Sexually Transmitted Diseases--Drug Treatment
  • Chancroid
    • Primary drugs:
      • azithromycin (Zythromax, single dose) or
      • ceftriaxone (Rocephin, single dose)
    • Alternative drugs (multiple dosing required)
      • ciprofloxacin (Cipro) (contraindicated in pregnancy)
      • erythromycin (estolate preparation, contradicted in pregnancy))
    • All preparations (particularly single-dose ceftriaxone (Rocephin), less effective in HIV patients)
    • Causative agent: Haemophilus ducreyi -- uncommon in the USA (localized epidemics; common cause in other countries of genital ulceration)
  • Genital Herpes
    • First episode
      •  Primary drugs:
        • acyclovir (Zovirax) or
        • famciclovir (Famvir) or
        • valacyclovir (Valtrex)
      •  Alternative drugs:
        • acyclovir (Zovirax)-- different dose schedule;
      •  Therapeutic effects:
        • reduced duration of pain;reduced viral shedding; reduced systemic symptoms following initial herpes simplex virus genital infection
        • increased rate of healing of recurrent lesions (treatment must begin early)
    • Recurrent (variable effectiveness in recurrence using antiviral treatment; early treatment initiation required for effectiveness)
      •  Primary drugs:
        • acyclovir (Zovirax) or
        • famciclovir (Famvir) or
        • valacyclovir (Valtrex)
    • Severe (Inpatients)
      •  Primary drug:
        • acyclovir (Zovirax)
    • Recurrence suppression:
      •  Primary drugs:
        • valacyclovir (Valtrex) or
        • acyclovir (Zovirax)
      •  Secondary drugs:
        • acyclovir (Zovirax) or
        • famciclovir (Famvir)
      •  Clinical Issues:
        • valacyclovir (Valtrex), acyclovir (Zovirax), famciclovir (Famvir):
          •  reduced frequency of symptomatic recurrences (reduction by 70-80%)
            • some continued asymptomatic HSV anogenital shedding
          •  no cumulative toxicity
          •  absence of resistance-development in immunocompetent patients
  • Pediculosis & Scabies
    •  Sexual acquisition of Phthirus pubis & Sarcoptes scabiei: treated with topical, 5% permethrin (Elimite) -- drug of choice for pubic lice and scabies
    •  Resistant infections (lice & scabies) possibly effective -- ivermectin (Stromectol)
  • Genital Warts & human papillomavirus (HPV) infection
    •  External genital warts (human papillomavirus (HPV))-- clinical manifestation:
      • dysplasia
      • cervical, genital, skin neoplasia
    •  Risk of cervical dysplasia/cancer-- not modified by current treatment
    •  Agents/treatments which may be effective for treating external genital warts ( response rate: 60%-70%; 20%-30% of responders will have recurrence)
      •  trichloroacetic acid
      •  cryotherapy -- liquid nitrogen or cryoprobe
      •  imiquimod (Aldara) -- 5% cream (self application;not recommended for use during pregnancy)
      •  podofilox (0.5% solution) or gel {podofilox (Condylox)}(self application; not recommended for use during pregnancy)
        • in pregnancy: trichloroacetic acid, electrodissication or electrocauterization may be used.
      •  laser therapy/surgery --sometimes effective {severe side effects noted}
    •  Subclinical HPV infection: no treatment recommended
    •  Short duration of HPV infection in young woman (and low-grade cervical dysplasia which may be associated) suggest conservative intervention
Reference:"Drugs for Sexually Transmitted Infections", The Medical Letter, vol. 41 (issue 1063), September, 24, 1999, Published by the Medical Letter, Inc, New Rochelle, N.Y.