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Ataei .B , MD. MPH.

Sexually Transmitted Infections. Ataei .B , MD. MPH. مرد جوانی 4 روز بعد از تماس جنسی مشکوک دچار ضایعه دردناک الت تناسلی می شود د. در معاینه زخم نمای کثیف دارد وبه اسانی خونریزی می نماید. ودر لمس سفتی ندارد. غده لنفاوی بزرگ و دردناک نیز در ناحیه اینگوینال لمس میگردد. تشخیص بالینی شما چیست؟.

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Ataei .B , MD. MPH.

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  1. Sexually Transmitted Infections Ataei .B , MD. MPH.

  2. مرد جوانی 4 روز بعد از تماس جنسی مشکوک دچار ضایعه دردناک الت تناسلی می شود د. در معاینه زخم نمای کثیف دارد وبه اسانی خونریزی می نماید. ودر لمس سفتی ندارد. غده لنفاوی بزرگ و دردناک نیز در ناحیه اینگوینال لمس میگردد. تشخیص بالینی شما چیست؟ CASE 1

  3. Usual causes Herpes simplex virus (HSV) Haemophilusducreyi (chancroid) ETIOLOGY

  4. culture, direct FA, ELISA, or PCR for HSV; consider HSV-2-specific serology. In chancroid-endemic area: PCR or culture for H. ducreyi Usual initial laboratory evaluation

  5. Herpes confirmed or suspected (history or sign of vesicles): Treat for genital herpes with : acyclovir,valacyclovir, or famciclovir Initial Treatment

  6. First episodes: acyclovir (200 mg 5 times per day or 400 mg tid), valacyclovir (1 g bid), famciclovir (250 mg bid) for 7–14 days is effective. Initial Treatment

  7. Symptomatic recurrent genital herpes: Short-course (1- to 3-day) regimens are preferred because of low cost and convenience. Oral acyclovir (800 mg tid for 2 days), valacyclovir (500 mg bid for 3 days), or famciclovir (750 or 1000 mg bid for 1 day, Initial Treatment

  8. Chancroid confirmed or suspected (diagnostic test positive, or HSV and syphilis excluded, and lesion persists): Ciprofloxacin 500 mg PO as single dose or Ceftriaxone 250 mg IM as single dose or Azithromycin 1 g PO as single dose Initial Treatment

  9. بیمار 30 ساله ای 3هفته بعد از یک تماس جنسی مشکوک دچار یک پاپول روی دستگاه تناسلی شده است این ضایعه 3 روز بعد تبدیل به اولسر با جدار منظم می شود که بدون درد ودر معاینه سفت است وهمراه با لنفادنوپاتی بدون درد یکطرفه میباشد. تشخیص بالینی شما چیست؟ CASE 2

  10. Usual causes Treponemapallidum (primary syphilis) lymphogranulomavenereum ETIOLOGY

  11. Dark-field exam, direct FA, PCR for T. pallidum; RPR or VDRL test for syphilis (if negative but primary syphilis suspected, repeat in 1 week); Usual initial laboratory evaluation

  12. Syphilis confirmed (dark-field, FA, or PCR showing T. pallidum, or RPR reactive): Benzathine penicillin 2.4 million units IM once to patient, Preventive treatment Recent (e.g., within 3 months) Seronegative partner(s), All seropositive partners Initial Treatment

  13. Every pregnant woman should undergo a nontreponemal test at her first prenatal visit If at high risk of exposure, again in the third trimester and at delivery. In the untreated pregnant patient with presumed syphilis, expeditious treatment appropriate to the stage of the disease is essential. Management of Syphilis in Pregnancy

  14. Recommended Follow-Up Evaluation after Therapy for Syphilis

  15. جوان 23 ساله ای 4 روز بعد از تماس جنسی مشکوک به علت ترشح از مجرا و سوزش ادرار به مطب شما مراجعه می نماید. تشخیص بالینی شما چیست؟ CASE 3

  16. (1) mucopurulent or purulent urethral discharge, (2) Gram stain of urethral secretions demonstrating 5 or more leukocytes per oil immersion microscopic field, or Urethritis

  17. (3) a positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine demonstrating 10 or more leukocytes per high-power field. Urethritis

  18. Neisseriagonorrhoeae* CAUSES OF NONGONOCOCCAL URETHRITIS Chlamydia trachomatis (15–50%)* Ureaplasmaurealyticum (10–40%)* Mycoplasmagenitalium (30%??) Trichomonasvaginalis (1–17%)* Herpes simplex virus (primary) (?%) ETIOLOGY

  19. Treatment Initial Treatment for Patient and Partners *Epidemiologic treatment of sexual partners is recommended

  20. Ceftizoxime (500 mg IM, single dose) or Cefotaxime (500 mg IM, single dose) or Spectinomycin (2 g IM, single dose) or Cefotetan (1 g IM, single dose) plus probenecid (1 g PO, single dose) or Cefoxitin (2 g IM, single dose) plus probenecid (1 g PO, single dose) Alternative regimens

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