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

Organism

Diagnostic Methods

Recommended Treatment

Alternative

Chlamydia trachomatis

Direct fluorescent antibody, enzyme immunoassay, DNA probe, cell culture, DNA amplification

Doxycycline 100 mg PO 2 times a day for 7 days or

Azithromycin (Zithromax) 1 g PO

Ofloxacin (Floxin) 300 mg PO 2 times a day for 7 days

Neisseria gonorrhoeae

Culture DNA probe

Ceftriaxone (Rocephin) 125 mg IM or

Cefixime 400 mg PO or

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

Levofloxacin (Levaquin) 250 mg PO once

Spectinomycin 2 g IM once

Treponema pallidum

Clinical appearance Dark-field microscopy Nontrepone mal test: rapid plasma reagin, VDRL

Treponemal test: MHA-TP, FTA-ABS

Primary and secondary syphilis and early latent syphilis (<1 year duration): benzathine penicillin G 2.4 million units IM in a single dose.

Penicillin allergy in patients with primary, secondary, or early latent syphilis (<1 year of duration): doxycycline 100 mg PO 2 times a day for 2 weeks.

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 papilloma 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 1025%

Human immunodeficiency virus

Enzyme immunoassay Western blot (for confirmation)

Polymerase chain reaction

Antiretroviral agents

Treatment of Pelvic Inflammatory Disease

Regimen

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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