Sandbox ID Genitourinary

Diseases Characterized by Genital, Anal, or Perianal Ulcers

• 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: Ciprofloxacin is contraindicated for pregnant and lactating women. 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. 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 HSV infections

• First clinical 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.

• Suppressive Therapy for Recurrent Genital Herpes

• 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 for recurrent genital herpes

• 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 disease

• 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: Acyclovir dose adjustment is recommended for impaired renal function. 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.

• HIV-infected patients

• Daily Suppressive Therapy

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

• Episodic Infection

• 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 genital herpes or severe recurrent herpes.
• Acyclovir should be administered IV to pregnant women with severe HSV infection.

• Neonatal Herpes

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Gonococcal infection

Further information: Gonococcal infection medical therapy and therapeutic approach

• Gonococcal 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 (DGI)

• 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

• Gonococcal Infections Among Infants

• Ophthalmia Neonatorum Caused by N. gonorrhoeae

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

• DGI and Gonococcal Scalp Abscesses in Newborns

• Preferred regimen:

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.

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