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Remember to check allergy status

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Adult Treatment - Genital Tract Infections

Contact UKTIS for information on foetal risks if patient is pregnant.

STI Screening: People with risk factors should be screened for chlamydia, gonorrhoea, HIV, syphilis. Refer individual and partners to GUM service. Risk factors: < 25y, no condom use, recent (<12mth)/frequent change of partner, symptomatic partner, area of high HIV.1,2

Pelvic inflammatory disease

BASHH
NICE-CKS

Refer woman & contacts to GUM service 1,2 B+. Always culture for gonorrhoea & chlamydia 2 B+ If gonorrhoea likely (partner has it, severe symptoms, sex abroad) use ceftriaxone regimen3 B+ or refer to GUM.

Medicine Calendar

metronidazole PLUS ofloxacin or doxycycline

400mg BD metronidazole PLUS 400mg BD ofloxacin 1,2,4,6 B or 100mg BD doxycycline 1,2,4 B+

14 days

If high risk of gonorrhoea ADD Ceftriaxone 3,5 C

500mg IM

STAT

Bacterial vaginosis

BASHH
PHE
NICE-CKS

Oral metronidazole is as effective as topical treatment 1 A+ but is cheaper. Less relapse with 7 day than 2g stat at 4 wks3 A+
Pregnant2 A+ /breastfeeding: AVOID 2g stat in pregnancy3 A+
Treating partners does not reduce relapse5 B+

Medicine Calendar

oral Metronidazole 1,3 A+

400mg BD or 2g (2g dose:(NOT IN PREGNANCY))

7 days 1 A+ OR 2g stat3 A+

or Metronidazole 0.75% vaginal gel 1 A+

5g applicatorful at night

5 nights 1 A+

or Clindamycin 2% cream 1 A+

5g applicatorful at night

7 nights 1 A+

Trichomoniasis

BASHH
PHE
NICE-CKS

Treat partners and refer to GUM service 1 B+ In pregnancy or breastfeeding: AVOID 2g single dose metronidazole. Consider clotrimazole for symptom relief (not cure) if metronidazole declined 3 B+

Medicine Calendar

metronidazole4 A+

400mg BD or 2g (2g dose:(NOT IN PREGNANCY))

5-7 days 4 A+ or 2g stat 4 A+

clotrimazole 3 B+

100mg pessary at night

6 nights 3 B+

Gonorrhoea

Antibiotic resistance is now very high. Use IM ceftriaxone plus azithromycin and refer to GUM.

Medicine Calendar

Ceftriaxone PLUS azithromycin

ceftriaxone 500mg IM and azithromycin 1g

stat dose for both drugs

Chlamydia trachomatis/urethritis

SIGN
BASHH
PHE
NICE-CKS

Opportunistically screen all aged 15-25yrs1
Treat partners and refer to GUM service2,3 B+

Pregnancy2 C or breastfeeding: azithromycin is the most effective option5 A+
Due to lower cure rate in pregnancy, test for cure 6 weeks after treatment3 C

Medicine Calendar

Azithromycin4 A+

1g

stat 4 A+

OR Doxycycline (NOT IN PREGNANCY)4 A+

100mg BD

7 days 4 A+

If PREGNANT or BREASTFEEDING- azithromycin 5 A+

1g (off-label use)

stat 5 A+

Or If PREGNANT or BREASTFEEDING- erythromycin 5 A+

500mg QDS

7 days 5 A+

Or If PREGNANT or BREASTFEEDING- amoxicillin 5 A+

500mg TDS

7 days 5 A+

Epididymitis

For suspected epididymitis in men over 35 years with low risk of STI15 C Refer men at High risk of STI to GUM.15 C

Medicine Calendar

Ofloxacin

200mg BD

14 days

or doxycycline

100mg BD

14 days

Vaginal candidiasis

BASHH
PHE
NICE-CKS

All topical and oral azoles give 75% cure 1 A+

In pregnancy: avoid oral azoles 2 B- and use intravaginal treatment for 7 days 3 A+,2,4 B-

Medicine Calendar

clotrimazole 1 A+

500mg pessary or 10% cream

stat

OR oral fluconazole1 A+

150mg orally

stat

PREGNANT: clotrimazole 3 A+

100 mg pessary at night

6 nights 5 C

PREGNANT
Second Option miconazole 2% cream 3 A+

5g intravaginally BD

7 days

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).