chemotherapy of std. gonorrhea and syphilis

1. CHEMOTHERAPY OF SEXUALLY
TRANSMITTED DISEASES
BY- CHINMAY V HEGDE

3. DRUG THERAPY OF SYPHILIS
Syphilis is caused by the spirochete Treponema
pallidum.
With adequate treatment of early cases almost 90%
cases can be cured.
According to classic Olso study untreated syphilis is
divided into
-Early syphilis
-Late syphilis

4. Early syphilis (duration less than 1 year)
(primary and secondary syphilis and latent syphilis)
Procaine penicillin 600,000 units IM daily for 10 days
Benzathine penicillin 2.4 mega units IM in a single dose
(1.2 mega units I each buttock )
PATIENTS WHO ARE ALLERGIC TO PENICILLIN
Doxycycline 100 mg bid
or
Erythromycin 500 mg orally qid on empty stomach

5. Syphilis of more than 1 year duration
(except neurosyphilis)
Procaine penicillin 600,000 units IM daily for 15 days
Benzathine penicillin 2.4 mega units IM once a week for
3 weeks
PATIENTS ALLERGIC TO PENICILLIN
DOXYCYCLINE 100 mg bid
Or
Erythromycin 500 mg orally qid on empty stomach for 15
days

6. NEUROSYPHILIS
PENICILLIN G IV 12 megaunits
daily in 4 divided doses for
12-14 days
Alternatively treated with
procaine penicillin 2- 4
million units once a day
together with probenecid 500mg
daily for 10 days.

7. Pregnancy and syphilis
• Syphilis can be acquired congenitally. If proper
treatment is given during pregnancy it can be
prevented.
Procaine penicillin 0.6 million units 10 days
Patients allergic to penicillin can be treated with
erythromycin.

8. Congenital syphilis
Procaine penicillin 100,000 units daily
for 10 days.
Interstitial keratitis is a common
complication of congenital syphilis
needs additional treatment with local
or systemic corticosteroids.

9. Reactions and contraindications
in penicillin treatment
•Allergy
•Jarish-Herxheimer reaction

10. DRUG THERAPY OF GONORRHEA
Introduction –
It is cause by Neisseria gonorrhea.
Colloquially it is called as “the clap”

11. Antimicrobial regimens for acute
uncomplicated gonorrhoea
Penicillin G(aqueous) 4.8 mega units injected in
two divided doses at two different sites. 30
minutes after 1g of probenecid orally.
Ampicillin 3.5g orally single dose preceded by 1g
of probenecid
Procaine penicillin 1.2 mega units + penicillin G 1
mega units IM followed by similar injections 24
hours apart

12. Cotrimaxazole 2 tablets twice daily for 5
days or 4 tablets twice daily for 2 days
Ciprofloxcin 500 mg orally, single dose
Levofloxacin 250 mg orally, single dose
Ceftriaxone 125-250 mg IM, single dose
Cefixime 400 mg orally, single dose
Spectinomycin 2 g IM , single dose

13. Gonorrhoea complicated by acute PID
•Procaine penicillin 2 mega units daily for 10
days + doxycycline 100mg BID for 14 days
•Cefoxitin IV 2g every 6 hours + doxycycline
IV 100mg every 12 hours. Continue IV drugs
for at least 48 hours after clinical
improvement. Continue doxycycline orally
100mg BID to complete 14 days of total
treatment.

14. •Gentamicin IV or IM 2 mg/kg(loading dose)
followed by 1.5 mg/kg every 8 hours
+clindamycin 900mg. IV every 8 hours; 48 hours
after the patient shows clinical improvement
change over to oral doxycycline 100mg 12 houly
to complete 14 days of total treatment.
•Oflaxacin orally 400 mg BID for 14 days +
clindamycin orally 450 mg.