• Age: teens - 20
• # of sexual partners
• Prostitution
• Illicit drug use
• Sexual preference

• Urethral infection -- dysuria and urinary frequency, purulent discharge
• Anorectal infection -- severe rectal, pruritus, bleeding
• Pharyngeal infection -- mild pharyngitis
• Abnormal vaginal discharge, uterine bleeding

Pelvic Inflammatory Disease

Disseminated gonorrhea

Ceftriaxone 125 mg IM x 1 dose

OR

Cefixime 400 mg PO x 1 dose

+

Azithromycin 1 g x 1 dose

Azithromycin 2 g PO x 1 dose (emerging resistance)

Cephalosporin

OR

Azithromycin

Incubation

10-90 days

Site of infection

External genitalia, perianal region, mouth, throat

Signs/Symptoms

Chancre sore, regional lymphadenopathy

Incubation

2-8 weeks

Site of Infection

Multisystem involvement

Signs/Symptoms

Pruritic or nonpruritic rash, mucocutaneous lesion, flu-like symptoms

Incubation

4-10 weeks (after secondary)

Site of Infection

Multisystem involvement (dormant)

Signs/Symptoms

Asymptomatic

Incubation

10-30 years

Site of Infection

CNS, heart, eyes, bones, joints

Signs/Symptoms

Cardiovascular syphilis, gumma lesions present, neurosyphilis

Benzathine PCN G IM

RPR at 6 and 12 months

Benzathine PCN G IM

RPR at 6 and 12 months

Benzathine PCN G IM

RPR at 6 and 12 months

Benzathine PCN G IM weekly x 3 weeks

OR

Aqueous crystalline PCN G IV infusion x 10-14 days

RPR at 6, 12, and 24 months

Benzathine PCN G IM weekly x 3 weeks

OR

Aqueous crystalline PCN G IV infusion x 10-14 days

CSF examination q 6 months until clear

• Acute febrile reaction of unknown MOA
• NOT an allergic reaction
• Flu-like symptoms: HA, myalgias, tachypnea, malaise
• Develops 2-24 hrs post PCN dose
• Tx: antipyretics, analgesics, and rest

Doxycycline

OR

Tetracycline

OR

Ceftriaxone

Doxycycline

OR

Tetracycline

OR

Ceftriaxone

Doxycycline

OR

Tetracycline

OR

Ceftriaxone

Doxycycline

OR

Tetracycline

OR

Ceftriaxone

• Usually asymptomatic
• Urethral discharge (watery)
• Abnormal vaginal discharge
• Dysuria
• Mild pharyngitis

PID

Infertility

Reiter Syndrome

Azithromycin 1 g PO x 1 dose

OR

Doxycycline 100 mg PO BID x 7 days

Abstain from sexual intercourse x 7 days post treatment

Young Age

Use of IUD

Poor socioeconomic status

Results from untreated chlamydia or untreated gonorrhea

• Pelvic pain
• Lower abdominal tenderness
• Cervical motion tenderness
• Oral Temp > 101 F
• Abdominal Cervical / Vaginal Discharge
• Elevated erythrocyte sedimentation rate
• Elevated C reactive protein
• LAb verification of Chlamydia or Gonorrhea

PO Outpatient Regimens

Ofloxacin x 14 days

OR

Levofloxacin x 14 days

+

Metronidazole x 14 days

OR

Ceftriaxone x 1 dose

+

Doxycycline x 14 days

Parenteral Inpatient Regimen

Cefoxitin IV + Doxycycline IV

1. Primary mucocutaneous infection
2. Infection of the ganglia
3. Establishment of latency
4. Reactivation (through physical/emotional stress)
5. Recurrent infection

• Asymptomatic (primary infection)
• Prodrome: mild burning, itching, tingling
• Multiple painful pustular or ulcerative lesions (usually heal in 2-4 weeks)
• Flu-like symptoms (fever, HA, malaise)

Palliative (not curative)

Acyclovir x 7-10 days

OR

Famciclovir x 7-10 days

OR

Valacyclovir x 7-10 days

Chronic Suppressive Tx (> 6 episodes/year):

Acyclovir

OR

Famciclovir

OR

Valacyclovir

Acyclovir 400 mg PO TID x 5 days

OR

Acyclovir 800 mg PO BID x 5 days

OR

Acyclovir 800 mg PO TID x 2 days

OR

Famciclovir 125 mg PO TID x 5 days

OR

Valacyclovir 500 mg PO BID x 5 days

OR

Valacyclovir 1 g PO QD x 5 days

MOA

• Inhibit DNA synthesis and viral replication of herpes virals
• Only active against replicating virus

AE

Famciclovir: N/D, HA, fever, dizziness fatigue

Valacyclovir: N/V/D, HA, abdominal pain, dizziness

Acyclovir: N/V/D, HA, lethargy, dizziness, rash, nephrotoxicity

Females:

Scant to copious, malodorous vaginal discharge

Pruritis

Males:

Often asymptomatic

Urethral discharge (clear to mucopurulent)

• PID
• Premature labor
• Infertility (male and female)
• Cervical neoplasia

Metronidazole 2 g PO x 1 dose

OR

500 mg Po BID x 7 days

OR

Tinidazole 2 g PO x 1 dose

• May take with food to decrease GI upset
• Use 7 day course in those with severe GI complaints
• Treat sexual partners simultaneously

AE

• N/V/D
• Abdominal pain
• HA
• Dizziness
• Dry mouth
• Metallic taste

Avoid EtOH:

• During treatment and 3 days post completion of therapy
• Can Cause Disulfiram-Like Rxn: N/V, HA, flushing, abdominal cramps

• Consider with metronidazole-resistant trichomoniasis
• Better tolerated than metronidazole

AE

• Nausea
• Dyspepsia
• Metallic/bitter taste

Avoid EtOH:

• During treatment and 3 days post completion of therapy
• Can Cause Disulfiram-Like Rxn: N/V, HA, flushing, abdominal cramps

Cryotherapy with liquid nitrogen or surgical removal for external warts

Patient Applied Therapy:

Podofilox sol'n or gel

Imiquimod cream

• HPV Vaccine
• Marketed for females (9-26 yrs)
• Stimulates antibody protection against 4 types of HPV (6, 11, 16, 18)

• Injection site reactions (pain and swelling)
• HA, fever, fatigue
• Fainting
• VTE: risk factors include concurrent OC uses, genetic predisposition to blood clots
• Not recommended in pregnant patients

• Eligible patients: lab evaluation indicates + Chlamydia or Gonorrhea, sexual partner exposure within 60 days
• Re-testing: 3 months after treatment

• Treatment Recommendations:

Azithromycin

OR

Cefixime