Evaluation

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Evaluation Treatment of Sexually Transmitted
Diseases

• Anthony Dekker, D.O., Associate Director
• Phoenix Indian Medical Center
• Director of Ambulatory Care and Community Health
• Phoenix, Arizona

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I. Introduction

• A. STDs are the most common reported infectious
  disease in adolescents.
• B. STDs can have serious medical consequences for
  the adolescent male/female.
• C. By age 19 years, gt 75 of adolescents report
  sexual debut.
• D. 50 of sexually active youth will experience
  an STD by the end of their 18th year.
• E. PID is the second most common hospital
  admission diagnosis for youth.

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II. Risk Factors
A. Host dependent (sexual behavior, race, gender,
ethnicity, contraceptive method, substance use,
therapeutic compliance) B. STD pathogen
(cervical biological factors, resistant
organisms)
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HEADSSS History

• Home environment
• Education or Occupational Issues
• Activities and Associates
• Drugs, Tobacco and Alcohol Diet
• Sexuality Issues
• Suicide and Depression Issues
• Savagery and Victimization

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Osteopathic Issues

• Holistic Diagnosis and Care
• The Bodys Ability to Heal Itself
• Viscero-somatic Reflex
• Somato-visceral Response
• Concomitant Issues

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III. Clinical Syndromes

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III. Clinical Syndromes cont...
d. Syndromes Vaginitis, cervicitis e. Vaginal
pHgt4.5 f. () trichomonads wet mount, pap smear
or culture. G. Resistance to metronidazole
has been reported TREATMENT Metronidazole 2 gm
po X 1 dose (non-pregnant women) or 250 mg po
TID X one week or 375 or 500 mg. po BID X 7 days.
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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...
Treatment Butoconazole 2 cream (Femstat) 5 gm
intravaginally x 3 days. Clotrimazole 1 cream
(Gyne-lotrimin) 5 gm x 7 days. Miconazole 200 mg
vaginal supp. (Monistat) 1 supp. x 3
days. Terconazole 0.8 cream (Terazol) 5 gm x 3
days. Fluconazole 150 mg tablet (Diflucan) 1 tab
po x 1 dose.

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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• Treatment Institute within 72 hours of outbreak
  or prodrome.
• First episode of Genital Herpes
• Acyclovir 200 mg po 5 times daily for 7-10 days
  or until clinical resolution.
• Recurrent episodes
• Acyclovir 200 mg po 5 times a day for 5 days, OR
• Acyclovir 400 mg po 3 times a day for 5 days, OR
• Acyclovir 800 mg po 2 times a day for 5 days.

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• Valcyclovir, two 500 mg q 8 hours for seven days
  for Herpes Zoster. For recurrent HSV infection,
  500 mg. b.i.d. for five days. For long term
  suppressive therapy 500 mg daily.
  
• Famciclovir, 500 mg. t.i.d. x 7 days for Herpes
  Zoster. For recurrent HSV infections, 500 mg.
  t.i.d. x 5 days. For acute HSV infection
  (investigational for HSV) This is not to be used
  in immunocompromised patients.
• Frequent Episodes
• Daily suppressive therapy Acyclovir 400 mp po
  2 times a day reassess rate of recurrences after
  on year of therapy.

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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HPV Therapies

• Chemical Cauterization with BCA, TCA, Podophyllin
  applied by Provider
• Self administered Podophylox
• Cryotherapy
• Surgical excision or desication
• Laser vaporization
• Interfuron Injection
• Immune Response Modification
• Observation

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Immune Response Modifier

• Imiquimod cream 5
• Aldara from 3M
• physician applied for first therapy
• only for external warts
• apply three times per week
• wash hand, no sex and leave on for 6 to 10 hours
• revisits monthly

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Imiquimod Therapy

• Inflammatory Issues
• Cost Factors
• Patient Selection
• Partner Evaluation
• Pre-treatment of Keritinized Warts
• Off Label Uses
• Future Research, Cervical Dysplasia, HSV

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...

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III. Clinical Syndromes cont...