5-30
Patient Education: This virus can be sexually transmitted even in the absence of active lesions. Latex
condoms are recommended.
Prevention and Hygiene: Health care workers should wear gloves to handle lesions to reduce risk of local
inoculation to the hand (herpetic whitlow).
No Improvement/Deterioration: Resistant herpes has been described in HIV patients who have been
maintained chronically on antiviral agents. Consider screen for HIV.
Treatment: Syphilis
Primary: Primary and secondary syphilis: 2.4 MU benzathine penicillin IM in a single dose
Neurosyphilis: penicillin G 2-4 MU q 4 hours IV x 10 -14 days
Latent: benzathine penicillin 2.4 MU q week for 3 doses
Alternative: Primary and secondary syphilis: doxycycline 100 mg po bid x 14 days
Neurosyphilis: ceftriaxone 2gm IV or IM qd for 14 days
Latent: doxycycline 100mg bid x 28 days
Follow-up Actions
Return evaluation: Refer for VDRL lab test at 6 and 12 months and expect titer to fall. If latent syphilis,
another VDRL at 24 months is recommended. HIV test at 4-6 weeks.
NOTES: Congenital syphilis causes preterm delivery, snuffles (obstructed nasal respiration), rash, stillbirth.
It can be asymptomatic initially but manifestations can include Hutchinson’s teeth, saddlenose, saber shins,
deafness. Suspect this if the umbilical cord is swollen and demonstrates a red/white/blue pattern like a
barber pole.
Evacuation/Consultant Criteria: Evacuation is not usually required for any of these conditions in the acute
phase. Consult urology, gynecology, infectious disease or preventive medicine experts as needed, particularly
in chronic cases.
Molluscum Contagiosum
Information about this infection which may appear as a STD can be found in the Skin chapter under Viral
Skin Infections.
Condyloma Acuminatum
Information about this infection which may appear as a STD can be found in the Skin chapter under Viral
Skin Infections, Warts.
STD: Vaginal Trichomonas
MAJ Ann Friedmann, MC, USAIntroduction: Trichomonas vaginalis, a sexually transmitted fungus, is a common cause of abnormal vaginal
discharge. The asymptomatic carrier rate in women is 10%. Sexual partners should be treated.
Subjective: Symptoms
Yellow-green discharge (may be frothy and malodorous but not usually fishy); vulvovaginal irritation and
burning; dysuria.
Objective: Signs
See Symptoms: GYN Problems: Pelvic Exam and Lab Procedures: Wet Mount.
Using Basic Tools: Characteristic discharge not always present; vulva may be edematous and inflamed;
redness of the cervix (“strawberry cervix”); tender vagina; no abdominal pain.
Using Advanced Tools: Lab: Vaginal pH: should be > 4.7 (test with urine dipstick); motile, flagellated
trichomonads on wet prep.