Sexual Transmitted Diseases

STDs

Dr. Salah Wageehuddein,

Clinical Pharmacy
 DEFINITION
• The spectrum of STDs includes:
– Gonorrhea
– Syphilis
– C. trachomatis
• The most current information on
epidemiology, diagnosis, & ttt of STDs
provided by the Centers for Disease Control &
Prevention (CDC) can be found at
http://www.cdc.gov.

Dr. Salah Wageehuddein, Clinical Pharmacy

GONORRHEA

Dr. Salah Wageehuddein, Clinical Pharmacy

 GONORRHEA
• Neisseria gonorrhoeae is a gram-negative
diplococcus estimated to cause up to 600,000
infections per year in the United States.
• Humans are the only known host of this
intracellular parasite.

Dr. Salah Wageehuddein, Clinical Pharmacy

 GONORRHEA
• CLINICAL PRESENTATION
• Infected individuals may be symptomatic or
asymptomatic, have complicated or
uncomplicated infections.

Dr. Salah Wageehuddein, Clinical Pharmacy

 GONORRHEA
• DIAGNOSIS
– Gram-stained smears
– Culture (the most reliable method)
– Enzymes, antigens, DNA, or lipopolysaccharide) in
clinical specimens.

Dr. Salah Wageehuddein, Clinical Pharmacy

 GONORRHEA
• Treatment
• All currently recommended regimens are
single-dose ttts with various oral or parenteral
cephalosporins & fluoroquinolones

Dr. Salah Wageehuddein, Clinical Pharmacy

 GONORRHEA
• Ceftriaxone is the only parenteral agent
recommended by the CDC as a 1st line agent for
ttt of gonorrhea.
• Coexisting chlamydial infection, constitutes the
major cause of postgonococcal urethritis,
cervicitis, in patients tted for gonorrhea.
• As a result, concomitant ttt with doxycycline or
azithromycin is recommended in all patients tted
for gonorrhea.
• A single dose of azithromycin (2 g) is highly
effective against chlamydia.
Dr. Salah Wageehuddein, Clinical Pharmacy
 GONORRHEA
• Pregnant women infected with N.
gonorrhoeae should be tted with either a
cephalosporin or spectinomycin, because
fluoroquinolones are C/Ied.
• Azithromycin or amoxicillin is the preferred ttt
for presumed Chlamydia trachomatis
infection.

Dr. Salah Wageehuddein, Clinical Pharmacy

 GONORRHEA
• ttt of gonorrhea during pregnancy is essential
to prevent complication on the neonate eyes.
• Tetracycline (1%) ophthalmic oint or
erythromycin (0.5%) ophthalmic oint be
instilled in each conjunctival sac immediately
postpartum to prevent ophthalmia
neonatorum.

Dr. Salah Wageehuddein, Clinical Pharmacy

GONORRHEA

Dr. Salah Wageehuddein, Clinical Pharmacy

GONORRHEA

Dr. Salah Wageehuddein, Clinical Pharmacy

Dr. Salah Wageehuddein, Clinical Pharmacy
 SYPHILIS

Dr. Salah Wageehuddein, Clinical Pharmacy

 SYPHILIS
• The causative organism of syphilis is
Treponema pallidum , a spirochete.
• Also syphilis can be acquired by nonsexual
personal contact e.g. blood transfusion.

Dr. Salah Wageehuddein, Clinical Pharmacy

 SYPHILIS
• Primary Syphilis
• Characterized by the appearance of a chancre
on cutaneous or mucocutaneous tissue &
persist only for 1-8 w before spontaneously
disappearing.

Dr. Salah Wageehuddein, Clinical Pharmacy

 SYPHILIS
• Secondary Syphilis
• Characterized by a variety of mucocutaneous
eruptions, resulting from widespread
hematogenous & lymphatic spread of T.
pallidum.
• Signs & symptoms of secondary syphilis
disappear in 4-10 w however, in untted
patients, lesions may recur at any time within
4 years.

Dr. Salah Wageehuddein, Clinical Pharmacy

 SYPHILIS
• Latent Syphilis
• Persons with a +ve serologic test for syphilis
but with no other evidence of disease have
latent syphilis.
• Most untted patients with latent syphilis have
no further sequelae; however, approximately
25-30% progress to either neurosyphilis or late
syphilis with clinical manifestations other than
neurosyphilis.

Dr. Salah Wageehuddein, Clinical Pharmacy

 SYPHILIS
• Tertiary Syphilis & Neurosyphilis
• 40% of patients with primary or secondary
syphilis exhibit CNS infection.

Dr. Salah Wageehuddein, Clinical Pharmacy

 SYPHILIS
• DIAGNOSIS
• Because T. pallidum is difficult to culture in
vitro, diagnosis is based primarily on dark-field
or direct fluorescent antibody microscopic
examination of serous material from a
suspected syphilitic lesion or on results from
serologic testing.
• Serologic tests are the mainstay.

Dr. Salah Wageehuddein, Clinical Pharmacy

 SYPHILIS
• Treatment
• See table 46-6 for ttt recommendations.
• Parenteral penicillin G is the ttt of choice for
all stages of syphilis.
• Benzathine penicillin G is the only penicillin
effective for single-dose therapy.
• Patients with abnormal cerebrospinal fluid
findings should be tted as having
neurosyphilis.
Dr. Salah Wageehuddein, Clinical Pharmacy
 SYPHILIS
• Pregnant patients:
• Penicillin is the ttt of choice at the dosage
recommended.
• To ensure ttt success & prevent transmission
to the fetus, some experts advocate an
additional IM dose of benzathine penicillin G,
2.4 million units, 1 week after completion of
the recommended regimen.

Dr. Salah Wageehuddein, Clinical Pharmacy

 SYPHILIS
• Jarisch-Herxheimer reaction:
• It may be appear in majority of patients tted for
primary & secondary syphilis after ttt.
• Characterized by flu-like symptoms such as
transient headache, fever, chills, malaise,
arthralgia, myalgia, tachypnea, peripheral
vasodilation, & aggravation of syphilitic lesions.
• This should not be confused with penicillin
allergy.
• It need symptomatic management with
analgesics, antipyretics, & rest.
Dr. Salah Wageehuddein, Clinical Pharmacy
 SYPHILIS
• Serology tests should be performed at 6 & 12
ms in all patients tted for primary & secondary
syphilis & at 6, 12, & 24 ms for early & late
latent disease.
• For women tted during pregnancy, monthly,
serology tests are recommended in those at
high risk of reinfection.

Dr. Salah Wageehuddein, Clinical Pharmacy

CHLAMYDIA

Dr. Salah Wageehuddein, Clinical Pharmacy

 CHLAMYDIA
• C. trachomatis is an obligate intracellular
parasite that has some similarities to viruses &
bacteria.

Dr. Salah Wageehuddein, Clinical Pharmacy

 CHLAMYDIA
• CLINICAL PRESENTATION
• They are more frequently asymptomatic, &
when present, symptoms tend to be less
noticeable.

Dr. Salah Wageehuddein, Clinical Pharmacy

 CHLAMYDIA
• Chlamydia may be transmitted to an infant
during contact with infected cervicovaginal
secretions.
• Nearly 2/3 of infants acquire chlamydial
infection after endocervical exposure, with the
primary morbidity associated of the infant’s
eyes, nasopharynx, rectum, or vagina.

Dr. Salah Wageehuddein, Clinical Pharmacy

 CHLAMYDIA
• DIAGNOSIS
• Culture of endocervical or urethral epithelial
cell scrapings is the most specific method.
• For rapid identification in genital secretions
(30 min):
– direct fluorescent antibody test.
– the enzyme immunoassay.
– DNA test.

Dr. Salah Wageehuddein, Clinical Pharmacy

 CHLAMYDIA
• Treatment
• Single-dose azithromycin & 7-day doxycycline
are the agents of choice.

Dr. Salah Wageehuddein, Clinical Pharmacy

CHLAMYDIA

Dr. Salah Wageehuddein, Clinical Pharmacy

 CHLAMYDIA
• Prophylaxis of ophthalmia neonatorum:
• Erythromycin (0.5%) or tetracycline (1%)
ophthalmic oint in lieu of silver nitrate.
• Although silver nitrate & antibiotic oint are
effective against gonococcal ophthalmia
neonatorum, silver nitrate is not effective for
chlamydial disease & may cause a chemical
conjunctivitis.

Dr. Salah Wageehuddein, Clinical Pharmacy

 CHLAMYDIA
• ttt of chlamydial infections with the
recommended regimens is highly effective;
therefore, post-ttt cultures are not routinely
recommended.
• Infants with pneumonitis should receive
follow-up testing, because erythromycin is
only 80% effective.

Dr. Salah Wageehuddein, Clinical Pharmacy