DrHanisah'sNotes

1. Granuloma Inguinale,
Lymphogranuloma Venereum,
Gonorrhea
082012100062
Nur Hanisah Zainoren

2. Objective
 To understand the underlying causes of the
diseases
 To understand the clinical findings of the
diseases
 To know and memorize the drug used for the
treatment of the diseases

3. Pathology of the Diseases

4. Granuloma Inguinale
 Chronic, relapsing granulomatous anogenital
infection
 Due to: Calymmatobacterium granulomatis
 Lesion occur on the skin or mucous membranes of
the genitalia or perineal area
 Painless infiltrated nodules that soon slough.
 A shallow, sharply demarcated ulcer forms, with a
beefy-red friable base of granulation tissue.

6. Lymphogranuloma Venereum
 LGV is an acute and chronic sexually transmitted
disease caused by Chlamydia trachomatis types
L1-L3
 Disease is acquired during intercourse or through
contact with contaminated exudate from active
lesions.
 After the genital lesions disappears, the infection
spreads to lymph channels and lymph nodes of
genital and rectal areas.

8. Gonorrhea
 Caused by: Neisseria Gonorrrhoeae
 Transmitted during sexual activity and has greater
incidence in the 15-29-year-old age group.
 Characterized by thick discharge from the penis
and vagina.
 In addition to male reproductive organs & female
genital tract, gonorrhea may infect the rectum,
throat, eyes, blood, skin & joints.

10. Pharmacotherapy of the
Diseases

11. Granuloma Inguinale
 Long duration of therapy
 The following recommended regimens should be
given for 3 weeks or until all lesions have healed:
Drug Dose Route
Azithromycin 1g
once weekly
O
Ciprofloxacin 700mg
twice daily
O
Doxycycline 100mg
twice daily
O
Erythromycin 500mg
4 times daily
O
TREATMENT OF

12. Lymphogranuloma Venereum
 Patient with a clinical presentation suggestive of
LGV should be treated empirically.
Drug Dose Route
Azithromycin 1g
once weekly
For 3 weeks
O
Doxycycline
*C/I in
pregnancy
100mg
twice daily
for 21 days
O
Erythromycin 500mg
4 times daily
For 21 days
O
TREATMENT OF

13. Gonorrhea
 The choice of which regimen to use should be based on
the national prevalences of antibiotic resistant organisms.
 Nationwide, strains of gonococci that are resistant to
penicillin, tetracycline, or ciprofloxacin have been
increasingly observed.
 Hence no longer be considered as 1st line therapy
 Treatment of:
1. Uncomplicated Gonorrhea
2. Disseminated gonococcal infection
3. Endocarditis
4. Postgonococcal urethritis and cervicitis
5. Pelvic inflammatory disease
TREATMENT OF

14. Gonorrhea
 1. Uncomplicated Gonorrhea
 Higher dose of IM Ceftriaxone in combination with
second drug (Azithromycin or Doxycyline)
regardless of concern for possible secondary infection
with chlamydia.
 For uncomplicated gonococcal infection of the cervix,
urethra, and rectum and pharyngeal gonorrhea
Ceftriaxone (250mg IM) + Azithromycin (1000mg orally as
SD) / Doxycycline (100mg BD for 7 days)
TREATMENT OF
*In case where an oral cephalosporin is the only option,
Cefixime (400mg, O, SD) can be combined with
Azithromycin/Doxycycline as above
but a “test of cure” is recommended 1 week after treatment

15. Gonorrhea
 2. Disseminated gonococcal infection should be
treated with:
1st option
 Ceftriaxone (1g daily, IV, until 48 hours after improvement
begins)
Cefixime (400mg daily, O, to complete at least one week of
antimicrobial therapy)
2nd option
 Oral fluoroquinolone :
Ciprofloxacin (500mg, BD)
OR
Levofloxacin (500mg, OD)
Switched to
for 7 days
TREATMENT OF

16. Gonorrhea
 3. Endocarditis should be treated with:
 Ceftriaxone ( 2g every 24 hours, IV, for at least 3 weeks)
 4. Postgonococcal urethritis and cervicitis are
treated with a regimen of erythromycin,
doxycycline or azithromycin
 5. Pelvic inflammatory disease:
1st option
 Cefoxitin (2g parenterally every 6 hours) OR
Cefotetan (2g IV every 12 hours)
 Doxycycline (100mg every 12 hours)
TREATMENT OF

17. Gonorrhea
 Pelvic inflammatory disease:
2nd option
 Clindamycin (900mg, IV every 8 hours)
 Gentamicin ( IV as a 2mg/kg loading dose followed by
1.5 mg/kg every 8 hours)
3rd option
 Ceftriaxone (250mg IM, SD) OR
[Cefoxitin (2g IM, SD) + Probenecid (1g orally as a
SD)]
 Doxycycline (100mg BD for 14 days)
 With or without Metronidazole (500mg, BD for 14 days)
TREATMENT OF

18. Conclusion
1. Granuloma inguinale
 Caused by: Calymmatobacterium granulomatis
 Treatment:
Drug Dose Route
Azithromycin 1g
once weekly
O
Ciprofloxacin 700mg
twice daily
O
Doxycycline 100mg
twice daily
O
Erythromycin 500mg
4 times daily
O

19. 2. Lymphogranuloma Venereum:
 Caused by: Chlamydia trachomatis types L1-L3
 Treatment:
Drug Dose Route
Azithromycin 1g
once weekly
For 3 weeks
O
Doxycycline
*C/I in pregnancy
100mg
twice daily
for 21 days
O
Erythromycin 500mg
4 times daily
For 21 days
O

20. 3. Gonorrhea
 Caused by: Neisseria Gonorrrhoeae
 Treatment:
1.Uncomplicated Gonorrhea
-Ceftriaxone/Cefixime+Azithromycin/Doxycycline
2.Disseminated gonococcal infection
-CeftriaxoneCefixime or
-Oral fluoroquinolones (Ciprofloxacin/Levofloxacin)
3.Endocarditis
-Ceftriaxone
4.Postgonococcal urethritis and cervicitis
-Erythromycin, Doxycycline or Azithromycin
5.Pelvic inflammatory disease
-Cefoxitin/Cefotetan+Doxycycline
-Clindamycin+Gentamicin
- Ceftriaxone OR [Cefoxitin + Probenecid] + Doxycycline
With or without Metronidazole

21. Reference
 Stephen J.McPhee, Macine A.Papakadis, Current
Medical Diagnosis and Treatment, McGrawHill.

22. Thank you 