1) Gonococcal infection – IP 3-14 days, painful, mucopurulent discharge, Dx – Gram stain of discharge shows intracellular diplococci, other tests available are culture, nucleic acid hybridization test, nucleic acid amplification test, Tx – Cefixime 400 mg PO single dose OR Ceftriaxone 125 mg IM OR Ciprofloxacin 500 mg PO OR ofloxacin 400 mg PO (effective against chlamydia), Levofloxacin 250 mg orally single dose (effective against chlamydia), syphilis and HIV serology, partner tracing and treating, counselling, all patients treated for gonorrhea must also be tested and evaluated for Chlamydia, syphilis, HIV, if any specific tests are not done for Chlamydia then all gonococcal infections must also be treated with drugs effective against Chlamydia as well,
2) Male patient urethritis – purulent, mucopurulent discharge, dysuria, pruritus, Ix – Gram stain microscopy (more than 5 WBC/oil immersion field, if no discharge then do a Gram stain on the sediment of the first void urine, Gram negative Intracellular Dipplcocci establish the GC infection, if it is negative treat for C. trachomatis if STD risk factors are positive, if not other etiological factors like Ureaplasma ueralyticum, Mycoplasma genitalium, T. vaginalis, HSV, adenoviral infections ), culture (urethral swabs), nucleic acid hybridization tests (uretrhal swabs), nucleic acid amplification test (urine, higher sensitivity), Mx – Gonococcal treatment see above, reginmens for Chlamydial infections are Azithromycin 1 g orally one dose OR Doxycyline 100 mg bid orally for 7 days OR Erythromycin base 500 mg orally 4 times daily for 7 days OR Ofloxacin 300 mg orally bid for 7 days OR Levofloxacin 500 mg orally once daily for 7 days, revaluaiton after 3 days if no improvement, symptoms alone without lab evidence of infection does not require treatment, avoid sexual intercourse until 7 days after therpy AND partner adequately treated, screen for HIV, syphilis, partner referral for evaluation and treatment, persistent symptoms, discomfort, irritative voiding syndrome after 3 months exclude chronic prostatitis and pelvic pain syndromes.
3) Female cervicitis – vaginal discharge, intermestrual bleeding, purulent or mucopurulent endocervical discharge visible on speculum exam or endocervical swab specimen, sustained endocervical bleeding easily induced by a gentle passage of a cotton swab through the cervical os, more than 10 WBC per high power field on microscopic exam of vaginal secretions (this is commonly associated with gonococcal and/or chlamydial infections, absence excludes cervicitis of infective origin), intracellular gram negative diplococci (low specificity), NAAT for N gonorrhoea and C. trachomatis, usually caused by N. gonorrhoea, C. trachomatis, mycoplasma genitalium, bacterial vaginosis, persistent abnormality in the vaginal flora, douching, chemical irritants, cervical ectopy (consider non-intfectious causes in persistent and treatment resistant cases), Tx – presumptive therapy in cases of high STD risk (age < 25 yrs, new sex partner, multiple sex partner, unprotected sex) with Azithromycin 1 g orally single dose (particularly in pregnancy) OR Doxycyline 100 mg orally bid for 7 days, in cases of chlamydial infections Erythromycin (500 mg orlly 4 times daily for 7 days), Ofloxacin (300mg orally twice daily for 7 days) or Levofloxacin (500 mg orally once daily for 7 days) also considered, sexual abstinence for 7 days after treatment started, exclude PID, sex partner treatment (if sexual contact within 60 days of symptom initiation) if gonococcal, chlmydia or tricho infections diagnosed, screen for HIV, syphilis.
4) Chlamydial infection – IP 1-3 weeks, purulent or mucoid genital discharge,