tailieunhanh - Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 19) Ulcerative

Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 19) Ulcerative Genital or Perianal Lesions: Treatment Immediate syndrome-based treatment for acute genital ulcerations (after collection of all necessary hdiagnostic specimens at the first visit) is often appropriate before all test results become available, because patients with typical initial or recurrent episodes of genital or anorectal herpes can benefit from prompt oral antiviral therapy (Chap. 172); because early treatment of sexually transmitted causes of genital ulcers decreases further transmission; and because some patients do not return for test results and treatment. The patient with nonvesicular ulcerative lesions who may not return for. | Chapter 124. Sexually Transmitted Infections Overview and Clinical Approach Part 19 Ulcerative Genital or Perianal Lesions Treatment Immediate syndrome-based treatment for acute genital ulcerations after collection of all necessary hdiagnostic specimens at the first visit is often appropriate before all test results become available because patients with typical initial or recurrent episodes of genital or anorectal herpes can benefit from prompt oral antiviral therapy Chap. 172 because early treatment of sexually transmitted causes of genital ulcers decreases further transmission and because some patients do not return for test results and treatment. The patient with nonvesicular ulcerative lesions who may not return for follow-up or may not discontinue sexual activity should receive initial treatment for syphilis together with empirical therapy for chancroid if there has been an exposure in an area where chancroid occurs or if regional lymph node suppuration is evident. In resource-poor settings lacking ready access to diagnostic tests this approach to syndromic treatment for syphilis and chancroid has helped bring these two diseases under control. Finally empirical antimicrobial therapy may be indicated if ulcers persist and the diagnosis remains unclear after a week of observation despite attempts to diagnose herpes syphilis and chancroid. Proctitis Proctocolitis Enterocolitis and Enteritis Sexually acquired proctitis with inflammation limited to the rectal mucosa the distal 10-12 cm results from direct rectal inoculation of typical STD pathogens. In contrast inflammation extending from the rectum to the colon proctocolitis involving both the small and the large bowel enterocolitis or involving the small bowel alone enteritis can result from ingestion of typical intestinal pathogens through oral-anal exposure during sexual contact. Anorectal pain and mucopurulent bloody rectal discharge suggest proctitis or protocolitis. Proctitis commonly produces tenesmus .