Sexually transmitted diseases
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 |
CTX 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 |
CTX 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 |
CTX 250mg IM x1 Cipro 500mg PO bid x 3days |
See CDC |
CTX |
Granuloma Inguinale (Donvanosis) Klebsiella granulomatis |
Painless lesions without LAD |
Doxycycline 100mg PO BID x 3wks and until all lesions heald |
Aizthromycin 1g po q week Ciproflox 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 CTX 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 |
CTX 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) |
CTX 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
Source
DeBonis
Adapted from CDC 2010 Guidelines