Cervicitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Antimicrobial therapy with adequate coverage against C. trachomatis should be provided for women at increased risk for C. trachomatis or if follow-up cannot be ensured and if a relatively insensitive diagnostic test is used in place of NAAT. Patients may also require concomitant therapy against N. gonorrhea". Medical therapies include either azithromycin, doxycycline, or a fluoroquinolone. Treatment of sexual partners is also indicated. Follow-up after completion of antimicrobial therapy regimen is required to evaluate for microbial resistance.

Medical Therapy

• Antimicrobial therapy with adequate coverage against C. trachomatis should be provided for women at increased risk for C. trachomatis or if follow-up cannot be ensured and if a relatively insensitive diagnostic test is used in place of NAAT.
• The following patients are at increased risk of C. trachomatis:
• Age ≥ 25 years

• New or multiple sex partners
• Patients who engage in unprotected sex

• Concomitant therapy for N. gonorrhea (gonococcal cervicitis) is recommended among the following patients:

• Patients in regions with high incidence of gonococcal infections
• Patients at high risk of gonococcal infections

Chlamydial Cervicitis

• Cervicitis, Chlamydial

• Preferred regimen (1): Azithromycin 1 g PO in a single dose
• Preferred regimen (2): Doxycycline 100 mg PO bid for 7 days
• Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (2): Erythromycin ethysuccinate 800 mg PO qid for 7 days
• Alternative regimen (3): Ofloxacin 300 mg PO bid for 7 days
• Alternative regimen (4): Levofloxacin 500 mg PO qd for 7 days
• Alternative regimen (5), pregnancy: Azithromycin 1 g PO in a single dose OR Amoxicillin 500 mg PO tid for 7 days OR Erythromycin base 500 mg PO qid for 7 days OR Erythromycin base 250 mg PO qid for 14 days OR Erythromycin ethysuccinate 800 mg PO qid for 14 days OR Erythromycin ethylsuccinate 400 mg PO qid for 14 days
• Note (1): A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
• Note (2): Sexual activity should be withheld for 1 week until the antimicrobial regimen is complete.
• Note (3): Avoid doxycycline and fluoroquinolones among pregnant women

Gonococcal Cervicitis

• Cervicitis, Gonococcal

• Preferred regimen: Cephalosporin IM in a single dose AND (Azithromycin 1 g PO in a single dose OR Doxycycline mg PO bid for 7 days)
• Alternative regimen, cephalosporin allergic: Azithromycin 2 g PO in a single dose
• Note (1): A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
• Note (2): Sexual activity should be withheld for 1 week until the antimicrobial regimen is complete.

Treatment of Sexual Partners

• Sexual partners should also be treated for the pathogens as listed above.
• A test of cure is also recommended 1 week after the first dose of antimicrobial therapy.
• The partner's sexual activity should be withheld for 1 week until the antimicrobial regimen is complete.

Follow-Up

• A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
• If symptoms persist, women should be instructed to return for re-evaluation because women with documented chlamydial or gonococcal infections have a high rate of reinfection within 6 months after treatment.

References

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