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admin | What Treats Bv | 30.08.2013
In the United States, most young, sexually active patients who have genital, anal, or perianal ulcers have either genital herpes or syphilis.
Some of the signs of a yeast infection are itching, burning or swelling in and around the affected area. Tea Tree essential oil has natural antibiotic properties that’s why it works best against sinus infections. The flowers from an elderberry plant are great ingredients that fight infection and inflammation of the sinus. Cellulitis is a bacterial skin infection, which is quite common, and if not treated immediately, can prove to be fatal. It's important to diagnose and start treatment early as if left untreated, this bacterial infection can spread rapidly and can be life threatening for the patient. The cause of cellulitis is one or more types of bacteria, which enter the body via a break or cut in the skin. As mentioned before, the lower region of the leg is the most common part of the body affected by cellulitis. Individuals who use certain medications, like corticosteroids which may weaken the immune system are also at an increased risk for cellulitis. Lymphedema which causes chronic swelling of the arms or legs due to which there may be cracks or fissures in the swollen tissue thus increasing the chances of entry of bacteria and cellulitis. Individuals who are involved in illegal intravenous drug use are at a higher risk for developing cellulitis. Individuals who are obese or overweight are more vulnerable for developing cellulitis, as well as having recurrent episodes of cellulitis. Treatment for cellulitis comprises of oral antibiotics which need to be taken for 14 days and they should be continued even if the symptoms have eased up and the patient is feeling better.
If the signs and symptoms do not clear up within a few days and if the cellulitis increases and the patient has fever, then hospitalization is required and I.V. It is very important to follow your doctor's instructions and take medication as instructed and complete the course of antibiotics even if the symptoms subside. The frequency of each condition differs by geographic area and population; however, genital herpes is the most prevalent of these diseases.
If it is a vaginal yeast infection, there will be pain or discomfort in the vagina during sex, a burning feeling when urinating, and odorless vaginal discharge. Pinecone extract strengthens and balances the immune system to help your body fight off yeast naturally. Streptococcus and staphylococcus are the two most common types of bacteria, which are responsible for cellulitis. Bacteria can enter through the skin which has broken from cuts, surgery, ulcer, puncture wounds, dermatitis, athlete's foot etc.
Skin which is vulnerable, such as dry or flaky or swollen skin can also be more susceptible towards bacterial entry. The doctor will let you know if the treatment is effective or not within three days of starting an antibiotic. The good thing about pinecone extract is there are no known side effects, and it does not kill off the good bacteria.Immunophen has been proven to get to the root of the problem by supporting the immune system to achieve its own healthy balance.
We all know how annoying sinus infections can be so here are ways to cure them inside the comforts of your home. Eucalyptus essential oil is a natural anti-bacterial ingredient that fights off sinus infections. If the affected area is kept elevated, then it speeds up the recovery process and the swelling also subsides quickly. Less common infectious causes of genital, anal, or perianal ulcers include chancroid and donovanosis.
For treating a yeast infection, only use plain, unsweetened yogurt.You can externally apply plain yogurt on the affected skin area and let it sit for at least 20 to 30 minutes, or preferebly overnight. Since yeast will always be with us it is critical to create a healthy immune system that has the ability to keep yeast in a healthy balance too. Continue reading and check if you’ve used or applied one sinus infection remedy without antibiotics listed below. Cellulitis commonly affects the skin on the lower legs; however, cellulitis can affect any part of the body. This will help relieve the itching sensation.For a vaginal yeast infection, dip a tampon in yogurt and then insert it in the vagina for two hours. Cellulitis can be limited only to the skin's surface or it can affect the underlying tissues and further spread to the bloodstream and lymph nodes. Therefore, all patients who have genital, anal, or perianal ulcers should be evaluated with a serologic test for syphilis and a diagnostic evaluation for genital herpes; in settings where chancroid is prevalent, a test for Haemophilus ducreyi should also be performed. I had strep throat and the doctor gave amoxicillin 500MG one capsule twice a day for ten days. Apply it on the affected skin area to control the growth of the infection.In case of oral thrush, swish the oil in your mouth for five to 10 minutes. Type-specific serology for HSV-2 might be helpful in identifying persons with genital herpes (see Genital Herpes, Type-Specific Serologic Tests). In addition, biopsy of genital, anal, or perianal ulcers can help identify the cause of ulcers that are unusual or that do not respond to initial therapy. HIV testing should be performed on all persons with genital, anal, or perianal ulcers who are not known to have HIV infection (see Diagnostic Considerations, sections on Syphilis , Chancroid, and Genital Herpes Simplex Virus).Health-care providers frequently must treat patients before test results are available, because early treatment decreases the possibility of ongoing transmission and because successful treatment of genital herpes depends on prompt initiation of therapy.
Soon the skin irritation and itching will lessen.Alternatively, you can dilute white or apple cider vinegar with plain water and then apply it externally on the affected skin area. Worldwide, chancroid appears to have declined as well, although infection might still occur in some regions of Africa and the Caribbean.
Chancroid, as well as genital herpes and syphilis, is a risk factor in the transmission of HIV infection (144).A definitive diagnosis of chancroid requires the identification of H. The antifungal, antibacterial and natural antibiotic components present in garlic can be highly effective in treating any kind of yeast infection.Crush a few garlic cloves and make a paste out of it. If you do not have fresh garlic, you can dilute garlic oil with vitamin E oil and a few drops of coconut oil and apply it to the affected skin.You can also take a couple of garlic tablets or eat a few fresh garlic cloves daily.
It can also treat urinary tract or any other kind of bladder infections.Drink unsweetened cranberry juice several times a day. This will speed up the healing process and produce effective results within a short time.If unsweetened cranberry juice is not available, you can take cranberry tablets two or three times a day. Worldwide, several isolates with intermediate resistance to either ciprofloxacin or erythromycin have been reported. However, because cultures are not routinely performed, data are limited regarding the current prevalence of antimicrobial resistance.Other Management ConsiderationsMen who are uncircumcised and patients with HIV infection do not respond as well to treatment as persons who are circumcised or HIV-negative.
If treatment is successful, ulcers usually improve symptomatically within 3 days and objectively within 7 days after therapy. If no clinical improvement is evident, the clinician must consider whether 1) the diagnosis is correct, 2) the patient is coinfected with another STD, 3) the patient is infected with HIV, 4) the treatment was not used as instructed, or 5) the H.
In addition, healing is slower for some uncircumcised men who have ulcers under the foreskin. Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might require needle aspiration or incision and drainage, despite otherwise successful therapy.
No adverse effects of chancroid on pregnancy outcome have been reported.HIV InfectionHIV-infected patients who have chancroid should be monitored closely because, as a group, they are more likely to experience treatment failure and to have ulcers that heal more slowly. HIV-infected patients might require repeated or longer courses of therapy than those recommended for HIV-negative patients, and treatment failures can occur with any regimen.
Because data are limited concerning the therapeutic efficacy of the recommended ceftriaxone and azithromycin regimens in HIV-infected patients, these regimens should be used for such patients only if follow-up can be ensured.Genital HSV InfectionsGenital herpes is a chronic, life-long viral infection. Most cases of recurrent genital herpes are caused by HSV-2, and at least 50 million persons in the United States are infected with this type of genital herpes (147). However, an increasing proportion of anogenital herpetic infections in some populations has been attributed to HSV-1 infection.Most persons infected with HSV-2 have not been diagnosed with genital herpes. Many such persons have mild or unrecognized infections but shed virus intermittently in the genital tract. As a result, the majority of genital herpes infections are transmitted by persons unaware that they have the infection or who are asymptomatic when transmission occurs. Management of genital HSV should address the chronic nature of the disease and go beyond the treatment of acute episodes of genital ulcers.Diagnosis of HSV InfectionThe clinical diagnosis of genital herpes is both nonsensitive and nonspecific.
The classical painful multiple vesicular or ulcerative lesions are absent in many infected persons. Recurrences and subclinical shedding are much less frequent for genital HSV-1 infection than for genital HSV-2 infection (150,151).
Both virologic and type-specific serologic tests for HSV should be available in clinical settings that provide care for persons diagnosed with or at risk for STDs.Virologic TestsCell culture and PCR are the preferred HSV tests for persons who seek medical treatment for genital ulcers or other mucocutaneous lesions.
The sensitivity of viral culture is low, especially for recurrent lesions, and declines rapidly as lesions begin to heal.
PCR assays for HSV DNA are more sensitive and are increasingly used in many settings (153,154).
PCR is the test of choice for detecting HSV in spinal fluid for diagnosis of HSV infection of the central nervous system (CNS). Viral culture isolates should be typed to determine which type of HSV is causing the infection. Failure to detect HSV by culture or PCR does not indicate an absence of HSV infection, because viral shedding is intermittent. Accurate type-specific HSV serologic assays are based on the HSV-specific glycoprotein G2 (HSV-2) and glycoprotein G1 (HSV-1).
The sensitivities of these glycoprotein G type-specific tests for the detection of HSV-2 antibody vary from 80%–98%, and false-negative results might be more frequent at early stages of infection.
False-positive results can occur, especially in patients with a low likelihood of HSV infection. Repeat or confirmatory testing might be indicated in some settings, especially if recent acquisition of genital herpes is suspected. IgM testing for HSV is not useful, because the IgM tests are not type-specific and might be positive during recurrent episodes of herpes (159).Because nearly all HSV-2 infections are sexually acquired, the presence of type-specific HSV-2 antibody implies anogenital infection. In this instance, education and counseling appropriate for persons with genital herpes should be provided. Other places in the body commonly attacked by Candida albicans are the genitalia, toenails, in belly buttons, underneath the breasts, under the fat rolls, crotch, glands in the penis, around the anus.


Most persons with HSV-1 antibody have oral HSV infection acquired during childhood, which might be asymptomatic. Basically, any part of the body has the possibility of getting yeast infections, anywhere warm and moist. However, acquisition of genital HSV-1 appears to be increasing, and genital HSV-1 also can be asymptomatic (147-149). HSV serologic testing should be considered for persons presenting for an STD evaluation (especially for those persons with multiple sex partners), persons with HIV infection, and MSM at increased risk for HIV acquisition.
Screening for HSV-1 and HSV-2 in the general population is not indicated.Management of Genital HerpesAntiviral chemotherapy offers clinical benefits to most symptomatic patients and is the mainstay of management.
Counseling regarding the natural history of genital herpes, sexual and perinatal transmission, and methods to reduce transmission is integral to clinical management.Systemic antiviral drugs can partially control the signs and symptoms of herpes episodes when used to treat first clinical and recurrent episodes, or when used as daily suppressive therapy. However, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued. Randomized trials have indicated that three antiviral medications provide clinical benefit for genital herpes: acyclovir, valacyclovir, and famciclovir (160-168).
Valacyclovir is the valine ester of acyclovir and has enhanced absorption after oral administration.
Topical therapy with antiviral drugs offers minimal clinical benefit, and its use is discouraged.First Clinical Episode of Genital HerpesNewly acquired genital herpes can cause a prolonged clinical illness with severe genital ulcerations and neurologic involvement. Even persons with first-episode herpes who have mild clinical manifestations initially can develop severe or prolonged symptoms. Intermittent asymptomatic shedding occurs in persons with genital HSV-2 infection, even in those with longstanding or clinically silent infection. Antiviral therapy for recurrent genital herpes can be administered either as suppressive therapy to reduce the frequency of recurrences or episodically to ameliorate or shorten the duration of lesions.
Some persons, including those with mild or infrequent recurrent outbreaks, benefit from antiviral therapy; therefore, options for treatment should be discussed. Safety and efficacy have been documented among patients receiving daily therapy with acyclovir for as long as 6 years and with valacyclovir or famciclovir for 1 year (171,172). Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy to prevent transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences. 1st thing in the morning spit in a clear glass of water if within 5 min there are tendrils flowing down it IS yeast… so what is a person to do??? Ease of administration and cost also are important considerations for prolonged treatment.Episodic Therapy for Recurrent Genital HerpesEffective episodic treatment of recurrent herpes requires initiation of therapy within 1 day of lesion onset or during the prodrome that precedes some outbreaks.
I am an asthmatic and inhalant treatments can caused this even if I rinse my mouth out as directed.
I also found if I drink or eat foods that have sugar in them or yeast breads the thrush comes back. Acyclovir dose adjustment is recommended for impaired renal function.CounselingCounseling of infected persons and their sex partners is critical to the management of genital herpes.
I can tell I have thrush even before it shows up on my tongue because my throat and tonsils will be sore, as if I am coming down with a cold. The goals of counseling include 1) helping patients cope with the infection and 2) preventing sexual and perinatal transmission (174,175).
An diet to kill thrush or candida is extremely limiting and quite frankly not very realistic. Although initial counseling can be provided at the first visit, many patients benefit from learning about the chronic aspects of the disease after the acute illness subsides.
Common concerns regarding genital herpes include the severity of initial clinical manifestations, recurrent episodes, sexual relationships and transmission to sex partners, and ability to bear healthy children. During an outbreak after I brush my teeth and tongue I sanitize my toothbrush by pouring a bit of hydrogen peroxide, or mouth wash or even a small amount of rubbing alcohol on it. I let the disinfectant sit on the brush for a moment than rinse it clean and make sure to dry it.
Type-specific serologic testing of the asymptomatic partners of persons with genital herpes is recommended to determine whether such partners are already HSV seropositive or whether risk for acquiring HSV exists.The risk for neonatal HSV infection should be explained to all persons, including men. Pregnant women and women of childbearing age who have genital herpes should inform their providers who care for them during pregnancy and those who will care for their newborn infant about their infection. Then I will take a dose of liquid antihistamine and swish it around like a mouth wash before swallowing.
Pregnant women who are not known to be infected with HSV-2 should be advised to abstain from intercourse with men who have genital herpes during the third trimester of pregnancy. In addition, such persons should be educated about the clinical manifestations of genital herpes.When exposed to HIV, HSV-2 seropositive persons are at increased risk for HIV acquisition.
Patients should be informed that suppressive antiviral therapy does not reduce the increased risk for HIV acquisition associated with HSV-2 infection (177,178).Management of Sex PartnersThe sex partners of patients who have genital herpes can benefit from evaluation and counseling.
Symptomatic sex partners should be evaluated and treated in the same manner as patients who have genital lesions. Asymptomatic sex partners of patients who have genital herpes should be questioned concerning histories of genital lesions and offered type-specific serologic testing for HSV infection.Special ConsiderationsAllergy, Intolerance, and Adverse ReactionsAllergic and other adverse reactions to acyclovir, valacyclovir, and famciclovir are rare.
Desensitization to acyclovir has been described (179).HIV InfectionImmunocompromised patients can have prolonged or severe episodes of genital, perianal, or oral herpes. Lesions caused by HSV are common among HIV-infected patients and might be severe, painful, and atypical.
Once you have had it, it can come back much quicker because it hasn’t fully left the body. Whereas antiretroviral therapy reduces the severity and frequency of symptomatic genital herpes, frequent subclinical shedding still occurs (180). Clinical manifestations of genital herpes might worsen during immune reconstitution after initiation of antiretroviral therapy.Suppressive or episodic therapy with oral antiviral agents is effective in decreasing the clinical manifestations of HSV among HIV-positive persons (181-183). The extent to which suppressive antiviral therapy will decrease HSV transmission from this population is unknown. Such persons should be managed in consultation with an HIV specialist, and alternate therapy should be administered.
All acyclovir-resistant strains are resistant to valacyclovir, and the majority are resistant to famciclovir.
Then take a variety of immune building supplements and detox tea ( nettle, dandelion, camomile and ribose). During this process I also learned that stress and unprocessed emotions were actually the cause of my adrenals, then immune then finally my gut packing up. Imiquimod is a topical alternative, as is topical cidofovir gel 1%, which is not commercially available and must be compounded at a pharmacy. So I suggest getting really happy people and understand you are really amazing xxx Sassy Siren January 22, 2015 at 3:44 pm ReplyIn other words, eat steamed vegetables ONLY. These topical preparations should be applied to the lesions once daily for 5 consecutive days.Clinical management of antiviral resistance remains challenging among HIV-infected patients, and other preventative approaches might be necessary. However, experience with another group of immunocompromised persons (hematopoietic stem-cell recipients) demonstrated that persons receiving daily suppressive antiviral therapy were less likely to develop acyclovir-resistant HSV compared with those who received episodic therapy with outbreaks (185).Genital Herpes in PregnancyMost mothers of infants who acquire neonatal herpes lack histories of clinically evident genital herpes (186). A conventional doctor put me on this diet for two weeks when I had a bad case of thrush on my boobs, and was nursing.
However, because recurrent genital herpes is much more common than initial HSV infection during pregnancy, the proportion of neonatal HSV infections acquired from mothers with recurrent herpes is substantial.
Prevention of neonatal herpes depends both on preventing acquisition of genital HSV infection during late pregnancy and avoiding exposure of the infant to herpetic lesions during delivery. Because the risk for herpes is high in infants of women who acquire genital HSV during late pregnancy, these women should be managed in consultation with an infectious disease specialist.Women without known genital herpes should be counseled to abstain from intercourse during the third trimester with partners known or suspected of having genital herpes. In addition, pregnant women without known orolabial herpes should be advised to abstain from receptive oral sex during the third trimester with partners known or suspected to have orolabial herpes. Some specialists believe that type-specific serologic tests are useful to identify pregnant women at risk for HSV infection and to guide counseling regarding the risk for acquiring genital herpes during pregnancy and that such testing should be offered to uninfected women whose sex partner has HSV infection. However, the effectiveness of antiviral therapy to decrease the risk for HSV transmission to pregnant women by infected partners has not been studied.All pregnant women should be asked whether they have a history of genital herpes. Sassy Siren January 22, 2015 at 3:49 pm ReplyWord of caution about using garlic paste ALONE. At the onset of labor, all women should be questioned carefully about symptoms of genital herpes, including prodromal symptoms, and all women should be examined carefully for herpetic lesions.
It can burn your skin, and in the most delicate region we’re talking about for a yeast infection, proceed, carefully.
Although cesarean section does not completely eliminate the risk for HSV transmission to the infant, women with recurrent genital herpetic lesions at the onset of labor should deliver by cesarean section to prevent neonatal HSV infection.The safety of systemic acyclovir, valacyclovir, and famciclovir therapy in pregnant women has not been definitively established.
Available data do not indicate an increased risk for major birth defects compared with the general population in women treated with acyclovir during the first trimester (188) — findings that provide assurance to women who have had prenatal exposure to acyclovir.
However, data regarding prenatal exposure to valacyclovir and famciclovir are too limited to provide useful information on pregnancy outcomes.
Acyclovir can be administered orally to pregnant women with first episode genital herpes or severe recurrent herpes and should be administered IV to pregnant women with severe HSV infection.
Acyclovir treatment late in pregnancy reduces the frequency of cesarean sections among women who have recurrent genital herpes by diminishing the frequency of recurrences at term (189-191); the effect of antiviral therapy late in pregnancy on the incidence of neonatal herpes is not known. I put apple cider vinegar down below (ouch) followed by coconut oil mixed with a drop of cinnamon oil (no pain) then a crush clove of garlic. No data support the use of antiviral therapy among HSV seropositive women without a history of genital herpes.Neonatal HerpesInfants exposed to HSV during birth, as documented by maternal virologic testing or presumed by observation of maternal lesions, should be followed carefully in consultation with a pediatric infectious disease specialist.
Surveillance cultures of mucosal surfaces to detect HSV infection might be considered before the development of clinical signs of neonatal herpes. In addition, administration of acyclovir might be considered for infants born to women who acquired HSV near term because the risk for neonatal herpes is high for these infants. All infants who have neonatal herpes should be promptly evaluated and treated with systemic acyclovir.
Clinically, the disease is commonly characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudoboboes) might also occur.
Extragenital infection can occur with extension of infection to the pelvis, or it can disseminate to intraabdominal organs, bones, or the mouth. The lesions also can develop secondary bacterial infection and can coexist with other sexually transmitted pathogens.The causative organism is difficult to culture, and diagnosis requires visualization of dark-staining Donovan bodies on tissue crush preparation or biopsy. Treatment has been shown to halt progression of lesions, and healing typically proceeds inward from the ulcer margins; prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers. However, the value of empiric therapy in the absence of clinical signs and symptoms has not been established.Special ConsiderationsPregnancyPregnancy is a relative contraindication to the use of sulfonamides.


Azithromycin might prove useful for treating granuloma inguinale during pregnancy, but published data are lacking. Consult with your doctor or other health care provider before using any of these tips or treatments.
LGV is an invasive, systemic infection, and if it is not treated early, LGV proctocolitis can lead to chronic, colorectal fistulas and strictures.
Genital and colorectal LGV lesions can also develop secondary bacterial infection or can be coinfected with other sexually and nonsexually transmitted pathogens.Diagnosis is based on clinical suspicion, epidemiologic information, and the exclusion of other etiologies for proctocolitis, inguinal lymphadenopathy, or genital or rectal ulcers. Comparative data between types of serologic tests are lacking, and the diagnostic utility of serologic methods other than complement fixation and some microimmunofluorescence procedures has not been established. Serologic test interpretation for LGV is not standardized, tests have not been validated for clinical proctitis presentations, and C.
Doxycycline is the preferred treatment.Recommended RegimenDoxycycline 100 mg orally twice a day for 21 days Alternative RegimenErythromycin base 500 mg orally four times a day for 21 days Although clinical data are lacking, azithromycin 1 g orally once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.HIV InfectionPersons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.SyphilisSyphilis is a systemic disease caused by Treponema pallidum. On the basis of clinical findings, the disease has been divided into a series of overlapping stages, which are used to help guide treatment and follow-up.
Latent syphilis acquired within the preceding year is referred to as early latent syphilis; all other cases of latent syphilis are either late latent syphilis or latent syphilis of unknown duration. The use of only one type of serologic test is insufficient for diagnosis, because each type of test has limitations, including the possibility of false-positive test results in persons without syphilis.
The VDRL and RPR are equally valid assays, but quantitative results from the two tests cannot be compared directly because RPR titers frequently are slightly higher than VDRL titers. Treponemal test antibody titers should not be used to assess treatment response.Some clinical laboratories and blood banks have begun to screen samples using treponemal tests, typically by EIA or chemiluminescence immunoassays (201,202).
This strategy will identify both persons with previous treatment for syphilis and persons with untreated or incompletely treated syphilis. The positive predictive value for syphilis associated with a treponemal screening test result might be lower among populations with a low prevalence of syphilis.Persons with a positive treponemal screening test should have a standard nontreponemal test with titer performed reflexively by the laboratory to guide patient management decisions. If the nontreponemal test is negative, then the laboratory should perform a different treponemal test (preferably one based on different antigens than the original test) to confirm the results of the initial test.
If a second treponemal test is positive, persons with a history of previous treatment will require no further management unless sexual history suggests likelihood of re-exposure. Unless history or results of a physical examination suggest a recent infection, previously untreated persons should be treated for late latent syphilis.
Laboratory testing is helpful in supporting the diagnosis of neurosyphilis; however, no single test can be used to diagnose neurosyphilis in all instances. Cerebrospinal fluid (CSF) laboratory abnormalities are common in persons with early syphilis.
The VDRL in cerebrospinal fluid (CSF-VDRL), which is highly specific but insensitive, is the standard serologic test for CSF. When reactive in the absence of substantial contamination of CSF with blood, it is considered diagnostic of neurosyphilis; however in early syphilis, it can be of unknown prognostic significance (203). Most other tests are both insensitive and nonspecific and must be interpreted in relation to other test results and the clinical assessment.
Therefore, the laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, CSF cell count or protein, and a reactive CSF-VDRL with or without clinical manifestations.
The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS testing on CSF can be considered. Combinations of benzathine penicillin, procaine penicillin, and oral penicillin preparations are not considered appropriate for the treatment of syphilis.
Reports have indicated that practitioners have inadvertently prescribed combination benzathine-procaine penicillin (Bicillin C-R) instead of the standard benzathine penicillin product (Bicillin L-A) widely used in the United States. Practitioners, pharmacists, and purchasing agents should be aware of the similar names of these two products to avoid using the inappropriate combination therapy agent for treating syphilis (206).The effectiveness of penicillin for the treatment of syphilis was well established through clinical experience even before the value of randomized controlled clinical trials was recognized. Therefore, nearly all the recommendations for the treatment of syphilis are based not only on clinical trials and observational studies, but approximately 50 years of clinical experience.Parenteral penicillin G is the only therapy with documented efficacy for syphilis during pregnancy.
Pregnant women with syphilis in any stage who report penicillin allergy should be desensitized and treated with penicillin (see Management of Patients Who Have a History of Penicillin Allergy).The Jarisch-Herxheimer reaction is an acute febrile reaction frequently accompanied by headache, myalgia, fever, and other symptoms that usually occur within the first 24 hours after the initiation of any therapy for syphilis. The Jarisch-Herxheimer reaction occurs most frequently among patients who have early syphilis, presumably because bacterial burdens are higher during these stages. Antipyretics can be used to manage symptoms, but they have not been proven to prevent this reaction.
The Jarisch-Herxheimer reaction might induce early labor or cause fetal distress in pregnant women, but this should not prevent or delay therapy (see Syphilis During Pregnancy).Management of Sex PartnersSexual transmission of T. Therefore, in the absence of clinical neurologic findings, no evidence exists to support variation from the recommended treatment regimen for early syphilis. Symptomatic neurosyphilis develops in only a limited number of persons after treatment with the penicillin regimens recommended for primary and secondary syphilis.
Therefore, unless clinical signs or symptoms of neurologic or ophthalmic involvement are present or treatment failure is documented, routine CSF analysis is not recommended for persons who have primary or secondary syphilis.Follow-UpTreatment failure can occur with any regimen. However, assessing response to treatment frequently is difficult, and definitive criteria for cure or failure have not been established.
In addition, nontreponemal test titers might decline more slowly for persons who previously have had syphilis (207). Because treatment failure usually cannot be reliably distinguished from reinfection with T. In rare instances, serologic titers do not decline despite a negative CSF examination and a repeated course of therapy. However, several therapies might be effective in nonpregnant, penicillin-allergic patients who have primary or secondary syphilis.
Doxycycline 100 mg orally twice daily for 14 days (209,210) and tetracycline (500 mg four times daily for 14 days) are regimens that have been used for many years. Compliance is likely to be better with doxycycline than tetracycline, because tetracycline can cause gastrointestinal side effects. Although limited clinical studies, along with biologic and pharmacologic evidence, suggest that ceftriaxone (1 g daily either IM or IV for 10–14 days) is effective for treating early syphilis, the optimal dose and duration of ceftriaxone therapy have not been defined (211). As such, the use of azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible.
Close follow-up of persons receiving any alternative therapies is essential.Persons with a penicillin allergy whose compliance with therapy or follow-up cannot be ensured should be desensitized and treated with benzathine penicillin. Patients who have latent syphilis and who acquired syphilis during the preceding year are classified as having early latent syphilis. In addition, for persons whose only possible exposure occurred during the previous 12 months, reactive nontreponemal and treponemal tests are indicative of early latent syphilis. In the absence of these conditions, an asymptomatic person should be considered to have late latent syphilis or syphilis of unknown duration. Nontreponemal serologic titers usually are higher during early latent syphilis than late latent syphilis. However, early latent syphilis cannot be reliably distinguished from late latent syphilis solely on the basis of nontreponemal titers. All patients who have syphilis should be tested for HIV infection.TreatmentBecause latent syphilis is not transmitted sexually, the objective of treating patients with this stage of disease is to prevent complications. In addition, birth and maternal medical records should be reviewed to assess whether children have congenital or acquired syphilis (see Congenital Syphilis). Older children with acquired latent syphilis should be evaluated as described for adults and treated using the following pediatric regimens (see Sexual Assault or Abuse of Children). Pharmacologic considerations suggest that an interval of 10–14 days between doses of benzathine penicillin for late syphilis or latent syphilis of unknown duration might be acceptable before restarting the sequence of injections. Missed doses are not acceptable for pregnant patients receiving therapy for late latent syphilis.
Pregnant women who miss any dose of therapy must repeat the full course of therapy.Follow-UpQuantitative nontreponemal serologic tests should be repeated at 6, 12, and 24 months. In such circumstances, even if the CSF examination is negative, retreatment for latent syphilis should be initiated. In rare instances, despite a negative CSF examination and a repeated course of therapy, serologic titers might fail to decline.
Nonpregnant patients allergic to penicillin who have clearly defined early latent syphilis should respond to therapies recommended as alternatives to penicillin for the treatment of primary and secondary syphilis (see Primary and Secondary Syphilis, Treatment). The only acceptable alternatives for the treatment of late latent syphilis or latent syphilis of unknown duration are doxycycline (100 mg orally twice daily) or tetracycline (500 mg orally four times daily), both for 28 days. These therapies should be used only in conjunction with close serologic and clinical follow-up. Based on biologic plausibility and pharmacologic properties, ceftriaxone might be effective for treating late latent syphilis or syphilis of unknown duration. However, the optimal dose and duration of ceftriaxone therapy have not been defined, and treatment decisions should be discussed in consultation with a specialist.
Some patients who are allergic to penicillin also might be allergic to ceftriaxone; in these circumstances, use of an alternative agent might be required. Some providers treat all patients who have cardiovascular syphilis with a neurosyphilis regimen. However, CSF laboratory abnormalities are common in persons with early syphilis, even in the absence of clinical neurological findings. No evidence exists to support variation from recommended treatment for early syphilis for patients found to have such abnormalities. Follow-up CSF examinations also can be used to evaluate changes in the CSF-VDRL or CSF protein after therapy; however, changes in these two parameters occur more slowly than cell counts, and persistent abnormalities might be less important (219,220).



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