- 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)
- 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
|