Bacterial STIs

Urinary tract and sexually

transmitted infections
CONTENTS
1. Objectives

2. Introduction

3. Soft chancre

4. Lymphogranuloma venereum

5. Gonorrhea

6. Syphilis
Primary syphilis.
Secondary syphilis.
7. Conclusions

8. Bibliography
 Bacterial STIs | 3

Objectives
• Describe the clinical and pathophysiological elements For example, there has been an appreciable decrease
of bacterial sexually transmitted infections. in the incidence of Haemophilus ducreyi (chancroid)
• State the latest aspects of diagnosis and treatment of in syphilis rates in the general population and in some
STIs of bacterial etiology. sequelae of these infections, including neonatal
conjunctivitis.

Introduction The draft global health sector strategy4 on STIs focuses

primarily on three infections, two of them bacterial,
Sexually transmitted infections (STIs) are a major that require immediate control measures and can be
global health problem, with at least one in 20 people monitored:
worldwide estimated to suffer from an STI each year.
According to WHO in 2016, more than 1 million people • Neisseria gonorrhoeae infection, due to the
suffered from an STI1. An estimated 357 million new increasing risk of intractable gonorrhea.
cases of curable STIs are reported each year in people • Treponema pallidum infection, with elimination of
aged 15-49 years: Trichomona vaginalis infection (142 congenital syphilis, involves syphilis control in key
million), C. trachomatis infection (131 million), N. populations and strong systems to ensure that all
gonorrhoeae infection (78 million) or syphilis (6 million). pregnant women are screened and treated.
The prevalence of these STIs varies according to region
and sex . Cost-effective interventions are in place for all three STIs,
and gonorrhea and syphilis infections are monitored
It is not the biological fact of being an adolescent
through the Global AIDS Response Progress Reporting
that leads to a higher prevalence of STIs, but the vital,
System, which tracks and reports on the progress and
educational, cultural, social, psychological and sexual
impact of the strategy being implemented.
conditioning factors that surround adolescents and
structure their sexual practices.

In Spain, for example, in 2015, the highest casuistry of Soft chancre

gonorrhea in the last 20 years was reported, with almost Chancroid, soft chancroid or Ducrey’s disease is a
5200 new cases, predominantly among men in a ratio of sexually transmitted genital ulcerative disease caused
7:1. In the case of syphilis, the highest casuistry of the by a gram-negative, anaerobic, facultative, facultative,
last two decades was also reported in that year, with streptobacillus bacterium called Haemophilus ducreyi.
3900 cases and a rate of 8.4 x 100,000 persons. It was an endemic entity until the 20th century and is
These epidemics have a profound impact on the health currently more common in the Caribbean, Africa and Asia,
and lives of children, adolescents and adults throughout where it is the causative agent of 23 to 56% of ulcers in
the world: the genital area. According to WHO data, 6-7 million cases
are estimated annually worldwide, but, due to the difficult
• Fetal and neonatal deaths: syphilis in pregnancy diagnosis and the lack of an available diagnostic test, the
causes more than 300,000 fetal and neonatal deaths exact number is unknown. It is known, for example, that it
per year and exposes another 215,000 children to is surpassed by herpes, being the most prevalent sexually
an increased risk of premature death. transmitted ulcerative disease.
• Infertility: STIs, such as gonorrhea and chlamydia,
The rate of transmission through sexual activity is
are important causes of infertility worldwide, mainly
high, but the exact value is unknown. The probability
by producing tubal obstruction. This phenomenon
of transmission of chancroid from one infected patient
increases the likelihood of other serious
to another, in a single sexual exposure, is 0.35%. It is a
complications, such as ectopic pregnancy, one of
pathogen that only infects humans, predominantly in
the leading causes of maternal death worldwide.
heterosexual patients, with a male:female ratio of 3:1 in
The physical, psychological and social consequences of endemic areas and 25:1 in outbreaks in developing cities.
STIs severely compromise the quality of life of infected
persons. There is controversy about who first isolated Haemophilus
ducreyi, but it is attributed to Lenglet in 1898, Bezancon,
In recent years, there have been important achievements Griffin and LeSourd in 1900, Petesen in 1895, Istoanamov
in improving the response to STIs. and Akopiants in 1897, and Ronald and Albritton in 1984.
 Bacterial STIs | 4

The incubation period is short, between three and seven They are distinguished as chancroid by having an irregular
days, with no prodromal symptoms. The initial lesion is a base and hemorrhagic sharp edges.
papule, with an erythematous, edematous halo; later, after
two to three days, a pustule forms; generally papules and Transient chancroid (chancre mou volant), in which
pustules are not painful. Then the formation of a soft ulcer ulceration evolves very rapidly, 4 to 6 days, and is followed
begins, with indeterminate borders; the base is formed by by lymphadenitis; this form of chancroid is difficult to
friable granulation tissue, covered by a necrotic, purulent, differentiate from lymphogranuloma venereum. Papular
yellowish-gray exudate. Chancroid ulcers are very chancroid (ulcus molle elevatum) begins as a papule and
vascular and their friable base bleeds easily. then ulcerates, rises especially at the edges, resembles
the lesions of condyloma acuminatum and secondary
When ulcers form, patients have moderate to severe pain; syphilis.
ulcers may be multiple in 50% of cases and persist for
months if untreated. Patients have lymphadenopathy For diagnosis, a detailed clinical history should be taken,
generally unilateral, painful, which progresses and forms the patient will have a history of sexual intercourse, some
an inguinal bubo, fluctuant, may have spontaneous ulcer with indeterminate borders, base with exudate,
rupture with cutaneous fistulization to the exterior. The purulent, yellowish-gray color, with moderate to severe
formation of lymphadenopathy and buboes is observed pain, lymphadenopathy or unilateral and fluctuating bubo.
less frequently in women. They may report other
• Microscopy: small, gram-negative microorganism.
symptoms, such as leucorrhea, light bleeding, dysuria,
It is not recommended due to its low sensitivity and
urgency, frequency of urination and dyspareunia (Figure specificity.
1).
• Culture: it is a very difficult bacterium to culture; few
Several types of ulcers are mentioned in the literature: clinical laboratories perform it; samples must be taken
giant ulcers, which are larger than 2 cm; serpiginous with a swab from the bottom of the ulcer, previously
ulcers, which are formed when small ulcers are joined washed with saline solution; a transport medium is
together; follicular ulcers (le chancre mou folliculaire), used for the bacterium to survive (Amies or Stuart); the
which originate in the hair follicle; and dwarf ulcers material obtained by puncture and aspiration of buboes is
(formes naines), which vary in size from 0.1 to 0.5 cm, are less sensitive than that of ulcers. The definitive diagnosis
the most common type of ulcer. 1 to 0.5 cm, are round, of chancroid requires the identification of Haemophilus
shallow, have the appearance of herpetic lesions. ducreyi in the culture medium; the sensitivity of this
diagnostic test is approximately 75% and it is useful to
know the antimicrobial susceptibility.
• Nucleic acid test: it is excellent for demonstrating
Haemophilus ducreyi in clinical material; it does not
require transport medium and has greater ranges of
positivity than culture medium. Few laboratories have
implemented it for the diagnosis of chancroid.
• Serology: Several studies have shown that the detection
of antibodies against Haemophilus ducreyi is not
appropriate for the diagnosis of chancroid in the acute
phase, but it is useful in the epidemiological aspect as a
follow-up method in past infections.
• Polymerase chain reaction: it is the diagnostic method
of choice, since it is a rapid, sensitive and superior test.

According to the Centers for Disease Control and Prevention,

a probable diagnosis of chancroid can be made if the
following criteria are met:

• The patient has one or more painful ulcers in

the genital area. The patient has no evidence of
Treponema pallidum infection with detection by dark
field microscopy or serology; these studies should be
performed at least seven days after the appearance
of the ulcers.
• Clinical manifestation, appearance of genital ulcers
and lymphadenopathy that are typical of chancroid.

Figure 1. Genital chancroid lesion with suppurative inguinal lymph node.

 Bacterial STIs | 5

• Negative test for herpes simplex virus, performed on If the entry site was genital, it will be represented by
the exudate from the ulcers. a regional suppurative lymphadenopathy (inguinal
syndrome), which is the form of presentation described for
Various antibiotic regimens are recommended; the classic LGV and the main symptom for which the affected
European Chancroid Treatment Guide proposes the man comes to the clinic. If the inoculation was anal, it will
following: present with symptoms of proctitis, such as tenesmus,
proctorrhagia and constipation (anorectal syndrome); in
• First line: ceftriaxone, single intramuscular dose of this form of the disease, there is usually no groin syndrome
250 mg. The response is generally good; another since these nodes are not affected. Less frequently, the
alternative is azithromycin, single dose of 1g, which inoculum is pharyngeal; in this case an inflammatory
is equally efficient. cervical adenopathy is observed.
• Second line: ciprofloxacin, 500 mg every 12 hours for
three days or erythromycin, 500 mg every 6 to 8 hours With regard to the inguinal syndrome, the lymphadenopathy
for seven days. is often unilateral, painful, non-mobile; in its evolution it can
fistulize through a mouth (inguinal bubo). The involvement
Tetracycline, amoxicillin or trimethoprim-
of the inguinal and femoral nodes, separated by the
sulfamethoxazole are not recommended, because
inguinal ligament, forms the “groove sign” or “groove sign”,
most strains are resistant to these previously very
pathognomonic of LGV. This clinical form is unusual in
common treatments.
women, as the lymph nodes affected are usually the iliac
Azithromycin and ceftriaxone have the advantage nodes; in these cases, the disease is manifested by severe
of being single-dose, with lower costs and adequate abdominal pain predominantly in the iliac fossae. Anorectal
adherence to treatment by the patient. Recently a study syndrome is the most frequent form of presentation in
was published with resveratrol, which is a phytoalexin MSM and women who practice anal penetration; it presents
present in plants with antibacterial effect; the study with signs and symptoms of proctocolitis indistinguishable
concluded that it can potentially be administered clinically and endoscopically from other etiologies, mainly
topically to prevent chancroid. inflammatory bowel disease (IBD).

Finally, in the third stage, chronic lymphatic involvement

Lymphogranuloma venereum generates abscesses, fistulas, edema, rectal stenosis and
genital elephantiasis. This last period is more frequently
Lymphogranuloma venereum (LGV) is an STI caused by observed in women, as a consequence of the indolent and
serotypes L1, L2 and L3 of Chlamydia trachomatis (CT), an insidious character that characterizes the first stages in this
obligate intracellular bacterium with 15 different serotypes. sex.
L1, L2 and L3 have the ability to penetrate the skin and
mucous membranes, with subsequent dissemination to As for the diagnosis, sampling can be from the material
the lymph nodes, while the remaining serotypes (A, B, Ba, of the first stage ulcer, rectal swabbing and/or puncture of
C-K) remain confined to the mucous membranes. This regional adenopathy. Historically, isolation in cell culture
difference determines the ulcerative nature and systemic (the most commonly used is with McCoy cells) was the
involvement of LGV as opposed to other diseases caused gold standard in diagnosis, but it is a difficult method with
by the same bacteria, such as urethritis or cervicitis. low yield (positive in 30% of cases).

The usual clinical presentation of LGV consists of three Currently, PCR techniques to detect bacterial DNA and
stages. The first is represented by a small, slightly painful serological techniques such as complement fixation (CF)
papule or vesicle, sometimes of herpetiform morphology, and direct microimmunofluorescence (DIMF) are the
at the site of inoculation. If the location of these lesions is techniques of choice. Real-time PCR allows confirmation
intraurethral, it may manifest as a nonspecific urethritis with of the bacterium and its serotypes through genotyping by
seropurulent exudate. The primary lesion ulcerates rapidly restriction analysis of the omp-1 gene.
and resolves spontaneously within a week, so it usually
goes unnoticed by the patient given the asymptomatic and
self-limited nature of the chancre (fugitive chancre). (Figure
2).

The second stage begins four to six weeks after the primary
lesion; the clinical presentation depends on the site of
inoculation.
 Bacterial STIs | 6

Serologies to detect TC (FC titers > 1: 64 or MIFD titers > 1:

256) support the diagnosis in an appropriate clinical context
Gonorrhea
(clinical suspicion, compatible epidemiology and having It is a Gram-negative, oxidase-positive, anaerobic,
ruled out other STIs such as syphilis, herpes, gonorrhea, intracellular diplococcus that can infect the columnar
chancroid), and have the advantage of being available in epithelium of the cervix, urethra, pharynx and
most laboratories. conjunctiva. Neisseria gonorrhoeae is an exclusively
human pathogen; 87.7 million new gonorrhea infections
Regarding treatment, the first choice is doxycycline, 100
are reported worldwide each year. In the United States,
mg every 12 hours orally for 21 days. In special situations
gonorrhea is the second most frequent and notifiable
such as pregnancy and lactation, the drug of choice is
sexually transmitted infection, with about 700,000
erythromycin, in doses of 500 mg four times a day for 21
new cases/year. Pathogens such as Chlamydia
days. In those subjects with advanced stages of the disease
trachomatis and Neisseria gonorrhoeae, in addition
with retractions and fistulas, surgical treatment of the
to causing a significant increase in morbidity by their
sequelae should be performed after antibiotic treatment.
own means, are associated with an increase in human
Patients should be followed until complete resolution of all
immunodeficiency virus (HIV) transmission (Figure 3).
signs and symptoms, usually for three to six weeks. Sexual
contacts in the 60 days prior to symptom onset should Persons at risk are those who have a history of sexual
be scheduled to rule out LGV and, while awaiting results, contact with: a person with confirmed or suspected
should receive empirical treatment with doxycycline, 100 gonococcal infection, a resident of an area with a high
mg/day for seven days, or azithromycin, 1g orally in a single prevalence of gonorrhea or at high risk for antimicrobial
dose. resistance and unprotected, a history of gonocococcal
infection and other STIs, including HIV. In addition sex
workers and their sexual partners, sexually active youth
<25 years of age, persons with multiple sexual partners,
and men who have sex with men (MSM).

Some men with gonorrhea may not have any symptoms.

However, men who do have symptoms may have:
burning sensation when urinating; white, yellow or
green discharge from the penis; pain or swelling in the
testicles (although this is less common).

Most women with gonorrhea have no symptoms. Even

when they do have symptoms, they are usually mild and
can be mistaken for symptoms of a vaginal or bladder
infection.
A

Figure 2. (A) Inflammatory adenopathy in the inguinofemoral region, (B) Figure 3. Neisseria gonorrhoeae, causative agent of gonorrhea.
Erythematous papules on the scrotum with peripheral scaly collarette
(Biett’s collarette)..
 Bacterial STIs | 7

Women with gonorrhea are at risk for serious Microscopy of endocervical smears in women has a
complications from the infection, even if they do not sensitivity between 30-50%. Specificity is high when
have any symptoms. Symptoms in women may include passed by trained personnel (>99%). Urethral smear
the following: pain or burning when urinating; increased microscopy in asymptomatic men is less sensitive (50-
vaginal discharge; vaginal bleeding between periods. 75%).

Rectal infections may cause no symptoms in both men Cultivation is recommended in the following situations:
and women or may cause the following: discharge; anal
itching; pain; bleeding; pain during bowel movements. • To determine antimicrobial susceptibility prior to
treatment, when possible.
Gonorrhea can also affect these parts of the body: • As a test of cure for treatment failure if suspected, or
in situations where there is an increased likelihood of
• Eyes: gonorrhea affecting the eyes may cause eye pain,
treatment failure.
sensitivity to light and pus-like discharge from one or
both eyes. • For symptomatic MSM.
• Throat: Signs and symptoms of a throat infection • In the case of sexual abuse.
may include a sore throat and swollen lymph nodes • To evaluate pelvic inflammatory disease (PID).
in the neck. • If the infection was acquired in countries or areas with
• Joints: if one or more joints become infected with high rates of antimicrobial resistance.
bacteria (septic arthritis), the affected joints may be For uncomplicated anogenital infection, ceftriaxone 500mg
feverish, red, swollen and extremely painful, especially intramuscular (IM) in a single dose is recommended, with
when moving them. azithromycin 1g orally (O.V.) in a single dose. Azithromycin
N. gonorrhoeae was identified in 1879 by Albert is recommended as co-treatment regardless of chlamydia
Neisser from exudates of patients with urethritis and test results, to delay the generalized emergence of
ophthalmineonitis. cephalosporin resistance. There is some in vitro evidence of
synergy between azithromycin and cephalosporins, the best
Nucleic acid amplification testing (NAA) has become the progress being eradication of pharyngeal gonorrhea when
most popular test for N. gonorrhoeae in the UK. This test is azithromycin was combined with cephalosporin therapy.
generally more sensitive than culture, there is a wider range
of test offerings and they are less demanding on sample Observations have raised serious concerns and failures have
quality for transport and storage. The AAN test shows high been reported with doses of cefixime for the treatment of
sensitivity (>96%) in both symptomatic and asymptomatic genital tract gonorrhea. Repeated treatment failures have
patients. Equivalent sensitivity is demonstrated in urine been reported with cefixime and other extended-spectrum
and urethral exudate specimens from men and in vaginal VO cephalosporins.
and endocervical specimens from women. The sensitivity
of the test in female urine is significantly lower and is not • Alternative regimes10:
an optimal specimen in women. - Cefixime 400mg VO in single dose is recommended
only when an intramuscular injection is
In men, the sample should be taken from the urethra, contraindicated, i.e., denied by the patient.
either directly from the urethral meatus or indirectly in the
- Spectinomycin 2g in single dose.
first urine sample. Samples taken directly from the urethra
are suitable for microscopy, culture and AAN. In the - Other cephalosporin regimens, in particular,
female patient, vulvo-vaginal and endocervical swabs can cefotaxime IM in single dose, or 2g cefoxitin IM
be taken; they are equally suitable for the detection of N. in single dose, plus probenecid 1g VO. Alternative
gonorrhoeae by AAN testing. This test is the specimen of injectable or oral cephalosporins offer no advantage
choice for screening asymptomatic women for gonorrhea. in terms of efficacy and pharmacokinetics over
ceftriaxone or cefixime.
Culture for N. gonorrhoeae can be used with specimens - Quinolones, in general, are not recommended in the
from all sites and provides a viable organism for treatment of gonorrhea due to their high prevalence
confirmatory testing. Direct seeding of the specimen and of resistance worldwide.
use of transport swabs gives acceptable results.

Gram-stained smear microscopy of urethral discharge in

men or endocervical secretions in women can be used as
a test to provide an immediate presumptive diagnosis of
gonorrhea. Microscopy of urethral smears from men with
urethral discharge has a high sensitivity (>95%).
 Bacterial STIs | 8

- When an infection is known prior to treatment and Data for Latin America and the Caribbean (LAC) indicate
is sensitive to quinolones, ciprofloxacin 500mg VO that this region has the highest rate of syphilis worldwide;
in a single dose or ofloxacin 400mg VO in a single according to WHO, of 12 million new infections worldwide
dose have demonstrated efficacy. per year, about three million occur in LAC. The median
seroprevalence of syphilis in pregnant women in LAC was
It is recommended in cases of gonococcal PID, ceftriaxone 3.9%, with a range of 0.7-7.2%, and it is estimated that more
500mgIM, immediately followed by oral doxycycline than 164,000 children are born annually with congenital
100mg twice/day, plus metronidazole 400mg/day for 14 syphilis12.
days.
The classic description of acquired syphilis is divided into
In cases of gonococcal epididymo-orchitis, ceftriaxone four stages: primary, secondary, latent and tertiary.
500mg IM, plus doxycycline 100mg twice/day for 10-14
days is recommended.
Primary syphilis
In gonococcal conjunctivitis, a three-day systemic regimen Treponema penetrates through small cutaneous-
is recommended, since the cornea may be involved and is mucosal abrasions. The incubation period may vary
relatively avascular. The eye should be irrigated with saline from 9 to 90 days. The initial lesion or chancre begins
or water and administered: as a papule which in a few days produces a superficial
• Ceftriaxone 500mg daily IM, for three days. ulcer with smooth edges and a generally clean bottom.
The lesion is not very painful and the induration of the
• If there is an established history of anaphylaxis to base is characteristic and palpable with a cartilaginous
penicillin or cephalosporin: spectinomycin 2g IM for consistency (hard chancre). The chancre is usually
three days, or azithromycin 2g PO plus doxycycline single, although the presence of two or more chancres
100mg twice/day, for one week, plus ciprofloxacin is not exceptional. It is accompanied by inguinal satellite
250 mg/day for three days. adenopathy, unilateral or bilateral, non-inflamed, non-
displaced and not oozing. It can appear in any location of
In disseminated gonococcal infection, ceftriaxone 1g IM
sexual areas. Syphilitic chancroid heals spontaneously
or IV every 24 hours, or 1g cefotaxime IM every 8 hours,
within 3-12 weeks. Chancroid lesions contain abundant
or ciprofloxacin 500mg IV every 12 hours (if the infection
treponemes and are contagious. (Figure 4)
is known to be sensitive), or spectinomycin 2g IM every
12 hours is recommended. Treatment should continue
for seven days, but may be changed 24-48 hours after Secondary syphilis
symptoms improve to one of the following oral regimens: Manifestations of secondary syphilis begin 4 to 10 weeks
cefixime 400mg twice/day, ciprofloxacin 500mg twice/ after the initial lesion. They are related to the dissemination
day, or ofloxacin 400mg twice/day. of Treponema. Secondary syphilis is accompanied by
moderate systemic symptoms, asthenia, febrile fever,
Syphilis generalized lymphadenopathy and is initially manifested by
the so-called syphilitic roseola (syphilitic maculosa syphilis).
It is caused by Treponema pallidum, a spiral bacterium This consists of a rash predominantly on the trunk and upper
or spirochete measuring 6 to 15 microns in length by 0.25 limbs formed by faint macular elements of a few millimeters
microns in thickness. It is a systemic disease whose in diameter, rounded or oval, somewhat confluent (Figure 5).
transmission mechanism is direct and intimate contact (Figure 5).
with lesions that release treponemes. Mother-to-child
In this phase, palmo-plantar papular lesions are very
transmission also occurs and very occasionally there is
characteristic, erythematous and often scaly with collarete
transmission mediated by blood transfusion or through
scale. When they become hyperkeratotic they are called
small abrasions of the epidermis that come into contact with
syphilitic nails. Secondary syphilis is almost always
syphilitic lesions.
accompanied by mucosal and semimucosal lesions,
Since 2002, its incidence has greatly increased, especially erythematous macules, papules and papulo-erosive lesions.
affecting men who have sex with men, and oral sex is also an In oral mucosa, palate and tongue are erosive lesions covered
important mechanism of transmission. with whitish-grayish membrane with red border, which are
called mucosal plaques. These lesions contain abundant
Despite the existence of effective prevention measures and treponemes and are a frequent source of infection.
relatively inexpensive treatment options, syphilis remains a
global problem with about 12 million infected per year. WHO Secondary syphilis is occasionally accompanied
estimates that each year one million pregnant women have by manifestations in internal organs, predominantly
syphilis; and 270,000 of the children born to these mothers cardiovascular and neurological complications (tertiary
had congenital syphilis. In 2002, the congenital syphilis rate syphilis).
was 11.2 per 100,000 births.
 Bacterial STIs | 9

Treponema pallidum cannot be cultured in vitro and its Henningsen T, Chancroide (enfermedad de Ducrey).
small size makes it difficult to observe with light microscopy Dermatol Rev Mex 2014; 58:33-9.
techniques. Laboratory methods are used to confirm clinical 6. La Rosa L, Svidler López L, Entrocassi AC, Santos B,
suspicion and for follow-up after treatment. In primary Caffarena D, Rodríguez Fermepin M. Polimorfismo
syphilis, the diagnostic method is darkfield visualization of clínico de linfogranuloma venéreo anorrectal en la
the treponemes in the chancre. Specific PCR is also available, ciudad de Buenos Aires.
but is not usually available in many centers.
7. Pérez Morente MA, Cano Romero E, Sánchez Ocón
Serology is the most commonly used method. There are two MT, Castro López E, Jiménez Bautista F, Hueso
types of tests. Screening tests are reaginic tests (VDRL and Montoro C. Factores de riesgo relacionados con las
RPR) and are very sensitive, but take a long time to become infecciones de Transmisión sexual. Revista Española
positive; they are titered and are used to monitor treatment. de Salud Pública 2017; 91: 1-6.
The most specific are the treponemal tests (FTA-ABS and 8. Prevención, diagnóstico, tratamiento y referencia de la
TPHA); they are the earliest to test positive and remain gonorrea en el primer y segundo niveles de atención.
positive for many years. Centro Nacional de Excelencia Tecnológica de Salud
de México. (Disponible en: http://www.cenetec.salud.
The treatment of syphilis depends basically on the stage. In gob.mx/descargas/gpc/CatalogoMaestro/SS-729-14-
primary, secondary and early latent syphilis, the treatment Gonorrea/GER_GONORREA_010914_vf.pdf).
of choice is penicillin G benzathine 2,400,000 IU i.m. in
9. Organización Mundial de la Salud. Estrategia
single dose. In latent syphilis of undetermined duration, the
Mundial de Prevención y Control de las
treatment of choice is 3 doses of penicillin G benzathine
Enfermedades de Transmisión Sexual 2006-2015.
2,400,000 IU i.m. once a week.
(Disponible en: https://apps.who.int/iris/bitstream/

Conclusions
• Sexually transmitted bacterial infections should
continue to be a concern for practitioners involved
in women’s reproductive health.
• Occasionally, the clinical presentation is not
sufficient to define the etiology of an STI, and
laboratory tests are needed to establish the
causative agent.
• Adequate treatment of STIs sometimes requires
prior information on antimicrobial sensitivity to
certain germs in high-prevalence settings.

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