Genital system infections

Question 1

Bacterial Vaginosis

Answer 1

Oral metronidazole
Suggested duration of treatment 5–7 days (or high-dose metronidazole as a single dose)
Alternatively, topical metronidazole for 5 days or topical clindamycin for 7 days

Question 2

Uncomplicated genital chlamydial infection and uncomplicated non-gonococcal urethritis (non-specific urethritis)

Answer 2

Contact tracing recommended.

First line: doxycycline
Alternative if tetracycline allergy or unsuitable: azithromycin.

Question 3

Gonorrhoea

Answer 3

First line:
If antimicrobial susceptibility unknown: ceftriaxone
If micro-organism is sensitive to ciprofloxacin: ciprofloxacin
Alternatives due to allergy, needle phobia or contra-indications:
Gentamicin plus azithromycin
If parenteral administration is not possible: cefixime [unlicensed use] plus azithromycin
In non-pharyngeal infections: spectinomycin [unlicensed] plus azithromycin
If unable to take standard therapy: azithromycin

Question 4

Pelvic inflammatory disease

Answer 4

Contact tracing recommended.

Doxycycline + metronidazole + single-dose of i/m ceftriaxone or ofloxacin + metronidazole
Suggested duration of treatment 14 days (except i/m ceftriaxone).
In severely ill patients initial treatment with doxycycline + i/v ceftriaxone + i/v metronidazole, then switch to oral treatment with doxycycline + metronidazole to complete 14 days’ treatment

Question 5

Early syphilis (primary, secondary, and early latent—less than 2 years since infection) and late latent syphilis (more than 2 years since infection)

Answer 5

First line: benzathine benzylpenicillin
Alternatives include: doxycycline

Question 6

Asymptomatic contacts of patients with infectious syphilis

Answer 6

First line: benzathine benzylpenicillin
Alternatives include: doxycycline