Ver el código de «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




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