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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.

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