STD Treatment

Drugs used in
STD
Dr. Lokeshwar Chaurasia

MD;Asst. Professor
Dept. of Pharmacology
Janaki Medical College
Introduction
STD/STI or venereal disease are
among most common diseases in
the world
An illness that has a significant
probability of transmission between
humans or animals by means of human
sexual behavior
Age group – 15 to 30yrs

Causes of Stds
 Bacteria: Gonorrhoea, chancroid,

: Granuloma venerium
(inguinale)
 Spirochete: Syphilis
 Clamydiae: Cervicitis,
Lymphogranuloma venerium
(inguinale)
 Viruses: HSV, HPV, HBV, CMV,
Contd…
Different forms are :

1.HIV & AIDS
2.Hepatitis B
3.Gonorrhea 4.
HSV inf
5. Syphilis
6.LGV inf.
7.Chancroid 8. Warts
9. Candidiasis
10.Donovanosis
11.Bacterial vaginosis
12. Chlamydia infections
Contd…
Some common forms of

presentations:
Urethral discharge
Vaginal discharge
Genital ulcers
Scrotal swelling
Prevention Methods:
 Abstinence and Reduction of

Number of Sex Partners
 Pre-exposure Vaccination
 Use of contraceptive device
 PEP for HIV
 Partner Management
STD Drugs
Gonococcal infection Amoxicillin+Probenecid

; Ciprofloxacin
Syphilis Inj. Benzathine

penicillin
G ;Doxycycline
Genital herpes Acyclovir oral

5times/day
Chancroid Azithromycin oral;

Ciprofloxacin
Lympogranuloma Doxycycline
Venereum
STD Drugs
Granuloma Inguinale Doxycycline,

Azithromycin,Ciproflox
acin
Bacterial Vaginosis Metronidazole ;clinda
mycin
Trichomoniasis Metronidazole/
tinidazole
Candidiasis Fluconazole
Warts Podophyllin 10-25% LA

Genital HSV Infections
First Episode
 Acyclovir
 200mg five times daily x 7-10
days
 Famciclovir
 250mg three times daily x 7-10
days
 Valacylovir
 1g twice daily x 7-10 days
Suppressive therapy
 Reduces frequency of
recurrences by 70-80%
 Acyclovir
 400mg twice daily
 Famciclovir
 250mg twice daily
 Valacyclovir
 1g once daily
Recurrent therapy
 Requires initiation within 1

day of lesion onset
 Acyclovir
 400mg three times daily x 5 days
 Famciclovir
 125mg twice daily x 5 days
 Valacyclovir
 1g once daily x 5 days
Syphilis
Systemic disease
 Primary Infection
 Ulcer or chancre at the infection site
 Secondary Infection
 Skin rash, mucocutaneous lesions,
lymphadenopathy
 Tertiary Infection
 Cardiac or ophthalmic manifestations,
auditory abnormalities, gummatous
lesions
Syphilis
Recommended regimen
Benzathine Penicillin G, 2.4 million units IM
Penicillin Allergy*
Doxycycline 100 mg twice daily x 14 days
or
Ceftriaxone 1 gm IM/IV daily x 8-10 days
or
Azithromycin 2 gm single oral dose
(preliminary data)
*Use in HIV-infection has not been
studied
Syphilis
Latent Syphilis
Recommended regimen
Benzathine penicillin G 2.4 million units
IM at one week intervals x 3 doses
Penicillin allergy*
Doxycycline 100 mg orally twice daily
or
Tetracycline 500 mg orally four times
daily
for 28 days;
Neurosyphilis
Recommended regimen
Crystalline penicillin G,3-4 million units IV
every 4 hours for 10-14 days
Alternative regimen
Procaine penicillin 2.4 million units IM
daily plus probenecid 500 mg orally four
times daily for 10-14 days
Penicillin Allergy
Ceftriaxone 2 gm daily IM/IV for 10-14
days
Congenital Syphilis
Crystalline penicillin G 100,000-150,000

units/kg/day, administered as 50,000
units/kg/dose IV 12 hourly during the
first 7 days.
or
Procaine penicillin G 50,000
units/kg/dose IM in a single daily dose
for 10 days
Chancroid
Caused by Hemophilus ducrey

Azithromycin 1 gm orally
or
Ceftriaxone 250 mg IM in a single dose
or
Ciprofloxacin 500 mg twice daily x 3
days
or
Erythromycin base 500 mg tid x 7 days
Lymphogranuloma Venereum
Recommended regimen
Doxycycline 100 mg twice daily for 21 days
Alternative regimen
Erythromycin base 500 mg four times daily for
21 days
Granuloma Inguinale (Venereum)
Recommended regimen
Doxycycline 100 mg BID
or
Tetracycline 500 mg QID
or
Trimethoprim-sulfamethoxazole 800 mg/160
mg twice daily
Minimum treatment duration three

weeks
Granuloma Inguinale
Alternative regimens
Ciprofloxacin 750 mg twice daily

or
Erythromycin base 500 mg four
times daily
or
Azithromycin 1 gm orally weekly
Minimum treatment duration

three weeks
Chlamydia trachomatis
Azithromycin 1 gm single dose

or
Doxycycline 100 mg bid x 7d
Chlamydia trachomatis
Erythromycin base 500 mg qid for 7 days

or
Erythromycin ethylsuccinate 800 mg qid
for 7 days
or
Ofloxacin 300 mg twice daily for 7 days
or
Levofloxacin 500 mg for 7 days
Neisseria gonorrhoeae
Cervix, Urethra, Rectum
Cefixime 400 mg
or
Ceftriaxone 125 IM
or
Ciprofloxacin 500 mg
Or
Ofloxacin 400 mg/Levofloxacin 250 mg for 7-10
days
Neisseria gonorrhoeae
Cervix, Urethra, Rectum
Spectinomycin 2 grams IM in a
single dose
or
Single dose cefotaxime 500 mg
or
Single dose gatifloxacin 400 mg
For 7 days
Candida Vulvovaginitis
Intravaginal regimens
Butoconazole, clotrimazole,
miconazole,
nystatin, tioconazole, terconazole
Oral regimen
Fluconazole 150 mg in a single dose
Recurrent VVC
 Four or more symptomatic

episodes/year
 Initial regimen of 7-14 days topical
therapy or fluconazole 150 mg
(repeat 72 hr)
 Maintenance regimens- clotrimazole,
ketoconazole, fluconazole,
itraconazole
 Non-albicans VVC- longer duration of
therapy with non-azole regimen
Trichomonas vaginitis
Recommended regimen
Metronidazole 2 gm orally in a single
dose
Alternative regimen
Metronidazole 500 mg twice a day
for 7 days
Pregnancy
Metronidazole 2 gm orally in a single
dose
Scabies
 Predominant symptom is pruritus

 Recommended regimen
Permethrin cream 5%
 Alternative regimen
Lindane 1% or Invermectin 200
ug/kg, repeat in 2 wks
 Sex partners and household contacts
within the preceding month should be
treated
Papilloma virus
Patient-applied
Podofilox 0.5% solution or gel
or
Imiquimod 5% cream
Provider-administered
Cryotherapy
or
Podophyllin resin 10-25%
or
Trichloroacetic or Bichloroacetic acid 80-90%
or
Surgical removal
Papilloma virus
Vaginal warts
Cryotherapy or TCA/BCA 80-90%
Urethral meatal warts
Cryotherapy or podophyllin 10-
25%
Anal warts
Cryotherapy or TCA/BCA 80-90%
HIV AIDS
Highly active antiretroviral therapy
(HAART)
 GOAL: Combination therapy(Synergism) with
maximally potent agents will produce
complete suppression of viral replication and
decrease the likelihood of emergence of
resistance.
Goal:Viral load less than 50 copies/ml
 HAART rapidly kills >99% virions,only a small
number survive within the resting
CD4lymphocytes
 Give rise to relapse on discontinuation of
treatment
despite complete absence of detectable
viraemia and normal CD4 cell count for years.
 Typically comprising a combination of
three to four antiretroviral
agents, has become the standard
of care.
 2 NRTIs + 1 NNRTI/ PI
 E.g. :
 Zidovudine+ lamivudine+
nevirapine
 Zidovudine + lamivudine+ efavirenz
 Zidovudine + lamivudine+
atazanavir
First-line antiretroviral regimens
Preferred regimen
nevirapine(2NRTI+1NNRTI)
Alternative regimen
efavirenz(2NRTI+1NNRTI)
 lamivudine+ Stavudine+ efavirenz(2NRTI+1NNRTI)
 lamivudine+ Stavudine+
nevirapine(2NRTI+1NNRTI)
Other option
lamivudine+ Tenofovir+ nevirapine
lamivudine+ Tenofovir+ efavirenz
lamivudine+ Tenofovir+ zidovudine
Prophylaxis of HIV infection
 Post exposure prophylaxis(PEP)

 Prophylaxis after sexual exposure
 Perinatal HIV prophylaxis
 Prevention of vertical
transmission to the offspring
during pregnancy
PEP
 To the victims (Doctors, nurses, paramedics

etc) of accidental exposure to HIV infection
through surgical instruments, blood
transfusion or needle-prick injury
 Aim: Suppress local viral replication prior to
dissemination, so that the infection is
aborted.
Basic regimen
Zidovudine 300 mg + Lamivudine 150 mg,
each twice a day for 4 weeks
Expanded regimen
Zidovudine 300 mg + Lamivudine 150 mg,
each twice a day + indinavir 800 mg thrice a
day
for 4
weeks
THANK YOU!!!

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Drugs used in

Dr. Lokeshwar Chaurasia

Age group – 15 to 30yrs

 Bacteria: Gonorrhoea, chancroid,

Different forms are :

Some common forms of

 Abstinence and Reduction of

Gonococcal infection Amoxicillin+Probenecid

Syphilis Inj. Benzathine

Genital herpes Acyclovir oral

Chancroid Azithromycin oral;

Granuloma Inguinale Doxycycline,

Warts Podophyllin 10-25% LA

 Requires initiation within 1

Crystalline penicillin G 100,000-150,000

Caused by Hemophilus ducrey

Minimum treatment duration three

Ciprofloxacin 750 mg twice daily

Minimum treatment duration

Azithromycin 1 gm single dose

Erythromycin base 500 mg qid for 7 days

 Four or more symptomatic

 Predominant symptom is pruritus

 Post exposure prophylaxis(PEP)

 To the victims (Doctors, nurses, paramedics

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