Sexually Transmitted Diseases Forum - Gonnorhea and Chlamydia treatment

If he didn't check the microorganism itself, he woud not know if it could be a drug resistant strain
eventually we may not have any drugs at all to treat these,
quinolones are failing with gon. From asia, hawaii, washington, calif, and for some reason from gon. From male to male
your partner should also be on antibiotics...

Here's a partner handout for gon...There's others for chlalmydia

you probably need a new drug and hopefully it will work, you might have a voracious resistant bug

*important reminders concerning treatment of gonorrhea:

the preferred oral treatment of uncomplicated gonorrhea of the cervix, urethra, and rectum in areas of high-fluoroquinolone (fq) resistance is cefixime. In the u.S., cefixime tablets are currently unavailable (anticipated release end of 2005). In areas of fq resistance the other preferred agent is ceftriaxone im. During the unavailability of cefixime, some states in the u.S. With high rates of fq-resistant gonorrhea have chosen to use the oral agent cefpodoxime (vantin). This regimen is currently not endorsed by the cdc.
Areas where the use of fluoroquinolones (fq) are not recommended for the treatment of gonorrhea include (as of november 2004): asia, pacific islands (including hawaii), india, israel, australia, united kingdom, united states (california, washington state, arizona [maricopa county], michigan [ingham, clinton, eaton, jackson, livingston and shiawassee counties], massachusetts, new york city), areas in canada with rates of fq resistance >3% to 5%, any area with rates of fq-resistant n. Gonorrhoeae >3% to 5%.
Populations who should not receive fqs for gonorrhea include: men who have sex with men (u.S.), people with sexual contacts from the above listed areas.
You may use your choice of either (or both) of the patient handouts to suit your needs. Active subscribers have our permission to reproduce copies of the patient handouts to hand to their own patients. (mass reproduction or electronic forwarding or dissemination is not authorized.)

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important information for partners about curing chlamydia

urgent and private
important information about your health.
Directions for treament of
sex partners receiving azithromycin
please read this very carefully

you have been exposed to chlamydia. You are likely to have chlamydia too.

What is chlamydia?

Chlamydia is a curable infection you get from having sex with a person who already has it. It is very important that you see your medical provider (doctor or nurse) as soon as possible to get treated and cured. This disease can be cured with medication.

Many people with chlamydia do not know they have it because they feel fine and have no signs of the disease. Even if you feel fine, you can pass chlamydia to others through sex. Even if you feel fine, chlamydia can cause serious damage to your body.

Chlamydia is a serious disease:

women with chlamydia can get a very bad infection in the lower abdomen if they don't get treated. Without treatment the bacteria moves up into the womb, the female organs, and nearby pelvic areas. This pelvic infection can cause damage that makes women sterile (unable to have children). It can also cause a "tubal pregnancy," which can result in death.

Men with chlamydia can sometimes develop an infection of the testicles (balls) and scrotum (sack) that causes pain and swelling.

Newborn babies with chlamydia can develop serious eye and lung infections.

A person with chlamydia has a greater chance of giving or getting hiv.

We want to be sure that you get the medicine you need as soon as possible. The best way to take care of yourself is to see a doctor for a check-up and medicine. If you cannot see a doctor within the next day or two, take the medicine enclosed or prescribed now, then see a doctor as soon as possible.

Before you take the medicine, please read the following:

this medicine is safe. However, do not take if any of the following are true:

you are female and having lower belly pain, vomiting, pain during sex, or fever.
You are pregnant or think you might be pregnant.
You are male and having burning with urination (pee), fluid or discharge from the end of your penis, or pain or swelling in the testicles (balls) or fever.
You ever had a bad reaction, rash, or allergy to the following antibiotics: azithromycin (zithromax), erythromycin, clarithromycin (biaxin).
You have a serious long-term illness like kidney, heart or liver disease.
You are currently taking another prescription medication.
If any of the above is true for you, talk to a medical provider as soon as possible.

If you are going to take the medicine, please read the following:

take all of this medicine at one time.
Don't share or give this medicine to anyone else.
Most common side effects include: diarrhea, nausea, abdominal pain, vomiting, and vaginal yeast infection.

If you experience yellowing of the skin or an allergic reaction (hives, difficulty breathing, or swelling of the body), call your medical provider immediately. These are serious side effects.

If you do not have a medical provider, contact a community health center or go to a local emergency room.

Do not have sex for the next 7 days. It takes 7 days for the medicine to cure chlamydia. If you have sex within 7 days after taking the medicine, you could still pass chlamydia to your sex partners. While condoms offer good protection, the safest way to not infect anyone else is to not have sex for 7 days.
Tell all sexual partners you have had in the past 2 months to also get checked for chlamydia. To avoid reinfection, do not have sex with any of these partners until they are checked for chlamydia.
If you have any questions about this medicine or chlamydia, please call your local health department. For other general information, you can call toll free the national std/hiv hotlines at 800-342-2437 or 800-227-8922. All calls are confidential. No one will ask for your name. For an std exam, testing, and medicine, go to a medical provider or call your local health department.

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important information for partners about curing gonorrhea

urgent and private
important information about your health
directions for taking gonorrhea medication
please read this very carefully

your sex partner has been treated for gonorrhea. You could have gonorrhea too.

What is gonorrhea?

Gonorrhea is an infection spread by having sex with someone who has gonorrhea.

Some people with gonorrhea may have pain or burning when they pee.
Women might also have increased vaginal discharge or vaginal bleeding between periods.
Men may have discharge from the penis or pain or swelling in the testicles (balls).
Many people with gonorrhea don't know they have it because they feel fine. But even though they don't feel sick, they can still pass gonorrhea to someone else. It is important that you get treated as soon as possible. If you don't get treated you can become very sick.

If you are a woman and have severe pain in your lower belly or have a fever, it is important that you see a doctor immediately. You could have pelvic inflammatory disease (pid). This condition can be very serious. It can prevent you from having children. It can also cause a "tubal pregnancy," which can result in death.

The best way to take care of yourself is to see a doctor right away. If you are unable see a doctor within the next day or two, take the medication enclosed or take the attached prescription to a pharmacy, then see a doctor as soon as possible.

If you have been given medication, please read carefully

what I need to know about my medications

you have been given two different medications (_________________ and azithromycin). It is important that you take both medications. These medications are very safe, but there are some things you should be aware of. Don't share or give this medication to anyone else.

Do not take these medications if:

you have a fever.
You have stomach pain, you are throwing up, or have diarrhea.
You are pregnant or there is a possibility that you are pregnant.
You have pain or swelling in the testicles (balls).
You have a long-term illness like kidney, heart, or liver disease, colitis or stomach problems.
You are allergic to penicillin.
You have ever had a bad reaction, rash, allergy, or breathing difficulty after taking the following medications: any penicillin, any cephalosporin, azithromycin (zithromax), erythromycin, clarithromycin (biaxin), cefixime (suprax), cefpodoxime (vantin), cefuroxime (ceftin), ciprofloxacin (cipro), ofloxacin (floxin), levofloxacin (levaquin).
You are taking another prescription medication.
What should I do if i'm not sure about my drug allergies?

If you don't know whether or not you have a drug allergy, or if you have any questions, you should call a doctor or pharmacist before taking this medication.

If you are not able to take this medication call a health care provider as soon as possible.

Do these medications cause side effects?

These medications are very safe but they can sometimes cause the following minor side effects:

stomach upset or minor diarrhea
headache
dizzy feeling
tired feeling
increased chance for sunburn when out in the sun
are there severe reactions that I should be concerned about?

These medications can cause more severe reactions, but this is rare. These reactions can include:

fever
swelling of the face, mouth, neck, hands, and feet
skin rash (especially if all over the body), hives
pain in the joints
difficulty breathing
fainting, slow or fast heartbeat
if you experience any severe reactions you should call 911 or go to the nearest emergency room right away!

What should I do after I take the medication?

Do not have sex for the next 7 days after you have taken this medication. That's how long it takes to cure gonorrhea. If you have sex before you are cured, you can pass gonorrhea to your sex partner. While condoms offer good protection, the safest way to not infect anyone else is to not have sex for 7 days.

Tell all sex partners you have had in the past 2 months to also get checked for gonorrhea. To avoid becoming infected again, do not have sex with any of these partners until they are checked for gonorrhea.

If you have any questions about the medication or gonorrhea please call your local health department. For other general information, you can call toll free the national std/hiv hotlines at 800-342-2437 or 800-227-8922. All calls are confidential. No one will ask for your name. For an std exam, testing, and medicine, go to a medical provider or call your local health department.

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patient-delivered partner therapy for gonorrhea and chlamydia

lead author: kim palacioz, pharm.D., assistant editor

background

effective management of a patient with a sexually transmitted disease (std) is necessary to prevent further complications and to reduce transmission. An important component of this process includes treatment of the exposed sexual partner(s). Notifying sexual partners of an exposure and getting them to see a healthcare provider is sometimes difficult to accomplish.1 often partners are asymptomatic and unlikely to seek treatment on their own. Others may lack access to healthcare or simply refuse to be evaluated for treatment.2

patient-delivered partner therapy (pdpt), the practice of giving patients medication to give to their sex partner, is suggested by some as an alternative to partner notification.3 but this method is controversial because it necessitates treating patients without proper evaluation. The current 2002 std guidelines from the cdc state the following concerning patient-delivered partner therapy as an alternative to partner notification: "a second such approach for which supporting data are being collected is the use of patient delivered therapy for treatment of contacts and others at risk, a technique that can considerably expand the role of practitioners in the control of stds."4 but the cdc guidelines fall short of recommending the practice because at the time, the approach had not been sufficiently studied. Recently published research by golden et al lends further support for the use of pdpt to reduce reinfection rates of stds.3

citation

golden mr, whittington wl, handsfield hh, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N engl j med 2005;352:676-85.

Methods

study participants included women and heterosexual men who were recently diagnosed with gonorrhea or chlamydia (n=2751). Patients were interviewed about the sex partners they had during the 60 days before diagnosis. Patients who were able to identify and provide contact information for at least one sexual partner were randomized to receive either standard referral (patients refer partner to clinic for evaluation and treatment) or expedited treatment (patient-delivered partner therapy). In the expedited treatment group, patients were given medication for up to three partners. If the patient was unable or unwilling to contact the partner, the study staff member made contact and offered the medication.

Partner packets for patients with gonorrhea contained one dose of cefixime 400 mg and 1 gm sachet of azithromycin. Patients with chlamydia received packets with only azithromycin. Other items in the packets included condoms, information about the medications, contact instructions if the partner had questions, and information about std prevention. Patients or partners received their partner packets either from the clinic, a participating pharmacy, or by mail. One week after medications were prescribed, calls were made to the pharmacy to find out who had picked up their partner packets. Reminder calls were made to those patients or partners who had not yet picked up their packets.

Results

after ten to 18 weeks, attempts were made to interview and retest all patients participating in the study. The primary outcome was persistent or recurrent gonorrhea or chlamydia. A total of 1,860 patients completed the study (n=931 expedited treatment and n=929 standard referral). The expedited treatment option was more effective for reducing persistent or recurrent gonorrhea than chlamydia. At follow-up, 3% of patients in the expedited treatment group had gonorrhea compared to 11% of patients in the standard referral group (p=0.01). The difference among chlamydia patients was not significant (11% expedited treatment vs 13% standard referral, p=0.17). Among women who reported no intercourse after treatment, 3% and 8% had persistent infections for gonorrhea and chlamydia, respectively (may represent treatment failure). Of the men who reported no intercourse after treatment, none tested positive for either gonorrhea or chlamydia. There were no reported drug-related adverse effects among patients or their partners.

Author conclusion

the authors conclude that patient-delivered partner therapy is effective in reducing the rates of persistent or recurrent infection in heterosexual patients with gonorrhea or chlamydia.

Commentary

although the use of patient-delivered partner therapy (pdpt) is a promising option for controlling the occurrence of stds, it is not a widely accepted practice.5 a frequently mentioned concern by practitioners is the potential liability associated with providing treatment to unseen patients.6 golden et al conducted a survey of state medical and pharmacy boards to determine the legal status of pdpt in the u.S.6 results of the survey indicate that the legality of pdpt is not clear in many states. Of the states that responded with at least one completed survey (47 states and the district of columbia) it was determined that pdpt is considered legal by the respondents of at least four states: washington state, colorado, california, and tennessee. California has passed legislation and tennessee amended their medical practice rules pertaining to pdpt (both specific to chlamydia treatment).7,8 washington state's medical board has a policy statement endorsing pdpt, similar to the one in colorado.8 sixteen medical boards and 19 pharmacy boards indicated that pdpt was not legal in their state, while other respondents said their "laws were vague and subject to interpretation" or they just didn't know the status. In a few states, the medical board and pharmacy boards gave conflicting answers concerning legality in their state (arizona, north carolina, and oregon).

Currently, the american medical association recognizes the benefits of pdpt.9 in states where pdpt is considered legal, they recommend its use when treatment of sex partners cannot be accomplished by other means.9 they also encourage state licensing boards, malpractice carriers and others "to consider the demonstrated benefits of pdpt when evaluating the appropriateness of this practice."9 other groups such as the cdc and the canadian std guidelines expert working group are also examining the practice of pdpt.

While research indicates that pdpt is beneficial and associated with minimal risks, it should not be the first choice for managing partners of std patients.2,10 an initial attempt should be made to have the exposed partner visit a healthcare professional. Direct interaction with the partner allows for testing of other stds, hiv, and pregnancy. It also provides an opportunity for std prevention counseling.1,2,11

also, pdpt will not be appropriate for all situations or patients. Patients requiring parenteral antibiotics for treatment (e.G., preferred treatment for syphilis) would not be candidates for pdpt. Also, there are some who recommend caution when considering pdpt for men who have sex with men because of the missed opportunity to diagnose hiv or syphilis.1 the decision to use pdpt should be made on a case-by-case basis.

If pdpt is considered, there are several options for getting the treatment medication to the partner. The medication can be given directly to the patient to deliver to the partner or prescriptions can be written (two separate prescriptions preferred) for the appropriate amount of medication (examples of these methods are more clearly described in the pdpt documents for california (www.Dhs.Ca.Gov /ps/dcdc/std/docs/pdt_guidelines_19.Pdf) and tennessee (www2.State.Tn.Us/health/std/pdfs/pdt.Pdf) .

No matter how the partner receives their medication (either directly from the patient or via a written prescription), it is important for the partner to receive educational materials. These materials should include information about the medication(s) being dispensed, warnings about adverse effects and who should not take the medication, contact phone numbers, and information about std prevention.2,3

conclusion

without appropriate treatment of a patient's sexual partners, reinfection and further transmission of an std is likely. Reinfection is of special concern for women with chlamydia, because recurrent infections increase the risk for pelvic inflammatory disease (pid), ectopic pregnancy, and infertility.2 when possible, clinicians should make every effort to evaluate and then treat sexual partners of patients diagnosed with an std. Patient-delivered partner therapy appears to be an effective option for those partners who would otherwise not be treated.