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Sexually Transmitted Diseases--Drug Treatment


Infections to be considered:

Chlamydia, including nonchlamydial, nongonococcal urethritis and cervicitis



Pelvic inflammatory disease

Vaginal infection




Genital herpes

  • Chlamydia: Drugs of choice

    • About the organism

    •  Urethritis, cervicitis, conjunctivitis, proctitis

      • Primary drugs:

        •  azithromycin (Zythromax)

          •  single dose usually effective for uncomplicated urethral or cervical infection caused by Chlamydia trachomatis

          •  azithromycin (Zythromax): expensive

          • Or

        •  doxycycline (Vibramycin, Doryx) {alternatives: tetracycline (Achromycin) or minocycline (Minocin)}

          •  seven-day treatment protocol

          •  less costly, patient compliance a concern

      •  Alternative drugs:

        •  ofloxacin (Floxin) { contraindicated in pregnancy)

        •   erythromycin {erythromycin estolate (Ilosone) contraindicated in pregnancy}

    • Nonchlamydial nongonococcal urethritis (NGU) in men

      •  Causative agents: Ureaplasma urealyticum, Mycoplasma genitalium et al.

      •  Treatment: normally responsive to azithromycin (Zythromax) or doxycycline (Vibramycin, Doryx)

        • Alternative treatment: erythromycin or ofloxacin (Floxin)

    • Infection in pregnancy:

      • Primary drug

        •  amoxicillin (Amoxil Polymox)

        •  probably safe/effective

      • Alternative drugs

        •  azithromycin (Zythromax) -- safety and pregnancy not established, but probably safe & effective (limited clinical experience with azithromycin (Zythromax) in pregnancy)

        •  erythromycin {erythromycin estolate (Ilosone) contraindicated in pregnancy}

          • Seven-day erythromycin treatment course may be poorly tolerated by patients -- gastrointestinal effects

      •  Contraindications:

        •  not for use in pregnancy: doxycycline (Vibramycin, Doryx), other tetracycline (Achromycin) and fluoroquinones

    •  Neonatal-- infant conjunctivitis/pneumonia risk if mother has Chlamydia trachomatis

      •  Ophthalmic tetracycline (Achromycin), erythromycin, silver nitrate: not reliable for prevention of newborn ocular chlamydial infection

      • Opthalmia

        •  Primary drug:

          • erythromycin 14 day treatment course

        •  Alternative drug:

          • azithromycin (Zythromax)

      • Pneumonia:

        •  Primary drug:

          • erythromycin

  • Gonorrhea:

    • About the organism

    • Drugs of choice

      • Urethral, cervical, rectal, pharyngeal

      • Primary drugs:-- highly effective with single, oral doses (uncomplicated anogenital & pharyngeal infection {even with penicillin-and tetracycline (Achromycin)-resistant Neisseria gonorrhoeae )

        •  cefixime (Suprax)

        •  ciprofloxacin (Cipro) (contraindicated in pregnancy)

        •  ofloxacin (Floxin) (contraindicated in pregnancy)

        •  ceftriaxone (Rocephin)-- single injection

        •  Fluoroquinone-resistant Neisseria gonorrhoeae strains (increasingly common in the USA {more common in Asia})-- susceptible to cefixime (Suprax) & ceftriaxone (Rocephin)

      • Alternative drug:

        •  spectinomycin (Trobicin)

          •  unreliable against pharyngeal gonococcal infection; may be used to manage pregnant women allergic to beta-lactam antibiotics

      • Drug Management of gonococcal opthalmia, bacteremia, arthritis, or meningitis in adults & and all gonococcal infection in children--

        • parenteral third-generation cephalosporin-- ceftriaxone (Rocephin)

      • All gonorrhea patients: should be given azithromycin (Zythromax) Laura doxycycline (Vibramycin, Doryx) for presumptive chlamydial infection

      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.

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