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9. Genito-urinary diseases
Sexually transmitted infections
– Antibiotic th erapy com bines 3 antibiotics to cov er th e m ost frequent causativ e
org anism s: g onococci, ch lam yd iae, and anaerobes.
• Am bulatory treatm ent:
cefixime P O : 400 m g as a sing le d ose or ceftriaxone IM : 250 m g as a sing le d ose
+ doxycycline P O : 200 m g /d ay in 2 d iv id ed d oses for 141d ays
+ metronidazole P O : 1 g /d ay in 2 d iv id ed d oses for 14 d ays
• T reatm ent in h ospital:
ceftriaxone IM : 250 m g /d ay once d aily
+ doxycycline P O : 200 m g /d ay in 2 d iv id ed d oses for 141d ays
+ metronidazole P O or IV : 1 g /d ay in 2 d iv id ed d oses or infusions for 14 d ays
Continue triple th erapy for 24 to 48 h ours after sig ns and sym ptom s h av e
im prov ed (resolution of fev er, d ecrease in pain), th en continue d oxycycline (or
eryth rom ycin) + m etronid azole to com plete 14 d ays of treatm ent.
– If an IU D is in place, it sh ould be rem ov ed (offer anoth er m eth od of contraception).
– Analg esic treatm ent accord ing to pain intensity.
– T reatm ent of th e partner: sing le d ose treatm ent for both g onorrh oea AN D ch lam yd ia
(as for Urethral discharge, pag e 231), wh eth er or not sym ptom s are present.
Infections after childbirth or abortion
– Antibiotic th erapy: treatm ent m ust cov er th e m ost frequent causativ e org anism s:
anaerobes, Gram neg ativ es and streptococci.
• Am bulatory treatm ent (early stag es only):
amoxicillin/clavulanic acid (co-amoxiclav) P O for 7 d ays
T h e d ose is expressed in am oxicillin. Depend ing on th e form ulation of co-
am oxiclav av ailable:
Ratio 8:1: 3000 m g /d ay = 2 tablets of 500/62.5 m g 3 tim es per d ay
Ratio 7:1: 2625 m g /d ay = 1 tablet of 875/125 m g 3 tim es per d ay
N ote: th e d ose of clav ulanic acid sh ould not exceed 375 m g /d ay.
or
amoxicillin P O : 3 g /d ay in 3 d iv id ed d oses + metronidazole P O : 1.5 g /d ay in
3 d iv id ed d oses for 7 9
d ays
• Tamreoaxtimcilelinn/tcilnavhulaonsipcitaacli:d (co-amoxiclav) IV (d ose expressed in am oxicillin):
3 g /d ay in 3 injections + gentamicin IM : 5 m g /kg once d aily
aomr picillin IV : 6 g /d ay in 3 injections
+ metronidazole IV : 1.5 g /d ay in 3 infusions
+ gentamicin IM : 5 m g /kg once d aily
O nce th e patient‟s cond ition h as im prov ed and oral treatm ent can be tolerated , co-
am oxiclav or am oxicillin + m etronid azole m ay be g iv en P O (as for am bulatory
treatm ent). S top antibiotic th erapy 48 h ours after resolution of fev er and
im prov em ent in pain.
In pregnant/breastfeeding women: erythromycin PO: 2 g/day in 2 to 4 divided doses for 14 days
1
Single dose azithromycin is not effective against chlamydia in the treatment of sexually transmitted UGTI.
241
Sexually transmitted infections
– Antibiotic th erapy com bines 3 antibiotics to cov er th e m ost frequent causativ e
org anism s: g onococci, ch lam yd iae, and anaerobes.
• Am bulatory treatm ent:
cefixime P O : 400 m g as a sing le d ose or ceftriaxone IM : 250 m g as a sing le d ose
+ doxycycline P O : 200 m g /d ay in 2 d iv id ed d oses for 141d ays
+ metronidazole P O : 1 g /d ay in 2 d iv id ed d oses for 14 d ays
• T reatm ent in h ospital:
ceftriaxone IM : 250 m g /d ay once d aily
+ doxycycline P O : 200 m g /d ay in 2 d iv id ed d oses for 141d ays
+ metronidazole P O or IV : 1 g /d ay in 2 d iv id ed d oses or infusions for 14 d ays
Continue triple th erapy for 24 to 48 h ours after sig ns and sym ptom s h av e
im prov ed (resolution of fev er, d ecrease in pain), th en continue d oxycycline (or
eryth rom ycin) + m etronid azole to com plete 14 d ays of treatm ent.
– If an IU D is in place, it sh ould be rem ov ed (offer anoth er m eth od of contraception).
– Analg esic treatm ent accord ing to pain intensity.
– T reatm ent of th e partner: sing le d ose treatm ent for both g onorrh oea AN D ch lam yd ia
(as for Urethral discharge, pag e 231), wh eth er or not sym ptom s are present.
Infections after childbirth or abortion
– Antibiotic th erapy: treatm ent m ust cov er th e m ost frequent causativ e org anism s:
anaerobes, Gram neg ativ es and streptococci.
• Am bulatory treatm ent (early stag es only):
amoxicillin/clavulanic acid (co-amoxiclav) P O for 7 d ays
T h e d ose is expressed in am oxicillin. Depend ing on th e form ulation of co-
am oxiclav av ailable:
Ratio 8:1: 3000 m g /d ay = 2 tablets of 500/62.5 m g 3 tim es per d ay
Ratio 7:1: 2625 m g /d ay = 1 tablet of 875/125 m g 3 tim es per d ay
N ote: th e d ose of clav ulanic acid sh ould not exceed 375 m g /d ay.
or
amoxicillin P O : 3 g /d ay in 3 d iv id ed d oses + metronidazole P O : 1.5 g /d ay in
3 d iv id ed d oses for 7 9
d ays
• Tamreoaxtimcilelinn/tcilnavhulaonsipcitaacli:d (co-amoxiclav) IV (d ose expressed in am oxicillin):
3 g /d ay in 3 injections + gentamicin IM : 5 m g /kg once d aily
aomr picillin IV : 6 g /d ay in 3 injections
+ metronidazole IV : 1.5 g /d ay in 3 infusions
+ gentamicin IM : 5 m g /kg once d aily
O nce th e patient‟s cond ition h as im prov ed and oral treatm ent can be tolerated , co-
am oxiclav or am oxicillin + m etronid azole m ay be g iv en P O (as for am bulatory
treatm ent). S top antibiotic th erapy 48 h ours after resolution of fev er and
im prov em ent in pain.
In pregnant/breastfeeding women: erythromycin PO: 2 g/day in 2 to 4 divided doses for 14 days
1
Single dose azithromycin is not effective against chlamydia in the treatment of sexually transmitted UGTI.
241
