Drugs used in STI

• ADO
• A- azithromycin (single oral dose)
• D- Doxycycline (bis 7D oral)
• O- ofloxacin

• mostly GI
• mild to moderate

• ceftriaxone - single IM + single oral of azithromycin
• cefixime - single oral

• cefoxitin/ cefotetan (IV) + doxycyline (oral)
• clindamycin + amyloglycoside

ceftriaxone (IM) + doxycycline +/- metronidazole for 14D

• infected by anaerobes
• metroniazole (oral 7D/ intravaginal gel)
• clidamycin (oral/ intravaginal)

• infected by protozoa
• metronidazole/ tinidazole (single dose)

• infected by fungi
• ropical azole antifungal agents

• penicillin G (all stages)
• benzathine penicillin G (single IM as slow release for early latent stage)

• podofilax (gel on visible lesion)
• imiquimod, 5-flurouracil, trichoroacetic acid
• intralesional alpha interferon (inject into warts; for recurrences)

denatures proteins and warts

cytokines

• acyclovir (prototype)
• valacyclovir, famciclovir (prodrugs/ ACV derivatives)
• foscarnet, cidofovir (reserved for severe/ complications)

• ACV -> ACV triphosphate (active form)
• first phosphorylation -> viral thymidine kinase; second and third phosphorylation -> host's cellular kinases
• competitive inhibition of viral DNA polymerase by ACV triphosphate -> chain termination -> incorporation into viral DNA

• an acyclic guanosine derivative with clinical activity against herpes infections
• first clinical -> oral, severe -> IV
• oral less effective for recurrences
• long term prophylaxis -> lower recurrences 
• low bioavailability (15%)

• an ester of ACV being converted to ACV by hepatic and intestinal enzymes
• only first clinical & recurrent
• bioavailability: 15-55%

• converted to penciclovir with similar action as ACV in viral shedding, lesion healing and resolution of symptoms
• only first clinical and recurrent

• NRTI/ NtRTI (nucleoside/nucleotide reverse transcriptase inhibitor)
• NNRTI (non-nucleoside reverse transcriptase inhibitor)
• PIs (protease inhibitor)
• Entry inhibitor
• INSTI (intergrase inhibitor)

• prolong duration & quality of survival + reduce HIV-associated morbidity
• restore/preserve immunity
• maximally & durably suppress viral load
• prevent transmission

• Zidovudine (NRTI)
• Tenofofir (NtRTI)

• active form: triphosphate form
• competitively inhibit HIV reverse transcriptase + viral DNA chain termination

• lactic acidosis
• hepatic steatosis
• lipodystrophy

• nevirapine
• efavirenz
• delavirdine
• etravirine
• rilpivirine

directly inhibit HIV-1 reverse transcriptase in a reversible and non-competitive manner

• rash
• CNA
• interaction (met. by P450)

• hepatotoxicity
• rash e.g. Steven- Johnson Syndrome

• neuropsychiatric (vivid dreams)
• tetragenic (not prescribed in preg)

• slow disease progression
• prolong survival

• suppress viral replication
• prevent perinatal HIV transmission

• saquinavir
• ritonavir
• lopinavir
• atazanavir
• darunavir
• fosamprenavir

specifically inhibit HIV-1 protease

• hyperlipidemia
• insulin resistance and diabetes
• lipodystrophy
• increase liver function test 
• increase risk of bleeding in hemophiliacs
• interaction (P450)

• enfuvirtide
• maraviroc

inhibit fusion of viral gp41 with host cell

antagonise CCR5 chemokine co-receptor on CD4 T cells

treatment of multi-drug resistance (MDR) CCR5- trophic HIV-1

• raltegravir
• dolutegravir

inhibit HIV-1 intergrase -> prevent propagation of viral infection

treatment of HIV-1 infection in treatment-experienced adult patients who have evidence of viral replication and HIV-1 strains resistant to multiple antiretroviral agents