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STD by Mind Map: STD

1. gonorrhea

1.1. complicated gonorrhea

1.1.1. meningitis

1.1.1.1. high dose IV ceftriaxone (1-2g ) every12 hour for 10 to 14 day

1.1.2. endocaraditis

1.1.2.1. high dose IV ceftriaxone (1-2g )every12 hour for 4 weeks

1.1.3. in neonates ; (IV or IM) ceftriaxone 25 to 50 mg/kg daily or cefotaxime 25mg/kg every 12 hours (safer) for DGI 7 day for meningitis 10 to 14 day

1.2. uncomplicated gonorrhea

1.2.1. urethitis , cervicitis , rectal

1.2.1.1. cetriaxon 250mg IM once ,, or cefixime 400mg PO once

1.2.2. pharyngeal

1.2.2.1. cetriaxon 250mg IM once

2. pelvic inflammatory disease

2.1. in patient

2.1.1. regimen B

2.1.1.1. Clindamycin 900 mg IV every 8 hours plus gentamicin loading dose IV or IM (2 mg/kg) followed by a maintenance dose of 1.5 mg/kg every 8 hoursb

2.1.2. regimen A

2.1.2.1. Cefotetan 2 g IV every 12 hours or cefoxitin 2 g IV every 6 hours plus doxycycline 100 mg IV or PO every 12 hours , Continue doxycycline (100 mg PO twice daily) after discharge to complete 14 days of therapy

2.1.3. alternative regimen

2.1.3.1. Ampicillins/sulbactam 3 g IV every 6 hours plus doxycycline 100 mg PO or IV every 12 hours

2.2. out patient

2.2.1. Ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg PO twice daily for 14 days with or without metronidazole 500 mg PO twice daily for 14 days

2.2.2. OR cefoxitin 2 g IM in a single dose and probenecid 1 g PO administered concurrently in a single dose plus doxycycline 100 mg PO twice daily for 14 days with or without metronidazole 500 mg PO twice daily for 14 days

2.2.3. OR other parenteral third-generation cephalosporins (e.g., ceftizoxime or cefotaxime) plus doxycycline 100 mg PO twice daily for 14 days with or without metronidazole 500 mg PO twice daily for 14 days

3. lymphogranuloma venereum

3.1. Treated BY Doxycycline 100 mg PO twice daily

3.2. or erythromycin base 500 mg PO four times a day for 21 days.

4. nongonococcal urethritis

4.1. Azithromycin 1g PO single-dose regimen, OR doxycycline 100 mg PO twice daily for 7 days may be prescribed when chlamydial urethritis is confirmed. OR Erythromycin base 500 mg PO four times a day or erythromycin ethylsuccinate 800 mg PO four times a day for 7 days are alternative . OR ofloxacin 300 mg PO twice daily or levofloxacin 500 mg PO every day for 7 days are other alternatives.

4.1.1. recurrent infection

4.1.1.1. If the patient was not compliant or re-exposure to an untreated partner should be retreated with the initial regimen .

4.1.1.2. If patients with persistent symptoms who were compliant with the initial regimen and were not reexposed metronidazole or tinidazole 2 g PO as a single dose + a single 1-g dose of azithromycin if not used for the initial regmen .

4.2. for sexual partener

4.2.1. (women who are sexual partners of men with NGU empirical treatment is recommended .)

4.2.1.1. Initiated with the same doxycycline regimen used for NGU.

4.2.1.2. Azithromycin 1 g PO as a single dose (safe and effective during pregnancy) or amoxicillin 500 mg PO three times a day for 7 days .

4.2.1.3. Erythromycin base 500 mg PO four times a day for 7 days,or Erythromycin base 250 mg PO four times a day for 14 days,or Erythromycin ethylsuccinate 800 mg PO four times a day for 7 days, or Erythromycin ethylsuccinate 400 mg PO four times a day for 14 days.

4.2.2. *Erythromycin estolate ,tetracyclines and fluoroquinolones should be avoided in pregnancy .

5. chancroid

5.1. Azithromycin 1 g PO for one dose.

5.2. ceftriaxone 250 mg IM once (preferred regimen for patient not allergic to pencillin)

5.3. ciprofloxacin 500 mg PO twice a day for 3 days. (contraindicated in pregnant)

5.4. Erythromycin base 500 mg PO three times a day for 7 days

6. syphilis

6.1. Early (primary, secondary, or early latent)a

6.1.1. Recommended dose Benzathine penicillin G 2.4 million units single dose IM

6.1.1.1. alternative dose

6.1.1.1.1. Doxycycline 100 mg PO BID for 14 days or Tetracycline 500 mg PO QID for 14 days or Ceftriaxone 1 g IM/IV every day for 8 to 10 days or Azithromycin 2 g PO × 1 dose

6.2. Late latent or latent syphilis of unknown duration

6.2.1. If CSF normal: benzathine penicillin G 2.4 million units/wk × 3 weeks IM , If CSF abnormal: treat as neurosyphilis

6.2.1.1. alternative dose

6.2.1.1.1. If CSF normal: doxycycline 100 mg PO BID for 28 days If CSF abnormal: treat as neurosyphilis

6.3. Neurosyphilis (asymptomatic or symptomatic)b

6.3.1. Aqueous crystalline penicillin G 18–24 million units IV every day × 10–14 day sc

6.3.1.1. alternative dose

6.3.1.1.1. Procaine penicillin 2.4 million units IM every day plus probenecid 500 mg PO QID, both for 10–14 days

6.4. Congenital

6.4.1. Aqueous crystalline penicillin G 100,000–150,000 units/kg/d, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life, and every 8 hours thereafter for a total of 10 daysd

6.4.1.1. alternative dose

6.4.1.1.1. If CSF normal: benzathine penicillin G 50,000 units/kg/dose IM in a single dose

6.4.2. or

6.4.3. Procaine penicillin G 50,000 units/kg/dose IM a day in a single dose for 10 days

7. bacterial vaginosis

7.1. nonpregnant

7.1.1. oral metronidazole 500 mg twice a day for 7 days OR

7.1.2. metronidazole gel 0.75% intravaginally daily for 5 days, OR

7.1.3. clindamycin cream 2% intravaginally at bedtime for 7 days.

7.1.4. The FDA has approved metronidazole extended release 750 mg once daily for 7 days AND a single dose of clindamycin intravaginal cream.

7.2. pregnant

7.2.1. Oral metronidazole 500 mg PO twice a day for 7 days, OR

7.2.2. 250 mg PO three times daily for 7 days OR

7.2.3. oral clindamycin 300 mg PO twice daily for 7 days.

8. trichomoniasis

8.1. metronidazole 2 g PO for one dose

8.1.1. if fail

8.1.1.1. either metronidazole 500 mg PO twice daily for 7 days or tinidazole 2 g PO as a single dose can be used. If either of these regimens fails, metronidazole or tinidazole 2 g PO daily for 5 days may be used.

9. vulvovaginal candidiasis

9.1. Nonprescription Products

9.1.1. Miconazole

9.1.1.1. Administer 1 applicatorful intravaginally at bedtime for 7 consecutive days

9.1.1.2. Administer 1 applicatorful intravaginally at bedtime for 3 consecutive days

9.1.1.3. Insert 1 suppository intravaginally at bedtime for 7 consecutive days

9.1.1.4. Insert 1 suppository intravaginally at bedtime for 3 consecutive days

9.1.1.5. Insert 1 suppository intravaginally at bedtime for 1 dose only

9.1.2. Clotrimazole

9.1.2.1. Administer 1 applicatorful intravaginally at bedtime for 7 consecutive days

9.1.2.2. Administer 1 applicatorful intravaginally at bedtime for 3 consecutive days

9.1.2.3. Insert 1 suppository intravaginally at bedtime for 7 consecutive days

9.1.2.4. Insert 1 suppository intravaginally at bedtime for 3 consecutive days

9.1.3. Butoconazole

9.1.3.1. Nonpregnant women: Administer 1 applicatorful intravaginally at bedtime for 3 consecutive days

9.1.3.2. Pregnant women during second and third trimesters: Administer 1 applicatorful intravaginally at bedtime for 7 consecutive days

9.1.4. Tioconazole

9.1.4.1. Administer 1 applicatorful intravaginally at bedtime for 1 dose only

9.2. Prescription Products

9.2.1. Butoconazole (sustained release)

9.2.1.1. Nonpregnant women: Administer 1 applicatorful at bedtime for 1 dose only

9.2.2. Fluconazole

9.2.2.1. Take 1 tablet PO for 1 dose only

9.2.3. Terconazole

9.2.3.1. Administer 1 applicatorful intravaginally at bedtime for 7 consecutive days

9.2.3.2. Administer 1 applicatorful intravaginally at bedtime for 3 consecutive days

9.2.3.3. Insert 1 suppository intravaginally at bedtime for 3 consecutive days

9.2.4. Nystatin

9.2.4.1. Insert 1 tablet intravaginally at bedtime for 14 consecutive days

10. genital herpes

10.1. First clinical episode

10.1.1. Acyclovir

10.1.1.1. 400 mg PO TID or 200 mg PO 5 times per day

10.1.2. Valacyclovir

10.1.2.1. 1 g PO BID

10.1.3. Famciclovir

10.1.3.1. 250 mg PO TID

10.2. Episodic recurrent infection

10.2.1. Acyclovir

10.2.1.1. 400 mg PO TID or 800mgPOBIDor 800 mg PO TID × 2days

10.2.2. Valacyclovir

10.2.2.1. 1 g every day or 500mgPOBID×3days

10.2.3. Famciclovir

10.2.3.1. 125 mg PO BID or1gPOBID×1day or 500 mg PO × 1 day, then 250mgBID×2days

10.3. Daily suppressive therapy

10.3.1. Acyclovir

10.3.1.1. 400mgPOBID

10.3.2. Valacyclovir

10.3.2.1. 500mg PO everyday or 1 g PO every day

10.3.3. Famciclovir

10.3.3.1. 250mgPOBID

10.4. Severe disseminated

10.4.1. Acyclovir

10.4.1.1. 5–10 mg/kg IV every 8 hours

10.4.2. Valacyclovir

10.4.2.1. Not indicated

10.4.3. Famciclovir

10.4.3.1. Not indicated

10.5. HIV-infected: episodic

10.5.1. Acyclovir

10.5.1.1. 400 mg PO TID or 200 mg 5 per day

10.5.2. Valacyclovir

10.5.2.1. 1 g PO BIDc

10.5.3. Famciclovir

10.5.3.1. 500 mg PO BID

10.6. HIV-infected: suppressive

10.6.1. Acyclovir

10.6.1.1. 400–800 mg PO BID or TID

10.6.2. Valacyclovir

10.6.2.1. 500 mg PO BID

10.6.3. Famciclovir

10.6.3.1. 500 mg PO BID

11. 11 genital warts

11.1. treatment

11.1.1. podophyllin 10%–25% BID for 3 days, followed by 4 days of no therapy

11.1.2. Podofilox 0.5% solution or gel , Imiquimod three times per week for up to 16 weeks.

11.1.3. Sinecatechins three times a day up to 16 weeks

11.1.4. Cryotherapy , Trichloroacetic acid (80%–90%)

11.2. prevention

11.2.1. quadrivalent vaccine