23.SexualTransmittedDiseases(STD)-ศ.คลินิก พญ.ยุพิน ไทยพิสุทธิกุล(25-11-61)

Treatment

1. Local treatment
antibiotic: fusidic acid,garamycin,mupirocin
antivirus : acyclovir

2. Systemic treatment
:acyclovir (200 mg.)1 x 5 x 5 days
:famcyclovir (250 mg.)1 x 3 x 5 days

Chancroid

Eitology Hemophilus ducreyi is
:pleomorphic slender , gram negative
non-motile , non-spore forming
facultative anaerobic streptobacillus
:reactive+ve for oxidase and alkaline
phosphatase
:reactive-ve for catalase

Clinical

• IP 3-7 day (48 hrs)

• well defined non-indurated ulcers 2-5 mm.
with purrulent exudate at genitalia , lips
tongue , breast , anus

• purrulent urethritis
• inguinal lymphadenopathy



Laboratory tests

1. Gram,Unna-Pappanheim stain
Wright stain
Giemsa stain
“school of fish”

2. Culture
3. PCR
4. Immunofluorescence
5. Antibody detection
6. Pathology





Treatment

1. Azithromycin 1 gm. oral single close
2. Ceftriaxone 250 gm. IM single dose
3. Ciprofloxacin 500 mg. oral bid. x 3 days
4. Erythromycin 500 mg. oral x 4 x 7 days
5. Norfloxacin 800 mg. oral single close

Lymphogranuloma venereum

Etiology

Chlamydia trachomatis serovars
L1 , L2 , L3 type
intracellular microorganisms

Clinical

1 Primary stage

. IP 7-12 days

• pustule,nodular ulceration
(prepuce,scrotum,penis )

• non-specific urethritis
• balanoposthitis
• tonsillitis
• cord like lymphangitis sinuses

2. Secondary stage (inguinal syndrome)

• 2-6 wks after primary stage last to 4-6
months

• enlarge and tender regional LN. (groove
sign of Greenblatt)

• multilocular abscess of LN.
• fever,malaise,arthralgia,hepatitis

3.Tertiary stage (genito-anorectal
sydrome)

• procto-colitis
• perirectal abscess fistular
• bilateral and scrotal elephantiasis
• ulcer with shiny yellowish white base
• anal stricture
• mixed papillary-follicular conjunctivitis





Laboratory test

1. Chlamydial serology positive
2. Culture
3. Frei test
4. Cytology
5. Antibody detection
6. PCR

Treatment

1. doxycycline 100 mg bid x 2 wks
2. erythromycin (250 mg)2 x4 x 2 wks
3. tetracycline (250 mg) 2x4 x 2 wks
4. sulphadiazine 1 g. oral four time x 2 wks
5. azithromycin 1 gm / wk x 3 wks orally
6. minocycline 300 mg initial then 200 mg. bid x 10

days
7. rifampicin 450 mg/ d x 10 days
8. azithromycin 1 gm oral single dose

+doxycycline 100 mg bid x 7 days

Donovanosis ( granuloma
inguinale)

Etiology

Calymmatobacterium granulomatis

:gram-ve bacillus,intracellular

pleomorphic intracytoplasmic cysts
with deep staining bodies “Donovan
bodies”

Cinical manifestation

IP. 3-90 วนั ( 17 วนั )
• papules , nodules
• fresh beefy-red , granulomatous painless

ulcer
• ulcerative / ulcerogranulomatous
• hypertrophic / verrucous
• necrotic , sclerotic , cicatricial type





Laboratory

1.demonstrate bipolar dense encapsulated
organism in macrophage by

• Giemsa stain
• Leishman stain
• Wright’s stain
• Silver impregnated stain (Warthin-Starray

2.PCR

3.culture

4.complement fixation test

Treatment 1

1. doxycycline 100 mg bid x 6 wks
2. bactrim 2 tab bid x 10-14 days
3. ampicillin 1-2 gm/d x 14 days
4. erythromycin 2 gm/d x 14 day
5. azithromycin 500 mg/d x 7 วนั or

gm/wk x 4 wks
6. ceftriaxone 1 gm IM/d x 7 days
7. spectinomycin 2 gm/4 gm IM single dose
8. ciprofloxacin 500 mg bid x 14 days

Genital Warts (condylogoma
accuminata

Etiology

Human papilloma virus (HPV)
type 6,11,16,18

Clinical

1 accuminate wart (Condyloma accuminata)
2 flat wart (condyloma planum)
3 bowenoid papulosis

Laboratory tests

1 colposcopy
2 biopsy





Treatment

1. podophyllin 10-25% :antimitotic apply
twice weekly

2. trichloracetic acid 80-100% once weekly
3. 5% 5-fluorouracil (efudix) bid
4. electric cautery
5. cryotherapy
6. interferon

End