Guidelines for the Management of Sexually Transmitted Infections: 1. INTRODUCTION: 1.6. Selection of drugs

Guidelines for the Management of Sexually Transmitted Infections
(2001; 88 pages)

Table des matières

PREFACE
1. INTRODUCTION
	1.1. Background
	1.2. Rationale for standardized treatment recommendations
	1.3. Case management
	1.4. Syndromic management
	1.5. Risk factors for STI-related cervicitis
	1.6. Selection of drugs
2. TREATMENT OF STI-ASSOCIATED SYNDROMES
	2.1. Urethral discharge
		2.1.1. Persistent or recurrent urethral discharge
	2.2. Genital ulcer
		Genital ulcer and HIV infection
		Inguinal bubo
	2.3. Scrotal swelling
	2.4. Vaginal discharge
		Cervical infection
		Vaginal infection
	2.5. Lower abdominal pain
	2.6. Neonatal conjunctivitis
3. TREATMENT OF SPECIFIC INFECTIONS
	3.1. Gonococcal infections
		Uncomplicated anogenital infection
		Disseminated infection
		Gonococcal ophthalmia
	3.2. Chlamydia trachomatis infections (other than lymphogranuloma venereum)
		Uncomplicated anogenital, endocervical or rectal infections
		Neonatal chlamydial conjunctivitis
		Infantile pneumonia
	3.3. Lymphogranuloma venereum
	3.4. Syphilis
		Early syphilis
		Late latent syphilis
		Neurosyphilis
		Syphilis and HIV infection
		Syphilis in pregnancy
		Congenital syphilis
	3.5. Chancroid
	3.6. Granuloma inguinale (Donovanosis)
	3.7. Genital herpes infections
		First clinical episode
		Recurrent infections
		Suppressive therapy
		Herpes in pregnancy
		Herpes and HIV co-infection
	3.8. Venereal warts
		Vaginal warts
		Cervical warts
		Meatal and urethral warts
	3.9. Trichomonas vaginalis infections
	3.10. Bacterial vaginosis
		Bacterial vaginosis in pregnancy
	3.11. Candidiasis
		Vulvovaginal candidiasis
		Vulvovaginal candidiasis in pregnancy
		Vulvovaginal candidiasis and HIV infection
		Balanoposthitis
	3.12. Scabies
	3.13. Phthiriasis (pediculosis pubis)
4. KEY CONSIDERATIONS UNDERLYING TREATMENTS
	4.1. The choice of antimicrobial regimens
	4.2. Comments on individual drugs
	4.3. Antimicrobial resistance in N. gonorrhoeae
	4.4. Antimicrobial resistance in H. ducreyi
5. PRACTICAL CONSIDERATIONS IN STI CASE MANAGEMENT
	5.1. The Public Health package for STI prevention and care
	5.2. Clinical considerations
	5.3. Education for primary prevention
	5.4. Education and counselling during an STI consultation
	5.5. Notification and management of sexual partners
	5.6. Access to services
6. CHILDREN⁶, ADOLESCENTS AND SEXUALLY TRANSMITTED INFECTIONS
	6.1. Evaluation for sexually transmitted infections
ANNEX. LIST OF PARTICIPANTS

1.6. Selection of drugs

Antimicrobial resistance of several sexually transmitted pathogens has been increasing in many parts of the world and this has rendered some low-cost regimens ineffective. Recommendations to use more effective drugs frequently raise concerns about cost and possible misuse.

A two-tier drug policy with the provision of less effective drugs at the peripheral health care level and the most effective and usually more expensive drugs only at a referral level may result in an unacceptable rate of treatment failures, complications and referrals, and may erode confidence in health services. This approach is not recommended. The drugs used for STI in all health care facilities should be at least 95% effective. Criteria for the selection of drugs are listed in the box below.

Criteria for the selection of STI drugs

Drugs selected for treating STI should meet the following criteria:

• high efficacy (at least 95%)
• low cost
• acceptable toxicity and tolerance
• organism resistance unlikely to develop or likely to be delayed
• single dose
• oral administration
• not contraindicated for pregnant or lactating women.

Appropriate drugs should be included in the national Essential Drugs list and in choosing drugs, consideration should be given to the capabilities and experience of health personnel.