AND

Sexually Transmitted Diseases

 Sexually Transmitted Diseases
• “Disease transmitted most
commonly and efficiently by sexual
contact”
• Organisms easily inactivated
• Suited to transmission by contact
of mucus membrane
• Organisms: Bacteria, spirochetes,
chlamydia, viruses, protozoa,
fungus
 Diseases
• Gonorrhea
• Syphilis
• Chancroid
• L.G.V
• Granuloma ingiunale
• Hepes virus,HIV, T.vaginitis
• Scabies, louse, bacterial vaginosis
• Shigellosis, hepatitis A,B,C,
cryptosporidiosis, salmonosis, etc.
 Syphilis

Primary Benzathine pen.2.4 M.U/i.m OR

Syphilis Dox 100mg BD x 2 weeks OR
T.C. 500 mg. QID x 2weeks OR
Ceftriaxone 1g.od im/iv x 10d OR
Azithromycin 2 g.oral single dose

Seconda Same as above

-ry
syphilis
 Syphilis contd…..
Latent •Benzathine pen. 2.4 MU x once a
Syphilis week x 3 weeks OR
•Dox.100 mg.BID x 4 weeks OR
•T.C. 500mg.BID x 4 weeks OR

Tertiary
Syphilis Same as above

Neuro •Pen G 4 MU iv x 4h x 10-14 days OR

syphilis •Pro pen.2.4MU.im OD x 10-14 days+
probenecid 500mg.QIDx10-14 days or
•Ceftriaxone 2 g.im x 10-14 days
 Gonorrhea

Gonorrhea •Ceftriaxone 125mg. Im single

(Uncomp.) •Cefpodoxime 400 mg.oral single
•Spectinomycin 1g. Im single dose

Gonorrhea
(Comp.) •Pen G 10MU iv daily x 5 days OR
Salphingitis, •Ceftriaxone 1 g. iv daily x 5 days
Prostatitis,
arthritis
•Cipro 500mg.BID x 5 days
 Chancroid.,G.I.,L.G.V

Chancroid •Azithromycin 1 g. oral single dose

•OR Ceftriaxone 250 im single
•OR Amox/Clav.500mg.TIDx7days
•E.mycin 500mg.qidx7 days
•OR Cipro 500mg OD x 3 days
G.I •E.mycin or T.C. 500mg.QID.3 weeks
•Amp. 500mg.QIDx12 weeks
•Dox. 100mg. BIDx3 weeks
LGV •E.Mycin 500mg.QIDx3weeks
(pregnancy)
 Urinary Tract Infections
• Classification
• Risk factors
• Patho-physiology
• Host defenses
• Organisms
• Drugs
• Pharmacotherapy
• Chemoprophylaxis
Classification:
• Urethritis. Cystitis. Pyelonephritis.
Prostatitis. Epidydymitis.

• Upper UTI and Lower UTI

 Classification contd….

• Uncomplicated- Previously healthy,

Lower risk of failure, Lower risk of
complications

• Complicated: Metabolic, Functional,

Structural abnormalities
 Risk Factors
• Children…Congenital anomalies
• Healthy women..Sexual activity,
Barrier methods, AMA
• Healthy men…Instrumentation,
Lack of circumcission, Anal
intercourse,
• Elderly…Ut.prolapse, EP, DM, Bowel
incont.
• All ages.. Catheter, Stone,Tumor,
Stricture, CRF,Transplantation
 Patho-Physio
(Ascending-Descending)
• Ascending-Bowel…Perinium…
Introitus…Vagina…Bladder…Host
defence vs Virulence …Mucosal
invasion …. Pyelonephritis

• Descending: Only 3%
 Host Defense

• Mechanical not immunological-

Neurogenic bladder, EP, Pregnancy.
• Antibact. sub in bladder
• Prostate secretion
• Dilute urine and Ph

• Immune system has no role in

prevention. No higher incidence in
immunocompromised. But severe
 Organisms

G(-)ve…95%
E.Coli (Uropathogen!)..80%
Staphy Saprophyticus
Coag.neg.Staph
Klebsiella
Proteus
Pseudomonas
Enterococci
Entero bacter
Candida
 Drugs
• Bacteriostatic: Sulfanomides, T.C.
• Bacteriocidal:
* Co-Trimox
* Extended spectrum
penicillins
* Aminoglycosides

* Fluoroquinolones

* Cephalosporins

* Monobactams

* Imipenem+Cilastatin

* Teicoplanin
 Drugs

• Urinary Antiseptics: NItrofurantoin

Methenamine
Nalidixic acid

• Urinary Anaelgesics:
Phenazopyridine
 Urinary Antiseptics

• Toxic drugs
• Produce adequate conc. in
urine
• Not for systemic use
• Only UTI( Local use)
 Nitrofurantoin

• Spectrum - Bacteriostatic, E.coli.

• MOA: Nitrofurantoin reduced to
toxic sub-damages DNA
• PK: Rapid absorption, 40% excreted
unchanged in urine
• Colours urine brown
• Ph less than 5.5
• Antagonizes Nalidixic acid
 Nitrofurantoin contd….

ADE:
• GIT symptoms-Macrocrystalline prep.
Well tolerated
• Hypersensitivity-Chills, rigors,
leukopenia, cholestatic
jaundice,Hepatic damage
• Hemolysis(G6PD def)
• Pneumonitis, Pulm.fibrosis
• Neuropathy
 Nitrofurantoin contd….

Uses:
• Not routinely used
• Dose-50-100 mg qid
• Chemoprophylaxis( Recurrent
infection)

C.I.: Not more than 14 days

Impaired renal function
Children<1 yr.
 Methenamine

Spectrum: All organisms, No resistance

MOA:
• Breaks down in water in acidic Ph to
formaldehyde
• NH4(CH²)6+6H²O+4H+=4NH4+6HCHO
• Proteus raise Ph (Urea splitting)
• Organism do not develop resistance
• Methenamine+ Mandelic(Ascorbic,
Hippuric) acid , enteric coated tab.
 Methenamine

ADE:
• GIT
• Albuminurea, Hematuria
• C.I. in renal insufficiency
• False +ve test for catecholamine
metabolites
Uses:
• Not routinely used, only in resistant
infections
 Phenazopyridine

• An azo dye
• Not antiseptic
• Urinary analgesic
• Reduces-Dysurea,frequency,
burning,urgency
• ADE: GIT, methemoglobinemia
• Dose: 200mg tid

Nalidixic acid
 Pharmacotherapy

• Bactericidal
• High sustained conc in tissues and
urine
• Should eliminate pathogens from
vagina, bowel. Normal flora should
not be affected
• Orally effective
• Minimal ADE
• Low cost
 Treatment goals
• Microbiological cure
• Clinical cure
• Prevent morbidity and mortality
• Pt compliance
• Prevent recurrence and relapse.
• Minimum secondary infection
 Uncomplicated (women)
Cystitis
Complicated
• Acute Mild,Mod
Uncomplicated
Severe

Pyelonephritis Mild,Mod
Complicated
Severe
• Chronic
Condition Empirical Tt

3 day regimen
Oral TMP-SMX,TMP,
Acute Quinolones
Uncomplicated
cystitis in women

7 day regimen
Macrocrystalline
Nitrofurantoin
Condition Circumstances Empirical Tt

Men, Failure of 7 Day

3 d. regimen, Oral TMP-SMX,
Children, Quinolone
Renal
disease,DM
Acute cystitis
complicated 7 day-Oral
Amox.,
Pregnancy Nitro.,
Cephalosporin,
TMP-SMX
Condition Circumstance Empirical Tt

•Mild-mod. •Oral quinolone7-

illness 14D
Acute •No nausea, OR
uncomplicated vomiting •Single dose
pyelonephritis •O.P.D. Ceftriaxone(1G)
or
•GM(3-5mg/kg)i.v

Followed by

•TMP-SMX 14 D
 Circumstances
Condition Empirical Tt

•Parenteral
quinolone, GM,
Acute Ceftriaxone,
uncomplicated Aztreonam, until
Sever illness
pyelonephritis defervescence
I.P
•Followed by
Oral quinolone,
cephalosporin or
TMP-SMX for 14
Days
Condition Circumstances Empirical Tt

Complicated Oral quinolone

pyelo.acute Mild,Moderate 10-14 days
(Catheterization,
Urologic Parenteral amp.,
GM, quinolone,
abnormalities, ceftriaxone,
stones, Sever aztreonam,
Immunosuppre ticarcillin,
-ssion, imipenem

Renal ↓
disease,DM) Oral quinolone or
 Chronic Pyelonephritis

• Obstruction eliminated
• If not possible
 Long term therapy ( Indefinite)
with TMP-SMX, TPM, Nitrofurantoin.
 Chemoprophylaxis

• Recurrence of uncomplicated cystitis,

uncorrectable ab., inoperable EP, chronic
indwelling catheter(Amp,TMP-SMX, Nitro)
• Infants-VUR
• Post coital prophy: > than 3 per year
--Voiding after sex.intercourse
--Cranberry juice or
--Cipro 125mg single dose, or
--TMP-SMX40/200, or
--Cephelexin 250mg, or
--Nitrofurantoin 50 mg. or
 Asymptomatic Bacteriuria

• Elderly or with catheter- no Tt.

• Pregnancy, neurotropic pts., recent
renal transplantation, young children-
Require Tt.

• Sulfa, Betalactams, Nitrofurantoin.

 Drug Dosage

• Cystitis: Parenteral
 TMP-SMZ-160/800 mg.BID Cipro 200-
 TMP 100mg. BID 400mg.BID
 Cipro.-250mg. QID GM-1mg/kg TID
 Nitrofurantoin- 100mg.QID
Ampicillin-1g qid
 Amox-250mg. TID
 Cefpodoxime proxetil- Imipenem/cilastat
100mg.QID -in-500mgTID
Aztreonam-1g
bid
 Pyelonephritis:
 TMP-SMX-As above
 Cipro- 500mg.BID
 Cefpodoxime proxetil-200mg BID