|
Disease /
Etiology
|
Preferred
|
Alternative
|
Comments
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|
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
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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.
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Viral
Sexually Transmitted Infections
|
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GENITAL HERPES
Herpes simplex virus 1 and 2
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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
|
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Herpes Genitalis
Suppressive
therapy:
(Indicated
if > 6 recurrences per year, severe, prolonged, or with psychosocial
problems)
|
Acyclovir 400mg PO q12h
|
Valaciclovir
500mg PO q24h
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Duration:
All for up to 6month - 1 year, then
reassess
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