1. 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  Nongonococcal urethritis  Pelvic inflammatory disease  Acute epididymitis  Syphilis

3. Sexually Transmitted Diseases  Types of STDs (cont’d)  AIDS  Trichomoniasis  Chancroid  Herpes simplex  Bacterial vaginosis  Condyloma acuminata  Proctitis  Venereal warts

4. Chlamydia trachomatis  Most common bacterial STD in the United States  Can cause:  Genital tract infections  Proctitis  Conjunctivitis  Lymphogranuloma venereum  Ophthalmia and pneumonia in infants  Pelvic inflammatory disease (PID) if untreated in women (also ectopic pregnancy and infertility)  Sterility (often asymptomatic infection)

5. 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

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

7. 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) CDC recommends not using fluoroquinolones for gonorrhea CDC recommends not using fluoroquinolones for gonorrhea

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

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 broad coverage and combination therapy are required

10. 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

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)

12. Syphilis  Caused by Treponema pallidum  Develops in three stages  Primary: “chancre”—hard, red, protruding, painless sore  Secondary: 2 weeks after chancre heals, secondary syphilis develops  Tertiary: develops 5–40 years after initial infection  Highly responsive to penicillin G

13. Other STDs  See Chapter 94 for treatment of HIV and AIDS  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)

14. Other STDs  Proctitis  Ceftriaxone and doxycycline  Genital and anal warts  Caused by human papillomavirus (HPV) (more than 40 types)

15. Herpes Simplex  Herpes simplex virus  Infection has reached epidemic proportions in United States  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)