:

ISBN

978-974-297-988-1

(The Global Fund)

1
2553
18,550

/



/
/
/
1


..2553
..2549



.. 2553

/
/

/
/

FDA PREGNANCY CATEGORIES



/
2553

1
9




/

/
1.







/


3
1 3
3
(
)

/ 1

(MSM)
(insertive) (receptive) (
4

 )



2.
2.1.
2
/

2.2. ( )

/

3 - 4
loop
2
GNID (Gram negative intracellular diplococci)
/

4

 speculum

loop
clue cells
GNID clue cells
(Pap smear) 1
loop
loop
GNID


(pharynx)
polyester


(anal Pap smear) 1
anoscope loop

GNID

loop
GNID
loop
GNID

3.

( )
3 - 6
4.

(Provider Initiated HIV Testing and Counseling; PITC)


3 - 6

3 (window period)


5.


6.
6.1.

6.2.
6.3.
6.4. (
)
()
6.5. /

7



7. /
/

8.
/ / ()
9.
/

10. 506 1, 2








/




4
1.

2.
( ; window period)
3.

4.

4







/
/


/

()

10



(PROVIDER INITIATED HIV TESTING AND COUNSELING; PITC)

3C
(confidential) (counseling)
(consent)
..2550 (UNAIDS)
(WHO) 2 2
1. Client Initiated HIV Testing and Counseling (CITC)

(Voluntary Counseling and Testing: VCT)
CITC
2. Provider Initiated HIV Testing and Counseling (PITC)


(PITC)




11


1. (Pre - test counseling)
2. (Post - test counseling)
3. (Ongoing counseling)
1. (Pre - test counseling)


(window period)


2. (Post - test counseling)

3. (Ongoing counseling)

12

/
( )

1. .

. ..2549 4-5
2. . ()
.
2553 9
3. .
1 : 2551

4. .
. HIV Counselling Handbook: A Comprehensive guide to
Voluntary Counselling and Testing, Provider-Initiated Testing and Counselling,
and Care Counselling for the Asia and Pacific Regions.

13

1. (GONORRHEA)
1. (uncomplicated gonorrhea)
1.1.

ceftriaxone
250 mg
1-2
cefixime
400 mg
1-4
1-4
1-4

1.
1 3 1
(
)
2. ceftriaxone
2
1.2. ( )

ceftriaxone
250 mg 1-2
1-2,4
2,4
1.3.

ceftriaxone
1
g 1-2,4
2
2,4

14


1. 1-2,4

2. (WHO) 125 mg 3
1.4.
1.4.1.

ceftriaxone 50 mg/ 1 kg ( 250 mg) 1-2
cefixime 8 mg/ 1 kg ( 400 mg) 5
2,4-5 ()
1 1-2,4
1.4.2.
1,3
ceftriaxone 50 mg/ 1 kg1,3 ( 250 mg)
45 kg
ceftriaxone 1 g 45 kg 5


1
periorbital cellulitis 7 1
3
/ 2,4
1
1.4.3.


2-4
15


ceftriaxone 50 mg/ 1 kg ( 250 mg)
1,3

/ 2,4

1. ceftriaxone (hyperbillirubinemia)
(prematurity)4 cefotaxime 100 mg
1,4
2. (Chlamydia trachomatis)
2,4 2,4
2-4
3. ceftriaxone 25 50 mg
1 kg 2,4
2. (complicated gonorrhea)
2.1. (local complicated gonorrhea)
Bartholins abscess, posterior urethritis, epididymitis, epididymo-orchitis,
paraurethral abscess, periurethral abscess, Cowper's gland abscess

2 1
1-2,4

1. Bartholins abscess drain marsupilization

2. 2

16

 ceftriaxone 250 mg
doxycycline 100 mg 10
(enteric bacteria)

levofloxacin 500 mg 10
ofloxacin
300 mg 10
2.2. (disseminated gonococal infection)

1. petechiae pustule , arthralgia, septic arthritis,
tenosynovitis
ceftriaxone 1 g 1 7 1-4
2,4
2,4
2. meningitis
ceftriaxone 1-2 g 12
10-14 1-2,4
2,4
2,4
3. endocarditis
ceftriaxone 1-2 g 12
4 2-4
2,4
2,4

1. meningitis 4 3
2.
1-2,4

17

 cephalosporin

azithromycin 2 g (
2,4 )

18

2.
(NONGONOCOCCAL URETHRITIS/NON GONOCOCCAL CERVICITIS)

doxycycline
100 mg 2 14 1,6
roxithromycin
150 mg 2 15 14 1,7
azithromycin
1 g * 1
1-4,8
(* 2 )

tetracycline
500 mg 4 14 1,6
erythromycin
500 mg 4 14 1
1-4

1. 3 2,4 doxycycline
tetracycline erythromycin 7
ofloxacin
300 mg 2 7 2-4
levofloxacin
500 mg 7 2,4
2. doxycycline tetracycline

azithromycin 1 g * 1
2-4,9
(* 2 )

roxithromycin 150 mg 2 15 14
erythromycin stearate 500 mg 4 14 1,9(
)
3. (recurrent and persistent
urethritis) Trichomonas vaginalis 2,4

19

 tinidazole
metronidazole

2 g
2 g

azithromycin
1 g

metronidazole 400 - 500 mg 2 7 3
tinidazole
500 mg 2 5 3
4.
5. 1-2,4

erythromycin 50 mg/ 1 kg/ 4 500 mg
14 2-5
azithromycin 20 mg/ 1 kg 1 g 5
* 1

(*
2 )

8 doxycycline 2,4
/ 2,4

20

3. (SYPHILIS)

1. () (early syphilis)
1.1. 1 (primary syphilis)
1.2. 2 (secondary syphilis)
1.3. 2 (early latent syphilis)

benzathine penicillin G 2.4 1-4

( 1.2 )
2-4

2-4
benzathine penicillin amoxicillin
/
2
( )
3
penicillin

doxycycline
100 mg 2 14 2-4
tetracycline
500 mg 4 14 2-4
erythromycin 500 mg 4 14 2-4

1. ceftriaxone 1 g
10-14 /
2

21

2. azithomycin 2 g
/ Treponema pallidum
azithomycin 2
2. (late syphilis) (1)
2.1. 2 (late latent syphilis)
2.2. (late benign gummatous syphilis)
2.3. (cardiovascular syphilis)

benzathine penicillin G 2.4 1

3 ( 1.2 )1-4
2-4

1. (latent syphilis) early latent

syphilis late latent syphilis 1-4
2. 2
penicillin

doxycycline 100 mg 2 30 1,3
tetracycline 500 mg 4 30 1,3
erythromycin 500 mg 4 30 1,3
28 2,4
2.4. (neurosyphilis)

aqueous crystalline penicillin G 12-24 /

2 - 4 4
14 3
2-4

22


1824 /
34 4
continuous infusion 1014 2,4
benzathine penicillin G 2.4
1 3
2-4 2,4
2
penicillin

doxycycline 200 mg 2 30 1,3
tetracycline 500 mg 4 30 1,3
ceftriaxone 2 g
1014 2,4 (cross-reaction)
penicillin 4
3. (syphilis in pregnancy)

1-4
penicillin
penicillin desensitization2,4
erythromycin stearate 500 mg 4 30 1,3
)
(congenital syphilis) ( 4)
2,4

23

4. (congenital syphilis)


( VDRL) (complete blood
count, CBC) VDRL ( titer ) TPHA, FTA-ABS, film long
bone

aqueous crystalline penicillin G 50,000 / 1 kg/

12
1 7 8

2-4
7 10
/ 2,4


benzathine penicillin G 50,000 / 1 kg 2,4
/ 2,4

2-4

1. 1-4
2. VDRL RPR titer 4 1-4
3. VDRL RPR titer 4 1-2,4 titer 1:8
1 1

1. (reinfection) 2,4
2. 2,4
3. 2,4
/ ( /2,4)
24

 / /3 benzathine penicillin G 2.4

1 3 1,3


4.
2,4

25

4. (CHANCROID)

ceftriaxone
250 mg 1-4
ofloxacin
400 mg 1,10
ciprofloxacin 500 mg 1,11
erythromycin 500 mg 4 7 1-4
1-4

1. 1-2,4 18 1
ofloxacin1, ciprofloxacin1-2,4 ceftriaxone1-2,4 erythromycin stearate1
2.

erythromycin 500 mg 4 14 12
3. (bubo)


1

4.
ciprofloxacin 500 mg 2 3 2-4
5. azithromycin 1 g 2-4 *
1
(* 2 )

6. Behcets disease, atypical herpes,immune

reconstitution inflammatory syndrome (IRIS ) 1
7.
erythromycin stearate 1-2,4

26

5. /
(LYMPHOGRANULOMA VENEREUM/BUBO/LGV)

doxycycline 100 mg 2 14 1,3
tetracycline 500 mg 4 14 1,3
erythromycin 500 mg 4 14 1,3
1-4

1. doxycycline, tetracycline
erythromycin stearate 1
2. (bubo)


1-4

3. doxycycline erythromycin
21 2,4
4. 14 3
5. 1-2,4

27

6. (ANOGENITAL HERPES)

1.

(first clinical episode)

acyclovir 400 mg 3 7 1,3
acyclovir 200 mg 5 7 1,3
valacyclovir 500 mg 2 7 1
famciclovir 250 mg 3 7 1,3

acyclovir 510 mg/ 1 kg 8
7 1,3

1. 7-10 2,4
2.
valacyclovir 1 g 2 2-4
2. (recurrence)
2.1. 1
2.2. acyclovir cream 5 (prodrome)1
2.3.

acyclovir
400 mg 3 5 1-4
acyclovir
200 mg 5 5 1-4
acyclovir
800 mg 2 5 2-4
acyclovir
800 mg 3 2 2
valacyclovir 500 mg 2 5 1,3
valacyclovir 1 g 5 2-4
famciclovir 125 mg 2 5 1-4
famciclovir
1 g 2 1 2,4

28

 famciclovir
500 mg 1 250 mg 2
2 2

valacyclovir 500 mg 2 3 2-4
3. (6 )
(suppressive treatment)
acyclovir
400 mg 2 2-4
valacyclovir
500 mg 2-4
valacyclovir
1 g 2-4
famciclovir
250 mg 2 2-4

- 1 /
3-4

- valacyclovir 500 mg valacyclovir acyclovir
10 2,4
4.

1. NSS 3% boric acid 15 4

2.
1,3-4

29

7. (VAGINAL TRICHOMONIASIS)

metronidazole
2 g 1-4
tinidazole
2 g 1-4
1,2-4

1. / 24

metronidazole 3-4 72
tinidazole 4
disalfiram - like reaction
2. metronidazole 3
3. metronidazole
tinidazole 2,4
4. metronidazole tinidazole
metronidazole 400 - 500 mg 2 7 2-4
tinidazole
500 mg 5 3

5. metronidazole 2 g
500 mg 2 7 2

30

8. (VAGINAL CANDIDIASIS)

fluconazole
150 mg 1-4
itraconazole
200 mg 2 1 1
clotrimazole
100 mg 7 4
clotrimazole
200 mg 3 4
clotrimazole
500 mg 1 3
ketoconazole
200 mg 2 5 1
ketoconazole
400 mg
5 1
2-4

1. 1
2. topical antifungal cream
clotrimazone cream 2 1
3. 1
4.

5.
6. 1-2,4

31

9. /
(BACTERIAL VAGINOSIS)

metronidazole 400-500 mg 2 7 1-4
clindamycin
300 mg 2 7 1-4
tinidazole
500 mg 2 7 1
2-4

1. / 24

metronidazole 3-4 72
tinidazole 4
disalfiram - like reaction
2. metronidazole clindamycin 1
3. metronidazole 3
4. metronidazole
tinidazole 2,4
5. tinidazole 2

tinidazole
2 g 3
tinidazole
1 g 5

6. 1-2,4

32

10. /
(PELVIC INFLAMMATORY DISEASE, PID)

ceftriaxone
250 mg 1-4

doxycycline
100 mg 2 14 1-4

roxithromycin
150 mg 2 15 14

metronidazole 400-500 mg 2 14 1-4

60 2,4

1. 4
2. 24

metronidazole dose disalfiram - like reaction

3.
1
4. metronidazole 2,4
5. 1-2,4

33

11./ (ANOGENITAL WART) /

(CONDYLOMA ACUMINATA)

1.
tincture podophyllin 25% 1
3
cervical dysplasia ()
10 0.5 1-2,4 ()
trichloroacetic acid (TCA) 80 -100% 1
1

- 1
- 1
- 1-4
2-4
- 1
imiquimod 5 % ( 6-10

)
1-4
( 3 ) 16
1
2.
(cryotherapy) liquid nitrogen
cryospray 1-4
1-4
(electrosurgery) 1-4
1,3-4

34


1. podophyllin 1025 % 2-4
2. podophyllin
(cryotherapy) liquid nitrogen TCA
TCA
2-4
3. (cryotherapy) podophyllin 2-4
4.
5.
2
6. 1-2,4
/

2,4

35

12. (MOLLUSCUM CONTAGIOSUM)

(
forcreps ) povidone iodine phenol
trichloroacetic acid 1,3
(
lidocaine prilocaine (Emla) 1 )

13

imiquimod cream14
tretinoin 0.1% cream14
cryotherapy / liquid nitrogen14-15
podophyllene 10-25%14
laser15

1. 6 - 9
15
2.
1
3.
cryotherapy
1

36

13. (SCABIES)

(12 )

gamma benzene hexachloride 1% cream

2 1
benzyl benzoate 25% emulsion
6 1
sulfur ointment 6-10%
1 3 ()1,3
ivermectin 200 g/ 1 kg
2 2,4
1-2,4

1. antihistamine
mild topical steroid triamcinolone 0.1%, betamethasone 0.1%
2 1
2. 4 1
3. 3 2,4 gamma
benzene hexachloride 8

4. ivermectin 15 kg2,4
5.

1-2,4

37

14. (PEDICULOSIS PUBIS)

gamma benzene hexachloride 1% cream

81,3 -121,16

1 3 1
7
6 - 8 16
1

1.
mild to moderate steroid cream triamcinolone 0.1%, betamethasone 0.1% cream
2
2. 2,4
3. ivermectin 250 g / 1 kg
2 2,4
4. 1-2,4

38

 /
/
42
1. (uncomplicated gonorrhea)

1 7 1

2 3 1-2,4 1
1-2,4

2 7

3 3 1-2,4 1
1-2,4
3
2,4
2. (nongonococcoal urethrltis, nongonococcal cervitltis)

1 2 1

2 1 1

3 3 1-2,4 1
1
3. (genital ulcers)

1 7 1

2 3 1-2,4 1
1-2,4
4. (lymphogranuloma venereum, LGV)

1 3 1

2 3 1-2,4 1
1-2,4

39

5.
5.1 / (early syphilis)

1 7 benzathine penicillin
14 ( penicillin)
1 2

(
42)
2

( 42)

2 3 1,3
/ titer VDRL/ RPR

window period

61-4, 121-4 241 titer

VDRL/RPR

- benzathine penicillin
3 1
- VDRL/RPR 1
- / VDRL/RPR 3, 6, 9, 12
24 4(
1 2
/
)

40

5.2 (late syphilis)

benzathine penicillin

/
Benzathine penicillin 7 3 dose
10-14 4

1 7 dose 2

( 42)
(
penicillin )
2 14 dose 3

(30
)

3 3 titer VDRL/RPR
()

61,4, 121,4 241,4 titer VDRL/RPR

-
VDRL/RPR
3
-
6
CSF VDRL CSF protein
CSF VDRL CSF protein

41

 6
protein 2 2
- VDRL/RPR 1
- V DRL/RPR 31, 6, 12,
18 24 2,4
5.3 (congenital syphilis)
- early congenital syphilis 5.1
- late congenital syphilis 5.2
5.4
VDRL/RPR
6.

1 7 1

2 3 1,4 1
1,4
7. / ()
(Pap smear)

1. 1
/ /



2. 3 / (
)

(window period)

42


1.
2.
3.
4.
5.

6.
7.

8.
9.
10.
11.
12.
13.

14.
15.
16.

.
..2549 ; 2549: 1-29.
Center of disease control and prevention. Sexually Transmitted Diseases Treatment guidelines, 2010.
MMWR ; 59 (RR-12) : 18-90
World health organization. guidelines for the management of sexually transmitted infections 2003.
Switzerland : 2003 : 2-62
Center of disease control and prevention. Sexually Transmitted Diseases Treatment guidelines, 2006.
MMWR ; 55 (RR-11) : 15-80
American Academy of Pediatrics. gonococcal Infections. In: Pickering LK, Baker CJ, Kimberlin DW,
Long SS, eds. Red Book 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk rove
Village, IL: American Academy of Pediatrics; 2009: 305-13
Burapangkul C, Parnikabutra K, Mangkalaviraj C, Et al . Efficacy of various tetracyclines in the
treatment of non-gonococcal urethritis.J Com Dis 1984 (Thai) ; 10 : 160-5
, .
Roxithromycin .
2537; 11: 7-11
Charoenwatanachokchai A, Chitwarakorn A, Palanuvej T, et al. Azithromycin in nongonococcal
urethritis. J Med Assoc Thai 1997; 80:440-5
Pregnancy safety index. In: MIMS Thailand 114 th edition 2009, pp. A1-A13.
Mokamukkul B, Ariyarit C, Buatiang A, et al. Efficacy of ofloxacin and erythromycin in the treatment of
chancroid in men. J Thai Med Soc STD 1990 ; 7: 1-4
Traisupa A, Won, C, Tesavibul P. Efficacy and safety of a single dose therapy of a 500 mg
ciprofloxacin tablet in chancroid patients.. Infection. 1988 ; 16 Suppl 1: S44-5
. . .

, ,
, . :
: 8 . : ;
2539: 52
Tom W. and Friedlander. Poxvirus infection in: Wolff K, Goldsmith LA, Katz, SI, et al. editor,
Fitzpatricks. Dermatology in general medicine. 7th ed. New York: Mcgraw-Hill; 2008: 1911-13
. . : 1 .
1 . : ; 2544: 83-4.
. . 1. . ,
2541: 124-6

43

 (ANAPHYLAXIS)
(anaphylaxis)
angioedema


1., ,

2. epinephrine (1:1000) 0.01 (ml.)/(kg.)

0.3 - 0.5 ml.
5 -15
epinephrine
(anterolateral thigh)


epinephrine 1-4
(g.)/ 0.1 g/kg./
epinephrine (1 : 1000) 1 ml. 5% D/W
250 ml. epinephrine 4 g/ml. 15-60 ml./
1-4 g/
3.diphenhydramine (benadryl) 1-2 mg./kg. 25 mg.
50 mg. 6
chlorpheniramine hydroxyzine
4.corticosteroid placebo-controlled trial
anaphylaxis corticosteroid
late phase reaction

corticosteroid anaphylaxis
4-6

44


dexamethasone 0.5-1 mg./kg./ 6

prednisolone
0.5-1 mg./kg./ 50 .
hydrocortisone 4-8 mg./kg./ 6

5.
epinephrine salbutamol
ipratropium bromide
6.
1.
anaphylaxis

2. anaphylaxis
(permeability)

50 10
epinephrine
crystalloid
5 -10 ml./kg. 5

3. vasopressor agents dopamine 2-20 g /kg./
90 mmHg

(Clinical practice guidelines for
anaphylaxis) preliminary
version available from :
http://www.allergythai.org/modules/Anaphylaxis/CPG070911full.pdf (Accessed January 03, 2011)

45





test

percentage of sensitivity by stage of untreated syphilis

specificity

primary

secondary

latent

late

VDRL

78
(74-87)

100

96
(88-100)

71
(34-94)

98
(96-99)

RPR

86
(77-99)

100

98
(95-100)

73

98
(93-99)

FTA-ABS

84
(70-100)

100

100

96

97
(84-100)

TPHA

88
(86-100)

100

100

96
(95-100)

(urethra)
(cervix)

(sensitivity)

(specificity)

(sensitivity)

(specificity)

Grams stain

95.9

99.5

62

99.8

culture

97.4

100

94.4

100

A manual of test for Syphilis,

America Public health Association 9th edition

46

FDA PREGNANCY CATEGORIES

US FDA 5 category A, B, C, D X
category A
category A


2 3
category B
category B

category B


2 3
category C
category C

category C

category D
category D

47

category X
category X
/

category X

FDA PREGNANCY CATEGORIES
generic
acyclovir

azithromycin
benzathine penicillin G
cefixime
ceftriaxone
ciprofloxacin
clindamycin
clotrimazole
doxycycline
erythromycin
eamciclovir
eluconazole
gamma Benzene hexachloride (Lindane)
imiquimod
itraconazole
ketoconazole
metronidazole
ofloxacin

route of administration (ROA)

pregnancy category

PO
parenteral
topical
PO
parenteral
PO
parenteral
PO
PO
topical
vaginal
PO
PO
PO
PO
topical
topical
PO
PO
PO
PO

B
B
B
B
B
B
B
C
B
B
B
D
B
B
C
C
B
C
C
B
C ; caution especially in
1st trimester

48

generic
sulfamethoxazole-trimethoprim
(cotrimoxazole)
tetracycline
tinidazole
triamcinolone
valacyclovir

route of administration (ROA)

pregnancy category

PO

C.

PO
PO
topical
PO

D
C
C
B

1. Pregnancy safety index. MIMS Thailand 114th edition 2009, pp. A1-A13.
2.

49

azithromycin

- - azithromycin

cefixime

- warfarin

ciprofloxacin

-



didanosine,sucralfate,


- aluminium salts

clindamycin

-chloramphenicol
macrolides
doxycycline

-
- barbiturates,
carbamazepine
- phenytoin

azithromycin
*
1 (*
- bioavailability
50%

2 )
- warfarin


- ciprofloxacin




ciprofloxacin
2

-
clindamycin

-clindamycin
chloramphenicol
macrolides

aluminium salts
clindamycin
2

- doxycycline

- doxycycline

- half-life
doxycycline

doxycycline
tetracycline
doxycycline 2

50

doxycycline
()

erythromycin

- digoxin

- digoxin

- penicillins

- penicillins

- benzodiazepines

- carbamazepine

- cardiotoxicity
- digoxin

- benzodiazepines
- carbamazepine

- cisapride
- digoxin

carbamazepine

digoxin

digoxin

- theophylline

- theophylline

theophylline

- ergotamine

- ergotamine

fluconazole

digoxin

digoxin

benzodiazepines

- rifampicin , cimetidine

- fluconazole

51

1
2

itraconazole

itraconazole
rifampicin
itraconazole

- cisapride
- sulfonylurea
- benzodiazepines
- simvastatin, ovastatin
- protease inhibitors
ritonavir, indinavir,
saquinavir
antacids,
histamine H2
antagonists
-

ketoconazole - cisapride
- antacids, histamine H2
antagonists
- rifampicin
-

-
itraconazole

- itraconazole

itraconazole

-
itraconazole
- itraconazole

- cardiotoxicity
-
ketoconazole
-
ketoconazole
- ketoconazole

52

antacids
itraconazole
2 .
itraconazole

antacids
ketoconazole
2

ketoconazole

gamma
benzene
hexachloride

- cream, oil, ointment

metronidazole

- disulfiram

-
- phenobarbitone

ofloxacin

roxithromycin

-



didanosine, sucralfate,


- ergotamine

-
gamma benzene
hexachloride

-


- disulfiram-like
reaction
- metronidazole

- ofloxacin

- ergotamine

- bioavailability

53

metronidazole

ofloxacin
2

15

tetracycline

- digoxin

- digoxin

- penicillins

- penicillins

-
-

- isotretinoin
- oral contraceptives

tinidazole

-





-

- tetracycline

- disulfiram-like
reaction

- tetracycline

54

digoxin

digoxin

3-4

tetracycline
1

2

1.

2.

3.

4.
5.

. Drug Interaction,
, , 2541, 56-381.
. Lincosamides : Lincomycin Clindamycin.
2 (
), ,
, 2543, 133-137.
. :

,, ,
: , 2545: 77-96.

Pregnancy safety index. MIMS Thailand 114 th edition 2009, pp. A1-A13.

55


1.


5
2.
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6.
7.

8.
9.

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56

(
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57

1
7 1

14 1

7 1

21 1

3
3 .1-2,4
Repeat HIV
VDRL /RPR
1 .1
3 .1-2,4
Repeat HIV
VDRL /RPR
3 .1-2,4
Repeat HIV
VDRL /RPR
3 .1-2,4
Repeat HIV
VDRL /RPR
3 .
6 .1-4
Repeat HIV
VDRL /RPR

7

dose 2

14
dose
3

3 .
Repeat HIV
VDRL /RPR

3
Repeat
HIV
VDRL/RPR
7

6 1-4
Repeat LP
VDRL/RPR

12 1-4
Repeat LP**
VDRL/RPR

4
-

5
-

12 .1-4
Repeat
HIV
VDRL
/RPR
6 .
VDRL/RPR

24 .1

12 .
VDRL/
RPR

24 1-4
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LP**
VDRL/RPR

3 .
Repeat HIV
VDRL /RPR

: 1) 0 /

2) LP = lumbar puncture ()
3) repeat =
4) * VDRL/RPR
5) **

58

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59

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60

61