2. Sexually Transmitted Infections Ataei .B , MD. MPH.

3. مرد جوانی 4 روز بعد از تماس جنسی مشکوک دچار ضایعه دردناک الت تناسلی می شود د. در معاینه زخم نمای کثیف دارد وبه اسانی خونریزی می نماید. ودر لمس سفتی ندارد. غده لنفاوی بزرگ و دردناک نیز در ناحیه اینگوینال لمس میگردد. تشخیص بالینی شما چیست؟ CASE 1

4. Usual causes Herpes simplex virus (HSV) Haemophilusducreyi (chancroid) ETIOLOGY

5. Herpes confirmed or suspected (history or sign of vesicles): Treat for genital herpes with : acyclovir,valacyclovir, or famciclovir Initial Treatment

6. First episodes: acyclovir (200 mg 5 times per day or 400 mg tid), valacyclovir (1 g bid), famciclovir (250 mg bid) for 7–14 days is effective. Initial Treatment

7. Chancroid confirmed or suspected (diagnostic test positive, or HSV and syphilis excluded, and lesion persists): Ciprofloxacin 500 mg PO as single dose or Ceftriaxone 250 mg IM as single dose or Azithromycin 1 g PO as single dose Initial Treatment

8. بیمار 30 ساله ای 3هفته بعد از یک تماس جنسی مشکوک دچار یک پاپول روی دستگاه تناسلی شده است این ضایعه 3 روز بعد تبدیل به اولسر با جدار منظم می شود که بدون درد ودر معاینه سفت است وهمراه با لنفادنوپاتی بدون درد یکطرفه میباشد. تشخیص بالینی شما چیست؟ CASE 2

9. Usual causes Treponemapallidum (primary syphilis) lymphogranulomavenereum ETIOLOGY

10. Dark-field exam, direct FA, PCR for T. pallidum; RPR or VDRL test for syphilis (if negative but primary syphilis suspected, repeat in 1 week); Usual initial laboratory evaluation

11. Syphilis confirmed (dark-field, FA, or PCR showing T. pallidum, or RPR reactive): Benzathine penicillin 2.4 million units IM once to patient, Preventive treatment Recent (e.g., within 3 months) Seronegative partner(s), All seropositive partners Initial Treatment

12. STDs (Lymphogranuloma Venereum) Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined, tested for urethral or cervical chlamydial infection, and treated with a chlamydia regimen (azithromycin 1 gm orally single dose or doxycycline 100 mg orally twice a day for 7 days).

13. جوان 23 ساله ای 4 روز بعد از تماس جنسی مشکوک به علت ترشح از مجرا و سوزش ادرار به مطب شما مراجعه می نماید. تشخیص بالینی شما چیست؟ CASE 3

14. (1) mucopurulent or purulent urethral discharge, (2) Gram stain of urethral secretions demonstrating 5 or more leukocytes per oil immersion microscopic field, or Urethritis

15. (3) a positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine demonstrating 10 or more leukocytes per high-power field. Urethritis

16. Neisseriagonorrhoeae* CAUSES OF NONGONOCOCCAL URETHRITIS Chlamydia trachomatis (15–50%)* Ureaplasmaurealyticum (10–40%)* Mycoplasmagenitalium (30%??) Trichomonasvaginalis (1–17%)* Herpes simplex virus (primary) (?%) ETIOLOGY

17. Treatment Initial Treatment for Patient and Partners *Epidemiologic treatment of sexual partners is recommended

18. Ceftizoxime (500 mg IM, single dose) or Cefotaxime (500 mg IM, single dose) or Spectinomycin (2 g IM, single dose) or Cefotetan (1 g IM, single dose) plus probenecid (1 g PO, single dose) or Cefoxitin (2 g IM, single dose) plus probenecid (1 g PO, single dose) Alternative regimens

19. STDs (Trichomoniasis) male partners should be evaluated and treated with either tinidazole in a single dose of 2 g orally or metronidazole twice a day at 500 mg orally for 7 days.

21. Treatment Regimens for Bacterial Urinary Tract Infections

22. Treatment Regimens for Bacterial Urinary Tract Infections

23. Treatment Regimens for Bacterial Urinary Tract Infections