Sexually transmitted diseases
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 125mg IM
OR
Cefixime (Suprax) 400mg po x1
Cipro 500po x 1 – not acceptable in MSM, travel, California, Hawaii
OR
Spectinomycin 2g IM x 1 OR
Azithromycin 2g po x 1
Treat and abstinence x 7d after both treated
CTX 125mg 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 5d
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: Benzathine Penicillin G 2.4 million U IM x1
Late: Benzathine Penicillin G 2.4million U IM qweek x 3
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
Parenteral:
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
Parenteral:
Clinda 900mg IV q8h
PLUS
Gent load 2mgkg IV; maintenance 1.5mg/kg q8h; single daily dosing may be substituted
Oflox 400mg IV q12h
OR
Levoflox 500mg IV qday
+/-
Metro 500mg IVq8h
OR
Unasyn 3g IV q6h
PLUS
Doxy 100mg IV or PO q12h
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
- BV: in pregnancy, associated with premature rupture of membranes, chorioamnionitis, preterm birth, postpartum infxn
†Test for HIV, syphilis
DeBonis
Adapted from CDC 2006