ATAEI .B , MD. MPH.

Sexually Transmitted Infections

CASE 1

جوانی مشکوک 4مرد جنسی تماس از بعد روز . در د شود می تناسلی الت دردناک ضایعه دچار

خونریزی اسانی وبه دارد کثیف نمای زخم معاینه . . لنفاوی غده ندارد سفتی لمس ودر نماید می

لمس اینگوینال ناحیه در نیز دردناک و بزرگمیگردد.

چیست؟ شما بالینی تشخیص

ETIOLOGY

Usual causes Herpes simplex virus (HSV) Haemophilus ducreyi (chancroid)

USUAL INITIAL LABORATORY EVALUATION

culture, direct FA, ELISA, or PCR for HSV; consider HSV-2-specific serology.

In chancroid-endemic area: PCR or culture for H. ducreyi

INITIAL TREATMENT 

Herpes confirmed or suspected (history or sign of vesicles):

Treat for genital herpes with : acyclovir, valacyclovir, or famciclovir

INITIAL TREATMENT

     First episodes: acyclovir (200 mg 5 times per day or 400 mg

tid), valacyclovir (1 g bid), famciclovir (250 mg bid) for 7–14 days is

effective.

INITIAL TREATMENT

Symptomatic recurrent genital herpes: Short-course (1- to 3-day) regimens are

preferred because of low cost and convenience.

Oral acyclovir (800 mg tid for 2 days), valacyclovir (500 mg bid for 3 days), or famciclovir (750 or 1000 mg bid for 1 day,

INITIAL TREATMENT

Chancroid confirmed or suspected (diagnostic test positive, or HSV and syphilis excluded, and lesion persists):

Ciprofloxacin 500 mg PO as single dose or Ceftriaxone 250 mg IM as single dose or Azithromycin 1 g PO as single dose

CASE 2

ای 30بیمار جنسی 3ساله تماس یک از بعد هفتهشده تناسلی دستگاه روی پاپول یک دچار مشکوک

ضایعه این جدار 3است با اولسر به تبدیل بعد روزسفت معاینه ودر درد بدون که شود می منظمیکطرفه درد بدون لنفادنوپاتی با وهمراه است

میباشد. چیست؟ شما بالینی تشخیص

ETIOLOGY

Usual causes Treponema pallidum (primary syphilis) lymphogranuloma venereum

USUAL INITIAL LABORATORY EVALUATION

Dark-field exam, direct FA, PCR for T. pallidum; RPR or VDRL test for syphilis (if negative but

primary syphilis suspected, repeat in 1 week);

INITIAL TREATMENT

Syphilis confirmed (dark-field, FA, or PCR showing T. pallidum, or RPR reactive):

Benzathine penicillin 2.4 million units IM once to patient,

Preventive treatment Recent (e.g., within 3 months) Seronegative partner(s), All seropositive partners

MANAGEMENT OF SYPHILIS IN PREGNANCY

Every pregnant woman should undergo a nontreponemal test at her first prenatal visit

If at high risk of exposure, again in the third trimester and at delivery.

In the untreated pregnant patient with

presumed syphilis, expeditious treatment appropriate to the stage of the disease is essential.

RECOMMENDED FOLLOW-UP EVALUATION AFTER THERAPY FOR SYPHILIS

Stage of Syphilis Tests to Perform When to Perform Re-Treatmenta Considered If:

Primary or secondary

Quantitative RPR or VDRL

HIV-uninfected: 6 and 12 monthsHIV-infected: 3, 6, 9, 12, and 24 months

1 .Titer increases by fourfold or

2 .Titer fails to decline by fourfold or test fails to become nonreactive by 6 months or

3 .Clinical signs persist or recur

CASE 3 ای 23جوان جنسی 4ساله تماس از بعد روز

سوزش و مجرا از ترشح علت به مشکوک. نماید می مراجعه شما مطب به ادرار

چیست؟ شما بالینی تشخیص

URETHRITIS

(1) mucopurulent or purulent urethral discharge,

(2) Gram stain of urethral secretions demonstrating 5 or more leukocytes per oil immersion microscopic field, or

URETHRITIS

(3) a positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine demonstrating 10 or more leukocytes per high-power field.

ETIOLOGY

Neisseria gonorrhoeae*

CAUSES OF NONGONOCOCCAL URETHRITIS

Chlamydia trachomatis (15–50%)* Ureaplasma urealyticum (10–40%)* Mycoplasma genitalium (30%??) Trichomonas vaginalis (1–17%)* Herpes simplex virus (primary) (?%)

TREATMENT

Treat chlamydial infection:  plus Treat gonorrhea (unless excluded):  

Azithromycin, 1 g PO; or  Ceftriaxone, 125 mg IM; or  

Doxycycline, 100 mg bid for 7 days

 Cefpodoxime, 400 mg PO; or 

 Cefixime, 400 mg PO 

Initial Treatment for Patient and Partners 

*Epidemiologic treatment of sexual partners is recommended

ALTERNATIVE REGIMENS

Ceftizoxime (500 mg IM, single dose)or Cefotaxime (500 mg IM, single dose)or Spectinomycin (2 g IM, single dose)or Cefotetan (1 g IM, single dose) plus

probenecid (1 g PO, single dose)or Cefoxitin (2 g IM, single dose) plus probenecid

(1 g PO, single dose)