Cervicitis medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==


*Treatment with antibiotics for 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'':<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>:*Women aged ≤25 years
*Treatment with antibiotics for 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'':<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>:
*Age ≥ 25 years
:*New or multiple sex partners
:*New or multiple sex partners
:*Patients who engage in unprotected sex
:*Patients who engage in unprotected sex
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:*Preferred regimen (1): [[Azithromycin]] 1 g PO in a single dose
:*Preferred regimen (1): [[Azithromycin]] 1 g PO in a single dose
:*Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 7 days
:*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 (1): [[Erythromycin]] base 500 mg PO qid for 7 days
:*Alternative regimen (2): Erythromycin ethysuccinate 800 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 (3): [[Ofloxacin]] 300 mg PO bid for 7 days
:*Alternative regimen (4): Levofloxacin 500 mg PO qd 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===
===Gonococcal Cervicitis===
*'''Cervicitis, Gonococcal'''<ref name="pmid22874837">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. | journal=MMWR Morb Mortal Wkly Rep | year= 2012 | volume= 61 | issue= 31 | pages= 590-4 | pmid=22874837 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22874837  }} </ref>
*'''Cervicitis, Gonococcal'''<ref name="pmid22874837">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. | journal=MMWR Morb Mortal Wkly Rep | year= 2012 | volume= 61 | issue= 31 | pages= 590-4 | pmid=22874837 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22874837  }} </ref>
:*Preferred regimen: [[Cephalosporin]] IM in a single dose {{and}} ([[Azithromycin]] 1 g PO in a single dose {{or}} [[Doxycyline]] mg PO bid for 7 days)
:*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
:*Alternative regimen, cephalosporin allergic: [[Azithromycin]] 2 g PO in a single dose
:*Note: A test of cure is recommended at 1 week after the first dose of antimicrobial therapy.
:*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.


===Recurrent and Persistent Cervicitis===


Women with persistent cervicitis should be reevaluated for possible reexposure to an STD. If relapse and/or reinfection with a specific STD has been excluded, BV is not present, and sex partners have been evaluated and treated, management options for persistent cervicitis are undefined; in addition, the utility of repeated or prolonged administration of antibiotic therapy for persistent symptomatic cervicitis remains unknown. Women who receive such therapy should return after treatment so that a determination can be made regarding whether cervicitis has resolved. Research is needed on the etiology of persistent cervicitis including the potential role ofM. genitalium (266). In women with persistent symptoms that are clearly attributable to cervicitis, referral to a gynecologic specialist can be considered.
===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===
===Follow-Up===
 
*A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
Follow-up should be conducted as recommended for the infections for which a woman is treated. 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. Therefore, repeat testing of all women with chlamydia or gonorrhea is recommended 3-6 months after treatment, regardless of whether their sex partners were treated (267).
*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.
 
===Management of Sex Partners===
 
Management of sex partners of women treated for cervicitis should be appropriate for the identified or suspected STD. Partners should be notified and examined if chlamydia, gonorrhea, or trichomoniasis was identified or suspected in the index patient; these partners should then be treated for the STDs for which the index patient received treatment. To avoid reinfection, patients and their sex partners should abstain from sexual intercourse until therapy is completed (i.e., 7 days after a single-dose regimen or after completion of a 7-day regimen). Expedited partner treatment and patient referral (see Partner Management) are alternative approaches to treating male partners of women that have chlamydia or gonococcal infections (68,69,71).
 
===Special Considerations===
 
'''HIV Infection'''
 
Patients who have cervicitis and also are infected with HIV should receive the same treatment regimen as those who are HIV negative. Treatment of cervicitis in HIV-infected women is vital because cervicitis increases cervical HIV shedding. Treatment of cervicitis in HIV-infected women reduces HIV shedding from the cervix and might reduce HIV transmission to susceptible sex partners (268–270).


==References==
==References==

Revision as of 17:14, 24 September 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Antimicrobial therapy is indicated in cervicitis. In postmenopausal women with cervicitis, hormonal therapy may be administered. Women with persistent and recurrent cervicitis should be evaluated for possible reexposure to an STD.

Medical Therapy

  • Treatment with antibiotics for 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:[1]:
  • 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:[2]
  • Patients in regions with high incidence of gonococcal infections
  • Patients at high risk of gonococcal infections

Chlamydial Cervicitis

  • Cervicitis, Chlamydial[1]
  • 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[2]
  • 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

  1. ↑ 1.0 1.1 Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
  2. ↑ 2.0 2.1 Centers for Disease Control and Prevention (CDC) (2012). "Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections". MMWR Morb Mortal Wkly Rep. 61 (31): 590–4. PMID 22874837.


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