ATAEI.B, MD. MPH. Sexually Transmitted Infections

 مرد جوانی 4 روز بعد از تماس جنسی مشکوک دچار ضایعه دردناک الت تناسلی می شود د. در معاینه زخم نمای کثیف دارد وبه اسانی خونریزی می نماید. ودر لمس سفتی ندارد. غده لنفاوی بزرگ و دردناک نیز در ناحیه اینگوینال لمس میگردد.  تشخیص بالینی شما چیست؟

 Usual causes  Herpes simplex virus (HSV)  Haemophilus ducreyi (chancroid)

 culture, direct FA, ELISA, or PCR for HSV; consider HSV-2-specific serology.  In chancroid-endemic area:  PCR or culture for H. ducreyi

 Herpes confirmed or suspected (history or sign of vesicles):  Treat for genital herpes with :  acyclovir, valacyclovir, or famciclovir

 First episodes:  acyclovir (200 mg 5 times per day or 400 mg tid),  valacyclovir (1 g bid),  famciclovir (250 mg bid) for 7–14 days is effective.

 Symptomatic recurrent genital herpes:  Short-course (1- to 3-day) regimens are preferred because of low cost and convenience.  Oral acyclovir (800 mg tid for 2 days), valacyclovir (500 mg bid for 3 days), or famciclovir (750 or 1000 mg bid for 1 day,

 Chancroid confirmed or suspected (diagnostic test positive, or HSV and syphilis excluded, and lesion persists):  Ciprofloxacin 500 mg PO as single dose or  Ceftriaxone 250 mg IM as single dose or  Azithromycin 1 g PO as single dose

 بیمار 30 ساله ای 3هفته بعد از یک تماس جنسی مشکوک دچار یک پاپول روی دستگاه تناسلی شده است این ضایعه 3 روز بعد تبدیل به اولسر با جدار منظم می شود که بدون درد ودر معاینه سفت است وهمراه با لنفادنوپاتی بدون درد یکطرفه میباشد.  تشخیص بالینی شما چیست؟

 Usual causes  Treponema pallidum (primary syphilis)  lymphogranuloma venereum

 Dark-field exam,  direct FA,  PCR for T. pallidum;  RPR or VDRL test for syphilis (if negative but primary syphilis suspected, repeat in 1 week);

 Syphilis confirmed (dark-field, FA, or PCR showing T. pallidum, or RPR reactive):  Benzathine penicillin 2.4 million units IM once to patient,  Preventive treatment  Recent (e.g., within 3 months)  Seronegative partner(s),  All seropositive partners

 Every pregnant woman should undergo a nontreponemal test at her first prenatal visit  If at high risk of exposure, again in the third trimester and at delivery.  In the untreated pregnant patient with presumed syphilis, expeditious treatment appropriate to the stage of the disease is essential.

Stage of SyphilisTests to PerformWhen to PerformRe-Treatmenta Considered If: Primary or secondary Quantitative RPR or VDRL HIV-uninfected: 6 and 12 months HIV-infected: 3, 6, 9, 12, and 24 months 1. Titer increases by fourfold or 2. Titer fails to decline by fourfold or test fails to become nonreactive by 6 months or 3. Clinical signs persist or recur

 جوان 23 ساله ای 4 روز بعد از تماس جنسی مشکوک به علت ترشح از مجرا و سوزش ادرار به مطب شما مراجعه می نماید.  تشخیص بالینی شما چیست؟

 (1) mucopurulent or purulent urethral discharge,  (2) Gram stain of urethral secretions demonstrating 5 or more leukocytes per oil immersion microscopic field, or

 (3) a positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine demonstrating 10 or more leukocytes per high-power field.

 Neisseria gonorrhoeae*  CAUSES OF NONGONOCOCCAL URETHRITIS  Chlamydia trachomatis (15–50%)*  Ureaplasma urealyticum (10–40%)*  Mycoplasma genitalium (30%??)  Trichomonas vaginalis (1–17%)*  Herpes simplex virus (primary) (?%)

Treat chlamydial infection: plusTreat gonorrhea (unless excluded): Azithromycin, 1 g PO; or Ceftriaxone, 125 mg IM; or Doxycycline, 100 mg bid for 7 days Cefpodoxime, 400 mg PO; or Cefixime, 400 mg PO Initial Treatment for Patient and Partners * Epidemiologic treatment of sexual partners is recommended

 Ceftizoxime (500 mg IM, single dose) or  Cefotaxime (500 mg IM, single dose) or  Spectinomycin (2 g IM, single dose) or  Cefotetan (1 g IM, single dose) plus probenecid (1 g PO, single dose) or  Cefoxitin (2 g IM, single dose) plus probenecid (1 g PO, single dose)