Granuloma inguinale, lymphogranuloma venereum, gonorrhea

DrHanisah'sNotes

1. Granuloma I nguinale , Lymphogranuloma Venereum , Gonorrhea 0820121000 62 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.

5. Lympho granuloma 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.

6. 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 .

7. Pharmacotherapy of the Diseases

8. 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

9. 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

10. 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 1 st line therapy Treatment of: Uncomplicated Gonorrhea Disseminated gonococcal infection Endocarditis Postgonococcal urethritis and cervicitis Pelvic inflammatory disease TREATMENT OF

11. 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

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

13. 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 : 1 st option Cefoxitin (2g parenterally every 6 hours) OR Cefotetan (2g IV every 12 hours) Doxycycline (100mg every 12 hours) TREATMENT OF

14. Gonorrhea Pelvic inflammatory disease : 2 nd option Clindamycin (900mg, IV every 8 hours) Gentamicin ( IV as a 2mg/kg loading dose followed by 1.5 mg/kg every 8 hours) 3 rd 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

15. 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

16. 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

17. 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

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

19. Thank you 