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==Background==
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*STD Prevalence: [[Human papillomavirus|HPV]] > [[Human papillomavirus|HSV-2]] > [[Trichomonas]] > [[Chlamydia trachomatis|Chlamydia]] > [[HIV]] > [[HBV]] > [[Neisseria gonorrhoeae|Gonorrhea]] > [[Syphilis]]
Disorder
*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
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1<sup>st</sup> line
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Alternative
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Partner
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In Pregnancy
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''N. Gonorrhea''


Urethritis/
==Clinical Features==
{{Genital images male}}
{{Genital images female}}


Cervicitis
==Differential Diagnosis==
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{{STD DDX}}
M: urethritis with d/c or simply dysuria;can be asymptomatic


F: purulent discharge; can be asymptomatic
==Evaluation==
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Ceftriaxone 125mg IM


OR
==Management <ref> https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf </ref>==
*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


Cefixime (Suprax) 400mg po x1
*It is important to treat sexual partners for all STDs
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**See [[Expedited Partner Therapy]]
Cipro 500po x 1 – not acceptable in MSM, travel, California, Hawaii


OR
==Disposition==


Spectinomycin 2g IM x 1 OR
==See Also==
*[[Human Papillomavirus (HPV)]]
*[[Pelvic Inflammatory Disease (PID)]]
*[[Ulcerative STDs]]
*[[Penile diagnoses]]
*[[Pelvic pain]]
*[[Expedited Partner Therapy]]


Azithromycin 2g po x 1
==External Links==
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Treat and abstinence x 7d after both treated
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CTX 125mg IM x 1
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''N. Gonorrhea''


Conjunctivitis
==References==
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<references/>
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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[[Category:Urology]] [[Category:ID]] [[Category:OBGYN]]
 
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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 5d
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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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Latent Syphilis
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Seroreactivity without other evidence of disease
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''Early''<span style="font-style: normal"><nowiki>: Benzathine Penicillin G 2.4 million U IM x1</nowiki></span>
 
''Late''<span style="font-style: normal"><nowiki>: Benzathine Penicillin G 2.4million U IM qweek x 3</nowiki></span>
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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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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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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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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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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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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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Epididymorchitis
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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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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
 
Parenteral:
 
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
 
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
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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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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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|}
 
<nowiki>*BV: in pregnancy, associated with premature rupture of membranes, chorioamnionitis, preterm birth, postpartum infxn</nowiki>
 
†Test for HIV, syphilis
 
DeBonis
 
Adapted from CDC 2006
 
 
<br/>Disorder
 
Clinical
 
1st line
 
Alternative
 
Partner
 
In Pregnancy
 
<br/>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
 
<br/>N. Gonorrhea
 
Conjunctivitis
 
2-5d after birth
 
Erythromycin ophthalmic 0.5% x1
 
Tetracycline ophthalmic 1% x1
 
 
 
 
 
<br/>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
 
 
 
 
 
<br/>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
 
<br/>Chlamydia
 
Trachomatis
 
Conjunctivitis
 
5-12d after birth; silver nitrate ophthalmic only rx gonorrhea
 
Erythromycin base 50mg/kg/day PO / 4 doses x14days
 
 
 
 
 
 
 
<br/>Chlamydia Trachomatis
 
Pneumonia
 
1-3months; afebrile, staccato cough with diffuse infiltrates on CXR; peripheral eosinophilia
 
Erythromycin base 50mg/kg/day po / 4 doses x14days
 
 
 
 
 
 
 
<br/>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
 
<br/>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
 
<br/>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
 
 
 
<br/>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
 
<br/>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
 
<br/>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
 
<br/>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
 
<br/>Secondary Syphilis
 
(T. pallidum)
 
Skin rash, mucocutaneous lesions, LAD
 
 
 
 
 
See CDC
 
 
 
<br/>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
 
 
 
<br/>Tertiary Syphilis
 
(T. pallidum)
 
Cardiac (aortitis), ophtho (iritis, uveitis), gumma
 
Benzathine Penicillin G 2.4million U IM qweek x 3
 
 
 
See CDC
 
 
 
<br/>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
 
 
 
 
 
<br/>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
 
 
 
 
 
<br/>HSV (suppressive)
 
 
 
Acyclovir 400mg PO BID
 
Famciclovir 250mg po BID
 
Valacyclovir 500mg PO qday
 
 
 
 
 
<br/>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
 
 
 
 
 
 
 
<br/>Epididymorchitis
 
 
 
 
 
 
 
 
 
 
 
<br/>Proctitis
 
Inflammation of the rectum (distal 10-12cm)
 
CTX 125mg IM x1 + Doxy 100mg po bid x 7d
 
 
 
 
 
 
 
<br/>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
 
 
 
 
 
<br/>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
 
 
 
 
 
<br/>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
 
<br/>[[Category:ID]]

Revisión actual - 16:16 28 jul 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
Obtenido de «https://www.wikem.org/w/index.php?title=Sexually_transmitted_diseases&oldid=362906»