MBBS Sem IV Lecture class

1. DRUGS USED IN SEXUALLY
TRANSMITTED INFECTION
Dr. Pravin Prasad
M.B.B.S., MD Clinical Pharmacology
Lecturer, Lumbini MedicalCollege
12 July 2018 (28 Ashadh 2075)Thursday

2. BYTHE END OFTHE CLASS, MBBS
SEM IV STUDENTSWILL BE ABLETO:
Understand the term sexually transmitted
infection (STI)
List the conditions included in STI
List the drugs used for the treatment of STI
Appreciate the syndromic approach for the
treatment of STI
Explain the advantages of syndromic approach

3. CHANGINGTERMS: CHANGING
CONCEPT
Venereal Disease (1658)
Venereal (1400s): related to sex
Considered Syphilis and
Gonorrhoea only
Chancroid, Lymphogranuloma
venerum, granuloma inguinale
also included

4. CHANGINGTERMS: CHANGING
CONCEPT
Sexually Transmitted Disease (1960s)
Both men and women could contract
disease
Attention to associated Clinical
Syndrome was also given
Only Symptomatic cases included

5. CHANGINGTERMS: CHANGING
CONCEPT
Sexually Transmitted Infections (WHO,
1994)
Included asymptomatic cases as well

6. STI: ETIOLOGICAL CLASSIFICATION
Disease Causative Organism
Syphilis Treponema pallidum
Chancroid Hemophilus ducreyi
Donovanosis Klebsiella granulomatis
Lymphogranuloma venerum Chlamydia trachomatis
Gonococcal genital infection Neisseria gonorrhoeae

7. STI: ETIOLOGICAL
CLASSIFICATION
Disease Causative Organism
Non gonococcal
genital infection
Chlamydia trachomatis
Mycoplasma genitalium
Ureoplasma urealyticum
Gardenella vaginalis
Candida albicans
Herpes genitalis Herpes simplex virus
AIDS Human immunodeficiency virus

8. 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

9. 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

10. 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

11. 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

12. 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

13. LYMPHOGRANULOMA
VENEREUM:TREATMENT
Doxycycline 200mg OD
for 21 days OR
 Erythromycin 2g OD
for 21 days

14. 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

15. 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

16. 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

17. DRUGS FOR ANTIRETROVIRAL
THERAPY (ART)
Class of Drug Example
Recommended
Dose
ReverseTranscriptase Inhibitors
Nucleoside group
(NRTIs)
Zidovudine 200mgTDS
Didanosine 125 mg BD
Stavudine 30 mg BD
Lamivudine 150 mg BD

18. DRUGS FOR ANTIRETROVIRAL
THERAPY (ART)
Class of Drug Example
Recommended
Dose
ReverseTranscriptase Inhibitors
Non-nucleoside Reverse
Transcriptase Inhibitors
group (NNRTIs)
Nevirapine 200 mg BD
Efavirenz 600 mg OD
Delavirdine 400 mgTDS

19. DRUGS FOR ART
Class of Drug Example
Recommended
Dose
Protease Inhibitors
Saquinavir 1200 mgTDS
Indinavir 800 mgTDS
Ritonavir 600 mg BD
Nelfinavir 750 mgTDS
Lopinavir 400 mg BD

20. HIV/AIDSTREATMENT: NNRTI
BASED REGIMEN
Preferred Regimen:
Efavirenz + Lamivudine + Zidovudine or
Stavudine
Alternative Regimen:
Efavirenz + Lamivudine + Didanosine
Nevirapine + Lamivudine + Zidovudine or
Stavudine or Didanosine

21. HIV/AIDSTREATMENT: PI BASED
REGIMEN
Preferred Regimen:
Lopinavir + Ritonavir + Lamivudine +
Zidovudine or Stavudine
Alternative Regimen:
Indinavir + Lamivudine +
Zidovudine/Stavudine
Indinavir + Ritonavir + Lamivudine +
Zidovudine/Stavudine

22. STI: CLASSIFICATION ACCORDING
TO MANIFESTATIONS
Manifestation Disease
Ulcers Herpes genitals
Chancre (primary
syphilis)
Chancroid
Donovanosis
Discharge Gonococcal infection
Chlamydial infection
Bacterial vaginosis
Trichomoniasis
Ureaplasma infection
Mycoplasma infection
Lymphadenopathy Chancroid
Syphilis
Herpes genitalis
Lymphogranuloma
venereum

23. STI: CLASSIFICATION ACCORDING
TO MANIFESTATIONS
Manifestation Disease
Rash Syphilis
HIV infection
Lymphogranuloma
venereum
Scabies
Itching Scabies
HIV infection
Pediculosis pubis
Nodules Anogenital
warts
Molluscum
contagiosum

24. 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

25. STI: ALGORITHM FOR GENITAL
ULCERTREATMENT
Patient complains of genital ulcer
Vesicles found or/and
history of recurrences
Treat for Herpes
Genitalis
Ulcers (no vesicles,
painful/painless)
Treat for syphilis
and chancroid
Examine

26. STI: SYNDROMIC APPROACH
Flow chart
Initiation
of therapy
Treatment
Cost Coverage
Implement
ation

27. 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

28. Thank you!!