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Chapter 94

Chapter 94. Drug Therapy of 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

stephanie-ellison
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Chapter 94

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  1. Chapter 94 Drug Therapy of Sexually Transmitted Diseases

  2. 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

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

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

  5. 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)

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

  7. 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

  8. 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

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

  10. 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

  11. 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

  12. 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)

  13. 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

  14. 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)

  15. 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)

  16. 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)

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