Sexually Transmitted Infections
- Chlamydia
- Gonorrhea
- NonChlamydia NonGonorrheal Uretrhitis and Cervicitis
- Mycoplasma genitalium causes 10-25% of nongonococcal urethritis (NGU).
- Ureaplasma urealyticum,
- Trichomonas vaginalis,
- herpes simplex virus or
- adenovirus, but
- the etiology of NGU is often unknown
- BV
- Organism: Gardnerella Vaginalis, Mobiluncus, various anaerobic bacteria and M. hominis
- Pathogenesis:
- Normal H2O2 producing Lactobacillus sp. species are replaced by BV causing organism; loss of H2O2 production, means pH rises
- Role of sexual transmission is unclear
- Diagnosis: AAFP 2011
- Amsel criteria (3 /4 should be present
- Thin, homogenous vaginal discharge
- Vaginal pH greater than 4.5
- Positive whiff test (fishy amine odor when 10 percent potassium hydroxide solution is added)
- At least 20 percent clue cells (vaginal epithelial cells with borders obscured by adherent coccobacilli on wet-mount preparation or Gram stain)
- Treatment
- Metronidazole or Tinidazole
- Even clindamycin works as these organisms are anaerobic bacteria
- Unlike Trichomoniasis, local metronidazole is effective as well
- Recurrence after treatment is common
- Can be treated with same or alternate agent
- Symptomatic second reoccurrence, that occurs can be treated with Metronidazole Gel as suppressive therapy
- Infected Male counterpart has not been found, and Treating Male partner, does not reduce the risk of subsequent reoccurrence
- Reference:
- Trichomoniasis
- Organism: Trichomonas Vaginalis
- Site of infection: Squamous Epithelial Tissue of Urogenital tract i.e vagina, urethra, and paraurethral glands.
- Less frequently involved sites include: Cervix, Bladder, Prostrate, Bartholin Glands
- Mode of infection:
- Humans are the only natural host, and is always transmitted sexually.
- Identified in 70 % of male sexual partners of infected women
- Treatment:
- Both symptomatic and asymptomatic patient and partner must be treated
- The 5-nitroimidazole drugs (metronidazole or tinidazole) are the only class of drugs that provide curative therapy of trichomoniasis.
- Only PO metronidazole works (Vaginal Metronidazole is not as effective)
- Resistance to Metronidazole, especially high-grade resistance is rare
- Tinidazole is better tolerated than Metronidazole
- Tinidazole is also effective against Metronidazole resistence
- Patient and partner should avoid intercourse until they and their partners have completed treatment and are asymptomatic, which generally takes about a week.
- References:
- Chancroid
- Genital Warts
- Syphilis
- Genital Herpes
- Proctitis: DDx:
- Non-Infectious Etiology
- Infectious Etiology
- MSM (4 Most prevalent DDx are)
- Gonorrhea
- HSV
- Chlymadia Trachomatis
- Serovar D through K:
- Most common cause of nongonoccal urethritis, and mucopurulent cervicitis
- Can cause procitis, usually mild and responds to one dose of Azithro
- Treatment: Single 1-g dose of azithromycin (eg. Zithromax) or 7 days’ treatment with doxycycline (eg. Vibramycin)
- Serovar L1, L2, L3: lymphogranuloma venereum (LGV)
- Usually cause more severe disease
- 3 Stages of LGV produce 3 distinct clinical syndromes
- Primary (painless ulcer that usually resolves spontaneously)
- Secondary (10-30 days, hallmark is lymphadenitis)
- Inguinal or Femoral Lymphadenitis (or both; may suppurate and form abscess, sinus or fistula) if Penis or Vagina is a site of inoculation
- Proctitis( If rectum is a site of inoculation
- Treatment: 3 week course of Doxycyline
- Tertiary (fibrosis and strictures leading to chronic genital ulceration, genital elephantiasis, anal fistulae and strictures, frozen pelvis, and infertility)
- Syphilis
- Ongoing infectious colitis also causing proctitis
- Bacteria: shigella, Escherichia coli, Clostridium difficile
- Protozoa: amoebiasis
- Virus: CMV
- Case 2-2006: A 31-Year-Old, HIV-Positive Man with Rectal Pain (DDx of Proctitis)
STDs Treatment Guidelines (Pharmacology)
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