1. pelvic inflammatory disease
1.1. in patient
1.1.1. regimen B
1.1.1.1. 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
1.1.2. regimen A
1.1.2.1. 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
1.1.3. alternative regimen
1.1.3.1. Ampicillins/sulbactam 3 g IV every 6 hours plus doxycycline 100 mg PO or IV every 12 hours
1.2. out patient
1.2.1. 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
1.2.2. 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
1.2.3. 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
2. syphilis
2.1. Early (primary, secondary, or early latent)a
2.1.1. Recommended dose Benzathine penicillin G 2.4 million units single dose IM
2.1.1.1. alternative dose
2.1.1.1.1. 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
2.2. Late latent or latent syphilis of unknown duration
2.2.1. If CSF normal: benzathine penicillin G 2.4 million units/wk × 3 weeks IM , If CSF abnormal: treat as neurosyphilis
2.2.1.1. alternative dose
2.2.1.1.1. If CSF normal: doxycycline 100 mg PO BID for 28 days If CSF abnormal: treat as neurosyphilis
2.3. Neurosyphilis (asymptomatic or symptomatic)b
2.3.1. Aqueous crystalline penicillin G 18–24 million units IV every day × 10–14 day sc
2.3.1.1. alternative dose
2.3.1.1.1. Procaine penicillin 2.4 million units IM every day plus probenecid 500 mg PO QID, both for 10–14 days
2.4. Congenital
2.4.1. 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
2.4.1.1. alternative dose
2.4.1.1.1. If CSF normal: benzathine penicillin G 50,000 units/kg/dose IM in a single dose
2.4.2. or
2.4.3. Procaine penicillin G 50,000 units/kg/dose IM a day in a single dose for 10 days
3. bacterial vaginosis
3.1. nonpregnant
3.1.1. oral metronidazole 500 mg twice a day for 7 days OR
3.1.2. metronidazole gel 0.75% intravaginally daily for 5 days, OR
3.1.3. clindamycin cream 2% intravaginally at bedtime for 7 days.
3.1.4. The FDA has approved metronidazole extended release 750 mg once daily for 7 days AND a single dose of clindamycin intravaginal cream.
3.2. pregnant
3.2.1. Oral metronidazole 500 mg PO twice a day for 7 days, OR
3.2.2. 250 mg PO three times daily for 7 days OR
3.2.3. oral clindamycin 300 mg PO twice daily for 7 days.
4. trichomoniasis
4.1. metronidazole 2 g PO for one dose
4.1.1. if fail
4.1.1.1. 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.
5. genital herpes
5.1. First clinical episode
5.1.1. Acyclovir
5.1.1.1. 400 mg PO TID or 200 mg PO 5 times per day
5.1.2. Valacyclovir
5.1.2.1. 1 g PO BID
5.1.3. Famciclovir
5.1.3.1. 250 mg PO TID
5.2. Episodic recurrent infection
5.2.1. Acyclovir
5.2.1.1. 400 mg PO TID or 800mgPOBIDor 800 mg PO TID × 2days
5.2.2. Valacyclovir
5.2.2.1. 1 g every day or 500mgPOBID×3days
5.2.3. Famciclovir
5.2.3.1. 125 mg PO BID or1gPOBID×1day or 500 mg PO × 1 day, then 250mgBID×2days
5.3. Daily suppressive therapy
5.3.1. Acyclovir
5.3.1.1. 400mgPOBID
5.3.2. Valacyclovir
5.3.2.1. 500mg PO everyday or 1 g PO every day
5.3.3. Famciclovir
5.3.3.1. 250mgPOBID
5.4. Severe disseminated
5.4.1. Acyclovir
5.4.1.1. 5–10 mg/kg IV every 8 hours
5.4.2. Valacyclovir
5.4.2.1. Not indicated
5.4.3. Famciclovir
5.4.3.1. Not indicated
5.5. HIV-infected: episodic
5.5.1. Acyclovir
5.5.1.1. 400 mg PO TID or 200 mg 5 per day
5.5.2. Valacyclovir
5.5.2.1. 1 g PO BIDc
5.5.3. Famciclovir
5.5.3.1. 500 mg PO BID
5.6. HIV-infected: suppressive
5.6.1. Acyclovir
5.6.1.1. 400–800 mg PO BID or TID
5.6.2. Valacyclovir
5.6.2.1. 500 mg PO BID
5.6.3. Famciclovir
5.6.3.1. 500 mg PO BID
6. gonorrhea
6.1. complicated gonorrhea
6.1.1. meningitis
6.1.1.1. high dose IV ceftriaxone (1-2g ) every12 hour for 10 to 14 day
6.1.2. endocaraditis
6.1.2.1. high dose IV ceftriaxone (1-2g )every12 hour for 4 weeks
6.1.3. 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
6.2. uncomplicated gonorrhea
6.2.1. urethitis , cervicitis , rectal
6.2.1.1. cetriaxon 250mg IM once ,, or cefixime 400mg PO once
6.2.2. pharyngeal
6.2.2.1. cetriaxon 250mg IM once
7. lymphogranuloma venereum
7.1. Treated BY Doxycycline 100 mg PO twice daily
7.2. or erythromycin base 500 mg PO four times a day for 21 days.
8. nongonococcal urethritis
8.1. 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.
8.1.1. recurrent infection
8.1.1.1. If the patient was not compliant or re-exposure to an untreated partner should be retreated with the initial regimen .
8.1.1.2. 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 .
8.2. for sexual partener
8.2.1. (women who are sexual partners of men with NGU empirical treatment is recommended .)
8.2.1.1. Initiated with the same doxycycline regimen used for NGU.
8.2.1.2. 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 .
8.2.1.3. 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.
8.2.2. *Erythromycin estolate ,tetracyclines and fluoroquinolones should be avoided in pregnancy .
9. chancroid
9.1. Azithromycin 1 g PO for one dose.
9.2. ceftriaxone 250 mg IM once (preferred regimen for patient not allergic to pencillin)
9.3. ciprofloxacin 500 mg PO twice a day for 3 days. (contraindicated in pregnant)
9.4. Erythromycin base 500 mg PO three times a day for 7 days
10. vulvovaginal candidiasis
10.1. Nonprescription Products
10.1.1. Miconazole
10.1.1.1. Administer 1 applicatorful intravaginally at bedtime for 7 consecutive days
10.1.1.2. Administer 1 applicatorful intravaginally at bedtime for 3 consecutive days
10.1.1.3. Insert 1 suppository intravaginally at bedtime for 7 consecutive days
10.1.1.4. Insert 1 suppository intravaginally at bedtime for 3 consecutive days
10.1.1.5. Insert 1 suppository intravaginally at bedtime for 1 dose only
10.1.2. Clotrimazole
10.1.2.1. Administer 1 applicatorful intravaginally at bedtime for 7 consecutive days
10.1.2.2. Administer 1 applicatorful intravaginally at bedtime for 3 consecutive days
10.1.2.3. Insert 1 suppository intravaginally at bedtime for 7 consecutive days
10.1.2.4. Insert 1 suppository intravaginally at bedtime for 3 consecutive days
10.1.3. Butoconazole
10.1.3.1. Nonpregnant women: Administer 1 applicatorful intravaginally at bedtime for 3 consecutive days
10.1.3.2. Pregnant women during second and third trimesters: Administer 1 applicatorful intravaginally at bedtime for 7 consecutive days
10.1.4. Tioconazole
10.1.4.1. Administer 1 applicatorful intravaginally at bedtime for 1 dose only
10.2. Prescription Products
10.2.1. Butoconazole (sustained release)
10.2.1.1. Nonpregnant women: Administer 1 applicatorful at bedtime for 1 dose only
10.2.2. Fluconazole
10.2.2.1. Take 1 tablet PO for 1 dose only
10.2.3. Terconazole
10.2.3.1. Administer 1 applicatorful intravaginally at bedtime for 7 consecutive days
10.2.3.2. Administer 1 applicatorful intravaginally at bedtime for 3 consecutive days
10.2.3.3. Insert 1 suppository intravaginally at bedtime for 3 consecutive days
10.2.4. Nystatin
10.2.4.1. Insert 1 tablet intravaginally at bedtime for 14 consecutive days
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