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Herpes and chlamydia: Is It Herpes or Something Else?

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Is It Herpes or Something Else?

Herpes is a common, incurable sexually transmitted disease. It’s so common in the United States that more than 1 out of every 6 people ages 14 to 49 has genital herpes, according to the Centers for Disease Control and Prevention (CDC). Because herpes is somewhat easier to pass from men to women than from women to men, more American women than men have it, the CDC notes.

Herpes is caused by the herpes simplex virus (HSV). There are two types of this virus: herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2). Both viruses are transmitted by close contact with a person who has the virus. HSV-1 is usually associated with cold sores around the mouth, while HSV-2 most often affects the genital area.

However, research has shown about one-half of all new cases of genital herpes in developed countries are caused by HSV-1, not HSV-2. This is because a person who has oral herpes caused by HSV-1 can spread it to their partner’s genitals during oral sex. You can also get genital herpes by having vaginal or anal sex with someone who has the virus.

A first genital herpes outbreak may cause multiple blisters that break and leave painful sores that take a week or more to heal. After your first outbreak, you may have more outbreaks, especially if you are infected with HSV-2. But the repeated outbreaks tend to be shorter and less severe each time you have one.

That being said, Planned Parenthood notes that many people who are infected with HSV have no symptoms, or their symptoms are very mild, so they often don’t know they have the virus. They may also mistake their symptoms for those of another STD or skin condition, such as a pimple or ingrown hair in their genital region.

On the plus side, this underscores how mild the symptoms of herpes can be. On the minus side, it helps explain how and why the infection is so widespread: If you don’t know you have it, you are unlikely to take steps to avoid spreading it. And herpes can be transmitted from one person to another even when there are no symptoms. Also, having herpes raises the risk of getting HIV.

Once you have herpes, you’ll always have it. There’s no cure for herpes. But there are medicines that can prevent or shorten outbreaks, as well as make it less likely you will pass it on to intimate partners. Still, if you have herpes, whether or not you take medication, you should tell anyone you have sex with so they know the risks. Your risk of spreading the virus is higher when sores or other symptoms are present, but it can be spread at any time. Also, while using condoms may help lower the risk of spreading herpes, it will not guarantee your partner will not get it.

Do you know how to recognize herpes?

Herpes and Chlamydia Treatments – Primary Care Medicine – Irvine, CA

Herpes and chlamydia are two of the most common STD’s out there. If you’re sexually active, you’re at risk for an STD. While condoms are the best way to prevent contraction of an STD, they’re not 100 percent effect. All sexually active individuals should be regularly tested for STDs.

Genital Herpes

Genital herpes is caused by two types of viruses: herpes simplex 1 and herpes simplex 2. In the United States, it’s estimated that about 1 in 6 individuals ages 14 to 49 have genital herpes. This disease is spread through all forms of sexual intercourse. The only way to avoid contracting herpes is abstinence.

Symptoms of genital herpes are vast. This disease can be spread whether you’re experiencing an outbreak or not. The most obvious symptom are one or more open sores around the mouth or genital areas. During your first outbreak, you may also experience fatigue, fever, and body aches.

Over the years your body will have fewer outbreaks, however, you’re never cured of genital herpes and should inform your partner of your infection. Medications can help shorten outbreaks and lessen symptoms. Avoid spreading the disease by not touching open sores.

Genital Herpes Treatment

Your physician will help you determine the best treatment path for herpes. The most important component of treatment is getting enough rest, eating healthy, and not spreading the disease through touch.

Drugs like Valtrex help slow the herpes virus and equip your body to better fight it. Acyclovir is an antiviral cream that also helps the body fight infection. The sooner you start on these medications, the sooner you’ll experience relief from the painful symptoms of herpes.

Chlamydia

Chlamydia is a bacterial infection that impacts both men and women. If left untreated it can cause serious damage to a woman’s reproductive system, making it impossible to conceive a child in the future.

Chlamydia is spread through all forms of sexual intercourse, and can be passed from men even if they do not ejaculate.

The only way to completely eliminate your risk of contracting chlamydia is by avoiding sex altogether. You can lessen your chance of contraction by using a condom every time you have sex and by limiting the number of sexual partners you have.

Common symptoms of chlamydia in women include a foul odor and greenish/yellow discharge. You might also experience pain while urinating. Men might have swelling in their testicles, along with a burning sensation while urinating.

Chlamydia Treatment

Chlamydia can be cured through treatment with antibacterial drugs. Your doctor will test for chlamydia usually using a urine sample or swab of your genital area. Some of the most commonly prescribed drugs are doxycycline, azithromycin, erythromycin, levofloxacin and ofloxacin. Your doctor will take into consideration your medical history and lifestyle prior to determining which course of treatment would work best for you. Although you can be cured, you can contract the disease repeatedly if you’re not careful.

Genital herpes and other sexually transmitted diseases

April is STD Awareness Month

Genital herpes, caused by the herpes simplex type 1 and type 2 viruses, is a very common sexually transmitted disease (STD). Any person who is sexually active is at risk for getting herpes. In fact, most people with the virus don’t have any symptoms; however, even without symptoms, the disease can still be spread between sexual partners.

According to the CDC, about one in every six people between the ages of 14 and 49 in the United States has genital herpes. Herpes is spread when someone has vaginal, anal, or oral sex with another person who has the disease. Generally, contact with the fluid in the sores can cause the infection. However, you can still get herpes from someone who is infected, even if they don’t have a visible sore. This is because the virus can be released through their skin.

Symptoms
Symptoms of herpes can be nonexistent or very mild. Sometimes this means that symptoms are mistaken for something else. Because of this, many people do not know they have herpes. When symptoms do occur, they usually show as sores that look like blisters on or around the genitals, rectum, or mouth. After the blisters break, they leave painful sores that can take weeks to heal.
A person with herpes can have genital ulcers and develop lesions in other areas such as buttocks, groin, fingers, or eye. Herpes can also cause some rare but serious complications including blindness, encephalitis (inflammation of the brain), and aseptic meningitis (inflammation of the brain linings).

Prevention
Avoiding vaginal, anal, or oral sex or being in an exclusive monogamous relationship with someone who has tested negative are the only ways to truly prevent getting herpes. Use of condoms with every sexual encounter can help protect you, but the virus can be present in areas of contact that are not covered by condoms.

Treatment
There is no cure for herpes. Antiviral medications can help treat the symptoms and prevent or shorten outbreaks. Research is being done on a vaccine but currently, nothing is available.

Be aware of other STDs
In addition to herpes, there are a number of other common STDs and a few of them are rising in numbers. Chlamydia, gonorrhea, syphilis, human papillomavirus, and pelvic inflammatory disease are some of the more common STDs along with herpes. The CDC estimates that in the United States, nearly 20 million new STDs occur every year and about half occur in people ages 15-24. The rate of syphilis increased 10 percent between 2012 and 2013 in men—particularly gay and bisexual men.

Basic prevention for all STDs

  1. Get the facts.
  2. Take control (abstinence, vaccines [if applicable], condoms, mutual monogamy, reduced number of sex partners).
  3. Get tested. 

 

Additional Resources
CDC Genital Herpes Fact Sheet
CDC Sexually Transmitted Diseases (STDs)
CDC April is STD Awareness Month

 

How to tell genital herpes apart from other skin conditions.

What to expect on this page

We summarize in this article how to recognize genital herpes and why it’s important to talk to your doctor if you’re worried you may have it.

The most common symptom of herpes is skin lesions. These lesions can be confused with similar-looking lesions caused by a number of other conditions.

Using photographs to help you see what we’re saying, we describe herpes lesions and compare and contrast them with the lesions caused by these diseases:

  • Syphilis
  • Chancroid
  • Lymphogranuloma venereum
  • Human papilloma virus (HPV)
  • Molluscum contagiosum
  • Ingrown hair and pseudofolliculitis
  • Folliculitis
  • Jock itch
  • Genital eczema
  • Epstein–Barr virus
  • Other rarer conditions

Oops … Is that Herpes?

How to recognize genital herpes

Overview

Genital herpes is a very common sexually transmitted disease (STD). It is so common that many people, when they find any skin lesion around the genital areas, are likely to think that it is herpes. They are not entirely wrong to think that way. Genital herpes is the main cause of genital ulcers worldwide.1 And the condition is usually associated with a stigma that can itself cause anxiety and even depression2 and might influence the affected person’s decision to disclose the infection to others or seek care.3

A genital sore is not great news regardless of what is causing it. However, many other conditions causing genital sores have a prognosis different from that of herpes. Some can be worse, but others, unlike herpes,4 can be completely cured. That’s why we’re beginning this article with an explanation of how to recognize genital herpes and differentiate it from other genital skin lesions.

A sleeping virus

The herpes virus is known for staying “asleep” in the body for a long time without showing symptoms. This feature is called latency: once the virus infects a person, after an initial phase that does not necessarily manifest with symptoms, it remains hidden in the body for many years, reactivating every now and then.4 Its reactivation is usually triggered by weakness of the immune system, such as in times of sustained stress, accumulated fatigue, heavy physical activity, or fever, but may not have any apparent cause.5,6

….genital herpes skin lesion suddenly appears as multiple vesicles

The reactivation of the virus rarely manifests with symptoms, so most people who have herpes don’t know it and most genital herpes transmission occurs in the absence of a visible skin lesion.

Herpes skin lesions

The most characteristic and most common symptom of genital herpes is skin lesions. They typically appear during periods when the virus is active, which corresponds to when the virus becomes highly infective through sex. When a person acquires herpes for the first time through sexual contact, after about two to four days of incubation, a genital herpes skin lesion suddenly appears as multiple vesicles (small sacs with a thin membrane and liquid inside) piled together and sitting on an inflamed base. These vesicles are commonly called herpes sores. They are a bit whiter or browner than the rest of the skin and are often delimited by a reddish ring from the inflammation. They resemble blisters and can progress into an ulcer, which is usually more painful. An ulcer is a break in the skin that usually takes time to heal. Lesions start to heal around 12 days after the sexual contact.8 The sites most frequently involved are, for women, the vagina, vulva, buttocks, anus, and thighs, and for men, the penis, scrotum, anus, buttocks, and thighs. Herpes skin lesions are expected to be fully healed after about 19 days.9

Figure 1. Genital herpes in the vesicles phase on the upper image,10 and in
the ulcer phase on the bottom image.11

General symptoms

The initial herpes infection is sometimes associated with general symptoms of fever, headache, malaise, and muscular aches. In addition, there is often a tender local lymphadenopathy (enlargement of lymph nodes) that manifests as a painful lump in the groin area. When the virus reactivates in an already infected person, these symptoms are milder or absent and the skin lesion, if it manifests, heals more quickly. However, the reactivation is often accompanied by prodromal symptoms (feelings that are experienced before the main symptoms), such as pain, tingling, and burning preceding the appearance of the skin lesion.5

It is not always Herpes

It is a sore but not a herpes

While genital ulceration is often associated with herpes, it can be the result of several other conditions, including but not limited to, other sexually transmitted diseases, inflammatory conditions, skin irritation, and allergic skin lesions. In addition to herpes, the main sexually transmitted diseases that present with a genital ulcer are primary syphilis and chancroid. In the United States, syphilis infection is more common than chancroid.

Syphilis

The skin lesion of primary syphilis usually develops about three weeks (up to 90 days) after contracting the disease through sexual contact. Initially, it appears as a dark red mark or spot, and it rapidly becomes ulcerated.

Unlike the genital herpes skin lesion, which presents with multiple vesicles, primary syphilis’s skin lesion is usually solitary. However, when grouped herpes vesicles progress, they might take look like a solitary ulcer and can resemble an ulcerated primary syphilis. However, a herpes ulcer is usually painful, while a primary syphilis skin lesion is typically painless. The lymphadenopathy of syphilis is also painless, unlike the lymphadenopathy associated with genital herpes, which is often painful. 12

Similarity Difference
Herpes vs Syphilis Both very prevalent in the United States. Both can present with multiple vesicles and get ulcerated. Herpes usually presents with multiple fluid-filled vesicles that turn into ulcers over time. Herpes ulcers are shallow, small, and on a red base (that is, they are surrounded by red skin). They are painful and may occur with painful lymphadenopathy. Syphilis usually has a solitary sore. A syphilis ulcer is usually deeper and larger and is painless in itself with painless lymphadenopathy.

Figure 2. Primary syphilis skin lesions that could be mistaken for genital herpes Joseph
Engelman, MD; San Francisco Department of Health.13

Chancroid

Chancroid is less common in the United States. It is prevalent in Africa and Asia. Its skin lesion appears about five days after sexual contact as a painful and inflamed spot that turns into an ulceration in several days.

Sometimes the skin lesion is solitary, but often more ulcers are present. A chancroid ulcer is usually deeper and bleeds easily when touched. It sometimes releases a purulent (infected) liquid. After some days, a painful local lymphadenopathy presents.14

Chancroid particularly resembles genital herpes when the latter is in its ulcerated form.

Similarity Difference
Herpes vs. chancroid Both very prevalent in the United States. Both can present with multiple vesicles and become ulcerated. Herpes starts as vesicles before it ulcerates. Its ulceration is superficial and sometimes appears as an elevation with a hole in the middle. Chancroid starts as an inflamed patch before it ulcerates. Its ulceration is deep and bleeds easily, and it can release a purulent liquid.

Figure 3. Chancroid of the penis accompanied with its lymphadenopathy. Source: CDC/Dr.
Pirozzi.15

Lymphogranuloma Venereum

Another sexually transmitted disease that presents with a genital ulcer resembling herpes is lymphogranuloma venereum, which is caused by the bacterium Chlamydia trachomatis. This disease is more common in tropical countries, but in the United States it tends to be particularly prevalent in men who have sex with men.

A genital skin lesion usually develops three days to three weeks after the sexual contact as a small vesicle that can ulcerate on its top and that heals after a few weeks. It is usually soft and painless.

The most characteristic sign of this disease is perhaps the painful lymphadenopathy that can progress to fistulas (a fistula is an abnormal canal that usually gets created by pus making its way out of where it formed).

Similarity Difference
Herpes vs. Lymphogranuloma Venereum Both can present with an ulceration. In the United States, both are most prevalent in men who have sex with men. Herpes starts as vesicles that can be painful. It is possible to have a painful lymphadenopathy in herpes, but it is unlikely to progress to fistulas, and the main symptom is the skin lesion. Lymphogranuloma venereum starts as a button that may go unnoticed. The skin lesion is painless. Painful lymphadenopathy is the main symptom and can progress to fistulas.

Figure 4. Lymphogranuloma Venereum’s lymphadenopathy16

Non-sexually transmissible diseases

Some other medical conditions that are not necessarily sexually transmitted can present with a skin lesion that patients sometimes confuse with a genital herpes. Epstein–Barr virus (EBV) in rare cases manifests with a painful genital ulceration that resembles common herpes. However, other manifestations would be more prominent in EBV infection, resembling the symptomatology of infectious mononucleosis with high fever and a swollen liver or spleen.17 Other rare conditions that can present with a herpes-like genital ulceration include Behcet disease, genital tuberculosis, amebiasis, and chancriform pyoderma.18

These conditions and the previously mentioned ones are challenging to diagnose even for doctors. Inspection of the skin lesions and history alone are usually not sufficient to accurately identify a genital ulcer. Laboratory
testing is often necessary to confirm a diagnosis.7

When it is clearly not genital Herpes

The following are some conditions that cause skin imperfections around the genital area. They do not necessarily look like genital herpes or pose a diagnostic problem. However, they are common conditions and many patients ask if their skin lesions are related to herpes.

Human Papillomavirus (HPV)

HPV is a common sexually transmitted infection that can manifest with warts in different parts of the genital area. HPV warts typically are cauliflower shaped. However, there are about 100 types of HPV, and flat, spiky, and dome-shaped forms are also commonly seen. HPV warts are usually firm and, unlike herpes, very unlikely to ulcerate.19

Similarity Difference
Herpes vs. HPV Skin lesion may present as multiple buttons organized in a flower shape. Herpes vesicles (sacs full of liquid with thin membranes) have a fragile consistency and are likely to ulcerate. HPV lesions are firm and very unlikely to ulcerate.

Figure 5. Genital HPV warts

Molluscum contagiosum

Molluscum contagiosum is a highly infectious condition caused by a virus and commonly seen in HIV patients. It usually presents with a growth sort of skin lesion. The skin lesions, known as mollusca, can appear anywhere on the body. They are small and raised and usually have a characteristic pit in the center. They may become itchy or painful, but they are smooth and firm and do not look like an ulcer.20

Similarity Difference
Herpes vs. Molluscum contagiosum Small buttons that can be found grouped. The dimpled aspect of mollusca can look like ulcerated herpes. Herpes lesions are fragile vesicles that ulcerate. They typically around the mouth and in the genital area. Molluscum contagiosum lesions are firm and smooth and only rarely ulcerate, and they are more likely to also be present on other body parts, such as the abdomen, legs, and arms.

Figure 6. Molluscum contagiosum21

Ingrown hair and pseudofolliculitis

When the hair is not properly shaved on fragile skin, it can curl inside it, forming a bump, and can progress to pseudofolliculitis or even folliculitis.

The skin in the genital area is particularly fragile, and ingrown hair can easily occur there as a result of a nonoptimal shaving technique. The bump of ingrown hair is usually small and firm, but it can look like a blister, which makes it look like a herpes lesion. It can also be painful, but its pain does not resemble the distinctive burning pain of herpes. It also does not ulcerate, and if it pops open it usually heals very quickly, unlike herpes.

When there is recurrence of ingrown hair, inflammation can occur in that area and present as redness of the surface of the skin and a chronic recurrence of itchy buttons. The condition is commonly seen in the beard area, especially on the neck and under the chin where the skin is more fragile, but it can also be seen in the pubis and other areas.

Estimated probabilities of HPV transmission from the penis to the anus were significantly higher than were those from the anus to the penis.

The skin lesions of pseudofolliculitis are, like ingrown hair and contrary to herpes, unlikely to ulcerate. They follow the pattern of hair growth, and they have particularly more pruritis or pain a day or two after shaving.22

Similarity Difference
Herpes vs. ingrown hair and pseudofolliculitis Like herpes, ingrown hair can look like a blister, and pseudofolliculitis tends to be more symptomatic a day or two after shaving. Herpes has vesicles that ulcerate and a characteristic burning pain. Ingrown hair and pseudofolliculitis have small, firm lesions that do not ulcerate and mild tingling pain and itching.

Figure 7. Ingrown hair (left) and pseudofolliculitis (right). Source : NHS

Folliculitis

A hair follicle can become infected and form an inflamed button, most commonly because of a superficial bacterial or fungal infection or the progression of ingrown hair toward the infection.

Herpes has vesicles that ulcerate

Folliculitis appears as a pimple, usually with a hair topping it and reddish surroundings. A white coloration—a sign of pus—can sometimes be seen under the skin of the button. If the folliculitis is due to ingrown hair, the ingrown hair can also sometimes be seen under the button.23

The pimple of folliculitis does not ulcerate and heals quickly when it opens. The condition is benign and usually self-limiting.

Similarity Difference
Herpes vs. folliculitis Folliculitis’s pimples might look like ulcerated herpes when they open. Herpes has vesicles that ulcerate. It has no relationship to hair. Folliculitis presents as pimples that do not ulcerate. Either a hair will top each pimple or an ingrown hair will be seen underneath it.

Figure 8. Folliculitis. Source:
HC-UFPR Dermatology Service

Jock itch

Jock itch, or tinea cruris, is a common dermatologic condition, especially in men. It is caused by a fungus and classically results in a well-delimited red patch of skin formed by a pattern of rings. The patch usually forms in the groin and skin folds in the genital area but can spread to other parts of the body. The infection might cause itching and even a burning sensation but does not cause the distinctive ulceration of genital herpes.24

Similarity Difference
Herpes vs. Jock itch The delimited red patch of jock itch might look like the inflamed background of herpes. Herpes has vesicles that ulcerate. Jock itch has no buttons or ulcerations.

Figure 9. Jock itch on the inner thigh of a man25

Genital eczema

Eczema, or dermatitis, refers to a group of skin diseases that cause skin inflammation. They have an allergic and environmental causal mechanism and are not contagious.

The genital area can be particularly prone to eczema since its skin and fragile and easily irritated and because of moisture and friction from clothing. Various types of eczema could affect the genital area, and each has its own characteristics. However, all types of eczema cause skin redness and itching. The skin lesion is poorly defined, and itching is usually the predominant symptom. Swelling is also a common feature of eczema. Bumps that can scar are frequent, blisters are rarer, and ulceration similar to that of herpes is almost exceptional unless the lesions have been extensively scratched.26,27

One type of eczema looks especially like herpes but has nothing to do with the herpes virus. It is called dermatitis herpetiformis. It is characterized by blisters filled with a clear fluid and is intensely itchy. It is related to celiac disease and gluten intolerance and its skin lesions can appear in multiple places on the body.28

Similarity Difference
Herpes vs. Eczema Both can present with blisters. With herpes, lesions that look like blisters are frequent, very prone to ulceration, and cause a burning sensation. With eczema, blisters are rare, ulceration is exceptional, and itching is the primary symptom.

Figure 10. Allergic Eczema. Source

SHOULD I TALK TO A DOCTOR ABOUT IT?

Now that you have a broad idea of how to differentiate a genital herpes ulcer from other commonly encountered conditions, you should consult your doctor when you suspect genital herpes for the first time. The first episode of herpes can have more noticeable symptoms than recurrences later will and it will be less difficult to ensure that the prognosis is benign and rule out more harmful conditions.

Herpes is still a condition often associated with anxiety, fear, and shame. Your healthcare provider can talk to you about your feelings in that regard and give you support and guidance.

With any genital condition, it is important to have the correct diagnosis made by your doctor, who will use laboratory tests for confirmation to establish a proper management plan.

References

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Number of cases | SmartSexResource

Reportable STIs

In BC, some sexually transmitted infections (STIs) are reportable to public health. Reportable STIs include chlamydia, gonorrhea, syphilis, and HIV.

Genital chlamydia is the most commonly reported STI in BC and the number of chlamydia infections has continued to rise each year since the late 1990’s. Gonorrhea, the next most commonly reported STI, had 5.8 times fewer cases than chlamydia in 2017. Syphilis is even less common, with 22.5 times fewer the number of cases than chlamydia in 2017.

HIV is less common than syphilis and the number of newly diagnosed HIV infections in BC has been decreasing over time. In 2017, there were 181 new cases of HIV, which is the lowest rate reported in BC.

These numbers are likely an underestimation because many people do not have symptoms and do not get tested, so they are not counted.

HPV

HPV is a virus commonly found in human bodies. HPV (human papillomavirus) is a very common STI, but it is not routinely reported. Other studies and statistics have been used to estimate the number of people in BC with HPV.

Over 75% of all sexually active adults in Canada will have at least one HPV infection in their lifetimes. Most people will clear it, so fewer people have HPV at any given time.

There are many strains of HPV, and only some are associated with genital warts or cancer. Of those who have a HPV associated with cancer, only a small number will go on to develop cancer.

In a 2004 study of BC women, between 15 and 69 years of age, 17% had HPV, and 12% had a HPV associated with cancer.

The number of men in BC with HPV is unknown but it is expected to be similar to the number of women. The figure for HPV shows the number of people in BC with HPV at any one time, not the number of new cases.

HPV vaccines  protect against the two most common of these cancer-causing HPV types.

Genital Herpes

Genital herpes is a very common STI, but like HPV, is not routinely reported. Genital herpes can be caused by type 1 or type 2 herpes simplex virus (HSV-1 and HSV-2). Historically, HSV-1 typically caused oral herpes (also called “cold sores”) and HSV-2 caused genital herpes. More recent data show that HSV-1 also causes genital herpes. In BC, up to 40% of genital herpes infections that are tested, are caused by HSV-1.

In some surveys, about 4% of adults say that they have been diagnosed with genital herpes. But other surveys using blood samples, show that about 1 in 5 (17%) adults have HSV-2. This difference shows that many people don’t know they have the herpes simplex virus.

This figure shows the number of people in BC with genital herpes at any one time, not the number of new cases.

Chlamydia, Gonorrhea, and Syphilis | ACOG

Antibiotic: A drug that treats certain types of infections.

Anus: The opening of the digestive tract through which bowel movements leave the body.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Chancre: A sore caused by syphilis that is found at the place of infection.

Chlamydia: A sexually transmitted infection caused by bacteria. This infection can lead to pelvic inflammatory disease and infertility.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Disseminated Gonococcal Infection: An infection that may result from untreated infection with gonorrhea and can be life-threatening. Symptoms include fever, chills, skin sores, and pain in the wrists, fingers, knees, or toes.

Genitals: The sexual or reproductive organs.

Gonorrhea: A sexually transmitted infection that can lead to pelvic inflammatory disease, infertility, and arthritis.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).

Meningitis: Inflammation of the covering of the brain or spinal cord.

Neurological: Related to the nervous system.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Pelvic Inflammatory Disease (PID): An infection of the upper female genital tract.

Penis: The male sex organ.

Rectum: The last part of the digestive tract.

Screening Test: Test that looks for possible signs of disease in people who do not have signs or symptoms.

Sexually Transmitted Infection (STI): An infection that is spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Syphilis: A sexually transmitted infection (STI) that is caused by an organism called Treponema pallidum. This infection may cause major health problems or death in its later stages.

Urethra: A tube-like structure. Urine flows through this tube when it leaves the body.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Vulva: The external female genital area.

Drug Treatment of Common STDs: Part I. Herpes, Syphilis, Urethritis, Chlamydia and Gonorrhea

CAROL WOODWARD, PHARM.D., West Virginia University Hospitals, Morgantown, West Virginia

MELANIE A. FISHER, M.D., M.SC., West Virginia University, Morgantown, West Virginia

Am Fam Physician. 1999 Oct 1;60(5):1387-1394.

 
This is Part I of a two-part article on drug treatment of common sexually transmitted diseases. Part II, “Vaginal Infections, Pelvic Inflammatory Disease and Genital Warts,” will appear in the next issue of AFP.

 

Related Editorial

In 1998, the Centers for Disease Control and Prevention released guidelines for the treatment of sexually transmitted diseases. Several treatment advances have been made since the previous guidelines were published. Part I of this two-part article describes current recommendations for the treatment of genital ulcer diseases, urethritis and cervicitis. Treatment advances include effective single-dose regimens for many sexually transmitted diseases and improved therapies for herpes infections. Two single-dose regimens, 1 g of oral azithromycin and 250 mg of intramuscular ceftriaxone, are effective for the treatment of chancroid. A three-day course of 500 mg of oral ciprofloxacin twice daily may be used to treat chancroid in patients who are not pregnant. Parenteral penicillin continues to be the drug of choice for treatment of all stages of syphilis. Three antiviral medications have been shown to provide clinical benefit in the treatment of genital herpes: acyclovir, valacyclovir and famciclovir. Valacyclovir and famciclovir are not yet recommended for use during pregnancy. Azithromycin in a single oral 1-g dose is now a recommended regimen for the treatment of nongonococcal urethritis.

Several advances have been made in the treatment of sexually transmitted diseases (STDs). These advances have been incorporated into the “1998 Guidelines for the Treatment of Sexually Transmitted Diseases,” published by the Centers for Disease Control and Prevention (CDC).1

Highly effective single-dose oral therapies are now available for most common curable STDs. Single-dose regimens may be used for the treatment of chancroid, nongonococcal urethritis, uncomplicated gonococcal infections, bacterial vaginosis, trichomoniasis, candidal vaginitis and chlamydial infections.

Improved therapies are now available for the treatment of genital herpes and human papillomavirus (HPV) infections. New regimens have been approved for the use of acyclovir (Zovirax) in the treatment of genital herpes. In addition, two new antiviral agents, valacyclovir (Valtrex) and famciclovir (Famvir), have been labeled for the treatment of genital herpes. Patient-applied therapies are now recommended for management of HPV.

A new testing method for the diagnosis of chlamydial infections employs an extremely accurate urine test that can easily be incorporated into screening programs. Hepatitis A and hepatitis B vaccines are now recommended for all sexually active adolescents and young adults.

Treatments for STDs in pregnant women have been improved, producing fewer side effects and reducing the number of premature births. Treatment guidelines for the management of STDs in special patient populations, including pregnant women, were recently published in this journal. 2

Genital Ulcer Diseases

Before a genital ulcer is treated, an accurate diagnosis with appropriate testing is essential. Concomitant testing for human immunodeficiency virus (HIV) infection should be considered.

CHANCROID

The goals of therapy for chancroid are to cure the infection, resolve symptoms and prevent transmission. Four recommended drug regimens for the treatment of chancroid are shown in Table 1. Two are single-dose regimens consisting of either azithromycin (Zithromax) or ceftriaxone (Rocephin). Erythromycin, which continues to be recommended for the treatment of chancroid, requires a seven-day dosing regimen. Ciprofloxacin (Cipro) has been added to the guidelines for the treatment of chancroid. However, ciprofloxacin is contraindicated for use in pregnant and lactating women, and in patients under 18 years of age. All four regimens are effective for treatment of chancroid in patients with or without HIV. Of note, several isolates of chancroid with intermediate resistance to either ciprofloxacin or erythromycin have been reported. Patients should be re-examined within three to seven days after initiation of therapy. Symptomatic improvement should be reported within three days if treatment is successful.

View/Print Table

TABLE 1

Treatment of Diseases Characterized by Genital Ulcers
Regimens
Disease Agent Dosage Cost*

Chancroid

Azithromycin (Zithromax)

1 g orally in a single dose

$ 20. 50 (brand)

Ceftriaxone (Rocephin)

250 mg IM in a single dose

13.00 (brand)

Ciprofloxacin (Cipro)

500 mg orally twice daily for 3 days

24.00 (brand)

Erythromycin base

500 mg orally four times daily for 7 days

6.50 to 9. 00 (generic)

Granuloma inguinale

Recommended regimen

Trimethoprim/sulfamethoxazole (Bactrim, Septra)

Double strength, taken orally twice daily for 21 days

54.00 (brand) 14.00 to 25.00 (generic)

or

Doxycycline (Vibramycin)

100 mg orally twice daily for 21 days

167. 00 (brand)

Alternative regimen

Ciprofloxacin

750 mg orally twice daily for 21 days

168.00 (brand)

or

Erythromycin base plus (during pregnancy)

500 mg orally four times daily for 21 days

19.50 to 27.00 (generic)

Aminoglycoside (i. e., gentamicin)

1 mg per kg IV three times daily for 21 days

337.00 (brand) 66.00 to 312.00 (generic)

Lymphogranuloma venereum

Recommended regimen

Doxycycline

100 mg orally twice daily for 21 days

80.00 (brand) 5.50 to 26.50 (generic)

Alternative regimen (including pregnancy)

Erythromycin base

500 mg orally four times daily for 21 days

42. 00 (brand) 20.50 to 27.50 (generic)

Herpes simplex virus

First episode

Acyclovir (Zovirax)

400 mg orally three times daily for 7 to 10 days

53.00 (brand) 37.50 to 43.00 (generic)

or

200 mg orally five times daily for 7 to 10 days

45. 00 (brand) 32.00 to 37.00 (generic)

Famciclovir (Famvir)

250 mg orally three times daily for 7 to 10 days

70.00 (brand)

Valacyclovir (Valtrex)

1 g orally twice daily for 7 to 10 days

56.00 (brand)

Recurrent episodes

Acyclovir

400 mg orally three times daily for 5 days

38. 00 (brand) 27.00 to 31.00 (generic)

or

200 mg orally five times daily for 5 days

32.50 (brand) 23.00 to 26.50 (generic)

or

800 mg orally twice daily for 5 days

50. 00 (brand) 35.00 to 40.00 (generic)

Famciclovir

125 mg orally twice daily for 5 days

28.00 (brand)

Valacyclovir

500 mg orally twice daily for 5 days

31.00 (brand)

Daily suppressive therapy

Acyclovir

400 mg orally twice daily

5. 00 (brand)† 3.50 to 4.00 (generic)

Famciclovir

250 mg orally twice daily

6.50 (brand)

Valacyclovir

500 mg orally once daily (in patients with < 10 episodes per year)

3.00 (brand)

Valacyclovir

1,000 mg orally once daily (in patients with > 10 episodes per year)

6. 00 (brand)

Syphilis

Primary and secondary disease

Benzathine penicillin G

2.4 million units IM in a single dose

24.00 (brand)

Penicillin allergy

Doxycycline

100 mg orally twice daily for 14 days

111.00 (brand) 6.00 to 25.00 (generic)

Tetracycline

500 mg orally four times daily for 14 days

3. 50 to 6.00 (generic)

Early latent disease

Benzathine penicillin G

2.4 million units IM in a single dose

24.00 (brand)

Late latent, unknown duration, tertiary disease

Benzathine penicillin G

7.2 million units IM total, divided into three weekly doses of 2.4 million units each

71.50 (brand)

Neurosyphilis

Aqueous crystalline penicillin G

18 to 24 million units IV daily, divided as 3 to 4 million units every 4 hours for 10 to 14 days

12. 00 (generic)

Procaine penicillin plus probenecid

2.4 million units of penicillin daily, plus 500 mg probenecid orally four times daily, both for 10 to 14 days

277.00 (generic)

TABLE 1

Treatment of Diseases Characterized by Genital Ulcers
Regimens
Disease Agent Dosage Cost*

Chancroid

Azithromycin (Zithromax)

1 g orally in a single dose

$ 20. 50 (brand)

Ceftriaxone (Rocephin)

250 mg IM in a single dose

13.00 (brand)

Ciprofloxacin (Cipro)

500 mg orally twice daily for 3 days

24.00 (brand)

Erythromycin base

500 mg orally four times daily for 7 days

6.50 to 9. 00 (generic)

Granuloma inguinale

Recommended regimen

Trimethoprim/sulfamethoxazole (Bactrim, Septra)

Double strength, taken orally twice daily for 21 days

54.00 (brand) 14.00 to 25.00 (generic)

or

Doxycycline (Vibramycin)

100 mg orally twice daily for 21 days

167. 00 (brand)

Alternative regimen

Ciprofloxacin

750 mg orally twice daily for 21 days

168.00 (brand)

or

Erythromycin base plus (during pregnancy)

500 mg orally four times daily for 21 days

19.50 to 27.00 (generic)

Aminoglycoside (i. e., gentamicin)

1 mg per kg IV three times daily for 21 days

337.00 (brand) 66.00 to 312.00 (generic)

Lymphogranuloma venereum

Recommended regimen

Doxycycline

100 mg orally twice daily for 21 days

80.00 (brand) 5.50 to 26.50 (generic)

Alternative regimen (including pregnancy)

Erythromycin base

500 mg orally four times daily for 21 days

42. 00 (brand) 20.50 to 27.50 (generic)

Herpes simplex virus

First episode

Acyclovir (Zovirax)

400 mg orally three times daily for 7 to 10 days

53.00 (brand) 37.50 to 43.00 (generic)

or

200 mg orally five times daily for 7 to 10 days

45. 00 (brand) 32.00 to 37.00 (generic)

Famciclovir (Famvir)

250 mg orally three times daily for 7 to 10 days

70.00 (brand)

Valacyclovir (Valtrex)

1 g orally twice daily for 7 to 10 days

56.00 (brand)

Recurrent episodes

Acyclovir

400 mg orally three times daily for 5 days

38. 00 (brand) 27.00 to 31.00 (generic)

or

200 mg orally five times daily for 5 days

32.50 (brand) 23.00 to 26.50 (generic)

or

800 mg orally twice daily for 5 days

50. 00 (brand) 35.00 to 40.00 (generic)

Famciclovir

125 mg orally twice daily for 5 days

28.00 (brand)

Valacyclovir

500 mg orally twice daily for 5 days

31.00 (brand)

Daily suppressive therapy

Acyclovir

400 mg orally twice daily

5. 00 (brand)† 3.50 to 4.00 (generic)

Famciclovir

250 mg orally twice daily

6.50 (brand)

Valacyclovir

500 mg orally once daily (in patients with < 10 episodes per year)

3.00 (brand)

Valacyclovir

1,000 mg orally once daily (in patients with > 10 episodes per year)

6. 00 (brand)

Syphilis

Primary and secondary disease

Benzathine penicillin G

2.4 million units IM in a single dose

24.00 (brand)

Penicillin allergy

Doxycycline

100 mg orally twice daily for 14 days

111.00 (brand) 6.00 to 25.00 (generic)

Tetracycline

500 mg orally four times daily for 14 days

3. 50 to 6.00 (generic)

Early latent disease

Benzathine penicillin G

2.4 million units IM in a single dose

24.00 (brand)

Late latent, unknown duration, tertiary disease

Benzathine penicillin G

7.2 million units IM total, divided into three weekly doses of 2.4 million units each

71.50 (brand)

Neurosyphilis

Aqueous crystalline penicillin G

18 to 24 million units IV daily, divided as 3 to 4 million units every 4 hours for 10 to 14 days

12. 00 (generic)

Procaine penicillin plus probenecid

2.4 million units of penicillin daily, plus 500 mg probenecid orally four times daily, both for 10 to 14 days

277.00 (generic)

GENITAL HERPES

Genital herpes is a recurrent, incurable viral disease. Patient counseling should include information about recurrent episodes, asymptomatic viral shedding, perinatal transmission and sexual transmission. Episodic antiviral therapy during outbreaks may shorten the duration of the lesions, and suppressive antiviral therapy may prevent recurrences.

During the first clinical episode, the goal of systemic antiviral drug therapy is to control the signs and symptoms of genital herpes. Daily suppressive therapy is recommended for use in patients who have six or more recurrences per year. Three antiviral medications have been proved in randomized trials to provide clinical benefit in patients with genital herpes: acyclovir, valacyclovir and famciclovir. Clinical experience with systemic acyclovir in the treatment of genital herpes has been substantial. Topical therapy is less effective than systemic therapy, and its use is not recommended. Two newer antiviral agents are valacyclovir and famciclovir.3,4 Valacyclovir is a valine ester of acyclovir with enhanced absorption properties when administered orally. Famciclovir, a prodrug of penciclovir, also has high oral bioavailability. The safety of antiviral therapy in pregnant women has not been established, but extensive clinical experience with acyclovir has been reassuring. Severe or first-episode disease that occurs during pregnancy may be treated with acyclovir. However, the routine administration of antiviral agents in pregnant women with uncomplicated or recurrent genital herpes is not recommended.

SYPHILIS

Syphilis is a systemic disease caused by the sexual transmission of Treponema pallidum. It can present as primary, secondary or tertiary disease. Primary disease presents with one or more painless ulcers or chancres at the inoculation site. Secondary disease manifestations include rash and adenopathy. Cardiac, neurologic, ophthalmic, auditory or gummatous lesions characterize tertiary infections. Latent disease may be detected by serologic testing, without the presence of signs and symptoms. Early latent disease is defined as disease acquired within the preceding year. All other cases of latent syphilis are considered late latent disease or disease of unknown duration.

The recommended treatment regimens have not changed since the 1993 CDC Guidelines. Parenteral penicillin G is still the preferred drug for treating all stages of syphilis, including disease in pregnant women. Table 1 outlines the different penicillin preparations and the proper dosages and durations of therapy, depending on the stage of syphilis at patient presentation. Patients with early disease and penicillin allergy may be desensitized first and then treated with penicillin or treated with another recommended regimen. Patients with HIV infection require treatment with penicillin at all stages of syphilis. Treatment may be associated with the Jarisch-Herxheimer reaction. This reaction is an acute febrile illness that may occur within the first 24 hours of therapy and includes symptoms such as headache and myalgias. Concomitant antipyretic therapy may be beneficial.

GRANULOMA INGUINALE AND LYMPHOGRANULOMA VENEREUM

Granuloma inguinale and lymphogranuloma venereum are rare in the United States. Granuloma inguinale presents as a painless, highly vascular ulcer that is caused by Calymmatobacterium granulomatis. Patients with lymphogranuloma venereum present most often with regional lymphadenopathy; it is often a diagnosis of exclusion. The disease is caused by L serogroup strains of Chlamydia trachomatis. The diagnosis is usually made clinically and serologically. Treatment regimens for these diseases are given in Table 1.

Diseases Characterized by Urethritis and Cervicitis

URETHRITIS

Urethritis is an infection characterized by mucopurulent or purulent discharge and burning during urination. Neisseria gonorrhoeae and C. trachomatis are the most common bacterial pathogens associated with urethritis. Empiric treatment is recommended in high-risk patients and those unlikely to return for follow-up. Treatment guidelines are outlined in Table 2.

View/Print Table

TABLE 2

Treatment of Urethritis and Cervicitis*
Regimens
Disease Agent Dosage Cost†

Nongonococcal urethritis

Recommended regimens

Azithromycin (Zithromax)

1 g orally (single dose)

$ 20. 50 (brand)

Doxycycline (Vibramycin)

100 mg orally twice daily for 7 days

55.50 (brand) 2.50 to 19.00 (generic)

Alternative regimens

Erythromycin base

500 mg orally four times daily for 7 days

6.50 to 9.00 (generic)

or

Erythromycin ethylsuccinate

800 mg orally four times daily for 7 days

10. 00 to 22.00 (generic)

or

Ofloxacin (Floxin)

300 mg orally twice daily for 7 days

62.50 (brand)

If high-dose erythromycin is not tolerated:

Erythromycin base

250 mg orally four times daily for 14 days

8. 00 to 24.00 (generic)

or

Erythromycin ethylsuccinate

400 mg orally four times daily for 14 days

5.00 to 11.00 (generic)

Recurrent/persistent urethritis

Metronidazole (Flagyl)

2 g orally in a single dose

11. 50 (brand) 1.50 to 3.00 (generic)

plus either

Erythromycin base

500 mg orally four times daily for 7 days

6.50 to 9.00 (generic)

or

Erythromycin ethylsuccinate

800 mg orally four times daily for 7 days

10. 00 to 22.00 (generic)

Chlamydial infection

Recommended regimens

Azithromycin

1 g orally (single dose)

20.50 (brand)

or

Doxycycline

100 mg orally twice daily for 7 days

55. 50 (brand) 2.50 to 19.00 (generic)

Alternative regimens

Erythromycin base

500 mg orally four times daily for 7 days

6.50 to 9.00 (generic)

or

Erythromycin ethylsuccinate

800 mg orally four times daily for 7 days

10. 00 to 22.00 (generic)

or

Ofloxacin

300 mg orally twice daily for 7 days

62.50 (brand)

Gonococcal infection

Uncomplicated infections of the cervix, urethra and rectum

Cefixime (Suprax)

400 mg orally in a single dose

$ 7. 50 (brand)

or

Ceftriaxone (Rocephin)

125 mg IM in a single dose

14.00 per 250-mg vial (brand)

or

Ciprofloxacin (Cipro)

500 mg orally in a single dose

4. 00 (brand)

or

Ofloxacin

400 mg orally in a single dose

5.00 (brand)

plus

Azithromycin

1 g orally in a single dose

20. 50 (brand)

or

Doxycycline

100 mg orally twice daily for 7 days

55.50 (brand) 2.50 to 19.00 (generic)

Uncomplicated infection of the pharynx

Ceftriaxone

125 mg IM in a single dose

14. 00 per 250-mg vial (brand)

or

Ciprofloxacin

500 mg orally in a single dose

4.00 (brand)

or

Ofloxacin

400 mg orally in a single dose

5. 00 (brand)

plus

Azithromycin

1 g orally in a single dose

20.50 (brand)

or

Doxycycline

100 mg orally twice daily for 7 days

55. 50 (brand) 2.50 to 19.00 (generic)

TABLE 2

Treatment of Urethritis and Cervicitis*
Regimens
Disease Agent Dosage Cost†

Nongonococcal urethritis

Recommended regimens

Azithromycin (Zithromax)

1 g orally (single dose)

$ 20.50 (brand)

Doxycycline (Vibramycin)

100 mg orally twice daily for 7 days

55. 50 (brand) 2.50 to 19.00 (generic)

Alternative regimens

Erythromycin base

500 mg orally four times daily for 7 days

6.50 to 9.00 (generic)

or

Erythromycin ethylsuccinate

800 mg orally four times daily for 7 days

10. 00 to 22.00 (generic)

or

Ofloxacin (Floxin)

300 mg orally twice daily for 7 days

62.50 (brand)

If high-dose erythromycin is not tolerated:

Erythromycin base

250 mg orally four times daily for 14 days

8. 00 to 24.00 (generic)

or

Erythromycin ethylsuccinate

400 mg orally four times daily for 14 days

5.00 to 11.00 (generic)

Recurrent/persistent urethritis

Metronidazole (Flagyl)

2 g orally in a single dose

11. 50 (brand) 1.50 to 3.00 (generic)

plus either

Erythromycin base

500 mg orally four times daily for 7 days

6.50 to 9.00 (generic)

or

Erythromycin ethylsuccinate

800 mg orally four times daily for 7 days

10. 00 to 22.00 (generic)

Chlamydial infection

Recommended regimens

Azithromycin

1 g orally (single dose)

20.50 (brand)

or

Doxycycline

100 mg orally twice daily for 7 days

55. 50 (brand) 2.50 to 19.00 (generic)

Alternative regimens

Erythromycin base

500 mg orally four times daily for 7 days

6.50 to 9.00 (generic)

or

Erythromycin ethylsuccinate

800 mg orally four times daily for 7 days

10. 00 to 22.00 (generic)

or

Ofloxacin

300 mg orally twice daily for 7 days

62.50 (brand)

Gonococcal infection

Uncomplicated infections of the cervix, urethra and rectum

Cefixime (Suprax)

400 mg orally in a single dose

$ 7. 50 (brand)

or

Ceftriaxone (Rocephin)

125 mg IM in a single dose

14.00 per 250-mg vial (brand)

or

Ciprofloxacin (Cipro)

500 mg orally in a single dose

4. 00 (brand)

or

Ofloxacin

400 mg orally in a single dose

5.00 (brand)

plus

Azithromycin

1 g orally in a single dose

20. 50 (brand)

or

Doxycycline

100 mg orally twice daily for 7 days

55.50 (brand) 2.50 to 19.00 (generic)

Uncomplicated infection of the pharynx

Ceftriaxone

125 mg IM in a single dose

14. 00 per 250-mg vial (brand)

or

Ciprofloxacin

500 mg orally in a single dose

4.00 (brand)

or

Ofloxacin

400 mg orally in a single dose

5. 00 (brand)

plus

Azithromycin

1 g orally in a single dose

20.50 (brand)

or

Doxycycline

100 mg orally twice daily for 7 days

55. 50 (brand) 2.50 to 19.00 (generic)

Several regimens for the management of patients with nongonococcal urethritis are outlined in Table 2. Oral azithromycin is recommended as single-dose therapy.5–7 Improved compliance and the ability to observe therapy are advantages associated with single-dose regimens.

MUCOPURULENT CERVICITIS

Mucopurulent cervicitis is often asymptomatic. It may be detected by the presence of purulent or mucopurulent endocervical exudate. Some women with this condition have an abnormal vaginal discharge and report vaginal bleeding after sexual intercourse. C. trachomatis or N. gonorrhoeae usually cause mucopurulent cervicitis, but in many cases neither organism can be isolated. Patients with positive cultures or nucleic acid amplification tests for the presence of C. trachomatis or N. gonorrhoeae always require treatment. Empiric therapy is recommended when the likelihood of infection with either organism is high or when patients are unlikely to return for treatment. Recommended treatment regimens are outlined in Table 2.

Uncomplicated Chlamydial and Gonoccocal Infections

CHLAMYDIAL INFECTION

Chlamydial genital infections are common among adolescents and young adults who are sexually active. C. trachomatis infection may be associated with pelvic inflammatory disease (PID), ectopic pregnancy and infertility. Since chlamydial infection is often asymptomatic and the sequelae can be serious, routine screening for disease during annual examinations is recommended. Single-dose therapy with azithromycin is as effective as a seven-day course of doxycycline (Vibramycin). Doxycycline is less expensive, but azithromycin may be cost-beneficial because it provides single-dose, directly observed therapy. Erythromycin and ofloxacin (Floxin) also may be used to treat C. trachomatis. Erythromycin is less efficacious than azithromycin and doxycycline, and its adverse gastrointestinal effects may decrease patient compliance. Ofloxacin is as effective as the recommended regimens but offers no dosing or cost advantages. Doxycycline and ofloxacin are contraindicated in pregnant women. In addition, the safety and efficacy of azithromycin in pregnant women has not been established; therefore, a seven-day course of either erythromycin or amoxicillin is recommended in this group. Since neither regimen is considered highly effective, cultures should be repeated in three weeks.

GONOCOCCAL INFECTION

Men with a gonococcal infection experience symptoms that require treatment, but women often are asymptomatic until complications of the infection, such as PID, occur. For this reason, screening is recommended in high-risk patients. Co-infection with C. trachomatis often occurs in patients with gonococcal infections. The cost of doxycycline therapy for C. trachomatis is less expensive than testing for the organism, so empiric treatment of co-infection is becoming routine. Also, dual therapy with doxycycline and azithromycin may decrease the development of antimicrobial-resistant N. gonorrhoeae, because most gonococci are susceptible to both drugs. Quinolone-resistant N. gonorrhoeae has been reported in the United States and is becoming more widespread in Asia. At this time, fluoroquinolone regimens can be used with confidence, but continued monitoring of emerging resistance will be important.

Table 2 outlines therapy for gonococcal infections. Four single-dose regimens are now available for treatment of uncomplicated gonococcal infections of the cervix, urethra and rectum. They include cefixime (Suprax), ceftriaxone, ciprofloxacin and ofloxacin. Cefixime, ciprofloxacin and ofloxacin are given orally, while ceftriaxone is administered intramuscularly. Gonococcal infections of the pharynx are more difficult to eradicate but, with the exception of cefixime, the recommended therapy is the same as for urogenital and anorectal infections, and should include concomitant treatment for chlamydial infection.

90,000 everything you need to know

Everyone is afraid of such negative consequences of sexual relations as chlamydia, gonorrhea, trichomoniasis or syphilis. However, more than one million people are infected with these infections every day, according to new estimates.

Unfortunately, although today we know more than ever about how to prevent these diseases, infection rates remain extremely high around the world.

Fortunately, all four of these infections are curable.

species of bacteria, viruses and parasites are transmitted through sexual contact.

of these are the most common sexually transmitted infections.

of these 8 infections – syphilis, gonorrhea, chlamydia and trichomoniasis – are treatable today.

hepatitis B infections, herpes simplex virus (HSV or herpes), HIV and human papillomavirus (HPV) are viral and incurable.

Sexually transmitted infections (STIs, also called sexually transmitted diseases or STDs) are often asymptomatic. However, if left untreated, they can cause serious consequences, including blindness and other neurological
disorders, infertility, mother-to-child transmission, or birth defects.

Human papillomavirus (HPV) and hepatitis B virus can cause cancer, but these viral infections can be avoided by vaccination.

An additional traumatic factor can be stigmatization of a person infected with a sexually transmitted infection.

STIs are transmitted primarily through sexual contact, including vaginal, anal and oral sex. In addition, some STIs are transmitted asexually, such as through blood or blood products. Many STIs, including chlamydia, gonorrhea, primary infection,
caused by hepatitis B virus, HIV and syphilis can also be transmitted from mother to fetus during pregnancy and childbirth.

They are not spread by household contacts such as eating and drinking, hugging or sneezing.

The latest WHO estimates are for only four treatable STIs (chlamydia, gonorrhea, syphilis and trichomoniasis).

Symptoms of these four treatable infections may include vaginal discharge, male urethral discharge, genital ulcers, painful urination, and abdominal pain.

The only way to reliably diagnose an STI is through testing.Unfortunately, most of the world’s population does not have access to reliable diagnostic testing for STIs due to their high cost and lack of test kits.
for laboratories or express diagnostics. Limited access to services for STIs, along with the asymptomatic course of these infections, leads to their further spread among different populations and communities, as well as on a global scale.

UNFPA ROVECA, Moldova [UNFPA trainer ROVECA and other activists help to educate vulnerable youth on sexual health issues, Moldova]

Information on four curable diseases

Chlamydia control

Chlamydial infection is one of the most common STIs in women, especially young women.

In 2016, 127 million cases of chlamydia were reported among men and women aged 15 to 49.

A symptom of chlamydia is painful urination, but more often the disease is asymptomatic.

It can affect the genital and urinary tract as well as the eyes. If left untreated, blindness, infertility, pelvic inflammatory disease, and ectopic pregnancy can develop. In addition, chlamydial infection can pose a serious risk
for the health of children born to infected mothers.

Chlamydia can be cured with antibiotic therapy, but we must not forget that reinfection is not uncommon.

Jonathan Torgovnik [Mississippi Youth Council representatives gather outside the state capitol to support sexuality education in their schools, USA]

Protecting yourself from trichomoniasis

Trichomoniasis is the most common curable STI infection. Its causative agent is the parasite Trichomonas vaginalis, which colonizes the lower genital tract and is transmitted, as a rule, through sexual intercourse.The peculiarity of this parasite in
the fact that it is capable of infecting areas not protected by a condom – that is, condoms cannot fully protect against trichomoniasis.

Trichomoniasis infects both men and women. Symptoms vary, but many people with an infection are unaware of it and can infect others.

To diagnose trichomoniasis, a medical professional must perform a laboratory test.

Increased vigilance against this infection is warranted, as trichomoniasis can increase the risk of contracting or spreading other STIs such as HIV, and pregnant women with the disease are more likely to have preterm labor.
and children with low body weight are born.

In 2016, 156 million new cases of trichomoniasis were reported among men and women aged 15 to 49.

UNICEF – Mawa [One target population – young men who have sex with men – in a public place, Bangladesh]

Syphilis is an insidious disease

Syphilis is transmitted through vaginal, anal and oral sex and causes ulcerative lesions (so-called chancres) of the genitals.If left untreated, syphilis can lead to serious and persistent disorders such as brain damage, blindness
and paralysis. For many people, syphilis is asymptomatic and unaware of their illness.

Syphilis occurs in three stages: in the first stage ulcers form, in the second there is a rash and inflammation of the lymph nodes, in the third the brain, heart and other organs can be affected.

An estimated 6.3 million people were infected with syphilis in 2016.

The disease is transmitted by contact with ulcerative lesions, mainly through vaginal, oral or anal intercourse.

Syphilis can be transmitted from mother to fetus during pregnancy or childbirth. In 2016, an estimated 200,000 stillbirths occurred among 988,000 pregnant women infected with syphilis. Syphilis is the second most important
cause stillbirth worldwide and can also lead to other adverse birth outcomes such as death of the newborn, congenital anomalies, prematurity and low birth weight.

The risk of syphilis should not be neglected; if you are at risk or notice symptoms of the disease, you must undergo timely examination and treatment. Syphilis can be treated with a simple penicillin regimen.

Gonorrhea: the super germ among STIs

Gonorrhea may soon become an incurable disease. It is a bacterial infection for which there are two drugs, but resistance is already developing to one of them.It is likely that soon we will have no treatment options for gonorrhea,
caused by multidrug-resistant strains.

Individuals diagnosed with gonorrhea are at risk of serious complications, and if left untreated, the disease can cause inflammation in the uterus and lead to infertility. The infection can also be transmitted from a pregnant woman
to kid.

In pregnant women, infection can provoke preterm labor or permanent blindness in the newborn.

In 2016, 87 million people were infected with gonorrhea among men and women aged 15 to 49.

WHO / Yoshi Shimizu [STI testing in Mongolia]

How to keep yourself safe

STIs are usually transmitted through sexual contact, finger, vaginal, oral or anal contact. Some infections can be transmitted through blood or blood products, and some (including chlamydia, gonorrhea, syphilis, HIV, herpes,
HPV infection and hepatitis B virus infection) can be passed from mother to child during pregnancy or childbirth.

How to protect yourself from these infections?

  • practice safe sex;
  • using condoms and doing it right;
  • use reliable sources of information on sexual health;
  • if a risk arises – seek testing and treatment in a timely manner; remember that most STIs are asymptomatic. Limit casual sex and use a condom with a new partner;
  • to be tested for STIs when changing sexual partners and after unprotected intercourse, as well as if there are concerns about possible infection / reinfection;
  • Discuss the potential risk of contracting an STI with a sexual partner;
  • make an informed decision about the acceptable degree of risk in sexual relations;
  • in the presence of pregnancy due to the risk of STIs, it is important to undergo examination and treatment before the child is born
  • Re-infection is possible even after successful treatment.To prevent re-infection, you should make sure that the sex partners are treated.

Condoms, when used properly, are one of the most effective protection against STIs, including HIV infection. Female condoms are also effective and safe.

A partner may often not be aware of an STI.

Any sexually active person can get an STI, but those who frequently change sex partners are at increased risk.Previous treatment for STIs does not protect against reinfection.

Juan Daniel Torres Courtesy of Photoshare [Community Development Community Outreach Discusses Health with Youth, Cambodia]

Knowledge is Power

No one is immune to STIs. Everyone should be aware of them, know the preventive measures, as well as the procedure for dealing with infection.

Comprehensive sexual health education for adolescents is essential.In the course of such comprehensive education, they should receive scientifically based information about human development, anatomy and reproductive health,
and information on contraception, childbirth and sexually transmitted infections (STIs), including HIV.

It is important that the appropriate information is communicated to children at a young age (before the onset of sexual activity).

In addition, access to STI and HIV counseling services is essential. Countries are increasingly implementing STI interventions targeting sex workers, men who have sex with men and injecting drug users.
drugs, however, in many low- and middle-income countries of the world, access to high-quality diagnostic tests is still limited.

Examination during pregnancy planning not STDs

You are planning a pregnancy, so you should know that you need to be screened before pregnancy for sexually transmitted infections. How to correctly pass all the tests, what kind of treatment is needed if an infection is still detected?

In this article, only those infections that are often the subject of controversy will be sanctified – how best to identify them, whether they always need to be treated, what treatment is best for a woman.Very often, patients engage in self-deception, completely trusting the results of a single analysis. Five infections will be consecrated – chlamydia, mycoplasmosis, urepaplasmosis, herpes, cytomegalovirus.

If you are diagnosed with chlamydia

Chlamydia is an infectious disease that is sexually transmitted during unprotected intercourse. Chlamydia bacteria can cause chlamydia. The likelihood that you will become infected with them in a household way – sitting on the toilet, swimming in the pool – is very low, since chlamydia quickly die outside the human body.

Chlamydia symptoms

The incubation period is 7 to 30 days. In a woman: white, yellow, transparent vaginal discharge, pain when urinating, during intercourse, pain in the lower abdomen, in the lumbar region. In a man: discharge from the urethra – transparent, scanty, pain during urination and coitus.

Chlamydia is often asymptomatic, it can be detected on the basis of the tests performed. Chlamydial infection can cause complications.For women, it is fraught with inflammatory diseases of the uterus and appendages, which can lead to infertility. For men, it is fraught with inflammation of the epididymis – epididymitis. In order to identify this infection, you need to pass an analysis for chlamydia using the PCR method – DNA diagnostics. If the doctor discovers chlamydia, then he will prescribe a course of treatment, which must be taken by both partners.

Chlamydia treatment: antibiotics are prescribed for 21 days. If chlamydia is detected during pregnancy, then the woman is also prescribed antibiotics, which are allowed during pregnancy – a course of 2 weeks, but this can be done only after 20 weeks of pregnancy.

Why is chlamydia dangerous during pregnancy

With chlamydia, the risk of termination of pregnancy increases. If the fetus becomes infected, it will lead to chlamydial pneumonia of the newborn, to the fact that he will develop inflammatory eye diseases. Treatment of chlamydial infection during pregnancy is a must!

If ureplasmosis is found, mycoplasmosis

Ureaplasma – bacteria that live in the human body, on the mucous membranes of the genitals, urinary tract.These microorganisms can be classified as opportunistic, which means that every person has them. If the number of bacteria grows sharply, then it begins to exceed the permissible limits, a person develops painful symptoms. This happens when the immune system is weakened.

Mycoplasmosis and ureaplasmosis are sexually transmitted. Also, another way of transmission is from a child to a mother, while a person may even grow up to a certain age and not even suspect that this disease is the cause of a weakened immune system.Symptoms of ureplasmosis: inflammatory diseases of the uterus and appendages, cystitis, pyelonephritis, kidney stones, bacterial vaginosis. In men, these bacteria most often multiply rapidly with urethritis, pyelonephritis, kidney stones.

Diagnosis of ureplasmosis

In order to detect ureplasmosis, you need to pass tests using PCR or culture.
The culture method shows a more objective picture – the number of bacteria. PCR provides information that these microorganisms are in the genitourinary tract, but their number is not established.If a woman is found to have mycoplasmas or ureaplasmas in the amount of 102, then treatment is not needed, but if in the amount of 104, then it is necessary to treat. Culture can also be used to determine which antibiotic will be useful for the treatment to be more effective. When ureaplasmas and mycoplasmas are detected by blood tests, false-positive results are often found.

Treatment of ureaplasmosis. They are usually treated when a woman has health problems – inflammation of the uterus, appendages, cystitis, pyelonephritis.If women are not in pain, then these infections do not need to be treated. Unmotivated use of antibiotics will only lead to a violation of the vaginal microflora.

If we are talking about planning a pregnancy, then it is imperative to treat it, even if a woman has no symptoms of the disease. Treatment consists of taking antibiotics for 10 days. In order to start taking, you need to do a culture of antibiotic sensitivity in order to determine the choice of the right drug. Both husband and wife must complete the course.

If ureaplasma is detected during pregnancy, then the woman is also prescribed an antibiotic. Treatment is carried out only after the 20th week of pregnancy. Prior to this, a woman is prescribed immunoglobulin therapy (from the 10th week of pregnancy).

Why ureaplasma and mycoplasma are dangerous

Ureaplasma and mycoplasma can lead to abortion or premature birth, the baby can also be infected. Also, children may develop urinary tract pathologies, cystitis, pyelitis.

If you find genital herpes

Herpes simplex virus is dangerous for your unborn baby. A genital child is sexually transmitted, can be passed from mother to child. A person lives and does not know that an infection lives in him, and when the immune system is weakened, herpes suddenly appears.

Symptoms of genital herpes – when infected with herpes, pain, burning, swelling appears in the genital area. These symptoms are accompanied by general malaise, fever, headache.Small bubbles appear on the genitals, which are filled with liquid. The blisters burst and painful red sores form. Heal within two weeks.
If a relapse of the disease occurs, then it is accompanied by a rise in temperature, hypothermia and stress can lead to relapses. Genital herpes is asymptomatic, it is possible for the husband to become infected with his wife, or vice versa.

Diagnosis of genital herpes : if you are planning a pregnancy, then you need to take a blood test from a vein for IgM and IgG antibodies to herpes simplex viruses.

If, according to the results of the analysis, antibodies of class G are detected, the body has already encountered genital herpes. If antibodies to class M immunoglobulins are present, genital herpes is in the acute stage.

Treatment of genital herpes : you need to be treated with antiviral drugs, the partner must also be tested – he may not be infected. Antiviral drugs should not be taken during pregnancy, but immunoglobulin therapy is mandatory.

What is the danger of genital herpes during pregnancy

Primary herpes infection during pregnancy is the most dangerous. It leads to abortion as well as serious fetal damage. If a pregnant woman becomes infected with this virus shortly before the expected birth of a child, then the doctor refuses natural childbirth, the woman is given a cesarean section. With natural childbirth, there is a high risk of infection of the child when passing through the mother’s birth canal. If the disease is in the acute phase, then the child is likely to become infected, so it is necessary to treat it in a timely manner.

If cytomegalovirus is detected

Cytomegalovirus is sexually transmitted, it can also be transmitted from mother to fetus, transmission of the virus through kissing, through blood is possible.

Cytomegalovirus is asymptomatic, in a month or two a mononucleosis-like syndrome. It is similar to ARVI and flu, accompanied by high fever, chills, a person is very tired, feels unwell, he has a headache.

If the immune system is weakened, then cytomegalovirus can cause serious diseases – damage to the eyes, lungs, digestive system and brain.

Diagnosis of cytomegalovirus : it can be detected by the results of a blood test from a vein for IgM and IgG antibodies to cytomegalovirus. If antibodies to class M immunoglobulins are recorded, then the disease is in the acute stage, if antibodies to class G immunoglobulins are found, then the body has already met with this infection.

Treatment of cytomegalovirus : the woman is prescribed immune drugs, during pregnancy, immunotherapy is carried out using approved drugs.

What is the danger of cytomegalovirus during pregnancy: primary infection with cytomegalovirus during pregnancy is dangerous, it can lead to infection of the fetus, to termination of pregnancy, to fetal malformations. Treatment of cytomegalovirus before pregnancy and during pregnancy is mandatory.

How to correctly pass the test to identify sexually transmitted diseases

Do this before your period, right after it. On such days, a woman’s immunity decreases.For 20 days before taking the tests, you need to stop taking antibiotics, stop lighting candles, etc. Before visiting a doctor, you do not need to wash yourself, take a shower.

When are the tests done?

For the first time – before pregnancy. If an infection is found, then you need to undergo treatment, then re-take the tests. For 3 weeks, you should have sex with condoms. Some of the partners may not heal.
After the onset of pregnancy, you will register with an obstetrician-gynecologist, the doctor will once again offer to take tests.New surges are possible during pregnancy, since a woman’s immunity is greatly weakened.
If a doctor prescribes several courses of antibiotics in a row to treat the same infection, then it is worth considering whether to continue treatment with him, it is worth looking for another clinic.

Obstetrician-gynecologist Kurylenko Elena Georgievna

STDs and their pharmacotherapy | Remedium.ru

Authors: L.K. OVCHINNIKOVA , officeM.N., E.A. OVCHINNIKOVA , Candidate of Medical Sciences, Head of the Center for Monitoring the Effective, Safe and Rational Use of Medicines, Federal State Institution IMTSEUAOSMP, Roszdravnadzor

According to the WHO, in recent years, there has been a significant increase in the number of sexually transmitted diseases (STDs) all over the world. One of the most numerous groups among these infections are diseases with a predominant lesion of the genitals (the so-called “minor” venereal diseases), which, in particular, include urogenital chlamydia, genitourinary trichomoniasis, genital herpes and urogenital candidiasis.Since these diseases are caused by different pathogens, different principles are at the heart of their drug treatment.

The prevalence of chlamydial infection, the causative agent of which is the intracellular microorganism Chlamidia trachomatis, in the population ranges from 1% to 10% and depends on the sexual activity of the surveyed contingent. Chlamydial infections can be transmitted through vaginal or anal intercourse and (less commonly) through oral-genital contact. These infections most often affect people with multiple sex partners.Serological signs of chlamydial infection are observed in 60-70% of infants born to carriers of this infection. Infection with chlamydia is possible in the household through the use of general personal hygiene items, as well as in swimming pools. According to statistics, chlamydia is recorded in women much more often than in men.

In women, the infection manifests itself as mucous or mucopurulent vaginal discharge with an unpleasant odor. There may be mild pain in the external and internal genital area, itching and burning (incl.hours when urinating), increased pain before menstruation, intermenstrual bleeding. The most common complications are endocervicitis, acute urethral syndrome, endometritis, acute salpingitis.

In men, the infection is often accompanied by urethritis, which lasts several months. When urinating, there may be itching and burning, scanty vitreous discharge from the urethra. Often there are slight pains in the same urethra, scrotum, lower back, testicles.In 70% of patients with chlamydia, psychoemotional disorders are associated – sleep disturbances, headache, irritability, weakness. The great danger of chlamydia is that it is very often asymptomatic; infected persons retain the microorganism for a long time.

Modern treatment of chlamydia is based on a combination of antibacterial drugs (ABP), which provide, incl. and intracellular action, with immunomodulators. Standard antibiotic regimens involve the use of both modern antibiotics, such as azithromycin macrolide (and in this case, control of cure is not required), and old ones, such as tetracycline ABP doxycycline (Unidox Solutab).Other treatment regimens are based on the oral administration of fluoroquinolone ofloxacin, macrolides of Rovamycin, Vilprafen, erythromycin, penicillin drug amoxicillin, etc. Chlamydia therapy involves the simultaneous treatment of both sexual partners.

The last 4 drugs are also used in the treatment of urogenital chlamydia in pregnant women. In addition, the use of erythromycin is at the heart of the treatment of chlamydial infection in newborns, because this old antibiotic eliminates nasopharyngeal colonization and prevents the development of pneumonia.
The peculiarity of chlamydial infection is the structure and reproduction of C. trachomatis. As an intermediate link between a virus and a bacterium, this microorganism has the most “bad” features of both. This circumstance often determines the low efficiency of monotherapy for infection with the listed ABPs. If we take into account that the pathogenesis of chlamydia is characterized by a decrease in the phagocytic activity of the T- and B-cell link of immunity, as well as a decrease in the ability of leukocytes to produce interferons, then in most cases it becomes necessary to include immunocorrecting agents in the complex treatment regimen for the disease.

Among the non-prescription immunomodulators for the treatment of chlamydia, the complex enzyme preparation Wobenzym is widely used, which increases the immunological reactivity of the body, reduces the number of circulating immune complexes in plasma and tissues, stimulates the level of functional activity of macrophages, cytotoxic T-lymphocytes, and activates the production of interferons. It is also important to note the fact that Wobenzym with chlamydia (as well as genital herpes, candidiasis, etc.)STDs) increases the concentration of antimicrobial drugs in the inflammation focus.

Of other OTC drugs with an immunomodulatory effect, Galavit rectal suppositories can be used in the complex treatment of chlamydia. Their action is based on the normalization of the functional state of macrophages, stimulation of the bactericidal activity of neutrophilic granulocytes, and, ultimately, an increase in phagocytosis and an increase in the body’s nonspecific resistance to infection. Among Rx drugs as part of immunotherapy, doctors often prescribe drugs such as Neovir, Cycloferon (injections), Viferon (rectal suppositories), Kipferon (intravaginal suppositories), etc.

Trichomoniasis

The incidence of trichominiasis caused by the simplest Trichomonas vaginalis varies from 2 to 40% in different countries. The proportion of this infection among other STDs is 65-80%. Its carriers are dominated by women. Domestic infection is rare. Infection of newborns through the birth canal is possible. Most often, the disease is detected in persons of the age category from 16 to 35 years old.

Like chlamydia, trichomoniasis is often asymptomatic.If the disease makes itself felt, then in women it usually manifests itself as fetid vaginal discharge of gray, white or yellow-green color (10%), which has a homogeneous watery or creamy consistency. The disease is accompanied by itching, burning, dysuria. The main complications are endometritis and salpingitis.

In men, the main symptoms of trichomoniasis are minor foamy or purulent discharge from the urethra and dysuria; urethritis, prostatitis, rarely epididymitis develops.Chronization of the process in almost 100% of cases leads to the development of chronic prostatitis. The basic drugs for the treatment of trichomoniasis are derivatives of 5-nitroimidazole. The mechanism of action of these drugs is the biochemical reduction of the 5-nitro group by intracellular transport proteins of protozoa. The reduced 5-nitro group inhibits the synthesis of nucleic acids in the microbial cell, which leads to the death of the pathogen. The cure rate of trichomoniasis when using this group of drugs is very high (86-97%).Simultaneous therapy of both sexual partners is recommended.

The drugs of this group differ little among themselves in the degree of activity, however, they differ somewhat in terms of dosage forms (DF), toxicological properties, etc. (see Algorithm). The most widely used drug is metronidazole, which can be administered to patients intravenously (Trichopol), orally (Trichopol), intravaginally (Flagil, Trichopol). We emphasize that the drug, regardless of the LF, should be dispensed from pharmacies solely as prescribed by a doctor, because its incorrect dosage is associated with a high risk of irreversible neurological disorders.

Ornidazole (Tiberal), tenonitrozole (Atrikan), nimorazole (Naxogin), tinidazole are alternative oral agents for the treatment of trichomoniasis. Atrikan at the same time has the least number of side effects among antiprotozoal drugs, but Tiberal is the only one in the given series of drugs that is compatible with alcohol.

The treatment of trichomoniasis in pregnant women is associated with certain difficulties. Among the drugs approved for use in the first trimester of pregnancy are Betadine vaginal suppositories based on the universal antiseptic povidone-iodine.This product has a good safety profile and is approved for dispensing from pharmacies without a doctor’s prescription. With a gestational age of more than 12 weeks. it is possible that the doctor prescribes metronidazole or nimorazole (once). In pediatrics, for the treatment of trichomoniasis, doctors, as a rule, resort to the help of the same metronidazole.

Genital herpes

Herpes simplex viruses (HSV) are infected with up to 90% of the world’s adult population. It is transmitted through both normal genital contact (usually HSV-2) and oral (HSV-1) and anal sex (HSV-2).Infection is possible if the sexual partner does not have any manifestations of the disease in more than 50% of cases. The overall chance for a woman to become infected from an infected male partner through unprotected sex is about 17% for a woman. The household route of infection with genital herpes is rare. The overall frequency of transmission of herpes to newborns is only 2 cases per 100,000 births (data for Europe).

After infection, HSV enters the nerve nodes located near the spinal cord, and remains in them for life.At the same time, symptoms of genital herpes occur only in a small proportion of carriers. More often, herpes infection manifests itself in the form of relapses, and their frequency is 3-4 times higher when infected with HSV-2. However, even in this case, 25% of all recurrences of infection occur in the form of clinically asymptomatic virus isolation. Patients who have antibodies to HSV-1 can become infected with HSV-2. In this case, the infection is shorter than with the primary infection with HSV-2, therefore, the first-onset and non-primary genital herpes is isolated.

In the clinical picture of infection, 3 different syndromes are distinguished. The first episode of primary genital herpes develops in individuals who do not have antibodies to HSV. With active shedding of the virus, about 75% of partners become infected. Characterized by pronounced local symptoms with multiple painful lesions progressing to ulceration, inguinal adenopathy, as well as general manifestations – fever, malaise, myalgia, headache, nausea. The first episode of non-primary herpes, which occurs in individuals with antibodies to another, heterologous type of virus, is milder, resembling a recurrent form, but its course is very variable.Finally, recurrent herpes (often caused by HSV-2) is preceded by local prodromal symptoms – pain, itching, paresthesias. The prodrome lasts 2 days. Further, “mild” local symptoms appear, which are half the average duration of an episode of primary herpes. The number of lesions is small and there are no general symptoms.

Specific treatment should be started as early as possible, after the first symptoms of the disease appear. The main treatment for the primary episode of genital herpes are oral “cyclovir” – famciclovir (Famvir), valacyclovir (Valtrex), acyclovir.In severe cases, it is possible to prescribe parenteral forms of acyclovir (Zovirax, Virolex) by a doctor. These drugs in the body undergo transformations with the formation of compounds capable of inhibiting HSV. High selectivity of action is determined by their ability to accumulate in cells affected by the virus.

The peculiarity of Valtrex and Famvir is that they are prodrugs: the first drug is converted in the body into acyclovir, and the second into penciclovir, through which the action of the drugs is mediated.Hence – the higher efficiency of these drugs compared to acyclovir, a shorter course duration and a more convenient daily regimen (Famvir is used once a day, Valtrex – 1-2, while acyclovir – 3-4 times).

With the frequency of exacerbations of genital herpes from 6 episodes per year, “cyclovir” can be prescribed for the prevention of infection. The number of relapses is reduced by 75% or more.
The safety of systemic therapy of pregnant women with “ciclovir” has not been fully proven.Only acyclovir can be used with caution in pregnant women.

As with chlamydia, the effectiveness of the treatment of genital herpes is significantly increased when antimicrobial (in this case, antiviral) therapy is supplemented with immunomodulation. For this purpose, many of the immunomodulators mentioned above can be used. However, drugs that simultaneously combine strong antiviral and immunomodulatory effects are of particular value. An example of such a drug is Panavir.It has a cytoprotective effect, protecting cells from the effects of viruses, inhibits viral replication in infected cell cultures and leads to a significant decrease in the infectious activity of HSV-1 and HSV-2, induces the synthesis of interferon in the body, increases the viability of infected cells, and inhibits the synthesis of viral proteins. The advantages of the drug include the large number of LF used for genital herpes (including the gel allowed for use in the framework of responsible self-medication).This allows you to vary the duration of therapy and the route of drug administration.

Candidiasis

Candidiasis is an opportunistic mycosis caused mainly by the fungus Candida albicans, which occurs with damage to the mucous membranes and skin. Urogenital candidiasis is characterized by a predominant lesion of the urogenital sphere.

In general, C. albicans is representative of the normal flora of a woman’s lower genital tract.They are present in 22% of women without symptoms of the disease and in 39% with symptoms of vulvovaginitis. It is estimated that 75% of women have at least one episode of genital fungal infection during their lifetime.

The factors predisposing to the growth of candida in the vagina are diabetes mellitus, pregnancy, obesity, treatment with antibiotics, steroids or immunosuppressants, wearing tight-fitting underwear.

Typical manifestations of vaginal candidiasis – redness of the tissues of the vulva and vagina, desquamation, edema, excoriation and white or yellow plaques protruding above the surface of the epithelium, which are difficult to remove, were noted only in 38-60% of women with positive results of C.albicans.
In other cases, candidiasis may be asymptomatic or cause only itching or discomfort.

Competent treatment of acute urogenital candidiasis (fungal infections) leads to the elimination of symptoms of the disease and the disappearance of Candida from the genital tract in 80-90% of cases, but recurrence of infection remains a problem.

Of great importance is the intravaginal forms of antimycotics, which, after administration, act directly in the lesion focus.

Among them, in the treatment of urogenital candidiasis, sertaconazole (Zalain suppositories), butoconazole (Ginofort cream), ketoconazole (Livarol suppositories) are often prescribed. From the means of earlier generations, miconazole (Ginesol-7 suppositories) and clotrimazole (vaginal tablets) are still widely used. Livarol, Ginesol and Clotrimazole are allowed without a doctor’s prescription.

Along with the local use of antifungal drugs, treatment regimens for candidiasis include oral administration of a number of drugs, in particular ketoconazole (Nizoral) for 5 days or fluconazole (Diflucan, Flucostat) – for 3 days (50 mg), or just once (150 mg) …Recall that the last drug is the only oral antimycotic approved for use in thrush without a doctor’s prescription.

During pregnancy, to eliminate candidiasis, it is possible (and even then with great caution) only local administration of azoles (means, the INN of which contains the suffix “azole”) for 7 days. With frequent relapses of the disease (4 times a year), treatment with ketoconazole tablets is recommended, followed by long-term local use of the same drug or other intravaginal drugs.Since one of the factors in the development of candidiasis is a decrease in the body’s defenses, it is advisable to “reinforce” antimycotic pharmacotherapy by taking immunomodulators. Treatment of the sexual partner of a woman with fungal vulvovaginitis or of the woman herself in the absence of clinical manifestations of the disease is not required.

A little about prevention

Finally, I would like to remind once again the old truth: like most other diseases, STDs are easier to prevent with the help of prophylactic means than to cure.Among antiseptic drugs, chlorhexidine is most often used for this purpose. This drug, administered intrauretally (Hexicon solution) or intravaginally (Hexicon solution, gel and suppositories), acts on a wide range of STD pathogens (bacteria, chlamydia, viruses, fungi, protozoa) and exhibits preventive efficacy against the considered infections when used no later than 2 hours after intercourse. In addition, Geksikon can be recommended as an auxiliary element in the complex treatment of these diseases.

As for medical products, condoms are still the most reliable means of protection against various STDs. Suffice it to say that with the same genital herpes, according to statistics, condoms reduce the risk of infection by almost 2 times.

Treatment of STDs: chlamydia, trichomoniasis, syphilis, ureaplasmosis in the clinic “Doctor Soran”

As the people say, all diseases are from the nerves and only syphilis is from love.In recent years, this disease has really become a real problem. An outbreak of syphilis in Arkhangelsk occurred in 1997 and lasted for about 10 years, but to this day the situation is far from successful … Indiscriminate love affairs, as you know, are fraught with other unpleasant diagnoses. Most often, along with the already mentioned syphilis, there are chlamydia and trichomoniasis. In general, more than 20 diseases belong to the group of infections that are primarily sexually transmitted: mycoplasmosis, ureaplasmosis, gonorrhea, genital herpes …

Chlamydia

Chlamydia is a kind of record holder among “intimate” diseases.The infection rate of the population is very high. There is even such statistics: chlamydia is the second most common disease after influenza! Chlamydiae are among the so-called “hidden infections”, the disease in 70 percent of cases goes unnoticed. It is difficult to identify it yourself. There are no symptoms, so the person sees no reason for concern and does not go to the doctor. The initial focus of infection is the mucous membrane – the urethra in men and the cervical canal in women. In no case should you reassure yourself: if it doesn’t bother, then there’s nothing to worry about.The longer the inflammatory process lasts, the more the immune system is depleted. As a result, everything can end with complications: prostatitis, infertility, hepatitis, arthritis.

Trichomoniasis

Trichomoniasis “makes itself known” with itching, burning and foul-smelling discharge. Symptoms can appear as a couple of days after intimate contact, and after a month. However, as in the case of chlamydia, they may not appear at all. The main lesions are the vagina and urethra in women and the urethra in men.For both, this infection, in the absence of the necessary treatment, threatens with various complications. In addition, for the representatives of the beautiful half of humanity, trichomoniasis not cured in time in the future can create big problems with the onset and course of pregnancy.

Syphilis

Syphilis proceeds in three stages. On the primary, a hard chancre appears – a red ulcer, lymph nodes may increase. This stage can last up to a month. The secondary period lasts from 3 to 6 months.The chancre passes, the lymph nodes decrease, but a rash appears – spots, pustules or nodules. Most often on the feet and palms, but in principle it can be anywhere (except for the face). The rash may disappear and reappear soon. Six months later, the defeat of the internal organs begins – this stage is the most advanced and dangerous.

Ureaplasmosis

With ureaplasmosis , the situation is not so clear-cut. For people who are far from medicine in general and dermatovenerology in particular, the question is rather unexpected: to treat or not to treat? And that’s why.For example, chlamydia should not be in the body at all, and if they are found, then it is imperative to be treated. But ureaplasma is considered a conditionally pathogenic microbe. A person cannot be sterile. Each of us is always parasitized by certain saprophytes that live at the expense of a person, live with him, but do not cause any harm.

Ureaplasma belongs to such microbes. When examining, it is imperative to determine its amount. And only if it exceeds the norm, treatment is necessary.In practice, it often turns out like this: a person came, passed the tests (with a high-precision technique, even if one microbe gets in, the machine works, that there is ureaplasma) and he is prescribed antibiotics. He undergoes a course of treatment, makes a control analysis, and this very high-precision technique again finds one microbe. The second course of treatment follows, the third, then the patient does not stand up and goes to another clinic: “They cannot cure me!” … We begin to discuss this topic, take crops to determine the amount of ureaplasma and it turns out that everything is within the normal range.He does not infect anyone, ureaplasma does not cause him any concern. It is impossible to achieve complete sterility – you will sooner “kill” your entire intestine with antibiotics than completely eliminate the ureaplasma. Or you will wear it out, and in six months it will appear again … At one of the conferences on dermatovenerology, a professor from St. Petersburg asked: “Colleagues, let’s not treat crosses, let’s treat people.” Many doctors have a different approach to the problem: they put a plus sign opposite the ureaplasma in the laboratory, and it automatically turns it into a minus and sometimes cannot achieve this.And for a person, especially if he has not been ill with anything before, this is stress: “How, I have an infection, but the treatment does not help ?!”. Against this background, sex life is disrupted, family problems begin – finding out on the topic of who infected whom: “If no one went to the side, did not walk anywhere, then where did it come from?” And no one will explain to the patient that he may have been living with this ureaplasma for 20 years, for the first time in his life he went to be examined and found out that it exists in his body. And it is far from the fact that she came from somewhere else.

It is impossible to cure sexually transmitted infections on your own! All that is needed here is the strict supervision of a doctor and professional equipment.

Remember that sexually transmitted infections are the easiest to get, but sometimes it is not so easy to cure it. But the main thing is to see a doctor on time.

Sexually transmitted diseases. Latent infections.

General

The most common STDs include genital herpes, chlamydia, human papillomavirus (HPV), genital warts (genital warts), chancre and syphilis (chancre), urethritis and vaginitis of gonococcal (gonorrhea) and non-phonococcal nature (non-phonococcal).

Here we will consider only a few of them.

Chlamydia

Bacterial infection spread by vaginal, oral and anal intercourse. In women, chlamydia can cause inflammation of the cervix and other pelvic organs, which are in the first place among the causes of ectopic pregnancies and female infertility. In men, chlamydial infection is manifested by inflammation of the urethra and epididymis (the organ in which sperm accumulates).

Gonorrhea (gonorrhea)

This is an infectious venereal disease in which the mucous membranes of the urogenital organs, the mucous membranes of the eyes, the oral cavity and the rectum are affected.

Genital herpes

Highly contagious viral disease, transmitted through sexual contact and enters the body through microcracks in the skin. The causative agent of the disease is the herpes virus of the second type. The main manifestations last three to four weeks, include tingling or mild soreness in the genital area, itching, small painful blisters and sores in the anus, buttocks or thighs, severe burning, especially when in contact with urine, an increase in the inguinal lymph nodes.Even after the symptoms disappear, the virus remains in the body for life, periodically causing exacerbations. It is very important for pregnant women to treat herpes before delivery, as the virus can be transmitted to the baby through the birth canal. This can lead to blindness, brain damage, and sometimes death of the child.

Syphilis

A highly contagious infection caused by spirochetes and transmitted by any type of sexual intercourse. The disease is most common among people with multiple sexual partners, especially those who do not use barrier methods of contraception.The first stage of the disease begins approximately 10 days after infection and manifests itself as a painless hard chancre (ulcer) on the external genitals, anus, and less often fingers, hands, the infection can be brought into the oral cavity. As a result, the same ulcers appear in the mouth and throat. Another characteristic symptom is enlarged lymph nodes.

If untreated, the infection progresses and can progress into the following two stages. The third is the most severe.It is characterized by the appearance of a skin rash all over the body (including the palms and soles), which may persist or disappear intermittently, ulcers in the mouth and throat, swollen lymph nodes throughout the body, headaches, bone pain, fever, loss of appetite. and hair loss, meningitis (inflammation of the lining of the brain). At this stage, serious complications arise, such as paralysis, cardiac abnormalities, mental illness. The damage to the body can be severe enough to cause death.

Trichomoniasis

Sexually transmitted bacterial infection. It is caused by the unicellular parasite Trichomonas vaginalis . This parasite is betrayed during intercourse, in women the vagina is most often affected, and in men the urethra. Trichomoniasis often occurs without clinical manifestations (especially in men). Symptoms usually appear 20 days after infection. In women, it can be thick yellow-green vaginal discharge, pain during intercourse, an unpleasant odor from the vagina, redness of the external genitals, itching, pain in the lower abdomen.In men, discharge from the penis, painful and difficult urination.

Candidiasis is the most troublesome for women, for men it can go unnoticed. The disease is caused by a conditionally pathogenic fungus, similar to yeast for dough.

STD Symptoms (STIs):

  • unusual discharge from the genitals;
  • various outgrowths of the mucous membrane of the external genital organs;
  • itching;
  • wounds and ulcers;
  • skin rash;
  • Pain and burning sensation when urinating.

Sexual infections are dangerous for their complications: inflammatory diseases of various internal organs, infertility, cancer, etc.

Only an experienced doctor can make an accurate diagnosis and identify the cause of the disease. In addition to the examination, you will have to conduct several studies for infections: take a vaginal smear (a smear from the urethra), make a bacteriological culture, donate blood for HIV and RW (analysis for syphilis), and PCR analysis will not be superfluous.

With STDs, self-healing does not occur, and the disappearance of some symptoms is explained by the transition of the disease into a latent form.Therefore, the earlier the diagnosis is made and treatment is started, the more chances are to be cured and not to get complications, such as infertility, both in men and women, acute conditions requiring surgical intervention, the possibility of intrauterine infection of the fetus in the womb, violations of the course of pregnancy and childbirth, the birth of an unviable or sick child, or even the death of an infected person (for example, from AIDS or hepatitis).

Treatment of chlamydia and cytomegalovirus | Only Clinic

Chlamydia and cytomegalovirus: treatment of infections

Chlamydia is one of the most common sexually transmitted diseases.As a rule, chlamydia infection occurs during unprotected intercourse, when the bacterium – the causative agent of the infection – enters the body of a man or woman. There is an opinion that dangerous bacteria, in particular chlamydia, can enter the human body at the household level – when visiting the pool or using dirty plumbing. However, this is not so – outside the body bacteria almost immediately cease to exist, so the likelihood of getting chlamydia, the treatment of which should be urgent, without sexual contact with an infected person, is negligible.
The asymptomatic period can last from a week to a month, until bacteria in the body signal its presence.

In women, the symptoms of chlamydia are yellow, white or transparent vaginal discharge. Also, there is always pain during urination, intercourse.

Approximately the same symptoms of chlamydia are observed in men: unpleasant discharge, increased pain during urination and coitus.

It often happens that the disease of chlamydia proceeds without symptoms and almost does not make itself felt for a long time.However, it is important to remember that the presence of harmful bacteria in the female body is fraught with complete infertility. At the same time, in men, chlamydia infection can trigger the onset of the process of inflammation of the epididymis.

Cytomegalovirus is another sexually transmitted infection. Cytomegalovirus infection, the treatment of which requires immediate medical attention. Cytomegalovirus is quite dangerous for the body of both men and women. It is especially important to get tested for the presence of this infection and, if necessary, begin treatment for pregnant women, as well as for couples who plan to become parents.
The result of the analysis for cytomegalovirus “Antibodies to cytomegalovirus IgG positive” – ​​this means that the examined person has a strong immunity to cytomegalovirus, because this person has had this infection. A positive test result for IgG antibodies to cytomegalovirus indicates that immunoglobulins are present in the patient’s blood, which have the ability to quickly and effectively neutralize viral particles of cytomegalovirus.

Cytomegalovirus IgG positive – this means very good test results.

Cytomegalovirus infection may not manifest itself in the human body for a long time. The main symptoms of cytomegalovirus are high fever, severe headache, decreased body tone. These symptoms are very similar to typical ARVI, ARI, flu. It is important to know that cytomegalovirus can progress to pneumonia, arthritis, encephalitis.

Chlamydia and cytomegalovirus: symptoms, treatment and prevention.

Experts advise those people who do not have a permanent sexual partner to periodically go for STI diagnostics, including DNA tests for the presence of bacteria in the body.If the disease was detected in the body of one of the partners, then the visit to the doctor must necessarily be joint.

The most common treatment option today is a course of antibiotics. Traditionally, an appointment is scheduled for three weeks. If bacteria were found in a pregnant woman, treatment is mandatory, modern medicine suggests the presence of specialized antibiotics for pregnant women, which must be prescribed by a doctor. Such a course will take only two weeks and will save the newborn from a number of unpleasant diseases.

Diagnostics and treatment of chlamydia and cytomegalovirus.

With regard to issues of treatment, modern medicine does not provide any precise instrument for eradicating this disease. Nevertheless, pharmaceuticals help to completely suppress the virus and extend its “incubation period” for many decades.

At the same time, such a feature of an infectious disease is another reason to contact competent specialists who will be able not only to recognize the problem in time, but also to prescribe the most advanced methods of treatment.

We invite you for diagnostics, treatment and rehabilitation at the private hospital Only Clinic, which is located in Nizhny Novgorod at st. Betancourt, 2, – we offer only the best and most progressive ways to complete recovery.

90,000 Make an appointment for a consultation or examination of a venereologist in a private clinic

Treatment of sexually transmitted diseases

STIs are a whole group of infections that are transmitted through sexual contact.In most countries, STIs are among the most common infectious diseases, and Russia is no exception. Among the most common STIs are chlamydia, trichomoniasis, mycoplasmosis, genital herpes, and papillomavirus infections of the genitals. Often these diseases are asymptomatic, and their treatment is quite difficult. However, it is these diseases that cause some of the most serious complications (chronic disorders, infertility, disability).

Chlamydia is one of the most common infections in the world.It is caused by chlamydia – microorganisms of eubacterial nature. In Russia, chlamydia is the second most common disease after influenza. It often proceeds without pronounced symptoms, is difficult to cure, and gives a lot of complications: in men it leads to infertility, chronic urethritis, orchiepididymitis (inflammation of the testicles), prostatitis, joint diseases.

Mycoplasmosis (ureaplasmosis) is also transmitted through sexual contact. The infection causes urethritis, prostatitis, orchiepididymitis, arthritis.May cause adhesions to the fallopian tubes, spontaneous abortion, premature birth and postpartum fever.

Trichomoniasis is the most common disease of the genitourinary tract in Russian climatic conditions. Caused by the simplest flagellate parasite. Trichomonas is also transmitted through sexual intercourse. The incubation period ranges from 5 to 15 days, but can last up to 21 days. Very often leads to complications – prostatitis, epididymitis, etc.

Genital herpes is caused by the herpes simplex virus. The disease is transmitted mainly through sexual contact, and infection can be carried out from persons who do not have symptoms of the disease at the time of intercourse or who do not know that they are sick. The possibility of infection with genital herpes during oral-genital contact and even by household means through personal hygiene products is not excluded. The presence of the virus during pregnancy can cause fetal death, causing up to 30% of spontaneous abortions in early pregnancy and over 50% of late miscarriages.Localization of genital herpes in men is characteristic: the head of the penis, the foreskin, at the rib.

Human papillomavirus infections genitals. The papilloma virus causes many diseases, including genital warts and even malignant formations, etc.

Taking into account the peculiarities of the manifestations of all STIs, as well as the complications they cause, the most important thing is, firstly, the most prompt and accurate identification of infectious agents.And for this you need modern laboratory diagnostics, which will be provided to you in our multidisciplinary clinic “L’Med”. And, secondly, in no case do not self-medicate, which can lead to a chronic form of the disease, but turn to a competent specialist who will prescribe individual and high-quality treatment.

Any PPI is successfully treated in our clinic. The key to this is the most modern laboratory equipment, the best technologies and treatment methods, as well as the consistently high level of professionalism of our doctors.

We also offer you anonymous examination and treatment of venereal diseases.

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Have you encountered the acronym STDs? If not, then you will be all the more interested in what it is. STDs are short for sexually transmitted diseases. This name is more recognizable and is usually associated with sexually transmitted diseases. This is partly true, but only partly.

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