• 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.