CHEMOTHERAPY OF SEXUALLY TRANSMITTED DISEASESBY- CHINMAY V HEGDE

DRUG THERAPY OF SYPHILIS

Syphilis is caused by the spirochete Treponema pallidum.With adequate treatment of early cases almost 90% cases can be cured.According to classic Olso study untreated syphilis is divided into-Early syphilis -Late syphilis

Early syphilis (duration less than 1 year)(primary and secondary syphilis and latent syphilis)

Procaine penicillin 600,000 units IM daily for 10 days

Benzathine penicillin 2.4 mega units IM in a single dose (1.2 mega units I each buttock )

PATIENTS WHO ARE ALLERGIC TO PENICILLINDoxycycline 100 mg bidorErythromycin 500 mg orally qid on empty stomach

Syphilis of more than 1 year duration(except neurosyphilis)

Procaine penicillin 600,000 units IM daily for 15 days

Benzathine penicillin 2.4 mega units IM once a week for 3 weeks

PATIENTS ALLERGIC TO PENICILLIN DOXYCYCLINE 100 mg bidOrErythromycin 500 mg orally qid on empty stomach for 15 days

NEUROSYPHILIS

PENICILLIN G IV 12 megaunits daily in 4 divided doses for 12-14 days

Alternatively treated with procaine penicillin 2- 4 million units once a day together with probenecid 500mg daily for 10 days.

Pregnancy and syphilis •Syphilis can be acquired congenitally. If proper treatment is given during pregnancy it can be prevented.

Procaine penicillin 0.6 million units 10 days

Patients allergic to penicillin can be treated with erythromycin.

Congenital syphilisProcaine penicillin 100,000 units daily for 10 days.

Interstitial keratitis is a common complication of congenital syphilis needs additional treatment with local or systemic corticosteroids.

Reactions and contraindications in penicillin treatment

•Allergy•Jarish-Herxheimer reaction

DRUG THERAPY OF GONORRHEAIntroduction –It is cause by Neisseria gonorrhea. Colloquially it is called as “the clap”

Antimicrobial regimens for acute uncomplicated gonorrhoeaPenicillin G(aqueous) 4.8 mega units injected in two divided doses at two different sites. 30 minutes after 1g of probenecid orally.

Ampicillin 3.5g orally single dose preceded by 1g of probenecid

Procaine penicillin 1.2 mega units + penicillin G 1 mega units IM followed by similar injections 24 hours apart

Cotrimaxazole 2 tablets twice daily for 5 days or 4 tablets twice daily for 2 days

Ciprofloxcin 500 mg orally, single doseLevofloxacin 250 mg orally, single dose

Ceftriaxone 125-250 mg IM, single dose

Cefixime 400 mg orally, single doseSpectinomycin 2 g IM , single dose

Gonorrhoea complicated by acute PID•Procaine penicillin 2 mega units daily for 10 days + doxycycline 100mg BID for 14 days•Cefoxitin IV 2g every 6 hours + doxycycline IV 100mg every 12 hours. Continue IV drugs for at least 48 hours after clinical improvement. Continue doxycycline orally 100mg BID to complete 14 days of total treatment.

•Gentamicin IV or IM 2 mg/kg(loading dose) followed by 1.5 mg/kg every 8 hours +clindamycin 900mg. IV every 8 hours; 48 hours after the patient shows clinical improvement change over to oral doxycycline 100mg 12 houly to complete 14 days of total treatment.•Oflaxacin orally 400 mg BID for 14 days + clindamycin orally 450 mg.