Complicated Infections Associated With N Gonorrhoeae
Epididymitis / epididymo-orchitis and PID
If epididymitis/epididymo-orchitis or PID are suspected, refer to STI-associated syndromes.
Gonococcal ophthalmia and disseminated infections in adults and youth 9 years or olderFootnote 39Footnote 40
Consult an infectious diseases specialist for guidance on management.
Hospitalization is indicated for meningitis and as well as for initial management of other disseminated infections.
Ceftriaxone 2 g IV/IM in a single dose
PLUS azithromycin 1 g PO in a single dose
- This is the usual duration of therapy, but treatment may be extended with severe involvement of the eyeFootnote 41.
- If there is macrolide resistance or contraindication to macrolide use, consider doxycycline 100 mg PO bid x 7 days
- IM administration should only be considered if an IV line is not available
Gonococcal infection in the neonates
Neonates born to birthing parents with untreated N gonorrhoeae infection at the time of delivery should be tested and treated immediately without waiting for test results. They should be managed by or in consultation with a paediatric infectious disease specialist or an experienced colleague.
Refer to the Canadian Paediatric Society’s article Preventing ophthalmia neonatorum for information about how to manage neonates born to birthing parents with untreated N gonorrhoeae infection.
Reporting And Partner Notification
Gonococcal infections are nationally notifiable and reportable by laboratories, physicians and designated health professionals to local public health authorities in all provinces and territories.
Local public health authorities should be promptly notified of suspected or confirmed treatment failures. The prompt notification of treatment failures will allow provincial and territorial STI prevention and control programs to quickly identify emerging patterns of AMR in their jurisdictions. This will enable P/Ts to collaborate with the Public Health Agency of Canada to issue timely electronic alerts through the Canadian Network for Public Health Intelligence .
Case finding and partner notification are critical to the prevention and control of gonococcal infections. Notify, clinically assess, test and provide empiric treatment to all sexual partners of the index case within 60 days prior to symptom onset or date of specimen collection . Empiric treatment is indicated regardless of clinical findings and without waiting for test results)Footnote 4Footnote 42.
Extend the length of time for partner notification
- To include additional time up to the date of treatment
- If the index case states there were no partners during the recommended trace-back period
- If all partners traced test negative
Alternative Treatment In Case Of Penicillins Or Cephalosporins Allergy Or Cephalosporins And/or Macrolides Resistance
In case of documented allergy to penicillins/cephalosporins or resistance to macrolides, refer to the alternative treatment recommendations for adults and youth below.
Cephalosporins allergy or resistance or severe non-IgE-mediated reaction to penicillins
Azithromycin 2 g in a single oral dose PLUS gentamicin 240 mg IM in two separate 3-mL injections of 40 mg/mL solution Footnote 28
- This combination therapy is not recommended in pregnancy
- Gentamicin alternative route of administration: 240 mg IV infused over 30 minutes may be considered when the IM route is not feasible.
Quinolone treatment regimens
This combination therapy/regimen should only be used if quinolone susceptibility is demonstrated or regional/local quinolone resistance rates are under 5% and a TOC can be assuredFootnote 29Footnote 3.
- Azithromycin 2 g in a single oral dose PLUS ciprofloxacin 500 mg in a single oral dose Footnote 21Footnote 30Footnote 31Footnote 32
- Azithromycin 2 g in a single oral dose PLUS gemifloxacin 320 mg in a single oral dose Footnote 28
- This combination therapy is not recommended in pregnancy
- At the time of publication, gemifloxacin is not available on the Canadian market. Once available in the United States, it will be made accessible through Health Canada’s Special Access Program
Contraindications to macrolides and cephalosporins
Resistance to both cephalosporin and azithromycin with failure or contraindications to previously noted regimens
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So What Is The Best Treatment For Chlamydia
Current guidance from both the National Institute of Clinical Excellence and the British Association for Sexual Health and HIV, state that doxycycline is the preferred and first-line treatment for chlamydia. This is due to antibiotic resistance, as research has shown that chlamydia responds better to doxycycline. Azithromycin should be used where doxycycline is not safe to be prescribed, and for patients who may experience difficulty in sticking to a one-week regime. To find out more information, you can visit our chlamydia FAQâs.
Whilst all of our content is written and reviewed by healthcare professionals, it is not intended to be substituted for or used as medical advice. If you have any questions or concerns about your health, please speak to your doctor.
The Costs Of Infertility
Treating chlamydia is easy, but for those who do not get treated or get treated too late, living with the damage caused by the infection can be hard.
Rabin has treated many women who never knew they had had chlamydia until they couldnt get pregnant due to blocked fallopian tubes. These women often wind up trying in vitro fertilization , which does not always succeed.
There are all kinds of costs involved for these women, say Rabin. There are emotional costs and physical costs. There are also financial costs with IVF. Its much better to not let the tubes get damaged, she says, and get pregnant the old-fashioned way.
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What If Symptoms Persist
Unfortunately, some types of gonorrhea bacteria dont respond to the usual antibiotic treatment. Doctors call this antibiotic resistance. Theyve been seeing a rise in these stronger bacteria for several years. If you continue to have symptoms a few days after treatment, see your doctor again. They may prescribe a longer course of different antibiotics
Cdc Updates Guidelines On Treatment Of Sexually Transmitted Infections
The Centers for Disease Control and Prevention has updated its guidelines for the treatment of people who have or are at risk for sexually transmitted infection .
Key changes were made to treatment recommendations for Neisseriagonorrhoeae, Chlamydiatrachomatis, Trichomonasvaginalis, pelvic inflammatory disease and
Along with the AAP Red Book, the guidelines are a source of clinical guidance for the diagnosis, management and treatment of STIs based on current evidence.
Adolescent screening recommendations
Reported rates of STI, including chlamydia and gonorrhea, continue to rise across the U.S. Prevalence rates of certain STIs are highest among adolescents and young adults .
The CDC continues to recommend routine laboratory screening for common STIs for all sexually active AYA.
It also suggests providers consider opt-out screening for chlamydia and gonorrhea for AYA females regardless of reported sexual activity as part of a clinical visit. Cost-effectiveness analyses indicate that opt-out chlamydia screening among AYA females could increase screening significantly, save costs and identify STIs among youths who do not disclose their sexual behavior.
Chlamydia continues to be the most commonly reported notifiable infectious disease in the U.S., and prevalence rates are highest among sexually active females ages 15-24.
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Summary Of The Evidence
There is no evidence relating to patient values and preferences but the Guideline Development Group agreed that there is probably no variability in the values people place on the outcomes. Research related to other conditions indicates that adherence may be improved with simpler medication regimens. The GDG therefore agreed that azithromycin may be more acceptable to patients since it is a single dose regimen . There is little to no evidence for equity issues and feasibility. Resistance in other infections that often co-occur with chlamydia may restrict the use of some medicines, such as ofloxacin. For many of these medicines, costs may differ between countries in places with high incidence of chlamydia, the cost differences between azithromycin and doxycycline may be large due to greater numbers of people requiring treatment.
In summary, there was moderate quality evidence for trivial differences in benefits and harms between azithromycin and doxycycline, and although the cost of azithromycin is higher, the single dose may make it more convenient to use than doxycycline. While the differences are also trivial with the other medicines, the evidence is low quality and these are therefore provided as alternatives, with the exception of delayed-release doxycycline, which is currently expensive.
See for list of references of reviewed evidence, and for details of the evidence reviewed, including evidence profiles and evidence-to-decision frameworks .
What Are The Symptoms Of Chlamydia
Many people with chlamydia have no symptoms at all, and their infection is only picked up with a screening test.
Guidelines currently recommend that all women under the age of 25 get screened for chlamydia every year. Older women at increased risk for an infection, such as those with a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection, should also be screen regularly.
Although routine screening for chlamydia in young men is not currently recommended, it should be considered in populations with a high prevalence of chlamydia or those at high risk for chlamydia .
Some people may have symptoms.
Women may notice an unusual vaginal discharge or problems when urinating , such as pain or burning, an increased need to urinate pain during sex bleeding between periods or after sex lower abdominal , or pelvic pain or cramps or.
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How Do The Symptoms Compare
Both men and women can get chlamydia or gonorrhea and never develop any symptoms.
With chlamydia, symptoms may not appear for a few weeks after youve contracted the infection. And with gonorrhea, women may never experience any symptoms at all or may only show mild symptoms, while men are more likely to have symptoms that are more severe.
A couple of the most telltale symptoms of these STIs overlap between the two , such as:
- burning when you pee
- abnormal discharge from the rectum
- pain in the rectum
- bleeding from the rectum
You may also develop symptoms that affect your throat if you engage in oral sex with someone who has one of these conditions. This can cause mouth and throat symptoms, including sore throat and a cough.
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Does Chlamydia Treatment Have Side Effects
An antibiotic called Doxycycline is the most common medicine used to treat chlamydia. Like most medicines, it can cause mild side effects. The most common side effects of Doxycycline are nausea, vomiting, upset stomach, loss of appetite, mild diarrhea, skin rash or itching, change in skin color, vaginal itching, or discharge. These side effects should go away after you finish taking the medicine. Talk to your nurse or doctor about any medicines youre already taking and any medical issues you already have before taking Doxycycline.
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Plans For Collection Laboratory Evaluation And Storage Of Biological Specimens For Genetic Or Molecular Analysis In This Trial/future Use
Participants will provide a serum sample on baseline and at each follow-up visit. Samples will be collected by trained laboratory personnel inside the clinics. Samples will be sent to the laboratory within 24h of collection. Sample processing and analysis will be conducted by trained laboratory staff following standard laboratory procedures. Samples will be destroyed after serological testing. The study team will not be involved in the sample collection, processing, analysis, and reporting.
There are no plans in this trial to evaluate or store biological specimens for genetic or molecular analysis for future use.
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Are There Any Other Precautions Or Warnings For This Medication
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Allergy: Before starting treatment with cefixime, make sure you tell your doctor about any adverse reactions you have had to medications, especially cefixime, cephalosporins, and penicillins. Some people who are allergic to penicillin may also be allergic to cephalosporins such as cefixime. If you have an allergic reaction, contact your doctor.
Antibiotic-associated colitis: This medication, like other antibiotics, may cause a potentially dangerous condition called antibiotic-associated colitis . Symptoms include severe, watery diarrhea that may be bloody. If you notice these symptoms, stop taking cefixime and contact your doctor as soon as possible.
Hemolytic anemia: Rarely, cefixime causes a condition where red blood cells are destroyed before the end of the cells normal lifespan. This condition is called hemolytic anemia, which can cause severe health complications. People who have had hemolytic anemia before may be more likely to experience hemolytic anemia caused by cefixime. If you notice symptoms of hemolytic anemia such as unusual fatigue, yellowing of the eyes or skin, dark urine, or pale skin, contact your doctor immediately.
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Drug Treatment Of Common Stds: Part Ii Vaginal Infections Pelvic Inflammatory Disease And Genital Warts
CAROL WOODWARD, PHARM.D., West Virginia University Hospitals, Morgantown, West Virginia West Virginia
MELANIE A. FISHER, M.D., M.SC., University, Morgantown, West Virginia
Am Fam Physician. 1999 Oct 15 60:1716-1722.
This is Part II of a two-part article on drug treatment of sexually transmitted diseases. Part I, Herpes, Syphilis, Urethritis, Chlamydia and Gonorrhea, appeared in the October 1 issue .
This article focuses on vaginal infections, pelvic inflammatory disease and genital warts, with brief mention of proctitis, enteritis and ectoparasitic infections. It should be noted that vaginal candidiasis and bacterial vaginosis are included in the following discussion, although these infections are not sexually transmitted. They are frequently diagnosed at the same time as sexually transmitted diseases , however, and the treatments often overlap.
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What Is The Dosage Of Suprax Vs Azithromycin
- The recommended adult dose for otitis media, tonsillitis, pharyngitis, and urinary tract infections is 400 mg once daily or divided and given as 200 mg every 12 hours.
- Pediatric patients have a recommended dose of 8 mg/kg/day once daily or in two doses of 4/mg/kg every 12 hours.
- Azithromycin can be taken with or without food, but food reduces stomach upset.
- Zmax should be taken on an empty stomach 1 hour before or 2 hours after a meal since food reduces its absorption.
- The adult azithromycin dose is 500-2000 mg in multiple or single doses.
- For most infections, azithromycin is taken once daily for a relatively short course of treatment .
- The first dose is often a “double dose,” twice as much as the remainder of the doses given.
- For acute bacterial sinusitis, azithromycin may be taken once daily for three days.
- Zmax usually is given as a single 2 g dose.
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Prevalence Of C Trachomatis And Association With Antibiotic Use
The overall prevalence of C. trachomatis was 10.8% , and recent antibiotic use was reported by 10.8% of patients who received C. trachomatis diagnoses. The association between antibiotic use and C. trachomatis differed between women, heterosexual men, and MSM . In univariate analyses, any recent antibiotic use was associated with a lower C. trachomatis prevalence in heterosexual men and in MSM but not in women . When adjusting for age and HIV status, the risk estimate for heterosexual men attenuated somewhat and became non-statistically significant however, the risk remained for MSM . After stratifying analyses of MSM by anatomic site, it appeared that the inverse association between antibiotic use and C. trachomatis was observed only for anorectal C. trachomatis in MSM and not for genital C. trachomatis in MSM or oral C. trachomatis in MSM .
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How Is Chlamydia Treated
The following are the recommended treatment regimens for chlamydia according to the Guidelines for Sexually Transmitted Diseases, released in 2015, but still considered current. Only one regimen should be chosen.
- Azithromycin 1 gram orally as a single dose
- Ofloxacin 300 mg orally twice a day for 7 days.
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What Dosage Treats Chlamydia
For people with uncomplicated genital chlamydia, the Centers for Disease Control and Prevention recommends a single dose of azithromycin taken orally to cure the infection.
Azithromycin comes in three forms:
- Regular-release powder
For both powder formulas, either you or a pharmacist mix it with liquid to take.
Always follow the directions from your doctor or pharmacist for taking azithromycin.
Azithromycin is taken as a single dose, one time.
It should be taken as soon as you receive the prescription. Azithromycin can be taken with or without food, however, the extended-release form is typically taken on an empty stomach.
If you take the liquid form, shake it well before using and use a dosing spoon to measure an accurate dose. If you are prescribed the powder, mix it with water according to directions.
Scenario : If The Patient Has Urethral Discharge And Gram Stain Results Are Not Available
Depending on whether the patient is at high risk for infection AND loss-to-follow up or not, there are two possible courses of action:
If at risk of STI AND loss-to-follow-up, treat for gonococcal urethritis with:
Cefixime 400 mg orally in a single dose PLUS EITHER Doxycycline 100 mg orally twice per day for seven days, OR, if poor compliance is expected, Azithromycin 1 gm. orally in a single dose
If not at high risk for infection or loss-to-follow-up, treat for non-gonococcal urethritis with:
Doxycycline 100 mg orally twice per day for seven days, OR, if poor compliance is expected, Azithromycin 1 gm orally in a single dose .
IN ADDITION, treatment for gonorrhea can be considered if the local prevalence is high OR the prevalence is high in the region where contact occurred.
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