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STD Treatment Chart

STD Treatment Chart

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Published by: IYERBK on Nov 03, 2008
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11/27/2012

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STD Treatment Chart
 
Disease Treatment AlternativetreatmentPregnancy Comments
Chlamydia
Azithromycin 1 gram p.o.single doseOrDoxycycline 100mg BID X7daysErythromycin base500mg QID X 7 daysOrErythromycinethylsuccinate 800mgQID X 7 daysOrOfloxacin 300mg BIDX 7 daysOrLevofloxacin 500mg X7 days*Doxycycline and Ofloxacincontraindicated in pregnancy*Repeat testing 3 weeksafter completion of treatmentErythromycin base 500mgQID X 7daysOrAmoxicillin 500mg TID X 7daysAlternative:Erythromycin base 250 mgQID X 14 daysOrErythromycin ethylsuccinate800mg QID X 7 days or400mg QID X 14 daysOrAzithromycin 1 gram p.o.single dose*Azithromycin best touse if compliance anissue*Doxycycline is lessexpensive*Erythromycin tends tohave more GI sideeffects; should do TOC 3weeks after completionof treatment*Ofloxacin has noadvantage overDoxycycline orAzithromycin and ismore $*Levofloxacin has notbeen _eval for treatment,but pharmacology andvitro microbiologyactivity similar toOfloxacin
Chancroid
Azithromycin 1 gm p.o.single doseOrCeftriaxone 250mg IMsingle doseOrCiprofloxacin 500mg p.o.BID X 3 daysOrErythromycin base 500mgp.o. TID X 7 daysCiprofloxacin iscontraindicated in pregnancyand lactating women
Epdidymitis
Ceftriaxone 250 mg IM
And
 Doxycycline 100mg BID X10 daysOrOfloxacin 300 mg p.o. BIDX 10 daysOrLevofloxacin 500 mg p.o. qday X 10 daysMost often caused byChlamydia or GC*Should seeimprovement 3 daysafter treatment initiated*Use Ofloxacin if Levofloxacin is notlikely STD related orallergic tocephalosporins orTetracycline
Gonorrhea
:Uncomplicated (cx, urethra, andrectum):[Quinolone resistant N.gonorrhoeae (QRNG) seen inAsia, Pacific, Hawaii, and WestCoast of US]Cefixime 400mg p.o. singledoseOrCeftriaxone 125mg IMsingle doseOrCiprofloxacin 500 mg p.o.single doseOrOfloxacin 400mg p.o. singledoseOrLevofloxacin 250 mg p.o.single dose
UncomplicatedPharyngeal
:Ceftriaxone 125 mg IMsingle doseOrCiprofloxacin 500mg p.o.single doseSpectinomycin 2 gm IMsingle doseQuinolones and Tetracyclinecontraindicated inpregnancyUse cephalosporin orSpectinomycinCefixime:97.4% cure rateCeftriaxone:99.1% cure rate at allanatomic sitesCiprofloxacin:99.8% cure rate cautionwith QRNGOfloxacin:98.6% cure rateSpectinomycin:98.2% cure rate, butexpensive; useful if cannot toleratecephalosporin orquinolone, if suspectpharyngeal need f/upharyngeal culture 3-5days after treatment
 
Granuloma Inguinale
 (Dunavanosis)Doxycycline 100 mg p.o.BID X 3 weeksOrTrimethoprim-Sulfamethoxazole DS p.o.BID X 3 weeksCiprofloxacin 750 mgp.o. BID X 3 weeksOrErythromycin base 500mg p.o. QID X 3 weeksOrAzithromycin 1 gm p.o.once/week X 3 weeks*Ciprofloxacin iscontraindicated in pregnancyand lactation*Doxycyclinecontraindicated in pregnancy*Trimethoprim-Sulfamethoxazolecontraindicated in 3
rd
 trimester of pregnancyTreatment for 3 weeks oruntil all lesions havehealed
Herpes
:1
st
clinical episodeEpisodic TherapySuppressive TherapyAcyclovir 400mg p.o. TIDX 7-10 daysOrAcyclovir 200mg p.o. 5 Xday for 7-10 daysOrFamciclovir 250 mg p.o.TID X 7-10 daysOr (Valtrex)Valacyclovir 1 gm p.o. BIDX 7-10 daysAcyclovir 400mg p.o. TID X5 daysOrAcyclovir 200mg p.o. 5 Xday for 5 daysOrAcyclovir 800mg p.o. TID X5 daysOrFamciclovir 125 mg p.o.BID X 5 daysOrValacyclovir 500mg p.o.BID X 3-5 daysOrValacyclovir 1 gm p.o.once/day for 5 daysAcyclovir 400mg p.o. BIDOrFamciclovir 250 mg p.o.BIDOrValacyclovir 500mg p.o. qdayOrValacyclovir 1 gm p.o. q dayAcyclovir ok to use inpregnancy; limitedinformation on Valacyclovirand FamciclovirMay extend past 10 daysif healing incompleteAllergic or adversereactions rare for allmentioned antiviraldrugsTopical therapy withantiviral drugs offerminimal benefit and isnot recommendedRequires initiation of therapy within 1 day of onsetAcyclovir is cheaper andis effectiveValacyclovir may be lesseffective than othertreatment in patient’swith 10 or moreoutbreaks/yearReduces recurrences by70-80%; reduces, butdoes not eliminate subclinical viral shedding
 
 
HPV
(Human PapillomavirusInfection)Patient applied:Practitioner applied:Podofilox 0.5% solution orgel (antimitotic drug thatdestroys warts)Pt. Applies solution withcotton swab or gel with afinger to the warts BID X 3days followed by 4 days off.May repeat cycle asnecessary up to 4 cycles.Max 0.5 cc/day and area notto exceed 10cm2. Mayexperience mild/mod pain orlocal irritation. Must be ableto see and reach warts forself- treatment.Or(Aldara) Imiquimod 5%cream (immune enhancerthat stimulates production of interferon and othercytokines)Apply once daily at bedtime3 X week up to 16 weeks.Must wash off 6-10 hoursafter application. Localinflammatory reactions arecommon.Cryotherapy (destroys wartby thermal-inducedcytolysis)Repeat q 1-2 weeks. Mayhave pain after treatmentfollowed by necrosis andsometimes blisteringOrTriachloracetic acid TCA80-90% (caustic agent thatdestroys wart by chemicalcoagulation of the proteins)Apply small amt to wartonly; allow to dry (will seearea turn white). Mayreapply weekly if necessaryDo not use in pregnancy;safety has not beenestablishedDo not use in pregnancy;safety has not beenestablishedPrimary goal of treatingvisible wars is theremoval of symptomaticwartsExisting data indicatetreating warts mayreduce, but probably noteradicate infectivityNo evidence suggest onetreatment is superior toothersTreatment modalityshould change if noresponse after 3 provideradministered treatmentsor not cleared after 6The first treatment maybe done in the office todemonstrate proper use.F/U may be useful afterseveral weeks todetermine response totreatment.Acid can be neutralizedwith sodium bicarbonateor soap
Lymphogranuloma venereum
 Doxycycline 100mg p.o.BID X 21 daysErythromycin base500mg p.o. QID X 21daysDoxycycline iscontraindicated in pregnancy
Mucopurulent cervicitis
Results of Chlamydiaand/or GC shoulddetermine need fortreatmentPt needs to follow up in48 hr. (Repeat pelvicexaminations to confirmdecrease in CMT

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