Education key to reducing STIs
Education is the best strategy for preventing the spread of sexually transmitted infections (STIs), according to a digest of the new guidelines on managing genitourinary tract infection released by the Urological Association of Asia and the Asian Association of UTI and STI.
“It is considered effective to provide such education by the age of 15 to 16 years, ideally before teenagers become sexually active,” said Ryoichi Hamasuna from the Department of Urology at the University of Occupational and Environmental Health in Japan, who discussed the STI part of the guidelines at the 14th Urological Association of Asia (UAA) Congress in Singapore.
Using condoms can protect individuals from some STIs but not all, he said, adding that “there [should be] no rush to have sex.”
Hamasuna also discussed the different treatment strategies for male urethritis (gonococcal urethritis, chlamydial urethritis, and non-chlamydial non-gonococcal urethritis, especially M. genitalium urethritis and Trichomonal urethritis), as well as diagnosis and treatment for genital skin diseases, including syphilis and herpes.
With antimicrobial resistant N. gonorrhoeae strains spreading worldwide, he recommended treating gonococcal infection with ceftriaxone (maximum dose for gonorrhoea in each country; intramuscularly or intravenous as a single shot) or spectinomycin (effective for urethritis, but not pharyngeal infection).
For patients with an allergy to ceftriaxone, clinicians should administer azithromycin (2 g orally once daily) or azithromycin extended release (2 g orally once daily). Maximum dose of each drug should be used if dual therapy is considered to prevent antimicrobial resistance, Hamasuna said.
For C. trachomitis infection, the recommended regimens are macrolide, tetracycline, or fluoroquinolone (azithromycin 1 or 2 g single dose; doxycycline 100 mg twice daily for 7 days).
Alternative treatment regimens include clarithromycin (200 mg twice daily for 7 days), levofloxacin (500 mg once daily for 7 days), ofloxacin (200 mg, thrice daily for 7 days), tosufloxacin (100 mg twice daily for 7 days), minocycline (100 mg twice daily for 7 days), or sitafloxacin (100 mg twice daily for 7 days).
For M. genitalium urethritis, Hamasuna recommended azithromycin (1 or 2 g single dose) or doxycycline (100 mg twice daily for 7 days). If these regimens fail, clinicians should administer moxifloxacin (400 mg once daily for 10 days) or sitafloxacin (100 mg twice daily for 7 days).
For trichomonal urethritis, the recommended treatments include metronidazole (2 g orally as a single dose) and tinidazole (2 g orally as a single dose). Should these fail, 500 mg of metronidazole must be given twice daily for 7 days.
Hamasuna also shared the diagnoses and treatments for genital skin diseases.
For syphilis, dark field microscopy and serological test are used to detect the disease. Recommended treatments include benzathine penicillin (2.4 million units single dose for early syphilis; 3 weeks for late syphilis), azithromycin (100 mg twice daily, tetracycline (500 mg, 4 times daily for 14 days for early syphilis), and ceftriaxone (1 to 2 g a day for 10 to 21 days for early syphilis).
In making a diagnosis for genital herpes, clinicians could use Tzanck smear test, PCR method, or HSV antigen detection assay.
Several treatment regimens are needed depending on the condition of the patient. For first episode, Hamasuna recommended the use of acyclovir (200 mg, 5 times daily; 400 mg, thrice for 7 to 10 days), famciclovir (250 mg, thrice daily for 7 to 10 days), or valacyclovir (1,000 mg, twice daily for 7 to 10 days).
For recurrent genital herpes, treatments include starting antiviral therapy within 48 hours of the onset of lesions, 5 days regimen, or ultra short regimens (1 to 2 days).
For patients with 6 or more recurrence a year, suppressive antiviral therapy should be used. This includes acyclovir (400 mg twice daily), famciclovir (250 mg twice daily), or valacyclovir (500 mg or 1,000 mg once daily).