• MS STD in males
• Gu or NGU
• NGU>GU

• G-, diplococci 
• purulent d/c, dysuria 
• untreated: cause disseminated GC= fever, arthritis, skin rash, septic shock

• commonly chlamydia
• could be: HSV, trichomonas, candida, mycoplasma 
• less profuse mucoid d/c 
• may have dysuria w/o urethral d/c 
• avoid sexual contact for 7d after tx
• always tx partner

• MC STD in females 
• oral contraception increases risk 
• transmission: M->F

• purulent d/c + edema 
• sx: dysmenorrhea, dysparunia, dysuria 
• 50% asymptomatic 

• mucopurulent cervicitis
• non-specific abd pain, spotting during intercourse 
• 30% c/o vaginal d/c

ceftriaxone or cefixime 

tx all pts for GU & NGU

• azithromycin OR doxycycline 

• sex active adolescents <20
• women 20-24 w/ inconsistent use of barrier method, new partner, >1 partner in last 3 mos.
• pregnant women in 3^rd trimester
• women undergoing abortion
• women w/ mucopurulent d/c on pelvic exam regardless of sx

• more mucoid, less purulent d/c 
• lower abd pain 
• cervix: friable w/ occasional ulcers, necrosis 
• external genital lesions absent 
• multinuclear giant cells w/ intranuclear inclusions  

TX: 

acyclovir 7-10d

famciclovir 7-10d

valcyclovir 7-10d

• lower abd pain (diffuse tenderness) 
• recent onset of pain worsens during  sex or mvmt
• pain bilateral, rarely longer than 2wk duration 
• abnormal uterine bleeding 
• vaginal d/c, urethritis, fever (T>101), chills
• <35 yrs 
• new, multiple partners
• oral contraception
• cervical motion tenderness

Outpatient: 

ceftriaxone IM, cefoxitin + doxycycline 

Inpatient: 

cefotetan, cefoxin + doxycycline 

OR 

Clindamycin + gentamycin 

complications of PID?

when to hospitalize?

complications:

• predispose ectopic pregnancy 
• during pregnancy can cause premature birth wt, low birth wt, abortion

• exposure not thru sex contact 
• risk ↑w/ Abx use, corticosteroids, diabetes
• vaginal itching, burning, dysuria 
• thick white d/c 
• labial erythema, edema, fissures
• red vaginal mucosa/cervix

• clotrimazole/ nystatin/ miconazole/fluconazole 

• maloderous thin gray/ white vag d/c
• asymptomatic 
• elevated pH
• fish odor produced w/ KOH prep
• "clue cells"

oral:metronidazole

topical: clindamycin or metronidazole 

• risk: sex active, pregnancy 
• copious frothy, green-gray malodorous vaginal d/c
• vaginal pain, dysparunia 
• strawberry cervix 

• metronidazole 
• male partners should be tx 
• can tx w/  metronidazole after first trimester 

• PAINLESS ulcer 
• nontender inguinal adenopathy 

• rash, alopecia, condylomata 

meningitis sx:

• HA, confusion, nausea, vomiting, stiff neck, visual acuity down, cranial neuropathies 
• do lumbar puncture 

• incurable, recurrent 
• sex transmission thru viral shedding, can occur during asymptomatic periods
• multiple vesicles on erythematus base 
• shallow PAINFUL ulcer 
• low grade fever, HA, malaise 
• resolve after 1wk 
• scraped lesion reveals multinucleated giant cells 

PCN G 

doxycycline 

• relies on serologic testing 
• primary:
  • skin lesion: papule/herpetiform ulcer
  • lesion is PAINLESS, heals rapidly
• secondary:
  • enlarged, PAINFUL lymphadenopathy, unilateral 
  • enlarged nodes: groove's-sign above & below inguinal line 

• doxycycline 
• erythromycin 
• needle aspiration of fluctuant lymph nodes

• erythametous papule, rapidly evolves into pustule, erodes into ulcer 
• more than one ulcer, confined to genitals 
• PAINFUL lymphadenopathy 
• ulcer is PAINFUL, erythymatous base, border demarcated

• single dose azithromycin or ceftriaxone IM

• MC viral STD in US
• genital warts 
• direct association w/ cervical cancer 

• gardacil, administer b/f pt is sexually active 
• cryotherapy 
• laser tx
• surgical removal