Lymphogranuloma venereum, treatment

The sulfas also remain clinically useful in the treatment of chancroid, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, and the fungus-related nocardiosis (7). In combination with pyrimethamine, they are recommended for toxoplasmosis (8) and have been used for chloroquine-resistant falciparium malaria (4,9). There has also been some use of sulfas for the prophylaxis of rheumatic fever. The sulfone, dapsone, remains an accepted treatment for all forms of leprosy (4). 

Respiratory, skin, and soft-tissue infections UTIs pelvic inflammatory disease (PID) brucellosis trachoma Rocky Mountain spotted fever typhus Q fever lickettsia severe acne (Adoxa) smallpox psittacosis ornithosis granuloma inguinale lymphogranuloma venereum intestinal amebiasis (adjunctive treatment) prevention of rheumatic fever ... 

The spectrum of sexually transmitted diseases (STDs) includes the classic venereal diseases—gonorrhea, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale—as well as a variety of other pathogens known to he spread hy sexual contact (Table 46-1). Common clinical syndromes associated with STDs are listed in Table 46-2. The most current information on epidemiology, diagnosis, and treatment of STDs provided by the Centers for Disease Control and Prevention (CDC) can be found at http //www.cdc.gov. 

This chapter is a review of the antimicrobial susceptibilities of the causative organisms and the treatment of the sexually transmitted infections most prevalent in North America and Western Europe, gonorrhea, nongonococcal urethritis, genital herpes virus infections, and trichomoniasis. Because of their relative rarity or because no important advances in therapy have been made in the past decade, syphilis, lymphogranuloma venereum, chancroid, and granuloma inguinale are not considered. 

Sulhsoxazole is used in urinary tract and systemic infections in lymphogranuloma venereum (genital, inguinal, or anorectal infections) in uncomplicated urethral, endocervi-cal, or rectal infechons caused by C. trachomatis in con-junctivihs, corneal ulcer, superflcial ocular infechons and as an adjunct in systemic treatment of trachoma. 

Tetracyclines are effective in the treatment of Rocky Mountain spotted fever, murine typhus, recrudescent epidemic typhus, scrub typhus, Q fever, lymphogranuloma venereum, psittacosis, tularemia, brucellosis, gonorrhea, certain urinary tract infections, granuloma inguinale, chancroid, syphilis, and disease due to Bacteroides and Clostridium. 

Chlamydia Doxycychne (100 mg twice daily for 21 days) is first-hne therapy for Lymphogranuloma Venereum. If relapse occurs, treatment is resumed with full doses and continued for longer periods. 

Resistance to sulfonamides is now common for N. meningitidiSy as well as in cases of bacillary dysentery. Antibiotics have generally replaced the sulfonamides for these purposes. Sulfonamides, particulady sulfisoxazole and sulfadiazine, are of value in treatment of infections due to Nocardia species, and sulfonamides are effective for trachoma. Inclusion conjunctivitis is also treated with sulfacetamide ointment. Oral administration of a sulfonamide, eg, sulfisoxazole, has been successful for treatment of lymphogranuloma venereum and chancroid Dapsone and sulfonamides have also been used for treatment of the skin disorder dermatitis herpetiformis. Sulfonamides have been used for long term prophylaxis of rheumatic fever, but are being replaced by penicillin for this purpose, except in cases of hypersensitivity to penicillin (19). 

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