Genital Infection

Microbiological specimens

Most common cause of Epididymo-orchitis is Mumps.  Please note this is a notifiable disease to Public Health England.

Common Pathogen(s)
Chlamydia trachomatis

Antibiotic – 1st line
Azithromycin 1g PO as a single dose.

 

2nd Line
Doxycycline 100mg q12h PO for 7 days
(C/I in pregnancy)
or
Erythromycin 500mg q12h PO for 14 days (70% cure rate)
or
Ofloxacin 200mg q12h PO or 400mg q24h PO for 7 days (Non-pregnant).

Comment
Refer to GUM and treat sexual partners.

Swabs from women or urine from both men and women to be tested by PCR for gonorrhoea (swabs superior sample for women) and chlamydia (one yellow topped bottle)

Women:
Cervical or vulvo-vaginal swab.
First voided urine sample.

Men:
First voided urine sample.
Urethral swab.

Often co-infected with Chlamydia dual treatment may be required

Common Pathogen(s)
Neisseria gonorrhoeae.

Antibiotic – 1st line
Ceftriaxone 500 mg IM as a single dose plus Azithromycin 1g PO as a single dose for both synergism and concomittant treatment of chlamydia.
or
Contact GU Medicine

 

2nd Line
Contact GU Medicine/ Treat on basis of susceptibility of isolate

Comment
Refer to GUM and treat sexual partners.

Swabs from woman or urine from both men and women to be tested by PCR for gonorrhoea (Swabs superior for woman) and chlamydia (one yellow topped bottle).

Women:
Cervical swab.
Rectal / oropharnygeal tests if symptomatic / at risk at these sites.

Men:
Urethral swab.
Rectal/ oropharnygeal tests if symptomatic at these sites.

See urinary section

Common Pathogen(s)
Neisseria gonorrhoeae;
Chlamydia trachomatis;
Mixed Anaerobes;
Enteric organisms.

Antibiotic – 1st line
Ceftriaxone 2g q24h IV for 24hours after clinical improvement and then switch to oral.
plus
Doxycycline 100mg q12h PO.

Oral switch for total of 14 days:
Doxycycline 100mg q12h PO
plus
Metronidazole 400mg q12h PO.

 

2nd Line

Clindamycin 900mg  q8h IV
plus
Gentamicin (click here for full gentamicin policy) 
Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.

5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min  or
3mg/Kg IV q24h (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation.
If patient is obese ie. 20% over ideal body weight – use adjusted body weight

IV for 24hours after clinical improve and then switch to oral:

Oral switch:
Clindamycin 450mg q6h PO  to complete 14days course

Or

Doxycyline 100mg PO 12h
plus

Metronidazole 400mg q12h PO to complete14days course

Comment
As above for Chlamydia and Gonorrhoea
Doxycycline and Ofloxacin contraindicated in pregnancy.

BASHH guidelines

Common Pathogen(s)
Herpes simplex virus
(HSV-1 and HSV-2).

Antibiotic – 1st line
Aciclovir 200mg PO 5 times a day for 5 days
or
Valaciclovir 500mg q12h PO  for 5 days

Comment

Refer to GUM 
Oral antivirals are indicated within 5 days of the start of the episode and while new lesions are forming.
Swab taken from base of lesion.

Antibiotic – 1st line
Discuss with GUM Clinic and Consultant Microbiologist

Common Pathogen(s)
Candida albicans.

Antibiotic – 1st line
Clotrimazole 1% cream applied 2-3 times a day for external symptoms plus Clotrimazole vaginal pessary insert 500mg at night as a single dose
or
Fluconazole 150mg PO as a single dose.