Single-dose regimens may be used for the treatment of chancroid, nongonococcal urethritis, uncomplicated gonococcal infections, bacterial vaginosis, trichomoniasis, candidal vaginitis and chlamydial infections. Improved therapies are now available for the treatment of genital herpes and human papillomavirus HPV infections. New regimens have been approved for the use of acyclovir Zovirax in the treatment of genital herpes.
In addition, two new antiviral agents, valacyclovir Valtrex and famciclovir Famvir , have been labeled for the treatment of genital herpes.
Patient-applied therapies are now recommended for management of HPV. A new testing method for the diagnosis of chlamydial infections employs an extremely accurate urine test that can easily be incorporated into screening programs. Hepatitis A and hepatitis B vaccines are now recommended for all sexually active adolescents and young adults. Treatments for STDs in pregnant women have been improved, producing fewer side effects and reducing the number of premature births. Treatment guidelines for the management of STDs in special patient populations, including pregnant women, were recently published in this journal.
Before a genital ulcer is treated, an accurate diagnosis with appropriate testing is essential. Concomitant testing for human immunodeficiency virus HIV infection should be considered. The goals of therapy for chancroid are to cure the infection, resolve symptoms and prevent transmission. Four recommended drug regimens for the treatment of chancroid are shown in Table 1.
Two are single-dose regimens consisting of either azithromycin Zithromax or ceftriaxone Rocephin. Erythromycin, which continues to be recommended for the treatment of chancroid, requires a seven-day dosing regimen.
Ciprofloxacin Cipro has been added to the guidelines for the treatment of chancroid. However, ciprofloxacin is contraindicated for use in pregnant and lactating women, and in patients under 18 years of age. All four regimens are effective for treatment of chancroid in patients with or without HIV. Of note, several isolates of chancroid with intermediate resistance to either ciprofloxacin or erythromycin have been reported.
Patients should be re-examined within three to seven days after initiation of therapy. Symptomatic improvement should be reported within three days if treatment is successful. Ceftriaxone Rocephin. Ciprofloxacin Cipro. Erythromycin base. Doxycycline Vibramycin. Erythromycin base plus during pregnancy. Famciclovir Famvir. Valacyclovir Valtrex. Reprinted from Centers for Disease Control and Prevention. Montvale, N. Cost to the patient will be higher, depending on prescription filling fee.
Genital herpes is a recurrent, incurable viral disease. Patient counseling should include information about recurrent episodes, asymptomatic viral shedding, perinatal transmission and sexual transmission.
Episodic antiviral therapy during outbreaks may shorten the duration of the lesions, and suppressive antiviral therapy may prevent recurrences.
During the first clinical episode, the goal of systemic antiviral drug therapy is to control the signs and symptoms of genital herpes. Daily suppressive therapy is recommended for use in patients who have six or more recurrences per year.
Three antiviral medications have been proved in randomized trials to provide clinical benefit in patients with genital herpes: acyclovir, valacyclovir and famciclovir. Clinical experience with systemic acyclovir in the treatment of genital herpes has been substantial.
Topical therapy is less effective than systemic therapy, and its use is not recommended. Two newer antiviral agents are valacyclovir and famciclovir. Famciclovir, a prodrug of penciclovir, also has high oral bioavailability. The safety of antiviral therapy in pregnant women has not been established, but extensive clinical experience with acyclovir has been reassuring. Severe or first-episode disease that occurs during pregnancy may be treated with acyclovir. However, the routine administration of antiviral agents in pregnant women with uncomplicated or recurrent genital herpes is not recommended.
Syphilis is a systemic disease caused by the sexual transmission of Treponema pallidum. It can present as primary, secondary or tertiary disease. Gonorrhea that remains untreated can have complications.
These differ in men and women, but both can lead to long term fertility issues. Therefore, both you and your partner must get treated. Untreated gonorrhea complications in men include the following CDC, :. Women have a higher risk of complications from untreated gonorrheal infections than men Sherrard, Pelvic inflammatory disease PID is one of the most common of these complications.
This condition occurs when the untreated infection travels up into the uterus, fallopian tubes, and ovaries. Symptoms of PID include:. If PID is found early, it can be treated. However, any damage that has been done by the infection and inflammation cannot be reversed. Approximately 1 in 8 women who have had PID at some point in their past will have difficulties getting pregnant.
In both men and women, there is a risk of the infection spreading throughout the body- disseminated gonococcal infection DGI. Fortunately, this occurs in only 0. DGI can occur without symptoms of genital, rectal, or oral gonorrhea infection Lohani, This condition can be life-threatening if left untreated. Once diagnosed with gonorrhea, both you and your partner s must receive prompt treatment.
In most cases, gonorrhea can be treated with a single dose of antibiotics. However, as with many other bacteria, we are starting to see the emergence of antibiotic-resistant gonorrhea ARG. This means that the bacteria are coming up with ways to resist being killed by our currently available drugs. Current UK treatment guidelines recommend an intramuscular injection of ceftriaxone or cefixime for gonorrhoea, and this should be provided at the same time of chlamydia therapy in patients with both infections.
The HPA is using its alert to remind clinicians that all laboratories should test gonorrhoea samples for resistance to ceftriaxone and cefixime as well as azithromycin, doxycyline, ciprofloxacin and penicillin and that cases of resistance should be reported.
Primary tabs View active tab Preview. Michael Carter. This article is more than 14 years old. Click here for more recent articles on this topic. July 22, Gonorrhea Self-Study Module external icon — An online learning experience that helps users learn how to manage gonorrhea. November 1, Related Links. STDs Home Page. See Also Pregnancy Reproductive Health. Find an STD testing site near you.
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