Sandbox ID Genitourinary

Chancroid

• Haemophilus ducreyi infection

• Chancroid

• Preferred regimen: Azithromycin 1 g PO as a single dose OR Ceftriaxone 250 mg IM as a single dose OR Ciprofloxacin 500 mg PO bid for 3 days OR Erythromycin 500 mg PO tid for 7 days

Note (1): Ciprofloxacin is contraindicated for pregnant and lactating women.

Note (2): Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed 3 months after the diagnosis of chancroid.

Note (3): Sex partners of patients who have chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patient's onset of symptoms.

Genital herpes

• Genital HSV infections

• First episode of genital herpes

• Preferred regimen: Acyclovir 400 mg PO tid for 7–10 days OR Acyclovir 200 mg PO five times a day for 7–10 days OR Famciclovir 250 mg PO tid for 7–10 days OR Valacyclovir 1 g PO bid for 7–10 days

Note: Treatment can be extended if healing is incomplete after 10 days of therapy.

• Recurrent genital herpes

• Suppressive therapy

• Preferred regimen: Acyclovir 400 mg PO bid OR Famciclovir 250 mg PO bid OR Valacyclovir 500–1000 mg PO qd for 7–10 days

• Episodic therapy

• Preferred regimen: Acyclovir 400 mg PO tid for 5 days OR Acyclovir 800 mg PO bid a day for 5 days OR Acyclovir 800 mg PO tid for 2 days OR Famciclovir 125 mg PO bid for 5 days OR Famciclovir 1000 mg PO bid for 1 day OR Famciclovir 500 mg PO once, followed by 250 mg PO bid for 2 days OR Valacyclovir 500 mg PO bid for 3 days OR Valacyclovir 1000 mg PO qd for 5 days

• Severe genital herpes

• Preferred regimen: Acyclovir 5–10 mg/kg IV q8h for 2–7 days or until clinical improvement is observed, followed by PO antiviral therapy to complete at least 10 days of total therapy.

Note (1): Acyclovir dose adjustment is recommended for impaired renal function.

Note (2): Symptomatic sex partners should be evaluated and treated in the same manner as patients who have genital lesions. Asymptomatic sex partners of patients who have genital herpes should be questioned concerning histories of genital lesions and offered type–specific serologic testing for HSV infection.

• Genital herpes in HIV–infected patients

• Suppressive therapy

• Preferred regimen: Acyclovir 400–800 mg PO bid–tid OR Famciclovir 500 mg PO bid OR Valacyclovir 500 mg PO bid

• Episodic therapy

• Preferred regimen: Acyclovir 400 mg PO tid for 5–10 days OR Famciclovir 500 mg PO bid for 5–10 days OR Valacyclovir 1000 mg PO bid for 5–10 days

• Genital herpes in pregnancy

• Acyclovir can be administered orally to pregnant women with first episode of genital herpes or recurrent genital herpes.
• Acyclovir should be administered IV to pregnant women with severe genital herpes.

• Neonatal herpes

• Disease limited to the skin and mucous membranes

• Preferred regimen: Acyclovir 20 mg/kg IV q8h for 14 days

• Disseminated and CNS disease

• Preferred regimen: Acyclovir 20 mg/kg IV q8h for 21 days

Gonococcal infections

• Neisseria gonorrhoeae infection

• Uncomplicated gonococcal infections of the cervix, urethra, and rectum

• Preferred regimen: Ceftriaxone 250 mg IM as a single dose AND (Azithromycin 1 g PO as a single dose OR Doxycycline 100 mg PO bid for 7 days)
• Alternative regimen: Cefuroxime 1 g PO as a single dose

• Uncomplicated gonococcal infections of the pharynx

• Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND (Azithromycin 1 g orally as a single dose OR Doxycycline 100 mg orally twice daily for 7 days)

• Gonococcal conjunctivitis

• Preferred regimen: Ceftriaxone 1 g IM in a single dose

• Disseminated gonococcal infection

• Preferred regimen: Ceftriaxone 1 g IV/IM every 24 hours
• Alternative regimen: Cefotaxime 1 g IV every 8 hours OR Ceftizoxime 1 g IV every 8 hours

Note: All of the preceding regimens should be continued for 24–48 hours after improvement begins, at which time therapy can be switched to Cefixime 400 mg PO bid to complete at least 1 week of antimicrobial therapy.

• Gonococcal meningitis

• Preferred regimen: Ceftriaxone 1–2 g IV every 12 hours for 10–14 days

• Gonococcal endocarditis

• Preferred regimen: Ceftriaxone 1–2 g IV every 12 hours for at least 4 weeks

• Ophthalmia neonatorum

• Preferred regimen: Ceftriaxone 25–50 mg/kg IV or IM in a single dose, not to exceed 125 mg

• Disseminated gonococcal infection and gonococcal scalp abscesses in newborns

• Preferred regimen:

Granuloma Inguinale

• Granuloma inguinale (donovanosis)

• Preferred regime: Doxycycline 100 mg orally twice a day for at least 3 weeks and until all lesions have completely healed

• Alternative regime (1): Azithromycin 1 g orally once per week for at least 3 weeks and until all lesions have completely healed

• Alternative regime (2): Ciprofloxacin 750 mg orally twice a day for at least 3 weeks and until all lesions have completely healed

• Alternative regime (3): Erythromycin base 500 mg orally four times a day for at least 3 weeks and until all lesions have completely healed

• Alternative regime (4): Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 weeks and until all lesions have completely healed

• NOTE(1): The addition of an Aminoglycoside (e.g., Gentamicin 1 mg/kg IV every 8 hours) to these regimens can be considered if improvement is not evident within the first few days of therapy.
• NOTE(2): Patients should be followed clinically until signs and symptoms have resolved.

• NOTE(3): Persons who have had sexual contact with a patient who has granuloma inguinale within the 60 days before onset of the patient's symptoms should be examined and offered therapy. However, the value of empiric therapy in the absence of clinical signs and symptoms has not been established.

• NOTE(4): Pregnancy is a relative contraindication to the use of sulfonamides. Pregnant and lactating women should be treated with the erythromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin). Azithromycin might prove useful for treating granuloma inguinale during pregnancy, but published data are lacking. Doxycycline and ciprofloxacin are contraindicated in pregnant women.

• NOTE(5): Persons with both granuloma inguinale and HIV infection should receive the same regimens as those who are HIV negative; however, the addition of a parenteral Aminoglycoside (e.g., Gentamicin) can also be considered.