3.16 – Obstetrics & Gynaecology Infections (New)

A) Adults

Disease / Etiology

Preferred

Alternative

Comments

Pelvic Inflammatory Disease

 
Chlamydia trachomatis
Neisseria Gonorrhoeae
Gardnerella vaginalis
Haemophilus influenza
Enteric Gram negative rods
Streptococcus agalactiae
Ureaplasma urealyticum
Mycoplasma hominis

 
Outpatient Regimen
(For mild to moderate PID):

Ceftriaxone 500 mg IM single dose
+
Doxycycline 100 mg PO q12H 
(or Azithromycin 1 gm PO / week)
+
Metronidazole 400 mg PO q12H

 
Inpatient Regimen
(For moderate to severe PID):

Ceftriaxone 2 gm IV q24H
+
Doxycycline 100 mg PO q12H
+
Metronidazole 400 mg PO q12H

 
Duration: 14 days 

Beta-lactam allergy : can use Clindamycin and Gentamicin (BASHH). 

Male partners should be contacted and offered screening for chlamydia and gonorrhea. 

Treat all male partners with Azithromycin 1 gm PO single dose.

Bacterial vaginosis


Gardnerella vaginalis
Mycoplasma hominis 
Provetella sp 
Mobiluncus


Metronidazole 400 mg PO q12H for 5 - 7 days

OR

Metronidazole 2 gm PO single dose

 
Clindamycin 300 mg PO q12H for 7 days


Treatment is indicated for symptomatic women, women undergoing gynaecological procedures and pregnant women.

Avoid alcohol with Metronidazole. 

Routine screening and treatment of male partners not indicated. 

Patients should be advised to avoid vaginal douching and the use of shower gels and strong scented soap. 

No evidence of teratogenicity of use Metronidazole in the first trimester of pregnancy. 

Vaginal Candidiasis


Candida albicans


Topical therapy
Clotrimazole pessary 500 mg single dose


Oral Therapy
Fluconazole 150 mg PO single dose 
(Pregnancy Category C) 
OR Itraconazole 200 mg PO q12H for 1 day 
(Pregnancy Category C)

 
Oral therapy is contraindicated in pregnancy.

Viral Sexually Transmitted Infections


GENITAL HERPES 
Herpes simplex virus 1 and 2


First episode - all for 5 days 

Aciclovir 400 mg PO q8H

OR

Valaciclovir 500 mg PO q12H 


Recurrent Episodes

Short course

Aciclovir 800 mg PO q8H for 2 days

OR

Valaciclovir 500 mg PO q12H for 3 days


5 days regimen

Aciclovir 400mg PO q8H for 5 days

OR

Valaciclovir 500mg PO q12H for 5 days

 

First episode - all for 5 days 

Aciclovir 200 mg PO 5 times / day 


Physical supportive measures: saline bathing, analgesia, local anaesthetics and psychological support.

Oral antiviral drugs indicated within 5 days of the start of the episode and while new lesions are still forming.

> 5 days of treatment required only in those with new lesions or those with severe signs and symptoms.

HSV 1: an increasing cause of genital HSV. 


*Valaciclovir is not available in UMMC

Herpes Genitalis
Suppressive therapy:
(Indicated if > 6 recurrences per year, severe, prolonged, or with psychosocial problems)

 

Acyclovir 400mg PO q12h

Valaciclovir 500mg PO q24h

Duration: All for up to  6month - 1 year, then reassess