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STI.pptx
- 2. STI: ETIOLOGICAL CLASSIFICATION Disease Causative Organism Syphilis Treponema pallidum Chancroid Hemophilus ducreyi Donovanosis Klebsiella granulomatis Lymphogranuloma venerum Chlamydia trachomatis Gonococcal genital infection Neisseria gonorrhoeae Non gonococcal genital infection Chlamydia trachomatis Mycoplasma genitalium Ureoplasma urealyticum Gardenella vaginalis Candida albicans Herpes genitalis Herpes simplex virus AIDS Human immunodeficiency virus
- 3. TREATMENT: EARLY SYPHILIS • Drug of Choice: • Benzathine penicillin 2.4 mega units, im, 2 divided doses, one in each buttock • Penicillin sensitive patients: • Doxycycline 100 mg BD for 14 days • Pregnancy: • Erythromycin stearate 2g daily, qid 14 days
- 4. LATE SYPHILIS (BENIGN, CARDIOVASCULAR): TREATMENT •Drug of Choice: •Benzathine penicillin (as above) once a week for 3 consecutive weeks •Penicillin Sensitive: •Doxycycline 100 mg BD for 28 days •Pregnancy: •Erythromycin stearate (as above) for 28 days
- 5. OTHER SYPHILIS: TREATMENT •Neurosyphilis: • Crystalline penicillin 3-4 million units, 4-hourly, iv for 14 days •Congenital syphilis: • Procaine penicillin 50000 IU/kg im daily for28 days
- 6. CHANCROID: TREATMENT • Azithromycin 1gm SOD; • Ceftriaxone 250 mg im SD; • Ciprofloxacin 1g oral OD for 3 days; • Erythromycin base 1.5 gm daily for 7 days
- 7. GONORRHOEA: TREATMENT • Uncomplicated: • Azithromycin 2g SOD OR • Cefixime 400mg SOD OR • Ceftriaxone 125mg im SD OR • Ofloxacin 400mg SOD • Complicated: • Ceftriaxone 1g im SD OR • Cefixime 400 mg BD for 7 days
- 8. LYMPHOGRANULOMA VENEREUM: TREATMENT • Doxycycline 200mg OD for 21 days OR • Erythromycin 2g OD for 21 days
- 9. DONOVANOSIS: TREATMENT • Doxycycline 200 mg OD for 3 weeks OR • Azithromycin 1g once a week for 3 weeks OR • Erythromycin 2g OD for 3 weeks
- 10. HERPES GENITALIS: TREATMENT • Episodic treatment: • Acyclovir 400mg TDS orally for 7 days for 1st episode and for 5 days for recurrent episode • Suppressive treatment: • Acyclovir 400 mg BD for 12 months
- 11. CANDIDIASIS: TREATMENT • Topical: • Clotrimazole 1% cream • Ketoconazole 2% cream • Systemic: • Ketoconazole 200 mg OD for 3 days OR • Fluconazole 150 mg once a week for 4 weeks
- 12. DRUGS FOR ANTIRETROVIRAL THERAPY (ART) Class of Drug Example Recommended Dose Reverse Transcriptase Inhibitors Nucleoside group (NRTIs) Zidovudine 200mg TDS Didanosine 125 mg BD Stavudine 30 mg BD Lamivudine 150 mg BD Reverse Transcriptase Inhibitors Non-nucleoside Reverse Transcriptase Inhibitors group (NNRTIs) Nevirapine 200 mg BD Efavirenz 600 mg OD Delavirdine 400 mg TDS Protease Inhibitors Saquinavir 1200 mgTDS Indinavir 800 mg TDS Ritonavir 600 mg BD Nelfinavir 750 mg TDS Lopinavir 400 mg BD
- 13. HIV/AIDS TREATMENT: NNRTI BASED REGIMEN •Preferred Regimen: •Efavirenz + Lamivudine + Zidovudine or Stavudine •Alternative Regimen: •Efavirenz + Lamivudine + Didanosine •Nevirapine + Lamivudine + Zidovudine or Stavudine or Didanosine
- 14. HIV/AIDS TREATMENT: PI BASED REGIMEN • Preferred Regimen: • Lopinavir + Ritonavir + Lamivudine + Zidovudine or Stavudine • Alternative Regimen: • Indinavir + Lamivudine + Zidovudine/Stavudine • Indinavir + Ritonavir + Lamivudine + Zidovudine/Stavudine
- 15. STI: CLASSIFICATION ACCORDING TO MANIFESTATIONS Manifestation Disease Ulcers Herpes genitals Chancre (primary syphilis) Chancroid Donovanosis Ulcers Gonococcal infection Chlamydial infection Bacterial vaginosis Trichomoniasis Ureaplasma infection Mycoplasma infection Lymphadenopathy Chancroid Syphilis Herpes genitalis Lymphogranuloma venereum Rash Syphilis HIV infection Lymphogranuloma venereum Scabies Itching Scabies HIV infection Pediculosis pubis Nodules Anogenital warts Molluscum contagiosum
- 16. STI: SYNDROMIC APPROACH •Algorithms for implementation at peripheral levels: •Syndrome for genital ulcer disease •Syndrome for urethral discharge •Syndrome for vaginal discharge •Syndrome for inguinal bubo
- 17. STI: ALGORITHM FOR GENITAL ULCER TREATMENT
- 19. CONCLUSION •Sexually Transmitted Infection (STI) is a broader term, includes asymptomatic cases as well •Can present with diverse symptoms (ulcer, discharge, swelling) •Syndromic approach has several advantages for the treatment of STI