แนวทางการดูแลรักษาโรคติดต่อทางเพศสัมพันธ์ พ.ศ. 2558

Final Master edit_ice.
indd 1
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ISBN 978-616-11-2629-2

1 2558 800
.

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/
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Final Master edit_ice.indd 2
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1 .
2 .
3 ...
4 ..
5 ...
6 .
7 ..

8 .

9 .
10 .
11 .
12 ...
13 .
14 ..

15 ..

16 .

..

2
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17 ..
18 .
19 .
20 .
21 .
22 .
23 .
24 .
25 .
26
27
28
29 ..
30
31
32
33
34
35 .
36
37
38 .
39 ..
12
12

3
7

/
40
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.. 2531

.. 2558
4

/

.. 2558
( )
2558
.. 2558
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1
2
3
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8 ()
3.9
3.10
3.11
3.12 /
3.13 /
3.14
4

3
7
13
14
22
29
32
38
41
44
48
53
56
59
62
66
69
73
79
80
87
99
.. 2558
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29/9/58 16:13
29/9/58 16:13
(Sexually transmitted infections; STIs)

5

(World Health Organization; WHO) .. 2551
498.9 1
248.5 ..2548 276.4 .. 25511

(Centers for Disease
Control and Prevention; CDC) .. 2556
Chlamydia trachomatis 1,401,906
446.6 1.5% .. 2555
.. 2558
29/9/58 16:13
333,004 106.1
0.6% .. 2555 17,375
5.5 10% .. 25552
506

19.49 2552 18.63
2556 10.42
3.67 3.07
0.94
0.54 3

3-5 4 /

.. 2558

.. 2558
29/9/58 16:13
.. 2558
1. World Health Organization. Baseline report on global sexually

transmitted infection surveillance 2012. Geneva: World Health
Organization; 2013. p. 1.
2. Centers for Disease Control and Prevention [internet]. Reported STDs
in the United States 2013 national data for chlamydia, gonorrhea,
and syphilis 2014 [cited 2015 May 17]. Available from: http://www.
cdc.gov/std/stats13/surv2013-print.pdf
3. .
.. 2557. :
; 2557. 43.
4. Wasserheit JN. Epidemiologic synergy: Interrelationships between
human immunodeficiency virus infection and other sexually
transmitted diseases. Sex Transm Dis 1992;19:61-77.
29/9/58 16:13
29/9/58 16:13

/

1
1.

.. 2558
29/9/58 16:13
/

3
1 3
3
(
)

(Men who have sex with men; MSM)
(insertive role)
(receptive role) (versatile role)

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

3-6

3 (window period)
.. 2558
29/9/58 16:13
3.
4.

2

/

( )

()

3-4
loop 2

GNID (Gram-negative intracellular diplococci)
()

4

()

speculum
.. 2558

(
) 3-6
29/9/58 16:13
loop
clue cells
GNID clue cells
(Pap smear) 1
loop
loop
GNID

(pharynx)
polyester

(anal Pap smear) Dacron swab 1
anoscope loop

GNID
(
)
loop
GNID
loop
GNID
5.

( 3)
10 .. 2558
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6.

(
)
()

7. /
/

8.
//
()
.. 2558 11
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9.
/

10. .1 506
( )
5

(
)

.1
5

.506
Electronic file R506

1. , .
.. 2553. 1. :
; 2553. 1-4.
12 .. 2558
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3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
3.10
3.11
3.12
3.13
3.14
()
.. 2558 13
29/9/58 16:13
3.1 Syphilis

1.
3 2 3
1 :
chancre
2 :
condylomata lata (mucous patch)

:
3 : 3 (benign gummatous
syphilis) (cardiovascular syphilis)
(neurosyphilis) 3

2. 1
T. Pallidum chancre
1 condylomata lata mucous patch
2 Dark field microscope
T. Pallidum definitive diagnosis
14 .. 2558
29/9/58 16:13
3.1

treponemal
test treponemal test (presumptive diagnosis)
nontreponemal test
treponemal test
(Diagnostic criteria)
Dark-field Nontreponemal Treponemal

microscopy
test
test
(Definitive
(Presumptive
diagnosis)
diagnosis)
1 Chancre specimen reactive reactive
chancre non reactive
non reactive
2 body specimen
reactive
reactive
rash, palmo
plantar rash,
condylomata
condylomata
lata
lata, mucous
mucous patch
patch, alopecia
*
reactive
reactive
* (early latent syphilis) = 1

(late latent syphilis) = 1
.. 2558 15
29/9/58 16:13
3. 1-3
3.1 (Early syphilis) 1 (primary syphilis)

2 (secondary syphilis) 1 (early latent
syphilis)
Benzathine penicillin G 2.4
( 1.2 )

Penicillin
Doxycycline 100 mg 2 14
Tetracycline 500 mg 4 14
Azithromycin 2 gm
Ceftriaxone 1-2 gm 1
10-14
Erythromycin 500 mg 4 14
3.2 (Late syphilis) 1 (late
latent syphilis) 3 (late benign gummatous syphilis)
(cardiovascular syphilis)
Benzathine penicillin G 2.4 1
3 ( 1.2 )

Penicillin
Tetracycline 500 mg 4 28
16 .. 2558
29/9/58 16:13
1. 1
(Primary
syphilis)
2.
2
(Secondary
syphilis)
3.

1
(Early latent
syphilis)
Benzathine
penicillin G 2.4

(
1.2

1%
Lidocaine
Epinephrine
0.5- 1ml)
3.1
Alternative option (
First line option Penicillin

Benzathine penicillin)
(Early syphilis)
Doxycycline 100 mg Doxycycline

2
14
Tetracycline

Tetracycline 500 mg

4
14
Azithromycin 2 gm

T. pallidum
Azithomycin
Ceftriaxone 1-2 gm
Ceftriaxone
cross
1 10-14 reaction
Penicillin 10%
Erythromycin 500 mg
4
(high failure rates)
14
bloodbrain barrier
placental
barrier
.. 2558 17
29/9/58 16:13

(Late syphilis)
1. Benzathine
Doxycycline 100 mg Doxycycline
1 (Late penicillin G 2.4
2
Tetracycline
latent syphilis) 28
2

2. 1 Tetracycline 500 mg
3
(Latent
28
alternative option
syphilis of
Late latent
unknown
syphilis
duration)
Latent syphilis of
3.
unknown
3 (Benign
duration
gummatous
Ceftriaxone
syphilis)

4.

(Cardiovascular

syphilis)

5.
Aqueous crystalline
penicillin G 18-24
(Neurosyphilis) /
3-4
4
10-14
Ceftriaxone 2 g
1
10-14
Ceftriaxone

Ceftriaxone
cross
reaction
penicillin 10%
18 .. 2558
29/9/58 16:13
3.1

1.
Ceftriaxone 1-2 gm Ceftriaxone

Penicillin
Penicillin 1

desensitized 10-14
Ceftriaxone
cross
Penicillin
reaction
penicillin 10%
Erythromycin

stearate 500 mg
blood 4 brain barrier
14
placental
barrier
2. Aqueous
/
(Congenital
crystalline
syphilis)
penicillin G

50,000 /
1 kg/

12
17
8

7
10
.. 2558 19
29/9/58 16:13
4. /
16
5.

6. /
( 1 2
1 ) VDRL RPR titer 4
612 ( VDRL titer 1:32 1:8) 1
12-24 TPHA FTA-ABS (reactive)

VDRL RPR titer
4 (treatment failure)

1,2 (retreatment) benzathine penicillin G 2.4
1 3
VDRL RPR titer
(reinfection)

1. (Early syphilis)
1 1
1 2

1

20 .. 2558
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3.1
2 3
titer VDRL/RPR

window period
6, 12 24 titer VDRL/
RPR

1. VDRL RPR
1
2. VDRL RPR 3, 6, 9,
12 24 (
)
2. (Late syphilis)
1. Janier M, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potocnik M, et al.

2014 European guideline on the management of syphilis. J Eur Acad
Dermatol Venereol 2014;28:1581-93.
2. Centers for Disease Control and Prevention. Sexually transmitted
diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;
64(RR-03):1-137.
3. Emerson CR. Syphilis: A review of the diagnosis and treatment. J
Infect Dis 2009;3:143-7
.. 2558 21
29/9/58 16:13
3.2 Gonorrhea

1. 1
1 :

1 :

2. 1
: Gram stain gram-negative
intracellular diplococci
: Culture Neisseria gonorrhoeae
3.
2
3.1 (Uncomplicated gonorrhea)
3.1.1 2
Ceftriaxone 250 mg
Cefixime 400 mg

22 .. 2558
29/9/58 16:13
3.2
3.1.2 2
Ceftriaxone 250 mg

1. 1 3
3
()
azithromycin 1 gm
2
2. ceftriaxone
2
3. cephalosporin azithromycin 2 gm
( )1
3.1.3 2
Ceftriaxone 250 mg

(sterile NSS)
5
3.2 (Complicated gonorrhea)
3.2.1 (Local complicated
gonorrhea) Bartholins abscess, epididymitis, epididymo-orchitis,
paraurethral abscess, periurethral abscess, cowperitis 1

2 6
6
.. 2558 23
29/9/58 16:13

1. Bartholins abscess drain
marsupialization 7
2.
2
Ceftriaxone 250 mg
Doxycycline 100 mg 10

(enteric bacteria)
Levofloxacin 500 mg 10
Ofloxacin 300 mg 10
3.2.2 (Disseminated
gonococcal infection)2

petechiae pustule , septic arthritis,

tenosynovitis Ceftriaxone 1 gm
1
7
azithromycin 1 gm
meningitis ceftriaxone 1-2 gm
12 10-14 2
azithromycin 1 gm
endocarditis ceftriaxone 1-2 gm
12 4 3-5
azithromycin 1 gm
4.
60
2
24 .. 2558
29/9/58 16:13
5. //
3.2
5.1 ceftriaxone 250 mg

azithromycin 1 gm 2
5.2 ceftriaxone 250 mg 2

azithromycin
5.3
5.3.1 2

45 kg ceftriaxone 125 mg.
45 kg
2
5.3.2

ceftriaxone 25-50 mg/ 1 kg (
125 mg) 2
45 kg ceftriaxone 50 mg/
1kg ( 1 gm) 8
45 kg ceftriaxone 1 gm
8
(sterile NSS)
9
9
/
9
.. 2558 25
29/9/58 16:13
10

5.3.3

9
Ceftriaxone 25-50 mg/ 1 kg ( 125 mg)
2
2
/
2, 9

2

1. Ceftriaxone
(hyperbillirubinemia)
(prematurity) cefotaxime 100 mg
11
2.
(Chlamydia trachomatis)
2
6.

26 .. 2558
29/9/58 16:13
7. /
3.2
7
4
(Uncomplicated gonorrhea)6
1 7 Gram stain,

culture
2 3

(Complicated gonorrhea)6
1
2 7
3 3
1. Reddy BSN, Khandpur S, Sethi S, Unemo M. Gonococcol infections.

In: Gupta S, Kumar B, editors. Sexually transmitted infections. 2nd
ed. Delhi: Mosby; 2012. p. 473-93.
64(RR-03):1-137.
3. Lyss SB, Kamb ML, Peterman TA, Moran SJ, Newman DR, Boran,
GB, et al. Chlamydia trachomatis among patients infected with
and treated for Neisseria gonorrhoeae in sexually transmitted
disease clinics in the United States. Ann Intern Med 2003;139:17885.
.. 2558 27
29/9/58 16:13
4. Lanjouw E, Ossewaarde JM, Stary A. Boag F, van der Meijden WI.

2010 European guideline for the management of Chlamydia
trachomatis infections. Int J STD AIDS 2010;21:729-37.
5. Sukiasian SH, Baum J. Bacterial conjunctivitis. In: Krachmer JH,
Mannis MJ, Holland EJ, editors. Cornea. 3rd ed. China: Mosby; 2011.
p. 521-33.
6. , .
.. 2553. 1. :
; 2553. 13-17,37.
7. Bhide A, Nama V, Patel S, Kalu E. Microbiology of cysts/abscesses
of Bartholin's gland: Review of empirical antibiotic therapy against
microbial culture. J Obstet Gynaecol 2010;30:701-3.
8. Woods CR. Gonococcal infections in neonates a young children.
Semin Pediatr Infect Dis 2005;16:258-70
9. Lindquist TD. Ophthalmia neonatorum. In: Krachmer JH, Mannis MJ,
Holland EJ, editors. Cornea. 3rd ed. China: Mosby;2011. p. 553-8.
10. Goodyear-Smith F. What is the evidence for non-sexual transmission
of gonorrhea in children after the neonatal period? A systematic
review. J Forensic Leg Med 2007;14(8):489-502.
11. Rutar T. Neonatal conjunctivitis. In: Hoyt CS, Taylor D, editors.
Pediatric Ophthalmology and Strabiismus. 4th ed. China: Mosby;
2013. p. 85-8.
28 .. 2558
29/9/58 16:13
3.3
3.3
Lymphogranuloma venereum (LGV)
1. 1
:

: (
groove sign)
2.

Chlamydia trachomatis serovars L1, L2, L31
3.
1
Erythromycin 500 mg 4 21
.. 2558 29
29/9/58 16:13
4.
60
1
5. //
5.1 doxycycline
erythromycin stearate1
5.2 erythromycin 7.5-12.5 mg 1 kg
4 14 2
6.
7. /
3.2 Gonorrhea

1

(bubo)

2, 3

1 3 4
2 3
4

30 .. 2558
29/9/58 16:13

3.3

64(RR-03):1-137.
2. Reddy BSN, Khandpur S, Sethi S, Unemo M, Lymphogranuloma
venereum (LGV). In: Gupta S, Kumar B, editors. Sexually transmitted
infections. 2nd ed. Delhi: Mosby; 2012. p. 506-21.
3. Stamm WE. Lymphagranuloma venereum. In: Holmes KK, Sparling
PF, Stamm BW, Piot P, Wasserheit JN, Corey L, et al, editors. Sexually
transmitted diseases. 4th ed. New York: McGraw Hill; 2008. p. 595-606.
4. , .
.. 2553. 1. :
; 2553. 38.
.. 2558 31
29/9/58 16:13
3.4
Nongonococcal urethritis

1. 1
:

:
2.

urethral Gram stain PMN 5 cells/oil field2
mucopurulent discharge cervix Gram
negative intracellular diplococci cervical Gram stain2
Chlamydial test positive1
3.
3.1

Azithromycin 1 gm * 1
1, 3 (* 2 )
32 .. 2558
29/9/58 16:13
3.4
Doxycycline 100 mg 2 14 3
Roxithromycin 150 mg 2 15
14 4
Erythromycin stearate 500 mg 4
14 3 3
1. (recurrent
and persistent urethritis)
- Mycoplasma genitalium
1
Azithromycin 1 gm
Moxifloxacin 400 mg 7
- Ureaplasma urealyticum
5
Moxifloxacin 400 mg 7
- Trichomonas vaginalis
1
Tinidazole 2 gm
Metronidazole 2 gm
2. doxycycline
erythromycin 7
1
Ofloxacin 300 mg 2 7
Levofloxacin 500 mg 7
3.
4. Erythromycin base
enteric-coated (erythromycin
stearate)6
5. azithromycin 1 gm 7
1
.. 2558 33
29/9/58 16:13
3.2 (Adult Nongonococcal

Conjunctivitis)

Tetracycline 250 mg 4 21 7
Erythromycin 500 mg 4 21 7
Doxycycline 100 mg 2 10 8
Azithromycin 1 gm 7, 8
4.
60
3
5. //
3
5.1
doxycycline tetracycline 1
Azithromycin 1 gm
Amoxicillin 500 mg 3 7
7
5.2
Amoxicillin 500 mg 3 7 1,9
7 1,10
5.3 Chlamydia trachomatis
5.3.1

1
34 .. 2558
29/9/58 16:13
3.4
45 kg erythromycin base 50 mg/

1 kg/ 4 500 mg
14
45 kg 8
azithromycin 1 gm
8 azithromycin doxycycline

5.3.2 (Neonatal Nongonococcal
Conjunctivitis)
erythromycin base 50 mg/ 1 kg/
4 14 azithromycin suspension
20 mg/ 1 kg 1 3 1

1, 11
1, 11

1
11

1. Erythromycin
80%
1, 12
2. erythromycin 6
Infantile Hypertrophic Pyloric Stenosis
(IHPS)
IHPS 1, 13
.. 2558 35
29/9/58 16:13
5.3.3

1, 11
6.

7. /3

3
1 2 urethral Gram stain
2 3

64(RR-03):1-137.
2. Ray K. Laboratory diagnosis of sexually transmitted infections. In:
Gupta S, Kumar B, editors. Sexually transmitted infections. 2nd ed.
Delhi: Mosby; 2012. p. 288-312.
3. , .
.. 2553. 1. :
; 2553. 18-9, 37
4. , , .
Roxithromycin .
2537.; 11: 7-11.
36 .. 2558
29/9/58 16:13
3.4
5. Horner PJ, Blee K, Falk L, Meijden W, Moi H. 2014 European guideline

on the management of non-gonococcal urethritis [Internet]. The
International Union against Sexually Transmitted Infections; 2014
[cite 2015 Jan 10]. Available from: http://www.iusti.org/regions/
europe/word_docs/2014/European_guidelineNGU_draft_10102014.pdf
6. DiSanto AR, Chodos DJ. Influence of study design in assessing food
effects on absorption of erythromycin base and erythromycin
stearate. Antimicrob Agents Chemother 1981;20(2):190-6.
7. Singal N, Rootman DS. Chlamydial infections. In: Krachmer JH,
Mannis MJ, Holland EJ, editors. Cornea. 3nd ed. China: Mosby; 2011.
p. 545-52.
8. Katusic D, Petricek I, Mandic Z, Petric I, Salopek-Rabatic J, Kruzic V.
et al. Azithromycin vs. doxycycline in the treatment of inclusion
conjunctivitis. Am J Ophthalmol 2003;135(4):447-51.
9. Drug.com [Internet]. Auckland: Drugsite Trust Online Resources;
c2000-15 [updated 2014 July 08; cited 2015 Jan 10]. Available from:
http://www.drugs.com/breastfeeding/amoxicillin.html
10. Merckmanuals.com [Internet]. New Jersey: Merck Online Resources;
c2010-14 [updated 2013 October; cited 2015 Jan 10]. Available
from: http://www.merckmanuals. com/professional/infectious_
diseases/bacteria_and_antibacterial_drugs/macrolides.html
11. Lindquist TD. Ophthalmia neonatorum. In: Krachmer JH, Mannis
MJ, Holland EJ, editors. Cornea. 3rd ed. China: Mosby; 2011. p. 553-8.
12. Patamasucon P, Rettig PJ, Faust KL, Kusmiesz HT, Nelson JD. Oral
v topical erythromycin therapies for chlamydial conjunctivitis. Am
J Dis Child 1982;136(9):817-21.
13. Centers for Disease Control and Prevention. Hypertrophic pyloric
stenosis in infants following pertussis prophylaxis with erythromycin
Knoxville, Tennessee, 1999. MMWR MorbMortal Wkly Rep
1999;48:1117-20
.. 2558 37
29/9/58 16:13
3.5 Chancroid

1. 1
:

:

2. 1
Unna-pappenheim Gram stain
gram-negative short rod bacilli school of fish
3.

Ceftriaxone 250 mg 2-5
Ciprofloxacin 500 mg 2 3 3-5
Erythromycin 500 mg 4 7-14 2-5
Azithromycin 1 gm 3
2-5
38 .. 2558
29/9/58 16:13
3.5

1.
erythromycin 500 mg 4
14 2,3
2.

2
3. Azithromycin 1 gm 3-5 * 1
2 (* 2 )
4.

5. //
ceftriaxone2,3,5 erythromycin stearate2
18 2 ciprofloxacin2,3,5
6.

erythromycin stearate 14 2,3
7. /
1 7 2
2 3 2,3,5
2 2,3,5

.. 2558 39
29/9/58 16:13

1. Lautenschlager S. Chancroid. In: Goldsmith LA, Katz SI, Gilchrest
BA, Paller A, Leffell DJ, Wolff K, editors. Fitzpatricks Dermatology
in General Medicine. 8th Revised ed. McGraw Hill; 2012. p. 2501-5
2. , .
.. 2553. 1. :
; 2553. 24.
64(RR-03):1-137.
4. World Health Organization. Guidelines for the management of
sexually transmitted infections. Geneva: World Health Organization;
2003. p. 28-299.
55(RR-11):1-93.
3
40 .. 2558
29/9/58 16:13
3.6
3.6 Trichomoniasis

1. 1
:

:

2.

1 : wet smear Trichomonas vaginalis
1 : Culture Trichomonas vaginalis
3.
1
Metronidazole 2 gm
Tinidazole 2 gm
Metronidazole 500 mg 2 7
.. 2558 41
29/9/58 16:13

/ 24
metronidazole 72 tinidazole
disulfiram-like reaction1-3 (
)3
4.
1
5. /
5.1 metronidazole1
5.2 metronidazole 2 gm
12 -24 1
3
6.
metronidazole 2 gm
500 mg 2 7 1
7. /

3
1 7 wet smear 4
2 3
4

42 .. 2558
29/9/58 16:13

3.6

64(RR-03):1-137.
2. Lanjouw E, Ossewaarde JM, Stary A. Boag F, van der Meijden WI.
2010 European guideline for the management of Chlamydia
trachomatis infections. Int J STD AIDS 2010;21:729-37.
3. Karamanakos PN, Pappas P, Boumba VA, Thomas C, Malamas M,
Vougiouklakis T, et al. Pharmaceutical agents known to produce
disulfiram-like reaction: Effects on hepatic ethanol metabolism
and brain monoamines. Int J Toxicol 2007;26(5):423-32.
4. , .
.. 2553. 1. :
; 2553. 40.
.. 2558 43
29/9/58 16:13
3.7
Anogenital Herpes

1. 1, 2
:

:
2. 1, 2
Tzanck test multinucleated giant
cell Polykaryotic cell
3.
3.1 (First clinical episode)

Acyclovir 200 mg 5 7-10 3
Acyclovir 400 mg 3 7-10 1, 3, 4
Valacyclovir 1 gm 2 7-10 3
Famciclovir 250 mg 3 7-10 1, 3, 4
44 .. 2558
29/9/58 16:13
3.7

Acyclovir 5-10 mg/ 1 kg 8
7 1
3.2 (Recurrence)

Acyclovir 400 mg 3 5 1, 3-5
Acyclovir 800 mg 2 5 3-5
Acyclovir 800 mg 3 2 3
Valacyclovir 500 mg 2 3-5 1, 3-5
Valacyclovir 1 gm 1 5 3-5
Famciclovir 125 mg 2 5 1, 3-5
Famciclovir 1 gm 2 1 3, 5
Famciclovir 500 mg 1 250 mg

2 2 3
3.3 (6 )
(suppressive treatment)

Acyclovir 400 mg 2 3-5
Valacyclovir 500 mg 1 3-5
Valacyclovir 1 gm 1 3-5
Famciclovir 250 mg 2 3-5

1 /
4-5
.. 2558 45
29/9/58 16:13
4.

5. /

NSS 3% boric acid 15 4

6.

1, 4-5
3
7. /
1 7 1
2 3 1, 3-5
1 1, 3-5

1. , .
.. 2553. 1. :
; 2553. 26-7.
2. Marque AR, Cohen JI. Herpes Simplex. In: Goldsmith LA, Katz SI,
Gilchrest BA, Paller A, Leffell DJ, Wolff K, editors. Fitzpatricks
46 .. 2558
29/9/58 16:13
3.7
dermatology in General Medicine. 8th Revised ed. McGraw Hill;

2012. p. 2367-82
64(RR-03):1-137.
2003. p. 2-62.
55(RR-11):1-93.
.. 2558 47
29/9/58 16:13
3.8 ()
Anogenital warts (Condylomata acuminata)

1. 1
:
1, 2
:
1, 2
3
2. 1
1,2
1
3.

(
3 )1
2

48 .. 2558
29/9/58 16:13
3.8 ()
3.1
3.1.1

3
1) Tincture podophyllin 25%

3
3
1-4
3
1-2
3
10 0.5
3 ()

1. cervical
dysplasia3
2. 3
2) Trichloroacetic acid (TCA) 80-100%

1-2 tincture podophyllin
25% 3
3
3) Imiquimod 5%
3
16 ( 6-10 ) 3

1.
.. 2558 49
29/9/58 16:13
2. 3
3. 12
3.1.2

1) (cryotherapy) liquid nitrogen
cryospray3
2) 3
3) (electrosurgery)3
4) 3
3.2
3.2.1 1
1) (cryotherapy)
2) TCA 80-100%
3)
4) podophyllin
3.2.2
1) Podophyllin3
2) (cryotherapy)1

1.
2.
3 ()
3.
(sexual abuse)
4.
2
2 (Cervarix) 16 18 4
(Gardasil) 6, 11, 16 184 2
HPV 16 18
50 .. 2558
29/9/58 16:13
4.
1. 1
2.
( )1, 2
3.8 ()
70%1 4 HPV 6 11
HPV 2 90%1, 4, 5
3 5 9-26 1

1
5. //

PAP smear 6
trichloroacetic acid (TCA) 80 -100%
tincture podophyllin 25% 3
imiquimod 5%3

3
6.

/
(recurrent) 3
.. 2558 51
29/9/58 16:13
7. /
1 1
2 3


59(RR-12):1-109.
2. British Association for Sexual Health and HIV. United Kingdom national
guideline on the management of ano-genital warts, 2007 [Internet].
[cited 2015 Jan 12]. Available from: http://www.bashh.org/
documents/86/86.pdf
3. , .
..2553. 1. :
; 2553: 32-3.
4. U.S. Food and Drug Administration. FDA approves New Indication for
Gardasil to prevent Genital Warts in Men and Boys [Internet]. [cited
2015 Jan 12]. Available from: http://www.fda.gov/NewsEvents/
Newsroom/PressAnnouncements/ucm187003.htm
5. U.S. Food and Drug Administration. FDA approves New Indication for
Gardasil to prevent Genital Warts in Men and Boys [Internet]. [cited
2015 Jan 12]. Available from: http://www.fda.gov/NewsEvents/
Newsroom/PressAnnouncements/ucm426485.htm
6. Ortoski RA, Kell CS, Anal cancer and screening guidelines for Human
Papillomavirus in men. J AM Osteopath Assoc,2011;111(3):35-43.
52 .. 2558
29/9/58 16:13
3.9
3.9 Molluscum contagiosum

1.
:
1
: 3-5
1
1 100 2
2.
1
Giemsa3
3.
3.1
Podophyllin 10-25%1-4 2-3 4
Imiquimod cream1-3 3 6-10
Tretinoin 0.1% cream1-3 1
3.2
sterile 1-2
.. 2558 53
29/9/58 16:13
1
Cryotherapy/liquid nitrogen1-3
Pulse Dye Laser2

1. 2
4 1
2. 1, 5
4.

6
5. //
3
podophyllin7, tretinoin 0.1%8 imiquimod cream9

podophyllin7 imiquimod9
6.
1

7. /
1 7
2 3
54 .. 2558
29/9/58 16:13

3.9
1. Douglas JM, Jr. Molluscum contagiosum. In Holmes KK, Sparling

PF, Stamm BW, Piot P, Wasserheit JN, Corey L, et al, editors. Sexually
transmitted diseases. 4th ed. New York: McGraw Hill; 2008. p. 546-50.
2. Dhar JK. Molluscum. In Gupta S. Kumar B, editors. Sexually
transmitted infections. 2nd ed. Delhi: Mosby;2012.p. 374-9.
3. Piggott C, Friedlander and Tom W.. Poxvirus infections in: Goldsmith
LA, Katz SI, et al. editor, Fitzpatricks. Dermatology in general
medicine. 8th ed. New York: Mcgraw-Hill; 2012. p. 2417-20.
4. Adler MW. ABC of sexually transmitted diseases. Genital warts and
molluscum contagiosum. Br Med J (Clin Res Ed):1984;288(6412):213-5.
5. , .
.. 2553. 1. :
; 2553. 1-29
6. British Association for Sexual Health and HIV. UK national guideline
forthe management of Genital Molluscum in adults, 2014 [Internet].
[cited 2015 May 21]. Available from: http://www.bashh.org/
documents/Molluscum%20contagiosum%202014%20final.pdf
7. Drug.com. [Internet]. Auckland: Drugsite trust online resources;
c2000-15 [update 2014 July 08; cited 2015 May 21]. Available from:
http://www.drugs.com/pro/podocon-25.html
http://www.drugs.com/pregnancy/tretinoin-topical.html
http://www.drugs.com /pregnancy/imiquimod-topical.html
.. 2558 55
29/9/58 16:13
3.10 Pediculosis pubis

1.
: 1
: , (maculae
ceruleae) , 1
3
2.
1
3.
3.1
gamma benzene hexachloride 1% cream
12 1

2, 3
permethrin 5% cream
2, 3
Ivermectin 250 g/ 1 kg
2 3
56 .. 2558
29/9/58 16:13
3.10
3.2 (Phthiriasis palprebrarum)

4
Ivermectin 200 g/ 1 kg/dose
1 5

6
4.
30
3
5. /3
permethrin 5% cream
Gamma benzene hexachloride 1% 2
6.
3
7. /7
1 1
1 1 7
2 3

.. 2558 57
29/9/58 16:13
1. Leone P. Gopalkrishnan TV, Usha V. Scabies and pediculosis pubis.

In Gupta S. Kumar B, editors. Sexually transmitted infections. 2nd
ed. Delhi: Mosby; 2012. p. 622-8.
2. Burkhart CN, Burkhart CG. Scabies, Other mites, and pediculosis.
In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, DJ. L,
editors. Fitzpatricks dermatology in general medicine. 8th ed. New
York: McGraw-Hill Medical; 2012. p. 2576-8.
64(RR-03):1-137.
4. Yoon KC, Park HY, Seo MS, Park YG. Mechanical treatment of
phthiriasis palpebrarum. Korean J Ophthalmol.2003;17(1):71-3.
5. Burkhart CG, Burkhart CN. Oral ivermectin therapy of phthiriasis
palpebrarum. Arch Ophthalmol. 2000;118:134-5.
6. Mansour AM. Photo essay: phthiriasis palprebrarum. Arch
Ophthalmol. 2000;118:1458-9.
7. , .
.. 2553. 1. :
; 2553. 35.
58 .. 2558
29/9/58 16:13
3.11
3.11 Scabies

1.
:

1
: burrows
(scabietic nodules)
1
2.

burrow , ,

1
.. 2558 59
29/9/58 16:13
3.

permethrin 5% cream 8-14
1 2,3
Benzyl benzoate 25% emulsion
6 4
Ivermectin 200 g/ 1 kg
2 2,3

1.

(8 ) 2
2. antihistamine
mild topical steroid2 triamcinolone 0.1%, betamethasone
0.1% 2
3.
72 3
4.
1-4
5. //
5.1 /
permethrin 5% cream/lotion1-3 2 2
Sulfur ointment 5-10%2
5.2
permethrin 5% cream/lotion2,3
Sulfur ointment 5-10%2
ivermectin 15 kg2, 3
60 .. 2558
29/9/58 16:13
6.
3.11
7. /

1. Chosidow O. Clinical practices. Scabies. N Eng J Med 2006; 354(16):

1718-27.
2. Burkhart CN, Burkhart CG. Scabies, other mites, and pediculosis. In:
Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, DJ. L, editors.
Fitzpatricks dermatology in general medicine. 8th ed. New york:
McGraw-Hill Medical; 2012. p. 2569-72.
64(RR-03):1-137.
4. , .
.. 2553. 1. :
; 2553. 35.
.. 2558 61
29/9/58 16:13
3.12 /
Pelvic Inflammatory Disease

1.
: 1-2
:
1-2
3
2.

(minimal criteria)
(additional criteria)

38.3C

wet smear
62 .. 2558
29/9/58 16:13
3.12 /

Neisseria gonorrhoeae
Chlamydia trachomatis
Erythrocyte sedimentation
rate (ESR) C-reactive protein
3.
(Out Patient Department; OPD)

1.
1.1. Ceftriaxone 250 mg 1, 2, 4, 5
1.2. Cefoxitin 2 gm 1-3
1.3. Other third generation cephalosporin (e.g. ceftizoxime or
cefotaxime)1-2

Doxycycline 100 mg 2 14 1-4
Azithromycin 1 gm 2 1
.. 2558 63
29/9/58 16:13
metronidazole 400-500 mg
2 14 metronidazole anaerobe
1-3
/
24 metronidazole 72 tinidazole
)
penicillin/cephalosporin
1. penicillin cephalosporin
< 2.5%1
2. cephalosporin Neisseria gonorrhoeae
quinolone1-3 cephalosporin gonorrhea
levofloxacin 500 mg 1
14 ofloxacin 400 mg 2 14 metronidazole
400-500 mg 2 14
Neisseria gonorrhoeae1
susceptibility testing1
Neisseria gonorrhoeae
cephalosporin cephalosporin quinolone
azithromycin 2 gm1
4.
60
60

64 .. 2558
29/9/58 16:13
5. /
6.
Mycoplasma hominis Streptococcus
1
7. /
72

1-2
3.12 /

1-3

64(RR-03):1-137.
59(RR-12):1-109.
3. Ross J, Judlin P, Jensen J. 2012 European guideline on the
management of pelvic inflammatory disease. Int J STD AIDS 2014;25: 3-4.
2003. p. 28-9.
5. , .
.. 2553. 1. :
; 2553. 31.
.. 2558 65
29/9/58 16:13
3.13 /
Bacterial Vaginosis

1.
: 1-2
: 1-2
3
2.
3 4 1
1. (pH) > 4.5
2. (fishy-amine smell) 10% KOH (
whiff)
3. clue cells (
coccobacilli )
4.
3.

Metronidazole 500 mg 2 7 1-4
Metronidazole 400 mg 2 7 3-5
Metronidazole 0.75% gel 5 gm 5 1-2
66 .. 2558
29/9/58 16:13
3.13 /
2
Tinidazole 2 gm 2 1-3
Tinidazole 1 gm 5 1-2
Clindamycin 300 mg 2 7 1-4
/
24 metronidazole 72 tinidazole
)
Metronidazole/Tinidazole
clindamycin metronidazole/tinidazole1,2
metronidazole
metronidazole
4.

1-4
5. /
metronidazole
1-3 (category B)3 tinidazole
1-3 (category C)3
6.
1-5
7. /
7 5
.. 2558 67
29/9/58 16:13

64(RR-03):1-137.
59(RR-12):1-109.
3. Jackir S, Gilbert D, David W. 2011 European (IUSTI/WHO) guideline
on the management of vaginal discharge, 2011. Int J STD AIDS
2011;22: 421-9.
2003. p. 56-8.
5. , .
.. 2553. 1. :
; 2553. 30.
68 .. 2558
29/9/58 16:13
3.14
3.14
Vulvovaginal Candidiasis

1.
: 1-2
:
1-2
2.
(pH) < 4.5
10% KOH mycelium
pseudohyphae / budding yeast1
3.
2
3.1
Fluconazole 150 mg 1-5
Itraconazole 200 mg 2 1 3, 5
Clotrimazole 500 mg Clotrimazole
100 mg 2 1 3 3-5
.. 2558 69
29/9/58 16:13
3.2

4 1 fluconazole
100-200 mg 4 7
fluconazole 100-200 mg / 6 1-2

fluconazole 150 mg 41-2

azoles , ,
azoles
simvastatin, antiretroviral drug, warfarin
4.
3
5. /
/ 1-3
clotrimazole 500 mg clotrimazole 100 mg 2
3 3-5
7-14
6.

7-14 1-2

.. 2558
(intravaginal)1
70 .. 2558
29/9/58 16:13
Miconazole 2% cream 5 gm 1 7 *
Clotrimazole 1% cream 5 gm 1 7-14 *
* (oil-based)
1
7. /
7 5
3.14

64(RR-03):1-137.
59(RR-12):1-109.
3. Jackir S, Gilbert D, David W. 2011 European (IUSTI/WHO) guideline
on the management of vaginal discharge, 2011. Int J STD AIDS
2011;22: 421-9.
2003. p. 58-9.
5. , .
.. 2553. 1. :
; 2553. 29.
6. Greenbaltt HK, Greenbaltt DJ, Liver injury associated with
ketoconazole: Review of the published evidence. J Clin Pharmacol
2014;54(12):1321-9.
.. 2558 71
29/9/58 16:13
29/9/58 16:13

/

1
4
1.
2.
(; window period)
3.
4.
.. 2558 73
29/9/58 16:13

1.

2.

3.
//
VDRL, Anti
HIV, HBsAg, Anti HBs Anti HCV
4. /

5.

74 .. 2558
29/9/58 16:13

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

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

(PITC)

7-10

ProviderInitiated HIV Testing and Counseling; PITC
.. 2558 75
29/9/58 16:13

Anti HIV VDRL, HBsAg, Anti HBs Anti HCV
1
Anti HIV
Anti HIV
Anti HIV 1 3
3 2557

(Test and Treat)

(Treatment as Prevention)

(PITC)

1. (Pre-test
counseling)
2. (Post-test
counseling)
3. (Ongoing counseling)
76 .. 2558
29/9/58 16:13
1. (Pre-test
counseling)
2. (Post-test
counseling)

1

(window period)

3. (Ongoing counseling)

.. 2558 77
29/9/58 16:13
1.
2.
3. /
4. (
)
5.

1. , .
.. 2553. 1. :
; 2553. 7-9.
2. . ()
.
2553 9.
3. , , .
2557. 1.
: ; 2557. 28.
78 .. 2558
29/9/58 16:13
29/9/58 16:13

(Syphilis screening tests)

(incubation period)
(asymptomatic) (latent syphilis)

(syphilis serologic screening tests)

1. (all pregnant women)
2. (people donating blood, blood products
solid organ)
3. (having a sex partner who has syphilis)
4. (high-risk of syphilis)

, (HIV, hepatitis
B, hepatitis C)
(commercial sex workers)
(MSM)

1 ,
80 .. 2558
29/9/58 16:13
(anonymous sex partners)
(Syphilis serologic tests) 2

1. Nontreponemal test
1.1 VDRL (Venereal Diseases Research Laboratory)
1.2 RPR (Rapid Plasma Reagins)
Nontreponemal test non specific treponemal test
reagin antiboby

(preliminary screening tests) Nontreponemal test
serological activity syphilis (active)
(monitor effective of treatment)
VDRL reagin antibody
antigen-antibody complex
cardiolipin/lecithin/cholesterol
reagin antibody (flocculation)
RPR reagin antibody VDRL

cardiolipin suspension
reagin
(flocculation)
2. Treponemal test
2.1 TPHA (Treponema Pallidum hemagglutination assay)
2.2 TPPA (Treponema Pallidum particle agglutination test)
2.3 FTA-ABS (Fluorescent Treponemal Antibody Absorption Test)
Treponemal test specific treponemal test
T. pallidum
(detect antibodies against T. pallidum protein) treponemal test
(conrmatory test)
nontreponemal test
.. 2558 81
29/9/58 16:13
TPHA micro-hemagglutination assay

sensitize sonicated T. pallidum
treponema antibody agglutination
treponemal test
TPPA TPHA
FTA-ABS
Indirect immunofluorescent antibody test

treponemal test
Immunochromatography test (Rapid test)
Treponemal Enzyme Immunoassay (EIA)
Chemiluminescence Immunoassay (CIA)
IgG immunoblot test for T. pallidum (Western blot)
(Algorithm for screening

for syphilis)
1. (Traditional algorithm for screening syphilis)

nontreponemal test
treponemal test

Primary screening tests : Nontreponemal test

Confirmatory tests : Treponemal test
82 .. 2558
29/9/58 16:13
: nontreponemal test
1) (Prozone phenomenon) 2

anitgen-antibody complex (false negative)
2) 30% (late latent syphilis)
VDRL/RPR
3) 1 (early primary syphilis)
2. (Reverse algorithm for screening syphilis)

US-CDC treponemal
test nontreponemal
test (automate)

treponemal test
primary screening tests nontreponemal test EIA
CIA 2014 European
Guideline on the Management of Syphilis
treponemal test nontreponemal test (VDRL RPR)
nontreponemal test nontreponemal
test treponemal test treponemal
test (different type treponemal test)
.. 2558 83
29/9/58 16:13
Traditional algorithm Reverse algorithm
http://www.cdc.gov/std/syphilis/syphilis-webinar-slides.pdf Karen
Hoover, MD, MPH Ina Park, MD, MS
different type treponemal test

Primary screening tests

: Treponemal test
Treatment monitoring with : Non-treponemal test
nontreponemal test nontreponemal
test high-risk (
80)
29/9/58 16:13

Nontreponemal Treponemal
test
test
1
chancre
2

condyloma
lata, mucous patch
alopecia

1.
2. *
3. Prozone
2
.. 2558 85
29/9/58 16:13
Nontreponemal Treponemal
test
test
febrile infective
illnesses ( malaria,
hepatitis, chickenpox,
measles, etc.), pregnancy,
(Biological injecting drug users,
false positive autoimmune diseases, HIV
VDRL/RPR) infection, chronic
infections leprosy, TB,
malignancies, chronic liver
disease, older age.
* (Treated syphilis) VDRL/RPR titer

(nonreactive) Treponemal test
(remainder of lives)

86 .. 2558
29/9/58 16:13
1. (Pregnancy Categories)
(U.S. Food and Drug
Administration ; US FDA) 5 Category A, B, C, D X1
Category A

2 3
Category B

()
(

2 3)
Category C

( )
.. 2558 87
29/9/58 16:13
Category D

(
)
Category X

2. US-FDA Pregnancy
Categories1

Generic
Acyclovir
Azithromycin
Benzathine Penicillin G
Benzyl Benzoate
Cefixime
Route of
Administration
PO
parenteral
topical
PO
parenteral
topical
PO
Pregnancy Category
B
B
B2
B
B
N/A
B
88 .. 2558
29/9/58 16:13
Doxycycline
Erythromycin
Famciclovir
Fluconazole
Gamma Benzene
Hexachloride
Imiquimod
Itraconazole
Ivermectin
Ketoconazole
Levofloxacin
Metronidazole
Ofloxacin
parenteral
parenteral
PO
PO (troche)
vaginal
PO
PO
PO
PO
topical
topical
PO
PO
PO
PO
PO
PO
Permethrin
topical
Podophyllin
topical
Roxithromycin
PO
Tetracycline
PO
Tinidazole
PO
Trichloroacetic acid
topical
Valacyclovir
PO
: N/A (Not Available) =
B
B
C
C
B
D
B
B
C (single dose for vaginal
candidiasis);
D (all other indication)
C2
Cefotaxime
Ceftriaxone
Ciprofloxacin
Clotrimazole
C2
C
2, 12
C
C
C
B
C ; caution especially in
1st trimester
B2
X3
N/A
D
C
C4
B
.. 2558 89
29/9/58 16:13
3. 6
1. (Antibacterial Drugs)
1. Cephalosporins
Cefixime
Warfarin
Warfarin 1. C l o t t i n g
5
parameters INR, PT5
2. Warfarin5
Ceftriaxone
Warfarin
Warfarin 1. Clotting
2, 6
parameters INR, PT6
2. Warfarin6
2. Macrolides
Azithromycin
6
parameters INR, PT6
2. Warfarin6
Azithromycin

52%7
1 2
1
Carbamazepine
Carbamazepine
Carbamazepine
6
6
Digoxin
Digoxin Digoxin
6
Digoxin6
Warfarin
Erythromycin
E r g o t a m i n e Ergotamine
6
Theophylline
Theophylline
6
1. /
sign ergotism
2.
Ergotamine6

Theophylline
6
90 .. 2558
29/9/58 16:13
Digoxin
2
2
Roxithromycin E r g o t a m i n e Ergotamine 8
Roxithromycin 1 15 8
8
3. Quinolones
Ciprofloxacin Ciprofloxacin 6
6

Ciprofloxacin

2
Levofloxacin Levofloxacin 6
6

Levofloxacin

2

Ofloxacin
Ofloxacin 1, 6
6

Ofloxacin

2 1
4. Tetracyclines
Doxycycline
Doxycycline Digoxin

Digoxin Digoxin6
6
.. 2558 91
29/9/58 16:13
Penicillins
(Bacteri-
cidal) 6
Penicillins

(Bacteriostatic)
Doxycycline
Doxycycline 6
Carbamazepine
Doxycycline Doxycycline
6

Tetracyclines 6
Phenytoin
Half-life
Doxycycline 6
1. Doxycycline
2
2. Clinical response
6
Oral contraceptives
6
6
Tetracycline
Digoxin
Doxycycline
6 3-4 6

(Chronic Alcohol
Consumption)
Doxycycline
6
Digoxin
6
Digoxin
Digoxin6
92 .. 2558
29/9/58 16:13
Penicillins
(Bactericidal) 6
Penicillins

(Bacteriostatic)
Tetracycline
Tetracycline
6
Oral contraceptives
6
6
6
Isotretinoin
6
Tetracycline
6 3-4 6

Tetracycline Tetracycline
6 1
2
1,6

GI upset1
2. (Antifungal Drugs
5. Azoles
Fluconazole Warfarin
NSAIDs
6
parameters INR, PT
2. Warfarin6
NSAIDs NSAIDs6
6
.. 2558 93
29/9/58 16:13
Itraconazole
HMG-CoA
Reductase Inhibitors
Simvastatin,
Atorvastatin,
Rosuvastatin
Protease
Inhibitors (PIs)
Ritonavir, Indinavir,
Saquinavir
NonNucleoside Reverse
Transcriptase
Inhibitors (NNRTIs)
Nevirapine,
Warfarin
Ergotamine
HMG-CoA
Reductase Inhibitors
Simvastatin,
Atorvastatin,
Rosuvastatin
HMG-CoA 1.
Reductase Inhibitors Fluconazole
6
2. HMG Rhabdomyolysis6 CoA Reductase Inhibitors6
3. Pravastatin

6
P I s ,
Fluconazole 6

6
Fluconazole Fluconazole

NNRTIs Fluconazole
6
6
6
parameters INR, PT
2. Warfarin6
Ergotamine Itraconazole
6

(peripheral
ischemia)6
Itraconazole Itraconazole
2
HMG-CoA 1. Itraconazole
Reductase Inhibitors 6
2. HMG CoA Reductase Inhibitors6
Rhabdomyolysis6 3. Pravastatin

6
94 .. 2558
29/9/58 16:13
Ketoconazole Warfarin
P I s ,
Itraconazole

6
Itraconazole

NNRTIs

6
Warfarin
6
6
Itraconazole

Itraconazole
6
Protease
Inhibitors (PIs)
Saquinavir
Non-Nucleoside
Reverse Transcriptase
Inhibitors (NNRTIs)
Nevirapine
1. C l o t t i n g
parameters INR, PT6
2. Warfarin6
Ergotamine
Ergotamine Ketoconazole
Ketoconazole
6
Ketoconazole 2
2,6
HMG-CoA
HMG-CoA 1.
Reductase Inhibitors Reductase Inhibitors Ketoconazole
Simvastatin,
6
Atorvastatin,
2. HMGRosuvastatin
Rhabdomyolysis6
CoA Reductase Inhibitors6
3. Pravastatin

6
Protease
P I s ,
Inhibitors (PIs)
Ketoconazole 6
Saquinavir
6
.. 2558 95
29/9/58 16:13
NonNucleoside Reverse
Transcriptase
Inhibitors (NNRTIs)
Nevirapine,
Efavirenz
Ketoconazole

NNRTIs

6
Ketoconazole

Ketoconazole
6
3. (Antiprotozoal Drugs)
6. Nitroimidazoles
Metronidazole Warfarin
Disulfiram
Tinidazole
Warfarin
Warfarin 1 . C l o t t i n g
6
parameters INR, PT6
2. Warfarin6
6

6
disulfiram-like
reaction10 ( 6 1
Metronidazole9, 10
)
11
parameters INR, PT11
2. Warfarin11
disulfiram-like
reaction 10 ( 3
Tinidazole9, 10
)
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4. (Anti-Parasitic Drugs)
INR 12
Warfarin

13
Ivermectin
Ivermectin
14

14
7. Avermectins
Ivermectin
Warfarin
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product/usa/pi_circulars/s/stromectol/stromectol_pi.pdf.
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http://www.drugs.com/food-interactions/ivermectin.html.
98 .. 2558
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(
/ )

()
.. 2558 99
29/9/58 16:13
1-2

1.

5
2.

3.

4.

5.

100 .. 2558
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6.

7.

8.

9.

10.
11.

12.

.. 2558 101
29/9/58 16:13

1.

2.
3.

4.
5.

6.

7.

8.

: http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/app-ann-b-eng.php
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(Sexually transmitted infections; STIs)

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1. World Health Organization. Baseline report on global sexually

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Dark-field Nontreponemal Treponemal

* (early latent syphilis) = 1

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3.1 (Early syphilis) 1 (primary syphilis)

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First line option Penicillin

Doxycycline 100 mg Doxycycline

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First line option Penicillin

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First line option Penicillin

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1. Janier M, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potocnik M, et al.

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petechiae pustule , septic arthritis,

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5.1 ceftriaxone 250 mg

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1. Reddy BSN, Khandpur S, Sethi S, Unemo M. Gonococcol infections.

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4. Lanjouw E, Ossewaarde JM, Stary A. Boag F, van der Meijden WI.

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1. Centers for Disease Control and Prevention. Sexually transmitted

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3.2 (Adult Nongonococcal

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45 kg erythromycin base 50 mg/

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1. Centers for Disease Control and Prevention. Sexually transmitted

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5. Horner PJ, Blee K, Falk L, Meijden W, Moi H. 2014 European guideline

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