Lecture 12: Pharmacological therapy for sexually transmitted infections

Ceftriaxone inhibits bacterial [...] synthesis by binding to penicillin-binding proteins, while Benzathine Penicillin G blocks cell wall [...]

cell wall, cross-linking

Azithromycin binds reversibly to the [...] ribosomal subunit, whereas Doxycycline reversibly binds to the [...] ribosomal subunit

50S, 30S

Inside anaerobic organisms, Metronidazole undergoes reduction to create toxic intermediates that cause microbial [...] breakage

DNA strand

Acyclovir is actively phosphorylated by viral [...] to selectively inhibit viral [...]

thymidine kinase, DNA polymerase

Fluoroquinolones like Ciprofloxacin are no longer used first-line for *Neisseria gonorrhoeae* due to high rates of [...]

antimicrobial resistance

What is the standard first-line empirical dual-therapy regimen for genital, oropharyngeal, and anorectal gonorrhoea?

Ceftriaxone IM single dose, Azithromycin oral single dose

For uncomplicated genital *Chlamydia trachomatis*, a single oral dose of [...] is preferred over a 7-day course of oral [...]

Azithromycin, Doxycycline

Lymphogranuloma venereum (LGV) and HIV co-infected patients with chlamydia require an extended oral Doxycycline course of [...] days

21

Neonatal conjunctivitis caused by Chlamydia requires immediate mechanical saline irrigation of the eyes combined with systemic oral [...] for 3 days

Azithromycin

What is the standard first-line empirical therapy for early syphilis, and what is the weekly regimen for late or late latent syphilis? (List both 2 regimens)

Benzathine Penicillin G IM single dose, Benzathine Penicillin G IM once weekly for 3 consecutive weeks

Symptomatic congenital syphilis newborns require fast-acting intravenous Benzylpenicillin or intramuscular Procaine Penicillin for a continuous course of [...] days

10

Why is Doxycycline strictly contraindicated during pregnancy?

causes permanent discoloration of teeth, hypoplasia of bone structures

What is the standard empirical triple-therapy regimen for a sexually active patient presenting with Vaginal Discharge Syndrome (VDS)?

Ceftriaxone 500 mg IM stat, Azithromycin 1 g oral stat, Metronidazole 2 g oral stat

How is the empirical VDS regimen adjusted for a patient with a severe penicillin allergy?

omit Ceftriaxone, increase oral Azithromycin to 2 g stat

What is the standard oral empirical regimen for a non-severely ill outpatient presenting with Lower Abdominal Pain (LAP) or PID (Identify all 3 drugs and their treatment durations)?

Ceftriaxone IM single dose, Azithromycin oral single dose, Metronidazole oral for 7 days

What is the standard first-line empirical dual-therapy regimen for Male Urethritis Syndrome (MUS) and Scrotal Swelling (SSW)?

Ceftriaxone IM single dose, Azithromycin oral single dose

What specific drug must be added to the standard Male Urethritis Syndrome (MUS) regimen if his partner is diagnosed with VDS?

Metronidazole oral single dose

Persistent urethral discharge in a male patient 7 days after standard empirical therapy suggests ceftriaxone [...] and requires immediate [...]

treatment failure, clinical referral

What is the standard empirical regimen for Genital Ulcer Syndrome (GUS) to cover syphilis, chancroid, and HSV simultaneously?

Doxycycline oral for 14 days, Acyclovir oral for 7 days

Due to the historical evolution of GUS etiologies since the late 1990s and the rise of HIV, [...] has emerged alongside Syphilis as a primary cause of genital ulcers

Herpes Simplex Virus

What is the standard empirical treatment regimen for a patient presenting with an infectious Bubo (List the drug and its 3-dose schedule)?

Azithromycin oral immediately, then weekly for 2 weeks

Balanitis or balanoposthitis caused by *Candida albicans* is treated topically with [...], but if concurrent urethritis is found, clinicians must apply the relevant [...]

Clotrimazole cream, STI flowchart

What are the 3 core mandates that must be completed for every comprehensive syndromic STI management case?

treat empirically and broadly, treat all recent sexual partners simultaneously, recommend routine HIV testing