Sexually transmitted diseases

Diagnosis

STD Visual Diagnosis (Male)

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  Chancroid

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  HSV

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  Primary Syphilis

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  Painless genital ulcer from lymphogranuloma venereum

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  Inguinal femoral lymphadenopathy (bilateral) from lymphogranuloma venereum

STD Visual Diagnosis (Female)

• 

  Chancroid

Management

Treatment Chart

Disorder	Clinical	1st line	Alternative	Partner	In Pregnancy
N. Gonorrhea Urethritis/ Cervicitis	M: urethritis with d/c or simply dysuria;can be asymptomatic F: purulent discharge; can be asymptomatic	Ceftriaxone 250mg IM OR Cefixime (Suprax) 400mg po x1	Spectinomycin 2g IM x 1 OR Azithromycin 2g po x 1	Treat and abstinence x 7d after both treated	Ceftriaxone 250mg IM x 1
N. Gonorrhea Conjunctivitis	2-5d after birth	Erythromycin ophthalmic 0.5% x1	Tetracycline ophthalmic 1% x1
N. Gonorrhea Disseminated (DGI)	Petechial, pustular acral skin lesions, Asymmetrical arthralgias, tenosynovitis, Septic Arthritis	Ceftriaxone 1g IM/IV q24 -continue x24-48h until improvement	Cefotax 1g IV q8 Spectinomycin 2g IV q12
Chlamydia Trachomatis	M: urethritis with d/c or simply dysuria; can be asymptomatic F: purulent discharge or cervical bleeding; can be asymptomatic	Azithromycin 1g po x1 OR Doxycycline 100mg po bid x 7d	Erythromycin base 500mg po qid x 7d OR Oflox 300mg po bid x 7d OR Levoflox 500mg po qd x 7days	Treat and abstinence x 7d after both treated	Azithromycin 1g po x1 or Amoxicillin 500mg po tid x 7d Or Erythro
Chlamydia Trachomatis Conjunctivitis	5-12d after birth; silver nitrate ophthalmic only rx gonorrhea	Erythromycin base 50mg/kg/day PO / 4 doses x14days
Chlamydia Trachomatis Pneumonia	1-3months; afebrile, staccato cough with diffuse infiltrates on CXR; peripheral eosinophilia	Erythromycin base 50mg/kg/day po / 4 doses x14days
Trichamonas Vaginalis	White, thick discharge	Metronidazole 2g po x 1 OR Tinidazole 2g po x 1 PLUS Azithro 1g po x 1 -intravag cream not recommended	Metronidazole 500mg bid for 7days; 1-2g po qday x 7d if recurrence OR Topical clotrimazole for metronidazole allergy– not as effective	Metronidazole 2g po x 1	Rx only if symptomatic but rx partner 1st trimester, Clotrimazole 100mg hs for 7days After 1st trimester, Metronidazole 2g po x 1
Bacterial Vaginosis Lactobacillus	White, fishy discharge	Metronidazole 500mg po bid for 7d OR 0.75% Metronidazole gel (one full applicator 5g) intravaginal qd for 5d OR 2% Clindamycin cream 5g qd for 7d	Clindamycin 300mg po bid for 7d (recurrence) OR Clindamycin ovules 100mg intravaginally qhs x 3d	Exam for STD No rx if nl	1st trimester, metronidazole 250mg po tid x7d After 1st trimester, 500mg po bid for 7days or 250mg po tid x7d or Clinda 300mg po bid x 7d
Candidiasis (Candida albicans)	Cottage cheese; [DM] or immunocompromised	Butoconazole 2% cream 5g intravaginally for 3d OR Butaconazole-sustained 2% intravag x1	Clotrimazole 1% 5g cream intravaginally for 7-14d (OTC) OR Clotrimazole 100mg intravag tablet x 7d	Candicidal cream if dermatitis present	Avoid fluconazole and ketoconazole. Rx with cream for 7d
Chancroid (H. ducreyi)	Painful ulcers with suppurative LAD	Azithromycin 1g PO x 1	Ceftriaxone 250mg IM x1 Cipro 500mg PO bid x 3days	See CDC	Ceftriaxone
Granuloma Inguinale (Donvanosis) Klebsiella granulomatis	Painless lesions without LAD	Doxycycline 100mg PO BID x 3wks and until all lesions heald	Azithromycin 1g po q week Ciprofloxacin 750mg PO bid x 3 weeks Bactrim DS 1tab PO BID x 3 wks	same	Erythromycin base 500mg po qid x 3wks
Lymphogranuloma Venereum (LGV) C. trach serovars L1-L3	Tender, unilateral LAD; can lead to proctitis, fistulas	Doxycycline 100mg po bid x 3 weeks	Erythromycin base 500mg po qid x 3wks	Treat within 60days of exposure with standard Chlamydia Rx	Erythromycin base 500mg po qid x 3wks
Chancre Primary Syphilis (T. pallidum	Painless ulcer, chancre	Benzathine Penicillin G 1.2million U IM x1	Doxycycline 100mg po bid x 14d Tetracycline 500mg po qid x 14d Ceftriaxone 1g IM/IV x 8-10d Azithromycin 2g po x 1?	See CDC	Penicillin; if allergic desensitize
Secondary Syphilis (T. pallidum)	Skin rash, mucocutaneous lesions, LAD			See CDC
Latent Syphilis	Seroreactivity without other evidence of disease	Early Late	Doxycycline 100mg po bid x 28d Tetracycline 500mg po qid x 28d	See CDC
Tertiary Syphilis (T. pallidum)	Cardiac (aortitis), ophtho (iritis, uveitis), gumma	Benzathine Penicillin G 2.4million U IM qweek x 3		See CDC
Neurosyphilis	Meningitis, syphilitic eye disease	Aqueous crystalline penicillin G 18-24million units/d administered as 3-4million units IV q4h or continuous infusion x 10-14days	Procaine penicillin 2.4million units IM qday + Probenecid 500mg po qid BOTH for 10-14d
HSV (1st episode)	Vesilcular rash	Acyclovir 400mg po TID x 7-10day	Famciclovir 250mg po TID x 7-10d Valacyclovir 1g PO BID x 7-10d
HSV (suppressive)		Acyclovir 400mg PO BID	Famciclovir 250mg po BID Valacyclovir 500mg PO qday
Epididymitis	Pain, swelling, inflammation of the epididymis	Ceftriaxone 250mg IM + Doxycyline 100mg po bid x 10d	Oflox 300mg po bid x 10d + levoflox 500mg po qday x 10d
Epididymorchitis
Proctitis	Inflammation of the rectum (distal 10-12cm)	Ceftriaxone 125mg IM x1 + Doxy 100mg po bid x 7d
PID	Sexually active, no other sources and: CMT OR uterine OR adnexal TTP	Outpt: Ceftriaxone 250mg IM x1 OR Cefoxitin 2g IM in a single dose and probenecid 1g orally administered concurrently in single dose OR Other parenteral 3rd gen cephalosporin (eg. ceftizoxime or cefotaxime) PLUS Doxy 100mg po bid x14d +/- Metronidazole 500mg po bid x 14d Inpt: Cefotetan 2g IV q12h OR Cefoxitin 2g IV q6h PLUS Doxycyline 100mg IV or PO q12 (similar bioavailability)	Outpt: Oflox 400mg po bid x 14d OR Levofloxacin 500mg po qday x 14d +/- Metronidazole 500mg po bid x 14d Inpt: Clinda 900mg IV q8h PLUS Gent load 2mgkg IV; maintenance 1.5mg/kg q8h; single daily dosing may be substituted +/- Metro 500mg IVq8h
Scabies	Crusted rash, intertiginous areas	Permethrin 5% cream applied to all areas of body from neck down and rinsed off after 8-14h	Ivermectin 200mcg/kg PO, repeated in 2weeks Lindane (1%) 1 ounce of lotion of 30g of cream applied in thin layer all over from neck down x 8 hours then rinse
Pediculosis Pubis	Puritic genitalia	Permethrin 1% cream: apply to affected areas x 10mins then wash off	Malathion lotion 0.5% apply x 8-12h then rinse OR Ivermectin 250mcg/kg PO repeated in 2 weeks

†Test for HIV, syphilis

See Also

• Pelvic Inflammatory Disease (PID)
• Ulcerative STDs

Source

DeBonis

Adapted from CDC 2010 Guidelines