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9. Genito-urinary diseases
Treatment of the patient
– Genital herpes
• Local treatm ent: clean th e area w ith soap and w ater, 0.5% gentian violet can be
applied for 5 d ays.
• Antiv iral treatm ent: aciclovir P O
In patients with a first episod e, treatm ent m ay red uce th e d uration of sym ptom
w h en g iv en with in 5 d ays after th e onset of sym ptom s: 1200 m g /d ay in 3 d iv id ed
d oses for 7 d ays
In patients w ith recurrence, g iv e th e sam e d ose for 5 d ays, but treatm ent is only
effectiv e if initiated d uring th e prod rom al ph ase or with in 24 h ours after th e onset
of sym ptom s.
In patients with frequent recurrences (m ore th an 6 episod es/year), see HIV infection
and AIDS, pag e 212.
• T reatm ent of pain: paracetam ol P O
– Syphilis
benzathine benzylpenicillin IM : 2.4 M U I/injection (h alf th e d ose in each buttock).
Ad m inister a sing le d ose for early syph ilis (less th an 2 years); one injection per w eek
for 3 w eeks for late syph ilis (m ore th an 2 years) or if th e d uration of infection is
unknown.
or, for penicillin-allerg ic patients:
doxycycline P O : 200 m g /d ay in 2 d iv id ed d oses for 14 2d ays
or
erythromycin P O : 2 g /d ay in 2 or 4 d iv id ed d oses for 14 d ays
– Chancroid 9
azithromycin P O : 1 g as a sing le d ose
or
ceftriaxone IM : 250 m g as a sing le d ose
or
ciprofloxacin P O : 1 g /d ay in 2 d iv id ed d oses for 3 d3 ays
or
erythromycin P O : 2 g /d ay in 2 or 4 d iv id ed d oses for 7 d ays
Fluctuant lym ph nod es m ay be aspirated th roug h h ealth y skin as required . Do not
incise and d rain lym ph nod es.
Note: treat sim ultaneously for syph ilis AN D ch ancroid as both are frequent, and cannot
be correctly d isting uish ed on clinical g round s.
– Lymphogranuloma venereum
doxycyclin P O : 200 m g /d ay in 2 d iv id ed d oses for 14 d ays
2
eorrythromycin P O : 2 g /d ay in 2 or 4 d iv id ed d oses for 14 d ays
Fluctuant lym ph nod es m ay be aspirated th roug h h ealth y skin as required . Do not
incise and d rain lym ph nod es.
2 Doxycycline is contra-indicated in pregnant women and breast-feeding women.
3 Ciprofloxacin should be avoided in pregnant women.
237
Treatment of the patient
– Genital herpes
• Local treatm ent: clean th e area w ith soap and w ater, 0.5% gentian violet can be
applied for 5 d ays.
• Antiv iral treatm ent: aciclovir P O
In patients with a first episod e, treatm ent m ay red uce th e d uration of sym ptom
w h en g iv en with in 5 d ays after th e onset of sym ptom s: 1200 m g /d ay in 3 d iv id ed
d oses for 7 d ays
In patients w ith recurrence, g iv e th e sam e d ose for 5 d ays, but treatm ent is only
effectiv e if initiated d uring th e prod rom al ph ase or with in 24 h ours after th e onset
of sym ptom s.
In patients with frequent recurrences (m ore th an 6 episod es/year), see HIV infection
and AIDS, pag e 212.
• T reatm ent of pain: paracetam ol P O
– Syphilis
benzathine benzylpenicillin IM : 2.4 M U I/injection (h alf th e d ose in each buttock).
Ad m inister a sing le d ose for early syph ilis (less th an 2 years); one injection per w eek
for 3 w eeks for late syph ilis (m ore th an 2 years) or if th e d uration of infection is
unknown.
or, for penicillin-allerg ic patients:
doxycycline P O : 200 m g /d ay in 2 d iv id ed d oses for 14 2d ays
or
erythromycin P O : 2 g /d ay in 2 or 4 d iv id ed d oses for 14 d ays
– Chancroid 9
azithromycin P O : 1 g as a sing le d ose
or
ceftriaxone IM : 250 m g as a sing le d ose
or
ciprofloxacin P O : 1 g /d ay in 2 d iv id ed d oses for 3 d3 ays
or
erythromycin P O : 2 g /d ay in 2 or 4 d iv id ed d oses for 7 d ays
Fluctuant lym ph nod es m ay be aspirated th roug h h ealth y skin as required . Do not
incise and d rain lym ph nod es.
Note: treat sim ultaneously for syph ilis AN D ch ancroid as both are frequent, and cannot
be correctly d isting uish ed on clinical g round s.
– Lymphogranuloma venereum
doxycyclin P O : 200 m g /d ay in 2 d iv id ed d oses for 14 d ays
2
eorrythromycin P O : 2 g /d ay in 2 or 4 d iv id ed d oses for 14 d ays
Fluctuant lym ph nod es m ay be aspirated th roug h h ealth y skin as required . Do not
incise and d rain lym ph nod es.
2 Doxycycline is contra-indicated in pregnant women and breast-feeding women.
3 Ciprofloxacin should be avoided in pregnant women.
237
