Chapter 94
Drug Therapy of Sexually
Transmitted Diseases
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
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
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
2
Sexually Transmitted Diseases

Types of STDs (cont’d)







AIDS
Trichomoniasis
Herpes simplex
Bacterial vaginosis
Condyloma acuminata
Proctitis
Pediculosis pubis and scabies
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
3
Fig. 94-1. Incidence of sexually transmitted diseases.
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
4
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)
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
5
Chlamydia trachomatis

Treatment for uncomplicated infections

Adults and adolescents
• Azithromycin (Zithromax)
• Doxycycline (Vibramycin)
 Infection in pregnancy
 Infants
 Preadolescent children
 Lymphogranuloma venereum
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
6
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
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
7
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
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
8
Nongonococcal Urethritis (NGU)



Caused by any organism other than Neisseria
gonorrhoeae
Prevalent among sexually active adolescent
girls
Treatment


Azithromycin (Zithromax)
Doxycycline (Vibramycin)
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
9
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
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
10
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
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
11
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)
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
12
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
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
13
Other STDs


See Chapter 93 for treatment of HIV
Bacterial vaginosis



Trichomoniasis


Nonpregnant women – metronidazole (Flagyl) or clindamycin
cream
Pregnant women – only oral clindamycin and metronidazole
Metronidazole (Flagyl)
Chancroid

Azithromycin (Zithromax), ceftriaxone (Rocephin),
ciprofloxacin (Cipro)
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
14
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)
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
15
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)
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.
16
Download
Related flashcards

Epidemiology

43 cards

Occupational diseases

36 cards

Bone fractures

40 cards

Create Flashcards