory Disease Treatment (cont ’ d) Hospitalized patients IV cefoxitin or cefotetan and doxycycline Follow with oral doxycycline Outpatients Ceftriaxone or cefoxitin; should also include doxycycline May be with or without metronidazole

Acute Epididymitis: 

Acute Epididymitis May be acquired sexually or nonsexually Fever accompanied by pain in the back of the testicles Treatment according to organism Ceftriaxone (Rocephin) plus doxycycline Ofloxacin (Floxin) or levofloxacin (Levaquin)

Syphilis: 

Syphilis Caused by Treponema pallidum Develops in three stages Primary: “ Chancre ” – hard, red, protruding painless sore Secondary: Two weeks after chancre heals – secondary syphilis develops Tertiary: Develops 5-40 years after initial infection Highly responsive to penicillin G

Other STDs: 

Other STDs See Chapter 93 for treatment of HIV Bacterial vaginosis Nonpregnant women – metronidazole (Flagyl) or clindamycin cream Pregnant women – only oral clindamycin and metronidazole Trichomoniasis Metronidazole (Flagyl) Chancroid Azithromycin (Zithromax), ceftriaxone (Rocephin), ciprofloxacin (Cipro)

Other STDs: 

Other STDs Proctitis Ceftriaxone and doxycycline Genital and anal warts Caused by HPV (over 40 types) Application done repeatedly until warts disappear Professional application – podophyllin (Podocon-25, Podofin), TCA, BCA Patient application – podofilox (Condylox) and imiquimod (Aldara)

Herpes Simplex: 

Herpes Simplex Herpes simplex virus Infection has reached epidemic proportions in U.S. Symptoms develop 6-8 days after contact After sores heal, virus remains latent and can recur Transmission possible even without sores present Treatment Acyclovir (Zovirax) Famciclovir (Famvir) Valacyclovir (Valtrex)