2019drug Used in STD

Drugs used
in
Sexually Transmitted Diseases
ผศ.ดร.พญ.ศรัณยภิญ โพธิกานนท์
ภาควิชาเภสัชวิทยา
คณะแพทยศาสตร์
1
จุดประสงค ์การศึกษา าบถึงอาการข ้างเคียง
จากยาทีใช่ ้ร ักษาโรคติดต่อ
ทาง เพศสัมพันธ ์
เมื่อสิ้นสุดการเรียนการสอน นักศึกษาสามารถ
1. ทราบถึงชนิดของโรคติดต่อทางเพศสัมพันธ์
2. เลือกยาที่เหมาะสมในการใช้รักษาโรคติดต่อทาง
เพศสัมพันธ์ได้
2
Sexually Transmitted Diseases (STDs)
main STDs
1. Gonorrhea
2. Chlamydial infection
3. Lymphogranuloma venereum
4. Chancroid
5. Syphilis
6. Granuloma inguinale
• other (Genital herpes, bacterial vaginosis,

trichomoniasis, vulvovaginal candidiasis)
4
1. Gonococcal infection (Neisseria gonorrhoea)
Gram-negative
intracellular
diplococci bacteria
• Male: penile discharge, painful urination

Female: usually asymptomatic, painful urination,
Vg discharge or bleeding, pelvic pain
New born: Opthalmia neonatorum
5
• Drug of choice = 3rd generation of Cephalosporin
• Ceftriaxone 250 mg IM or Cefixime 400 mg
(in a single dose)
• Disseminated treatment at least 7 days

• Meningitis Cef-3 1-2 g q 12 h 10-14 days
• Endocarditis treat at least 4 wk
SE: pain, allergy

* skin rashes to anaphylactic shock
* cross-reactivity between penicillin and
cephalosporins : 5-10%
• Cephalosporin allergy
• Gemifloxacin block DNA synthesis
• Azithromycin inhibit protein synthesis
• Alternative regimen
• Spectinomycin inhibit protein synthesis
• Pregnant woman: cephalosporin or spectinomycin

(contraindication in pregnant = fluoroquinolone)
Prevent ophthalmia neonatorum
1% tetracycline hydrochloride or
1% silver nitrate dispensed or
Erythromycin (0.5%) ophthalmic ointment
a single application at birth
8
2.Chlamydial infection
• most common cause of nongonococcal urethritis (NGU)
• Chlamydia trachomatis
• Clinical: usually asymptomatic
• Azithromycin 1 g orally in a single dose or Doxycycline

100 mg orally twice a day for 14 days
• Mechanism: inhibit protein synthesis
• contraindication in pregnancy = Doxycycline

Gonorrhea coinfection with Chlamydia infection
Ceftriaxone plus Azithromycin or Doxycycline

3.Lymphogranuloma Venereum (LGV)
• caused by Chlamydia trachomatis serovars L1-L3

• ่ ยวะเพศ + ต่อมนาเหลื
อาการ:แผลเจ็บทีอวั ้ องโต
Recommended Regimen :
Doxycycline 100 mg 2 21 d
Alternative Regimen :
erythromycin base 500 mg 4 21 d
12
Gram-negative rod
Haemophilus ducreyi.
4. Chancroid
• Painful soft ulcer with necrotic base
• PO : azithromycin 1 g SD or
ciprofloxacin 500 mg bid for 3 d
erythromycin base 500 mg qid for 7 d
• IM : ceftriaxone 250 mg SD
5.Syphilis Treponema pallidum
Syphilis chancre
Painless
Raise and hard
border
Red and smooth
base
Tertiary
primary secondary neurosyphillis
• Primary, secondary, latent syphilis (< 1 y)
Benzathine penicillin G 2.4 million unit IM single dose
• Latent syphilis (> 1 y)

Benzathine penicillin G 2.4 million unit IM once a week
for 3 successive weeks (Total =7.2 mu)
• Neurosyphilis
Penicillin G 18-24 mu IV (3-4 mu q 4h) for 10-14 days
กรณีแพ้ยา Penicillin
• Doxycycline
• Tetracycline
• Azithromycin
• Ceftriaxone
• Erythromycin
~ 14 days
Syphilis
Jarisch-Herxheimer reaction
(fever, rash, hypotension, headache and myalgia)
• = inflammatory response to the destruction of

Treponema
• occur within 24 h after penicillin therapy
• is not a manifestation of
penicillin allergy
17
6. Granuloma Inguinale (Donovanosis)
• Klebsiella granulomatis
• Painless ulcer, mild inguinal lymphadenopathy
Donovan bodies =
gram –ve rod-shaped,
oval organism in
19
cytoplasm of
mononuclear cell
Recommended Regimen
Azithromycin 1 g orally once per week or
500 mg daily for at least 3 weeks and until all
lesions have completely healed
Alternative Regimens
Doxycycline
20
Genital Herpes Simplex
• Herpes simplex virus type 1, 2

• Blisters and sore
• PO : Acyclovir, Famciclovir
21
• viral thymidine kinase to acyclovir monophosphate
acyclovir triphosphate
dead end because no OH to attached new base
Famciclovir
SE: nausea, vomiting, diarrhea,

Bacterial vaginosis
• bacteria such as Lactobacillus and anaerobes

• Positive whiff test
• Rx : PO: metronidazole 500 mg 2 7d
23
Mechanism of action:
Prodrug Free-radical metronidazole DNA damage

ferredoxin
SE: disulfiram-like reaction (nausea, vomiting, dizziness)
Alcohol acetaldehyde acetic acid

ADH ALDH
Disulfuram
ADH = alcohol dehydrogenase Metronidazole
ALDH = acetaldehyde dehydrogenase
Trichomoniasis
Trichomonas vaginalis
• PO : metronidazole
25 MM2560
Vulvovaginal Candidiasis
• Topical or systemic antifungal agents

• Nystatin vaginal tablet
pore formation at ergosterol
26
•clotrimazole, miconazole (vaginal tablet)
•fluconazole, itraconazole
Inhibit Lanosterol 14alpha- demethylase

Inhibit ergosterol synthesis
Partner treatment
• Partner: within 60 day before symptoms
same treatment
STDs
1. Gonorrhea Ceftri
2. Chlamydial infection Azithro or Doxy
3. Lymphogranuloma venereum Doxy
4. Chancroid Azithro or Ceftri
5. Syphilis Pen G
6. Granuloma inguinale Azithro
- Genital herpes Acyclo, Famci

- Bacterial vaginosis Metro
- Trichomoniasis Metro
- Vulvovaginal candidiasis Nystatin, Clotri, Itra
30

2019drug Used in STD

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2019drug Used in STD

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Drugs used

• other (Genital herpes, bacterial vaginosis,

• Male: penile discharge, painful urination

New born: Opthalmia neonatorum

• Disseminated treatment at least 7 days

SE: pain, allergy

• Pregnant woman: cephalosporin or spectinomycin

a single application at birth

• Azithromycin 1 g orally in a single dose or Doxycycline

• contraindication in pregnancy = Doxycycline

Ceftriaxone plus Azithromycin or Doxycycline

• caused by Chlamydia trachomatis serovars L1-L3

• Painful soft ulcer with necrotic base

• Latent syphilis (> 1 y)

• = inflammatory response to the destruction of

• Herpes simplex virus type 1, 2

SE: nausea, vomiting, diarrhea,

• bacteria such as Lactobacillus and anaerobes

Prodrug Free-radical metronidazole DNA damage

SE: disulfiram-like reaction (nausea, vomiting, dizziness)

Alcohol acetaldehyde acetic acid

• Topical or systemic antifungal agents

Inhibit Lanosterol 14alpha- demethylase

- Genital herpes Acyclo, Famci

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