Transcript دكتر عطايي
Sexually Transmitted Infections
ATAEI .B , MD. MPH.
CASE 1
مرد جوانی 4روز بعد از تماس جنسی مشکوک دچار ضایعه
دردناک الت تناسلی می شود د .در معاینه زخم نمای کثیف
دارد وبه اسانی خونریزی می نماید .ودر لمس سفتی ندارد.
غده لنفاوی بزرگ و دردناک نیز در ناحیه اینگوینال لمس
میگردد.
تشخیص بالینی شما چیست؟
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
بیمار 30ساله ای 3هفته بعد از یک تماس جنسی مشکوک
دچار یک پاپول روی دستگاه تناسلی شده است این ضایعه 3
روز بعد تبدیل به اولسر با جدار منظم می شود که بدون درد
ودر معاینه سفت است وهمراه با لنفادنوپاتی بدون درد یکطرفه
میباشد.
تشخیص بالینی شما چیست؟
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 months
HIV-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
جوان 23ساله ای 4روز بعد از تماس جنسی مشکوک
به علت ترشح از مجرا و سوزش ادرار به مطب شما
مراجعه می نماید.
تشخیص بالینی شما چیست؟
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
Initial Treatment for Patient and Partners
Treat gonorrhea (unless
excluded):
plus
Treat chlamydial infection:
Ceftriaxone, 125 mg IM; or
Azithromycin, 1 g PO; or
Cefpodoxime, 400 mg PO; or
Doxycycline, 100 mg bid for 7
days
Cefixime, 400 mg PO
*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)