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9. Genito-urinary diseases
Treatment of the patient
– Cervicitis
T reat for both ch lam yd ia AN D g onorrh oea.
Non-pregnant women
Treatment for chlamydia Treatment for gonorrhoea
azithromycin P O : 1 g as a sing le d ose PLUS cefixime P O : 400 m g as a sing le d ose
or or
doxycycline P O : 200 m g /d ay in ceftriaxone IM : 250 m g as a sing le d ose
2 d iv id ed d oses for 7 d ays or
spectinomycin IM : 2 g as a sing le d ose
Pregnant women
azithromycin P O : 1 g as a sing le d ose PLUS cefixime P O : 400 m g as a sing le d ose
or or
erythromycin P O : 2 g /d ay in ceftriaxone IM : 250 m g as a sing le d ose
2 or 4 d iv id ed d oses for 7 d ays
– Bacterial vaginosis and trichomoniasis 9
tinidazole P O : 2 g as a sing le d ose
or metronidazole P O : 2 g as a sing le d ose
In th e case of treatm ent failure:
tinidazole P O : 1 g /d ay in 2 d iv id ed d oses for 5 d ays
or metronidazole P O : 800 to 1000 m g /d ay in 2 d iv id ed d oses for 7 d ays
– Vulvovaginal candidiasis
clotrimazole (500 m g v ag inal tablet): 1 tablet as a sing le d ose, inserted d eep into th e
v ag ina at bed tim e
or, if not av ailable,
clotrimazole (100 m g v ag inal tablet): one tablet inserted d eep into th e v ag ina at
bed tim e for 6 d ays
or nystatin (100,000 IU v ag inal tablet): one tablet inserted d eep into th e v ag ina at
bed tim e for 14 d ays
If th e patient h as extensiv e v ulv ar inv olv em ent, miconazole 2% cream (2 applications
to th e v ulv a d aily for 7 d ays) m ay be used in com bination w ith th e intrav ag inal
treatm ent abov e. M iconazole cream m ay com plem ent, but d oes not replace,
treatm ent w ith clotrim azole.
Treatment of the partner
W h en th e patient is treated for v ag initis or cerv icitis, th e sexual partner receiv es th e
sam e treatm ent as th e patient, w h eth er or not sym ptom s are present.
In th e case of v ulv ov ag inal cand id iasis, th e partner is treated only if sym ptom atic
(itch ing and red ness of th e g lans/prepuce): miconazole 2%, 2 applications d aily for
7 d ays.
235
Treatment of the patient
– Cervicitis
T reat for both ch lam yd ia AN D g onorrh oea.
Non-pregnant women
Treatment for chlamydia Treatment for gonorrhoea
azithromycin P O : 1 g as a sing le d ose PLUS cefixime P O : 400 m g as a sing le d ose
or or
doxycycline P O : 200 m g /d ay in ceftriaxone IM : 250 m g as a sing le d ose
2 d iv id ed d oses for 7 d ays or
spectinomycin IM : 2 g as a sing le d ose
Pregnant women
azithromycin P O : 1 g as a sing le d ose PLUS cefixime P O : 400 m g as a sing le d ose
or or
erythromycin P O : 2 g /d ay in ceftriaxone IM : 250 m g as a sing le d ose
2 or 4 d iv id ed d oses for 7 d ays
– Bacterial vaginosis and trichomoniasis 9
tinidazole P O : 2 g as a sing le d ose
or metronidazole P O : 2 g as a sing le d ose
In th e case of treatm ent failure:
tinidazole P O : 1 g /d ay in 2 d iv id ed d oses for 5 d ays
or metronidazole P O : 800 to 1000 m g /d ay in 2 d iv id ed d oses for 7 d ays
– Vulvovaginal candidiasis
clotrimazole (500 m g v ag inal tablet): 1 tablet as a sing le d ose, inserted d eep into th e
v ag ina at bed tim e
or, if not av ailable,
clotrimazole (100 m g v ag inal tablet): one tablet inserted d eep into th e v ag ina at
bed tim e for 6 d ays
or nystatin (100,000 IU v ag inal tablet): one tablet inserted d eep into th e v ag ina at
bed tim e for 14 d ays
If th e patient h as extensiv e v ulv ar inv olv em ent, miconazole 2% cream (2 applications
to th e v ulv a d aily for 7 d ays) m ay be used in com bination w ith th e intrav ag inal
treatm ent abov e. M iconazole cream m ay com plem ent, but d oes not replace,
treatm ent w ith clotrim azole.
Treatment of the partner
W h en th e patient is treated for v ag initis or cerv icitis, th e sexual partner receiv es th e
sam e treatm ent as th e patient, w h eth er or not sym ptom s are present.
In th e case of v ulv ov ag inal cand id iasis, th e partner is treated only if sym ptom atic
(itch ing and red ness of th e g lans/prepuce): miconazole 2%, 2 applications d aily for
7 d ays.
235
