Treatments

Drug Treatments For Common Infections

Neisseria gonorrhoea: Ceftriaxone 500 mg IM or if known to be a sensitive strain Ciprofloxacin 500 mg stat.
Also give Zithromax 1 gram stat or Doxycycline 100 mg bd for 1 week (because 50% of GC patients will also have chlamydia or non specific urethritis)
Non Specific Urethritis/Chlamydia: Azithromycin 1 gram stat
Alternatives: Doxycycline 100mg BD for 1 week. Erythromycin 250 mg qds for 2 weeks (500 mg bd works just as well as qds).
Pregnancy: Erythromycin is the first choice. If intolerant of this, Amoxycillin can be used.
Rectal chlamyda: Doxycycline 100mg BD for 2 weeks. If LGV a possibility treat for 3 weeks.
Pelvic Inflammatory Disease Ofloxacin 400 mg bd for 2 weeks
+/- Metronidazole 400 mg bd for a week..
Epididymo-orchitis Ofloxacin 200 mg bd for 2 weeks
Bacterial Vaginosis: Metronidazole 400 mg bd for a week
Metronidazole 2 grams stat
Zidoval Gel PV x 5 nights
Clindamycin (Dalacin C 2%) nocte PV for a week
Amoxycillin 500 mg qds for 5 days.
Candidiasis: Clotrimazole pessary 500 mg (Canesten 1) and Canesten cream.
Fluconazole (Diflucan) 150 mg PO stat.
Itraconazole (Sporanox) 200 mg bd for one day. If recurrent – any treatment monthly x 6 mnths
Canesten HC useful if inflammation is a significant feature.
Sensilube (vulvo-vaginal lubricant) useful to prevent recurrences.
Herpes Simplex: Acyclovir 200 mg x 5 daily for 5 days, however many clinics now use 400mg five times a day when case is severe and continue until no new lesions appear.
Analgesia:-
General: Co-Dydramol x 2 tablets 4-hourly.
Local: Lignocaine gel or EMLA to allow patient to pass urine. Also, PU in bath or shower helpful. Zovirax cream may be useful in recurrences. Sensilube for sex can prevent recurrences.
If pregnant: and severe enough to warrant systemic therapy then Acyclovir (Zovirax) 200 mg x 5 per day for 5 days.
Prophylaxis – Acyclovir 400 mg bd – no need to monitor LFTs.
Trichomonas (TV): Metronidazole 400 mg bd for a week
Metronidazole 2 grams stat,
Tinidazole 2 grams stat.
Genital Warts: Podophyllotoxin 0.1% (Warticon cream) for home use (if soft fleshy warts). Warticon is now difficult to get hold of but Condylene is a liquid preparation that will do.
Imiquimod (Aldara) cream for three days a week for a month and review.
Good for recalcitrant warts and recurrences less likely. First line for peri-anal.
In clinic: Cryotherapy.
95% Trichloroacetic acid. See attached PDF Editorial in BMJ on HPV by Dr O’Mahony, explaining the value of Gardasil (HPV) vaccination in cases of chronic or recurrent disease.

Updated December 2013
Please note:
COCH Dept of GU Medicine recommendations only. Clinic website: www.chestersexualhealth.co.uk. Department not responsible for inaccuracies.