Sexually transmitted diseases: Difference between revisions
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Revision as of 19:55, 10 September 2020
Background
- STD Prevalence: HPV > HSV-2 > Trichomonas > Chlamydia > HIV > HBV > Gonorrhea > Syphilis
- STD New infections: HPV > Chlamydia > Trichomonas > Gonorrhea > HSV-2 > Syphilis > HIV > HBV [1]
- It is important to treat sexual partners for all STDs
Clinical Features
STD Visual Diagnosis (Male)
Primary Syphilis
Painless genital ulcer from lymphogranuloma venereum
Inguinal femoral lymphadenopathy (bilateral) from lymphogranuloma venereum
STD Visual Diagnosis (Female)
Differential Diagnosis
Sexually transmitted diseases
- Chancroid
- Chlamydia trachomatis
- Granuloma inguinale
- Hepatitis B
- Herpes Simplex Virus-2
- HIV
- Human papillomavirus
- Lymphogranuloma venereum
- Neisseria gonorrhoeae
- Trichomonas
- Syphilis
Evaluation
Epididymitis/Epididymorchitis
- For acute epididymitis likely caused by STI [2]
- Ceftriaxone 500 mg IM in a single dose PLUS
- Doxycycline 100 mg orally twice a day for 10 days
- For acute epididymitis most likely caused by STI and enteric organisms (MSM)
- Ceftriaxone 500 mg IM in a single dose PLUS
- Levofloxacin 500 mg orally once a day for 10 days
- For acute epididymitis most likely caused by enteric organisms
- Levofloxacin 500 mg orally once daily for 10 days
For persons weighing ≥150 kg, 1 g of ceftriaxone should be administered.
GC/Chlamydia Conjunctivitis
Chlamydial
- Doxycycline 100mg PO BID for 7 days OR
- Azithromycin 1g (20mg/kg) PO one time dose
- Newborn Treatment: Azithromycin 20mg/kg PO once daily x 3 days or erythromycin PO 50 mg/kg/day in 4 divided doses for 14 days [3]
- Disease manifests 5 days post-birth to 2 weeks (late onset)
Gonococcal
- Due to increasing resistance, CDC recommends dual therapy with Ceftriaxone and Azithromycin (even if patient is negative for Chlamydia).
- Ceftriaxone 1g IM single dose PLUS
- Azithromycin 1g PO one dose
- Newborn Treatment:
- Prophylaxis: Erythromycin ophthalmic 0.5% x1
- Disease manifests 1st 5 days post delivery (early onset)
- Treatment Ceftriaxone 25-50mg IV or IM, max 125mg or cefotaxime single dose of 100 mg/kg (preferred if the patient has hyperbilirubinemia)
- Also requires evaluation for disseminated disease (meningitis, arthritis, etc.)
Lymphogranuloma Venereum
- Doxycycline 100mg PO BID x 21 days (first choice) OR
- Erythromycin 500mg PO QID x 21 days OR
- Preferred for pregnant and lactating females
- Azithromycin 1g PO weekly for 3 weeks OR
- Alternative for pregnant women - poor evidence for this treatment currently
- Tetracycline, Minocycline, or Moxifloxacin (x21 days) are also acceptable alternatives to Doxycycline
- Treat sexual partner
- Doxycycline 100mg PO BID x 7 days OR
- Azithromycin 1gm PO x1
Proctitis
Inflammation of the rectum (distal 10-12cm)
- Ceftriaxone 125mg IM x1 + 100mg po bid x 7d
Urethritis (male)
Uncomplicated Infection
Treatment to cover both gonorrhea and chlamydia
Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.
Standard
- Gonorrhea
- Ceftriaxone IM x 1 (500mg if <150kg, 1g if ≥150kg)
- Chlamydia
- Doxycycline 100 mg PO BID x 7 days
Ceftriaxone contraindicated
- Gonorrhea
- Gentamicin 240 mg IM x 1 PLUS azithromycin 2 g PO x 1, OR
- Cefixime 800 mg PO x 1
- Chlamydia^
- Doxycycline 100 mg PO BID x 7 days
^Additional chlamydia coverage only needed if treated with cefixime only
Partner Treatment
- Gonorrhea
- Cefixime 800mg PO x 1
- Chlamydia
- Nonpregnant: doxycycline 100mg PO BID x 7 days, OR
- Pregnant: azithromycin 1g PO x 1
Recurrent or Persistent
Target M. genitalium
- Moxifloxacin 400 mg daily x 7 days
Consider coverage of trichomonas, among men who have sex with women
- Metronidazole 2 g PO in a single dose
- Azithromycin 1 g PO x1
See Also
- Human Papillomavirus (HPV)
- Pelvic Inflammatory Disease (PID)
- Ulcerative STDs
- Penile diagnoses
- Pelvic pain
- Expedited Partner Therapy
References
- ↑ CDC: STI Fact sheet 2013
- ↑ https://www.cdc.gov/std/treatment-guidelines/epididymitis.htm
- ↑ Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N. Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):e107-e115. doi: 10.1093/jpids/piy060. PMID: 30007329; PMCID: PMC6097578.