Std Flashcards
Discharge syndrome management includes
First line (preferred)
Ceftriaxone 250mg IM stat plus Azithromycin 1gm po stat
Alternative
Ciprofloxacin, 500mg PO stat/Spectinomycin 2 gm IM stat PLUS Doxycycline 100
mg po bid for 7 days/Tetracycline 500 mg po QID for 7 days/Erythromycin 500 mg QID for 7 days in cases of contraindications for Tetracycline (e.g. for children and
pregnancy)
Complications of urethral discharge syndrome
Common acute complications
Disseminated gonococci syndrome
Perihepatitis
Acute epididymo-orchitis
Common chronic complications
Urethral stricture
Infertility
Reiter‘s syndrome (the most common type of inflammatory polyarthritis in young
men)
Causes of urethral discharge syndrome
N gonorrhea
C trachomatis
mycoplasma genitalium,
Trichomonas vaginalis, and
Ureaplasma urealyticum.
If resistance for treatment occurs treat for M genitalium and T vaginalis
Metronidazole 2 gm po. stat/Tinidazole 1gm po once for 3 days (Avoid Alcohol!) PLUS
Azithromycin 1 g orally in a single dose (only if not used during the initial episode to address doxycycline resistant M.genitalium)
Syphillis clinical signs
The ulcer is
typically painless, clean base and raised boarder.
Genital herpes signs
It produces lifelong infection after the primary infection (latency). The lesions are painful, erythematous macules which progressively form vesicles, pustules, ulcer and crusts
Chancroid signs
which ulcerate with dirty base and soft edge. Inguinal fluctuant adenopathy (buboes) may occur following ulcer.
LGV signs
disease starts as painless papules that develops an ulcer. After a few days painful regional lymphadenopathy develop and associated systemic symptoms may occur.
Granuloma inguinale
presents with non-suppurative painless genital ulcer and beefy-red appearance
Complications of genital
Treatment of genital ulcer includes
- Treatment for non- vesicular genital ulcer
Benzathine penicillin 2.4 million units IM stat/Doxycycline (in penicillin allergy)
100mg bid for 14 days, PLUS
Ciprofloxacin 500mg bid orally for 3 days /Erythromycin 500mg tab QID for 7 days PLUS
Acyclovir 400mg TID orally for 10 days (or 200 mg five times per day of 10 day) - Treatment for vesicular, multiple or recurrent genital ulcer
Acyclovir 200 mg five times per day for 10 days Or Acyclovir 400 mg TID for 7 days
N.B. There is no medically proven role for topical acyclovir, its use is discouraged. 3. Treatment for recurrent infection episodes:
Treatment should be initiated during prodrome or immediately after onset of symptoms.
Local care: Keep affected area clean and dry
Acyclovir 400 mg P.O. TID for 5 to 7 days,
Suppressive treatment: recommended for patients with 6 recurrences or more per year
Acyclovir, 400mg P.O. BID for 1 year
N.B. The need for continued suppressive therapy should be reassessed.
Vaginal discharge causative agents
N. gonorrhoeae, Chlamydia trachomati, Trichomonas vaginalis, Gardnerella vaginalis (Polymicrobial), Candida albicans.
Vaginal discharge mgt
Ceftriaxone 250mg IM stat/Ciprofloxacin 500mg po stat/ Spectinomycin 2 gm IM stat PLUS Azithromycin 1gm po stat/Doxycycline 100 mg po bid for 7 days PLUS Metronidazole 500 mg bid for 7 days
If discharge is white or curd-like add Clotrimazole vaginal pessary 200 mg at bed time
Note: The preferred regimen is Ceftriaxone 250mg IM stat + Azithromycin 1gm po stat
+ Metronidazole 500 mg bid for 7daysIf risk assessment negative
Metronidazole 500 mg bid for 7 days
If discharge is white or curd-like add
Clotrimazole vaginal pessary 200 mg at bed time for 3 days, OR miconazole vaginal pessary 200mg at bed time for 3 days.
Complications of N gonorrhea and c trachomatis
Urethritis
Prostatitis
Epididemitis
Pid
Infertility
Pneumonia vulvovaginitis
Diagnosis of discharge is made by
Urinary analysis
Swab
Culture
T vaginalis type of discharge
Foul smelling greenish vaginal discharge
Along with strawberry cervix
