Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 94 Drug Therapy of Sexually Transmitted Diseases

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.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

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.3 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.4 Fig Incidence of sexually transmitted diseases.

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.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)

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.6 Chlamydia trachomatis  Treatment for uncomplicated infections  Adults and adolescents Azithromycin (Zithromax) Azithromycin (Zithromax) Doxycycline (Vibramycin) Doxycycline (Vibramycin)  Infection in pregnancy  Infants  Preadolescent children  Lymphogranuloma venereum

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.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

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.8 Gonococcal Infections  Neisseria gonorrhoeae (cont’d)  Causes Urethral, cervical, and rectal infection Urethral, cervical, and rectal infection Pharyngeal infection Pharyngeal infection Conjunctivitis Conjunctivitis  Treatment (cephalosporins preferred) Cefixime (Suprax) Cefixime (Suprax) Ceftriaxone (Rocephin) Ceftriaxone (Rocephin) Ciprofloxacin (Cipro) Ciprofloxacin (Cipro) 2007 CDC – recommends not using fluoroquinolones for gonorrhea 2007 CDC – recommends not using fluoroquinolones for gonorrhea

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.9 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.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

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.11 Pelvic Inflammatory Disease  Treatment (cont’d)  Hospitalized patients IV cefoxitin or cefotetan and doxycycline IV cefoxitin or cefotetan and doxycycline Follow with oral doxycycline Follow with oral doxycycline  Outpatients Ceftriaxone or cefoxitin; should also include doxycycline Ceftriaxone or cefoxitin; should also include doxycycline May be with or without metronidazole May be with or without metronidazole

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.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)

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.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

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.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)

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.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 Professional application – podophyllin (Podocon-25, Podofin), TCA, BCA Patient application – podofilox (Condylox) and imiquimod (Aldara) Patient application – podofilox (Condylox) and imiquimod (Aldara)

Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.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) Acyclovir (Zovirax) Famciclovir (Famvir) Famciclovir (Famvir) Valacyclovir (Valtrex) Valacyclovir (Valtrex)