Sexually transmitted diseases (STDs) are a major health problem for adolescents. Health care providers for adolescents play a critical role in preventing and treating STDs. In May 2002, the Centers for Disease Control and Prevention published the Sexually Transmitted Diseases Treatment Guidelines 2002. These evidence-based guidelines are based on a systematic literature review focusing on information that had become available since the 1998 Guidelines for Treatment of STDs. This article reviews the new STD treatment guidelines for gonorrhea, chlamydia, bacterial vaginosis, trichomonas, vulvovaginal candidiasis, pelvic inflammatory disease, genital warts, herpes simplex virus infection, syphilis, and scabies. Although these guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed.
"Because of its polymicrobial nature, PID is treated with antibiotics covering a broad spectrum of pathogens. Guidelines from the US Centers for Disease Control and Prevention recommend outpatient treatment of PID with ofloxacin, levofloxacin , ceftriaxone plus doxycycline, or cefoxitin and probenecid plus doxycycline, all with optional metronidazole for full coverage against anaerobes and bacterial vaginosis . Compliance with antibiotic therapy for PID is poor, however, particularly in adolescents and in patients undergoing complex, prolonged treatment regimens  . "
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy and safety of moxifloxacin versus ofloxacin plus metronidazole in patients with uncomplicated pelvic inflammatory disease (uPID; defined as PID symptoms and signs, but no complications such as septicemia, perihepatitis, and tubo-ovarian abscess) in Turkey.
This was a multicenter, prospective, randomized, parallel-group study conducted between June 2010 and March 2013 in four hospitals in Turkey. Women received a 14-day course of either oral moxifloxacin at 400mg once daily (n=560) or oral ofloxacin at 400mg twice daily plus oral metronidazole at 500mg twice daily (n=543).
A total of 1156 women were randomized to the study. Total compliance was achieved in 1103 patients. For the primary measure of efficacy (clinical cure), moxifloxacin showed no difference compared with ofloxacin plus metronidazole (445/560 [79.5%] vs. 449/543 [82.7%]; p=0.172). Bacteriological cure rates were high and comparable between treatment arms (99/119 [83.2%] vs. 93/110 [84.5%]; p=0.781). Drug-related adverse events occurred less frequently with moxifloxacin than with ofloxacin plus metronidazole (210/560 [37.5%] vs. 252/543 [46.4%]; p=0.003). Furthermore, moxifloxacin treatment was lower in cost and achieved higher patient compliance compared with ofloxacin plus metronidazole (31.4 Euros vs. 23.4 Euros and 7/578 (1.2%) vs. 22/578 (3.8%), respectively; p=0.005).
In patients with uPID, once-daily moxifloxacin monotherapy was clinically and microbiologically as efficacious as twice-daily ofloxacin plus metronidazole therapy and was associated with fewer drug-related adverse events, lower patient non-compliance, and a lower treatment cost.
European journal of obstetrics, gynecology, and reproductive biology 08/2013; 171(1). DOI:10.1016/j.ejogrb.2013.08.012 · 1.70 Impact Factor
"Accurate diagnosis with effective treatment to prevent further transmission is one of the essential elements for control of gonococcal infections . Treatment strategies should be devised to utilize appropriate and preferably single-dose therapy that could be conveniently administered at the time of diagnosis . Surveillance of Neisseria gonorrhoeae antimicrobial resistance is crucial in guiding empirical therapy in any individual setting as resistance may vary in different countries . "
[Show abstract][Hide abstract] ABSTRACT: Emergence and spread of drug resistant Neisseria gonorrhoeae is global concern. We evaluated trends of antimicrobial resistance in Neisseria gonorrhoeae over years 1992-2009 in Pakistan. Resistance rates were compared between years (2007-2009) and (1992-2006). Antimicrobial susceptibility testing was performed and interpreted according to Clinical Laboratory Standards Institute (CLSI) criteria using the disk diffusion methodology against penicillin, ceftriaxone, tetracycline and ofloxacin. Additional antibiotics tested in 100 strains isolated during 2007-2009, included cefotaxime, cefoxitin, cefuroxime, cefipime, ceftazidime, ceftizoxime, cefixime, cefpodoxime, spectinomycin and azithromycin. Neisseria gonorrhoeae ATCC 49226 was used as control. Chi-square for trend analysis was conducted to assess resistance trend over the study period. During study period significant increase in combined resistance to penicillin, tetracycline and ofloxacin was observed (P value <0.01). Resistance rates during the two study period also increased significantly (P value <0.01). Ceftriaxone resistance was not observed. None of the isolates were found to be resistant or with intermediate sensitivity to additional antibiotics. Our findings suggest that penicillin, ciprofloxacin, tetracycline should not be used in the empirical treatment of gonorrhea in Pakistan. Ceftriaxone and cefixime should be the first line therapy; however periodic MICs should be determined to identify emergence of strains with reduced susceptibility.
Journal of Tropical Medicine 09/2011; 2011(1687-9686):960501. DOI:10.1155/2011/960501
"In the US, contact tracing is required for TB , recommended for human immunodeficiency virus (HIV) , and not uncommon for other sexually transmitted diseases (STDs)  . Contact tracing has also been used (and modeled) for severe acute respiratory syndrome (SARS) , footand-mouth-disease , smallpox [16, 17], and avian influenza . "
[Show abstract][Hide abstract] ABSTRACT: Contact tracing (also known as partner notification) is a primary means of controlling infectious diseases such as tuberculosis (TB), human immunodeficiency virus (HIV), and sexually transmitted diseases (STDs). However, little work has been done to determine the optimal level of investment in contact tracing. In this paper, we present a methodology for evaluating the appropriate level of investment in contact tracing. We develop and apply a simulation model of contact tracing and the spread of an infectious disease among a network of individuals in order to evaluate the cost and effectiveness of different levels of contact tracing. We show that contact tracing is likely to have diminishing returns to scale in investment: incremental investments in contact tracing yield diminishing reductions in disease prevalence. In conjunction with a cost-effectiveness threshold, we then determine the optimal amount that should be invested in contact tracing. We first assume that the only incremental disease control is contact tracing. We then extend the analysis to consider the optimal allocation of a budget between contact tracing and screening for exogenous infection, and between contact tracing and screening for endogenous infection. We discuss how a simulation model of this type, appropriately tailored, could be used as a policy tool for determining the appropriate level of investment in contact tracing for a specific disease in a specific population. We present an example application to contact tracing for chlamydia control.
Health Care Management Science 01/2008; 10(4):341-55. DOI:10.1007/s10729-007-9027-6 · 1.05 Impact Factor
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