Genital Infections

Question 1

What is the treatment of choice for bacterial vaginosis?

Answer 1

FIRST LINE:
- oral metronidazole (5-7 days OR as a high-dose single administration)

SECOND LINE:

• topical metronidazole (5 days)
• topical clindamycin (7 days)

Question 2

What is the treatment of choice for uncomplicated genital chlamydia infection?

Answer 2

FIRST LINE:

• Azithromycin (single dose)
• Doxycycline (7 days)

SECOND LINE:
- Erythromycin (14 days)

**contact tracing recommended

Question 3

What is the treatment of choice for non-gonococcal urethritis and non-specific genital infection?

Answer 3

Treat as if infection is caused by chlamydia

FIRST LINE:

• Azithromycin (single dose)
• Doxycycline (7 days)

SECOND LINE:
- Erythromycin (14 days)

**contact tracing recommended

Question 4

What is the treatment of choice for uncomplicated gonorrhea infection?

Answer 4

FIRST LINE:

• IM ceftriaxone (if susceptibility unknown)
• oral ciprofloxacin (if sensitive)

SECOND LINE: due to allergy, needle phobia, or contraindications

• IM gentamicin + oral azithromycin
• oral cefixime + oral azithromycin (if parenteral administration is not possible)

Question 5

In addition to abx treatment, what other measures should be taken in cases of gonorrhea infection? (2)

Answer 5

1. Contact tracing

2. Test of cure following treatment

Question 6

What are the temporal requirements for antibiotic treatment of gonorrhea? (2)

Answer 6

Treatment is only recommended for those presenting:

• within 14 days of exposure OR
• those presenting after exposure with a positive test

Question 7

How long should individuals receiving treatment for gonorrhea avoid sexual intercourse?

Answer 7

Sexual intercourse should be avoided until 7 days after patients and their partner(s) have completed treatment

Question 8

What is the treatment of choice for patients with PID?

Answer 8

FIRST LINE:

• doxycycline + metronidazole + single-dose IM ceftriaxone
• ofloxacin + metronidazole (14 days)

*in severely ill patients, initial treatment with doxycycline + IV ceftriaxone + IV metronidazole, then switch to oral treatment with doxycycline + metronidazole to complete 14 days treatment

**contact tracing recommended

Question 9

What is the treatment of choice for early syphilis infection?

Answer 9

Syphilis infection is considered “early” if infection has been some time in the last 2 years

FIRST LINE:
- Benzathine benzylpenicillin (deep IM injection, single dose; repeat dose after 7 days for women in the third trimester of pregnancy)

**contact tracing is recommended

SECOND LINE:

• doxycycline (14 days)
• erythromycin (14 days)

Question 10

What is the treatment of choice for late latent syphilis infection?

Answer 10

Syphilis is considered late latent syphilis when asymptomatic infection has been present for more than 2 years

FIRST LINE:
- benzathine benzylpenicillin (once weekly for 2 weeks)

SECOND LINE:
- doxycycline (28 days)

**contact tracing recommended

Question 11

What is the treatment of choice for asymptomatic contacts of patients with infectious syphilis?

Answer 11

Doxycycline (14 days)