Sexually Transmissible Infections

Approximately 12 million patients are diagnosed with a sexually transmissible infection (STI) annually in the United States. Sequella of STIs include infertility, chronic pelvic pain, ectopic pregnancy, and other adverse pregnancy outcomes.

Diagnosis and Treatment of Bacterial Sexually

Transmissible Infections

Organ

Diagnos

Recommended

Alternative

ism

tic Meth

Treatment

ods

Chlam

Direct flu

Doxycycline 100

Ofloxacin (Floxin)

ydia

orescent

mg PO 2 times a

300 mg PO 2 times

tracho

antibody,

day for 7 days or

a day for 7 days

matis

enzyme

Azithromycin

immuno

(Zithromax) 1 g

assay,

PO

DNA

probe, cell

culture,

DNA am-

plification

Neisse

Culture

Ceftriaxone

Levofloxacin

ria

DNA

(Rocephin) 125

(Levaquin) 250 mg

gonor

probe

mg IM or

PO once

rhoeae

Cefixime 400 mg

Spectinomycin 2 g

PO or

IM once

Ciprofloxacin

(Cipro) 500 mg

PO or

Ofloxacin (Floxin)

400 mg PO

plus Doxycycline

100 mg 2 times a

day for 7 days or

azithromycin 1 g

PO

Trepo

Clinical

Primary and sec-

Penicillin allergy in

nema

appear-

ondary syphilis

patients with pri-

palli

ance

and early latent

mary, secondary,

dum

Dark-field

syphilis (<1 year

or early latent

micros-

duration):

syphilis (<1 year of

copy

benzathine peni-

duration):

Nontrepon

cillin G 2.4 million

doxycycline 100 mg

emal test:

units IM in a sin

PO 2 times a day

rapid

gle dose.

for 2 weeks.

plasma

reagin,

VDRL

Treponem

al test:

MHA-TP,

FTA-ABS

Diagnosis and Treatment of Viral Sexually Transmissible Infections

Organism

Diagnostic Methods

Recommended Treatment Regimens

Herpes simplex virus

Clinical appearance Cell culture confirmation

First episode: Acyclovir (Zovirax) 400 mg PO 5 times a day for 7-10 days, or famciclovir (Famvir) 250 mg PO 3 times a day for 7-10 days, or valacyclovir (Valtrex) 1 g PO 2 times a day for 7-10 days. Recurrent episodes: acyclovir 400 mg PO 3 times a day for 5 days, or 800 mg PO 2 times a day for 5 days or famciclovir 125 mg PO 2 times a day for 5 days, or valacyclovir 500 mg PO 2 times a day for 5 days

Daily suppressive therapy: acyclovir 400 mg PO 2 times a day, or famciclovir 250 mg PO 2 times a day, or valacyclovir 250 mg PO 2 times a day, 500 mg PO 1 time a day, or 1000 mg PO 1 time a day

Human papillom a virus

Clinical appearance of condyloma papules Cytology

External warts: Patient may apply podofilox 0.5% solution or gel 2 times a day for 3 days, followed by 4 days of no therapy, for a total of up to 4 cycles, or imiquimod 5% cream at bedtime 3 times a week for up to 16 weeks. Cryotherapy with liquid nitrogen or cryoprobe, repeat every 1-2 weeks; or podophyllin, repeat weekly; or TCA 80-90%, repeat weekly; or surgical removal.

Vaginal warts: cryotherapy with liquid nitrogen, or TCA 80-90%, or podophyllin 10-25%

Organ

Diagnostic

Recommended Treatment Regi

ism

Methods

mens

Human

Enzyme

Antiretroviral agents

immun

immunoassa

o-

y

defi

Western blot

ciency

(for confirma-

virus

tion)

Polymerase

chain reac-

tion

Treatment of Pelvic Inflammatory Disease

Regi men

Inpatient

Outpatient

A

Cefotetan (Cefotan) 2 g IV q12h; or cefoxitin (Mefoxin) 2 g IV q6h plus doxycycline 100 mg IV or PO q12h.

Ofloxacin (Floxin) 400 mg PO bid for 14 days plus metronidazole 500 mg PO bid for 14 days.

B

Clindamycin 900 mg IV q8h plus gentamicin loading dose IV or IM (2 mg/kg of body weight), followed by a maintenance dose (1.5 mg/kg) q8h.

Ceftriaxone (Rocephin) 250 mg IM once; or cefoxitin 2 g IM plus probenecid 1 g PO; or other parenteral third-generation cephalosporin (eg, ceftizoxime, cefotaxime) plus doxycycline 100 mg PO bid for 14 days.

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