How Can I Manage Sexually Transmitted Infections?
Management and treatment of STIs depend on the infectious organism:
- Herpes simplex I & II: Oral antivirals (acyclovir, valcyclovir, and others) will not eradicated the HSV but will limit the frequency of outbreaks and reduce their severity.
- HIV and AIDS: Treated with antiviral regimens and symptomatic support, respectively. Effectiveness of treatment is quantified by blood tests for “viral load” response.
- Hepatitis B: Untreated, hepatitis B leads to liver failure, cirrhosis, and increased risk for liver cancer. Treatment with antivirals is begun depending on the presence of cirrhosis and HBV antibody levels. Resistance and breakthrough make hepatitis B very dangerous even with treatment. Counseling is advised to instruct patients on how to delay further liver damage by the avoidance of alcohol and having a hepatitis A vaccination.
- ● Hepatitis C: Untreated, hepatitis C becomes a chronic hepatitis which can involve the kidneys, skin, thyroid, and has been associated with the development of diabetes. State-of-the-art antiviral regimens have logged an excellent success rate in treating hepatitis C.
- Gonorrhea, Chlamydia, and syphilis: treatment is by antibiotics, with diagnostic tests after treatment to document a “test of cure.”
- HPV: Human papilloma virus may never cause a problem, but it can cause cervical cancer, metastatic disease, and death if untreated in women. Cigarette smoking is considered a co-carcinogen in this process. HPV disease also may stop progressing in the dysplasia (pre-cancerous) stage. This allows women with early disease to be followed conservatively via observation (colposcopy–magnified views of the cervix) and colposcopically-directed biopsies as outpatients. More advanced lesions and carcinoma-in-situ can be destroyed via excision, cyrosurgery, or laser ablation.
For genital warts, an immunological cream (imiquimod) can be used to enhance the immune response against the virus. They can also be destroyed via chemical (painted podophyllotoxin) or electrical cautery. Excision and laster vaporization are additional options. All of these methods have a high failure and/or recurrence rate if the HPV in the cervix is not eradicated.
● Trichomoniasis and bacterial vaginosis: Treated with oral antibiotics (men and women) or antibiotic suppositories or vaginal cream in women.
● Molluscum contagiosum: These small, harmless, solid, raised papules are simply scraped off of the skin. Repeated sessions are necessary to catch lesions that are missed initially.
A crucial part of any treatment includes follow-up for a “test of cure” in the bacterial and syphilis infections, repeat Pap smears and colposcopy for surveillance of previous HPV infections, and serial determinations of viral load for HIV and hepatitis.