Sandbox ID Genitourinary: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 139: Line 139:


===Cystitis===
===Cystitis===
*  Acute Uncomplicated Cystitis
:* Preferred regime: Nitrofurantoin monohydrate/macrocrystals 100 mg bid X 5 days (avoid if early pyelonephritis suspected) OR Trimethoprim-sulfamethoxazole 160/800 mg (one DS tablet) bid X 3 days (avoid if resistance prevalence is known to exceed 20 or if used for UTI in previous 3 months) OR Fosfomycin trometamol 3 gm single dose (lower efficacy than some other recommended agents; avoid if early pyelonephritis suspected) OR Pivmecillinam 400 mg bid x 5 days (lower efficacy than some other recommended agents; avoid if early pyelonephritis suspected)


===Epididymitis===
===Epididymitis===

Revision as of 19:14, 5 June 2015

Asymptomatic bacteriuria

  • Premenopausal, Nonpregnant Women[1]
  • NOTE: Screening for and treatment of asymptomatic bacteriuria in premenopausal, nonpregnant women is not indicated.
  • Pregnant Women
  • Diabetic Women
  • NOTE: The duration of antimicrobial therapy should be 3–7 days.
  • NOTE: Screening for or treatment of asymptomatic bacteriuria in diabetic women is not indicated.
  • Older Persons Residing in the Community
  • NOTE: Routine screening for and treatment of asymptomatic bacteriuria in older persons resident in the community is not recommended.
  • Elderly Institutionalized Subjects
  • NOTE: Screening for and treatment of asymptomatic bacteriuria in elderly institutionalized residents of longterm care facilities is not recommended.
  • Subjects with Spinal Cord Injuries
  • NTOE: Asymptomatic bacteriuria should not be screened for or treated in spinal cord–injured patients.
  • Patients with Indwelling Urethral Catheters
  • NOTE (1): Asymptomatic bacteriuria or funguria should not screened for or treated in patients with an indwelling urethral catheter.
  • NOTE (2): Antimicrobial treatment of asymptomatic women with catheter-acquired bacteriuria that persists 48 h after catheter removal may be considered.
  • Urologic Interventions
  • For prevention of UTI:
  • Preferred regime: Removal after 72 hrs.
  • Immunocompromised Patients and Other Patients
  • NOTE: No recommendation can be made for screening for or treatment of asymptomatic bacteriuria in renal transplant or other solid organ transplant recipients.

Ectoparasitic Infections

Pediculosis Pubis

  • Preferred regime: Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes OR Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes
  • Alternative regime: Malathion 0.5% lotion applied for 8--12 hours and washed off OR Ivermectin 250 µg/kg orally, repeated in 2 weeks


Scabies

  • Preferred regime: Permethrin cream (5%) applied to all areas of the body from the neck down and washed off after 8--14 hours OR Ivermectin 200ug/kg orally, repeated in 2 weeks
  • Alternative regime: Lindane (1%) 1 oz. of lotion (or 30 g of cream) applied in a thin layer to all areas of the body from the neck down and thoroughly washed off after 8 hours


Human papillomavirus infection

Genital Warts

External Genital Warts
  • Patient-Applied:
  • Provider--Administered:
  • Preferred regime: Cryotherapy with liquid nitrogen or cryoprobe, repeat applications every 1-2 weeks OR Podophyllin resin 10%-25% in a compound tincture of benzoin OR Trichloroacetic acid (TCA) OR Bichloroacetic acid (BCA) 80%-90% OR Surgical removal either by tangential scissor excision, tangential shave excision, curettage, or electrosurgery.
  • Alternative regime: intralesional interferon, photodynamic therapy, and topical [[Cidofovir].
Cervical Warts
  • Preferred regime: For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated. Management of exophytic cervical warts should include consultation with a specialist.
Vaginal Warts
  • Preferred regime: Cryotherapy with liquid nitrogen. The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation OR TCA or BCA 80%--90% applied to warts. A small amount should be applied only to warts and allowed to dry, at which time a white frosting develops. If an excess amount of acid is applied, the treated area should be powdered with talc, sodium bicarbonate, or liquid soap preparations to remove unreacted acid. This treatment can be repeated weekly, if necessary.
Urethral Meatus Warts
  • Preferred regime: Cryotherapy with liquid nitrogen OR Podophyllin 10%--25% in compound tincture of benzoin. The treatment area and adjacent normal skin must be dry before contact with podophyllin. This treatment can be repeated weekly, if necessary. The safety of podophyllin during pregnancy has not been established. Data are limited on the use of podofilox and imiquimod for treatment of distal meatal warts.
Anal Warts
  • Preferred regime: Cryotherapy with liquid nitrogen OR TCA or BCA 80%--90% applied to warts. A small amount should be applied only to warts and allowed to dry, at which time a white frosting develops. If an excess amount of acid is applied, the treated area should be powdered with talc, sodium bicarbonate, or liquid soap preparations to remove unreacted acid. This treatment can be repeated weekly, if necessary. OR Surgical removal

Vaginal infection

Bacterial vaginosis

  • Preferred regime: Metronidazole 500 mg orally twice a day for 7 days OR Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days OR Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
  • Alternative regime (1): Tinidazole 2 g orally once daily for 3 days
  • Alternative regime (2): Tinidazole 1 g orally once daily for 5 days
  • Alternative regime (3): Clindamycin 300 mg orally twice daily for 7 days
  • Alternative regime (4): Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days
Bacterial vaginosis during pregnancy

Trichomoniasis

T. vaginalis

  • Alternative regime: Metronidazole 500 mg orally twice a day for 7 days
Trichomoniasis during pregnancy
  • Preferred regime: 2 g Metronidazole in a single dose at any stage of pregnancy, withholding breastfeeding during treatment and for 12--24 hours after the last dose will reduce the exposure of the infant to metronidazole.

Vulvovaginal candidiasis

Uncomplicated VVC
  • Preferred regime:
  • Over-the-Counter Intravaginal Agents: Butoconazole 2% cream 5 g intravaginally for 3 days OR Clotrimazole 1% cream 5 g intravaginally for 7--14 days OR Clotrimazole 2% cream 5 g intravaginally for 3 days OR [Miconazole]] 2% cream 5 g intravaginally for 7 days OR Miconazole 4% cream 5 g intravaginally for 3 days OR Miconazole 100 mg vaginal suppository, one suppository for 7 days OR Miconazole 200 mg vaginal suppository, one suppository for 3 days OR Miconazole 1,200 mg vaginal suppository, one suppository for 1 day OR Tioconazole 6.5% ointment 5 g intravaginally in a single application
  • Prescription Intravaginal Agents: Butoconazole 2% cream (single dose bioadhesive product), 5 g intravaginally for 1 day OR Nystatin 100,000-unit vaginal tablet, one tablet for 14 days OR Terconazole 0.4% cream 5 g intravaginally for 7 days OR Terconazole 0.8% cream 5 g intravaginally for 3 days OR Terconazole 80 mg vaginal suppository, one suppository for 3 days
  • Oral Agent: Fluconazole 150 mg oral tablet, one tablet in single dose
Complicated VVC
  • Recurrent Vulvovaginal Candidiasis (RVVC)
  • Preferred regime: 7-14 days of topical therapy OR a 100-mg, 150-mg, or 200-mg oral dose of Fluconazole every third day for a total of 3 doses followed by Oral Fluconazole (i.e., 100-mg, 150-mg, or 200-mg dose) weekly for 6 months
  • Severe VVC
  • Preferred regime: Topical Azole for 7-14 days OR 150 mg of Fluconazole in two sequential doses (second dose 72 hours after initial dose.
  • Nonalbicans VVC
  • Preferred regime: nonfluconazole Azole drug (oral or topical) for 7-14 days.
Vulvovaginal candidiasis during pregnancy
  • Preferred regime: topical Azole therapies for 7 days

Cervicitis

Chancroid

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.

Chlamydial infections

  • Preferred regime: Azithromycin 1 g orally in a single dose OR Doxycycline 100 mg orally twice a day for 7 days
  • Alternative regime (1): Erythromycin base 500 mg orally four times a day for 7 days
  • Alternative regime (3): Levofloxacin 500 mg orally once daily for 7 days
  • Alternative regime (4): Ofloxacin 300 mg orally twice a day for 7 days

Chlamydial infections during pregnancy

  • Preferred regime: Azithromycin 1 g orally in a single dose OR Amoxicillin 500 mg orally three times a day for 7 days
  • Alternative regime (1): Erythromycin base 500 mg orally four times a day for 7 days
  • Alternative regime (2): Erythromycin base 250 mg orally four times a day for 14 days

Chorioamnionitis

Cystitis

  • Acute Uncomplicated Cystitis
  • Preferred regime: Nitrofurantoin monohydrate/macrocrystals 100 mg bid X 5 days (avoid if early pyelonephritis suspected) OR Trimethoprim-sulfamethoxazole 160/800 mg (one DS tablet) bid X 3 days (avoid if resistance prevalence is known to exceed 20 or if used for UTI in previous 3 months) OR Fosfomycin trometamol 3 gm single dose (lower efficacy than some other recommended agents; avoid if early pyelonephritis suspected) OR Pivmecillinam 400 mg bid x 5 days (lower efficacy than some other recommended agents; avoid if early pyelonephritis suspected)

Epididymitis

  • Preferred regime: Ceftriaxone 250 mg IM in a single dose AND Doxycycline 100 mg orally twice a day for 10 days
  • For acute epididymitis most likely caused by enteric organisms
  • Preferred regime: [[Levofloxacin] 500 mg orally once daily for 10 days OR Ofloxacin 300 mg orally twice a day for 10 days
  • NOTE: Patients who have uncomplicated acute epididymitis and also are infected with HIV should receive the same treatment regimen as those who are HIV negative.

Genital herpes

  • First episode of genital herpes
Note: Treatment can be extended if healing is incomplete after 10 days of therapy.
  • Recurrent genital herpes
  • Suppressive therapy
  • Episodic therapy
  • 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
  • Episodic therapy
  • 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

  • Uncomplicated gonococcal infections of the cervix, urethra, and rectum
  • Uncomplicated gonococcal infections of the pharynx
  • Gonococcal conjunctivitis
  • Disseminated gonococcal infection
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

  • 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.


Lymphogranuloma venereum

  • Preferred regime: Doxycycline 100 mg orally twice a day for 21 days
  • Alternative regime: Erythromycin base 500 mg orally four times a day for 21 days
  • NOTE (1): azithromycin 1 g orally once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
  • NOTE (2): Pregnant and lactating women should be treated with erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
  • NOTE (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.

Pelvic inflammatory disease

  • Parenteral Treatment
  • Preferred regime (2): Clindamycin 900 mg IV every 8 hours AND Gentamicin loading dose IV or IM (2 mg/kg of body weight), followed by a maintenance dose (1.5 mg/kg) every 8 hours. Single daily dosing (3--5 mg/kg) can be substituted.
  • Alternative regime: Ampicillin/Sulbactam 3 g IV every 6 hours AND Doxycycline 100 mg orally or IV every 12 hours.
  • Oral Treatment
  • Preferred regime (2): Cefoxitin 2 g IM in a single dose and Probenecid, 1 g orally administered concurrently in a single dose AND Doxycycline 100 mg orally twice a day for 14 days ± Metronidazole 500 mg orally twice a day for 14 days
  • Alternative regime (2): Levofloxacin 500 mg orally once daily or Ofloxacin 400 mg twice daily for 14 days {{withorwithout]] Metronidazole 500 mg orally twice daily for 14 days.

Proctitis

Prostatitis, acute bacterial

Prostatitis, chronic bacterial

Pyelonephritis

Syphilis

Syphilis Among non-HIV-Infected Persons

Treponema pallidum

Primary and Secondary Syphilis
Latent Syphilis
  • Early Latent Syphilis
  • Late Latent Syphilis or Latent Syphilis of Unknown Duration
  • Preferred regime: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervalspediatric
  • Pediatric regime: [[Benzathine penicillin G[[ 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units)
Tertiary Syphilis
  • Preferred regime: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals
Neurosyphilis
  • Preferred regime: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
  • Alternative regime: Procaine penicillin 2.4 million units IM once daily AND Probenecid 500 mg orally four times a day, both for 10--14 days

Syphilis Among HIV-Infected Persons

Primary and Secondary Syphilis Among HIV-Infected Persons
Latent Syphilis Among HIV-Infected Persons
  • early latent
  • late latent
Neurosyphilis Among HIV-Infected Persons
  • Preferred regime: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
  • Alternative regime: Procaine penicillin 2.4 million units IM once daily AND Probenecid 500 mg orally four times a day, both for 10--14 days

Syphilis During Pregnancy

  • Preferred regime: Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection

Congenital Syphilis

  • condition 1 : Infants with proven or highly probable disease and (1)an abnormal physical examination that is consistent with congenital syphilis;（2）a serum quantitative nontreponemal serologic titer that is fourfold higher than the mother's titer;¶ or（3）a positive darkfield test of body fluid(s).
  • Preferred regime: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days OR Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days
  • NOTE: If more than 1 day of therapy is missed, the entire course should be restarted. Data are insufficient regarding the use of other antimicrobial agents (e.g., ampicillin). When possible, a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis. The use of agents other than penicillin requires close serologic follow-up to assess adequacy of therapy. In all other situations, the maternal history of infection with T. pallidum and treatment for syphilis must be considered when evaluating and treating the infant.
  • condition 2: Infants who have a normal physical examination and a serum quantitive nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was not treated, inadequately treated, or has no documentation of having received treatment; (2)mother was treated with erythromycin or another nonpenicillin regimen;†† or (3)mother received treatment <4 weeks before delivery.
  • Preferred regime: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days OR Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days OR Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
  • NOTE:If the mother has untreated early syphilis at delivery, 10 days of parenteral therapy can be considered.
  • condition 3:Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was treated during pregnancy, treatment was appropriate for the stage of infection, and treatment was administered >4 weeks before delivery and (2)mother has no evidence of reinfection or relapse.
  • condition 4: Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother's treatment was adequate before pregnancy and (2)mother's nontreponemal serologic titer remained low and stable before and during pregnancy and at delivery (VDRL <1:2; RPR <1:4).
  • Preferred regime: No treatment is required; however, benzathine penicillin G 50,000 units/kg as a single IM injection might be considered, particularly if follow-up is uncertain.

Urethritis

Nongonococcal Urethritis

  • Alternative regime (1): Erythromycin base 500 mg orally four times a day for 7 days
  • Alternative regime (3): Levofloxacin 500 mg orally once daily for 7 days
  • Alternative regime (4): Ofloxacin 300 mg orally twice a day for 7 days

Recurrent and Persistent Urethritis




References

  1. ↑ Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; et al. (2005). "Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults". Clin Infect Dis. 40 (5): 643–54. doi:10.1086/427507. PMID 15714408.
  2. ↑ Workowski, Kimberly A.; Berman, Stuart; Centers for Disease Control and Prevention (CDC) (2010–12–17). "Sexually transmitted diseases treatment guidelines, 2010". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR–12): 1–110. ISSN 1545-8601. PMID 21160459. Check date values in: |date= (help)
  3. ↑ Workowski, Kimberly A.; Berman, Stuart; Centers for Disease Control and Prevention (CDC) (2010–12–17). "Sexually transmitted diseases treatment guidelines, 2010". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR–12): 1–110. ISSN 1545-8601. PMID 21160459. Check date values in: |date= (help)
  4. ↑ Workowski, Kimberly A.; Berman, Stuart; Centers for Disease Control and Prevention (CDC) (2010–12–17). "Sexually transmitted diseases treatment guidelines, 2010". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR–12): 1–110. ISSN 1545-8601. PMID 21160459. Check date values in: |date= (help)
  5. ↑ Centers for Disease Control and Prevention (CDC) (2012–08–10). "Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections". MMWR. Morbidity and mortality weekly report. 61 (31): 590–594. ISSN 1545-861X. PMID 22874837. Check date values in: |date= (help)
Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox_ID_Genitourinary&oldid=1106209"