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Sexually transmitted diseases (STDs)
 Infections or parasitic diseases transmitted primarily through sexual contact
Types of STDs
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Chlamydia trachomatis
Gonococcal infections
Pelvic inflammatory disease
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Acute epididymitis
Syphilis
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Types of STDs (cont’d)
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AIDS
Trichomoniasis
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Herpes simplex
Bacterial vaginosis
Condyloma acuminata
Proctitis
Pediculosis pubis and scabies
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Fig. 94-1. Incidence of sexually transmitted diseases.
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Most common bacterial STD in the U.S.
Can cause:
 Genital tract infections
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Proctitis
Conjunctivitis
Lymphogranuloma venereum
Ophthalmia and pneumonia in infants
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Pelvic inflammatory disease (PID) if untreated in women
Sterility (often asymptomatic infection)
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Treatment for uncomplicated infections
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Adults and adolescents
•
Azithromycin (Zithromax)
•
Doxycycline (Vibramycin)
Infection in pregnancy
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Infants
Preadolescent children
Lymphogranuloma venereum
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Neisseria gonorrhoeae
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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
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Neisseria gonorrhoeae (cont’d)
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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
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Caused by any organism other than Neisseria gonorrhoeae
Prevalent among sexually active adolescent girls
Treatment
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Azithromycin (Zithromax)
Doxycycline (Vibramycin)
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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
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Treatment (cont’d)
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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
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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)
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Caused by Treponema pallidum
Develops in three stages
 Primary: “Chancre” – hard, red, protruding
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 painless sore
Secondary: Two weeks after chancre heals – secondary syphilis develops
Tertiary: Develops 5-40 years after initial infection
Highly responsive to penicillin G
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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)
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Proctitis
 Ceftriaxone and doxycycline
Genital and anal warts
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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)
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Herpes simplex virus
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Infection has reached epidemic proportions in U.S.
Symptoms develop 6-8 days after contact
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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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