Sexually transmitted diseases: Difference between revisions
 
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== Chart  ==
==Background==
*STD Prevalence: [[Human papillomavirus|HPV]] > [[Human papillomavirus|HSV-2]] > [[Trichomonas]] > [[Chlamydia trachomatis|Chlamydia]] > [[HIV]] > [[HBV]] > [[Neisseria gonorrhoeae|Gonorrhea]] > [[Syphilis]]
*STD New infections: HPV > Chlamydia > Trichomonas > Gonorrhea > HSV-2 > Syphilis > [[HIV]] > HBV <ref>[http://www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-2013.pdf CDC: STI Fact sheet 2013]</ref>


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==Clinical Features==
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{{Genital images male}}
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{{Genital images female}}
'''Disorder'''


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==Differential Diagnosis==
'''Clinical'''
{{STD DDX}}


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==Evaluation==
'''1<sup>st</sup> line'''


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==Management <ref> https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf </ref>==
'''Alternative'''
*Consider empiric treatment for [[Gonorrhea]] and [[Chlamydia]]:
**[[Ceftriaxone]] 500 mg IM x1 (1g IM for pts > 150 kg) '''AND'''
**[[Doxycycline]] 100mg PO BID x 7 days (preferred) '''OR'''
**[[Azithromycin]] 1g PO x 1 (alternative regimen) '''OR'''
**[[Azithromycin]] 500 mg PO x 1 and 250mg PO daily x 4 days


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*It is important to treat sexual partners for all STDs
'''Partner'''
**See [[Expedited Partner Therapy]]


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==Disposition==
'''In Pregnancy'''
 
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''N. Gonorrhea''
 
Urethritis/
 
Cervicitis
 
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M: urethritis with d/c or simply dysuria;can be asymptomatic
 
F: purulent discharge; can be asymptomatic
 
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Ceftriaxone 250mg IM
 
OR
 
Cefixime (Suprax) 400mg po x1
 
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Spectinomycin 2g IM x 1
 
OR
 
Azithromycin 2g po x 1
 
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Treat and abstinence x 7d after both treated
 
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CTX 250mg IM x 1
 
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''N. Gonorrhea''
 
[[Gonorrheal Conjunctivitis|Conjunctivitis]]
 
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2-5d after birth
 
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Erythromycin ophthalmic 0.5% x1
 
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Tetracycline ophthalmic 1% x1
 
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''N. Gonorrhea''
 
Disseminated
 
(DGI)
 
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Petechial, pustular acral skin lesions,
 
Asymmetrical arthralgias, tenosynovitis,
 
Septic arthritis
 
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CTX 1g IM/IV q24
 
-continue x24-48h until improvement
 
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Cefotax 1g IV q8
 
Spectinomycin 2g IV q12
 
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''Chlamydia Trachomatis''
 
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M: urethritis with d/c or simply dysuria; can be asymptomatic
 
F: purulent discharge or cervical bleeding; can be asymptomatic
 
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Azithromycin 1g po x1
 
OR
 
Doxycycline 100mg po bid x 7d
 
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Erythromycin base 500mg po qid x 7d OR
 
Oflox 300mg po bid x 7d
 
OR
 
Levoflox 500mg po qd x 7days
 
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Treat and abstinence x 7d after both treated
 
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Azithromycin 1g po x1 or
 
Amoxicillin 500mg po tid x 7d
 
Or
 
Erythro
 
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''Chlamydia''
 
''Trachomatis''
 
Conjunctivitis
 
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5-12d after birth; silver nitrate ophthalmic only rx gonorrhea
 
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Erythromycin base 50mg/kg/day PO / 4 doses x14days
 
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''Chlamydia Trachomatis''
 
Pneumonia
 
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1-3months; afebrile, staccato cough with diffuse infiltrates on CXR; peripheral eosinophilia
 
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Erythromycin base 50mg/kg/day po / 4 doses x14days
 
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''Trichamonas vaginalis''
 
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White, thick discharge
 
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Metronidazole 2g po x 1
 
OR
 
Tinidazole 2g po x 1
 
PLUS
 
Azithro 1g po x 1
 
-intravag cream not recommended
 
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Metronidazole 500mg bid for 7days; 1-2g po qday x 7d if recurrence
 
OR
 
Topical clotrimazole for metronidazole allergy– not as effective
 
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Metronidazole 2g po x 1
 
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Rx only if symptomatic but rx partner
 
1<sup>st</sup> trimester, Clotrimazole 100mg hs for 7days
 
After 1<sup>st</sup> trimester,<span> </span>Metronidazole 2g po x 1
 
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Bacterial Vaginosis
 
''Lactobacillus''
 
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White, fishy discharge
 
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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
 
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Clindamycin 300mg po bid for 7d (recurrence)
 
OR
 
Clindamycin ovules 100mg intravaginally qhs x 3d
 
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Exam for STD
 
No rx if nl
 
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1<sup>st</sup> trimester, metronidazole 250mg po tid x7d
 
After 1<sup>st</sup> trimester, 500mg po bid for 7days or 250mg po tid x7d or Clinda 300mg po bid x 7d
 
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Candidiasis
 
(''Candida albicans''<span style="font-style: normal">)</span>
 
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Cottage cheese;
 
DM or immunocompromised
 
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Butoconazole 2% cream 5g intravaginally for 3d
 
OR
 
Butaconazole-sustained 2% intravag x1
 
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Clotrimazole 1%<span> </span>5g cream intravaginally for 7-14d (OTC)
 
OR
 
Clotrimazole 100mg intravag tablet x 7d
 
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Candicidal cream if dermatitis present
 
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Avoid fluconazole and ketoconazole.
 
Rx with cream for 7d
 
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Chancroid
 
(''H. ducreyi''<span style="font-style: normal">)</span>
 
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Painful ulcers with suppurative LAD
 
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Azithromycin 1g PO x 1
 
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CTX 250mg IM x1
 
Cipro 500mg PO bid x 3days
 
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See CDC
 
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CTX
 
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Granuloma Inguinale<span> </span>(Donvanosis)
 
''Klebsiella granulomatis''
 
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Painless lesions without LAD
 
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Doxycycline 100mg PO BID x 3wks and until all lesions heald
 
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Aizthromycin 1g po q week
 
Ciproflox 750mg PO bid x 3 weeks
 
Bactrim DS 1tab PO BID x 3 wks
 
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same
 
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Erythromycin base 500mg po qid x 3wks
 
|-
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Lymphogranuloma Venereum (LGV)
 
''C. trach'' <span style="font-style: normal">serovars L1-L3</span>
 
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Tender, unilateral LAD; can lead to proctitis, fistulas
 
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Doxycycline 100mg po bid x 3 weeks
 
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Erythromycin base 500mg po qid x 3wks
 
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Treat within 60days of exposure with standard Chlamydia Rx
 
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Erythromycin base 500mg po qid x 3wks
 
|-
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Chancre-
 
Primary
 
Syphilis
 
(''T. pallidum''<span style="font-style: normal">)</span>
 
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Painless ulcer, chancre
 
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Benzathine Penicillin G 1.2million U IM x1
 
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Doxycycline 100mg po bid x 14d
 
Tetracycline 500mg po qid x 14d
 
CTX 1g IM/IV x 8-10d
 
Azithromycin 2g po x 1?
 
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See CDC
 
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Penicillin; if allergic desensitize
 
|-
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Secondary Syphilis
 
(''T. pallidum''<span style="font-style: normal">)</span>
 
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Skin rash, mucocutaneous lesions, LAD
 
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See CDC
 
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|-
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Latent Syphilis
 
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Seroreactivity without other evidence of disease
 
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''Early''
 
''Late''
 
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Doxycycline 100mg po bid x 28d
 
Tetracycline 500mg po qid x 28d
 
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See CDC
 
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|-
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Tertiary Syphilis
 
(''T. pallidum''<span style="font-style: normal">)</span>
 
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Cardiac (aortitis), ophtho (iritis, uveitis), gumma
 
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Benzathine<span> </span>Penicillin G 2.4million U IM qweek x 3
 
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See CDC
 
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|-
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Neurosyphilis
 
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Meningitis, syphilitic eye disease
 
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Aqueous crystalline penicillin G 18-24million units/d administered as 3-4million units IV q4h or continuous infusion x 10-14days
 
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Procaine penicillin 2.4million units IM qday + Probenecid 500mg po qid<span> </span>
 
BOTH for 10-14d
 
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|-
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HSV (1<sup>st</sup> episode)
 
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Vesilcular rash
 
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Acyclovir 400mg po TID x 7-10day
 
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Famciclovir 250mg po TID x 7-10d
 
Valacyclovir 1g PO BID x 7-10d
 
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|-
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HSV (suppressive)
 
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Acyclovir 400mg PO BID
 
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Famciclovir 250mg po BID
 
Valacyclovir 500mg PO qday
 
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|-
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Epididymitis
 
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Pain, swelling, inflammation of the epididymis
 
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CTX 250mg IM + Doxycyline 100mg po bid x 10d
 
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Oflox 300mg<span> </span>po bid x 10d + levoflox 500mg po qday x 10d
 
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|-
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Epididymorchitis
 
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| style="border-right: 0.5pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0in; border-left: medium none; width: 1.25in; padding-top: 0in; border-bottom: 0.5pt solid" valign="top" width="90" | <br>
| style="border-right: 0.5pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0in; border-left: medium none; width: 1.5in; padding-top: 0in; border-bottom: 0.5pt solid" valign="top" width="108" | <br>
|-
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Proctitis
 
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Inflammation of the rectum (distal 10-12cm)
 
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CTX 125mg IM x1 + Doxy 100mg po bid x 7d
 
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| style="border-right: 0.5pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0in; border-left: medium none; width: 1.5in; padding-top: 0in; border-bottom: 0.5pt solid" valign="top" width="108" | <br>
|-
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[[PID]]
 
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Sexually active, no other sources and: CMT OR uterine OR adnexal TTP
 
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'''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 3<sup>rd</sup> 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)''
 
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'''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
 
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| style="border-right: 0.5pt solid; padding-right: 5.4pt; border-top: medium none; padding-left: 5.4pt; padding-bottom: 0in; border-left: medium none; width: 1.5in; padding-top: 0in; border-bottom: 0.5pt solid" valign="top" width="108" | <br>
|-
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Scabies
 
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Crusted rash, intertiginous areas
 
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Permethrin 5% cream applied to all areas of body from neck down and rinsed off after 8-14h
 
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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
 
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|-
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Pediculosis Pubis
 
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Puritic genitalia
 
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Permethrin 1% cream: apply to affected areas x 10mins then wash off
 
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Malathion lotion 0.5% apply x 8-12h then rinse
 
OR
 
Ivermectin<span> </span>250mcg/kg PO repeated in 2 weeks
 
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|}
 
†Test for HIV, syphilis


==See Also==
==See Also==
*[[Pelvic Inflmatory Disease (PID)]]
*[[Human Papillomavirus (HPV)]]
*[[Pelvic Inflammatory Disease (PID)]]
*[[Ulcerative STDs]]
*[[Ulcerative STDs]]
*[[Penile diagnoses]]
*[[Pelvic pain]]
*[[Expedited Partner Therapy]]


== Source  ==
==External Links==
DeBonis


Adapted from CDC 2010 Guidelines
==References==
<references/>


[[Category:GU]] [[Category:ID]] [[Category:OB/GYN]]
[[Category:Urology]] [[Category:ID]] [[Category:OBGYN]]

Latest revision as of 16:16, 28 July 2022

Background

Clinical Features

STD Visual Diagnosis (Male)

STD Visual Diagnosis (Female)

Differential Diagnosis

Sexually transmitted diseases

Evaluation

Management [2]

Disposition

See Also

External Links

References

  1. ↑ CDC: STI Fact sheet 2013
  2. ↑ https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf
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