Drug treatment of common STDs: Part II. Vaginal infections, pelvic inflammatory disease and genital warts

The Centers for Disease Control and Prevention (CDC) released new guideline s for the treatment of sexually transmitted diseases (STDs) in 1998. Severa l treatment advances have been made since the previous guidelines were publ ished. Part II of this two-part series on STDs describes recommendations fo r the treatment of diseases characterized by vaginal discharge, pelvic infl ammatory disease, epididymitis, human papillomavirus infection, proctitis, proctocolitis, enteritis and ectoparasitic diseases. Single-dose therapies are recommended for the treatment of several of these diseases, A single 1- g dose of oral azithromycin is as effective as a seven-day course of oral d oxycycline, 100 mg twice a day, for the treatment of chlamydial infection. Erythromycin and ofloxacin are alternative agents. Four single-dose therapi es are now recommended for the management of uncomplicated gonococcal infec tions, including 400 mg of cefixime, 500 mg of ciprofloxacin, 125 mg of cef triaxone or 400 mg of ofloxacin. Advances in the treatment of bacterial vag inosis also have been made. A seven-day course of oral metronidazole is sti ll recommended for the treatment of bacterial vaginosis in pregnant women, but intravaginal clindamycin cream and metronidazole gel are now recommende d in nonpregnant women. Single-dose therapy with 150 mg of oral fluconazole is a recommended treatment for vulvovaginal candidiasis, Two new topical t reatments, podofilox and imiquimod, are available for patient self-administ ration to treat human papillomavirus infection. Permethrin cream is now the preferred agent for the treatment of pediculosis pubis and scabies.