Bacterial STD

urethral inflammation without GNID

• gram negative intracellular diplococci
• if on urethral smear-->gonorrhea infection

• epididymitis
• prostatitis
• Reiter's syndrome

• mucopurulent or purulent d/c
• + leukocyte esterase test on first-void urine or microscopic exam of urine sediment = >10wbc per high power field
• gram stain of secretions = >5wbc per oil immersion field

• Azithromycin 1 g po, single dose + no sex for 7 days
• OR
• Doxycycline 100 mg po bid for 7 days + no sex for 7 days
• -tx partner
• rescreen in 3 months or at next presentation. Must wait at least 3 weeks for rescreen or will have false+

• Erythromycin base 500 mg po 4x day, 7 days
• OR
• Erythromycin ethylsuccinate 800 mg po 4x day, 7 days OR
• Ofloxacin 300 mg po 2x day, 7 days
• OR
• Levofloxacin 500 mg po daily for 7 days

return for E&M if persist or recur after completion of abx

• -mucopurulent cervicitis or PID
• -sex partner with CT
• -age < 25 and sexually active
• -age > 25 and >1 partner in past 3-6 months or inconsistent condom use
• -currently pregnant
• -pre IUD insertion
• -h/o CT or GC in past 2 years

• -scaring of fallopian tubes
• -potential infertility
• -PID
• -increased r/o ectopic pregnancy

• females more asx
• higher incidence among black and native americans

• d/t possible reinfection secondary to:
• non-compliance w/ abx
• too quickly resumed sex activity after abx
• bacterial resistance
• reinfection (new partner or same un-tx partner)

*must wait 3+ weeks prior to rescreen or high rate of false+

only necessary in pregnancy

• women: **asx**
• -increased or abnormal vaginal d/c
• -dysuria (men>women)
• -dysparunia (change from baseline)
• advised by partner to get tested
• men:
• -urethral d/c in men
• -scrotal pain
• -dysuria

• -body aches
• -edema
• -adenopathy

Azithromycin 1gm single dose + abstain from sex for 7 days

or

Doxyocycline 100 mg bid x 7 days and no sex for 7 days

• high resistance in:
• SE Asia
• HI
• CA
• WA
• pacific

other geographic resistance to PCN and tetacycline

must do test of cure 4 weeks out

increasing trends among MSM

• raising in heterosexuals
• highly geographic. Higher in south and among blacks

• non-specific tests:
• RPR
• VDRL

• FTA
• TPPA

• -MSM sex in past 12 months
• -HIV serology if previous neg or unknown
• -serology for syphilis
• -pharyngeal GC culture

If receptive anal: GC and CT cultures

Repeat 2-6 months for high risk groups

primary: chancre - usually non-painful

• secondary: papulosquamous or papulopustural rash
• classic= rash on palms and feet
• alopecia common

latent: ulcerated gumma

biological and behavioral