Module 9 14 Urethritis Cervicitis

Question 1

Question

Answer 1

Answer

Question 2

What are the first-line treatment options for urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis?

Answer 2

Cefixime or Ceftriaxone (administered as a single dose) along with Azithromycin or Doxycycline.

Question 3

What is the second-line treatment option for this condition?

Answer 3

Ciprofloxacin (single dose) along with Azithromycin or Doxycycline.

Question 4

What should be done with sexual partners of individuals with urethritis, and over what time frame?

Answer 4

All sexual partners from 60 days prior to symptom onset should be evaluated and treated.

Question 5

When should a test of cure be performed after treatment, and what is the preferred method for this test?

Answer 5

A test of cure should be performed 1-2 weeks after completing therapy, preferably using cultures.

Question 6

Why is routine treatment for both N. gonorrhoeae and C. trachomatis recommended in urethritis cases?

Answer 6

Routine treatment is recommended because these two pathogens often coexist.

Question 7

What are the recommended treatment options for pregnant and nursing women with gonococcal urethritis, and what should be done post-treatment?

Answer 7

Cefixime or ceftriaxone are recommended, and Azithromycin is used to treat concomitant chlamydial infection. A culture should be performed 4-5 days post-treatment.

Question 8

What are the alternatives for individuals with severe penicillin allergy when treating gonococcal urethritis?

Answer 8

Alternatives include Azithromycin with gentamicin or gemifloxacin, but Azithromycin should not be used as monotherapy due to resistance concerns.

Question 9

When can quinolones be considered for treatment, and what conditions should be met?

Answer 9

Quinolones can be considered as an alternative if susceptibility is demonstrated, and a test of cure can be performed.

Question 10

What are the first-line treatment options for gonococcal urethritis in children under 9 years, and what should be added to the treatment regimen?

Answer 10

Cefixime or Ceftriaxone (administered as a single dose), and Azithromycin should be added to the regimen.

Question 11

What is the recommended dosage for Cefixime in this context?

Answer 11

The recommended dosage for Cefixime is 8 mg/kg as a single dose (Maximum: 400 mg).

Question 12

What is the recommended dosage for Ceftriaxone when administered intramuscularly (IM) in this context?

Answer 12

The recommended dosage for Ceftriaxone (IM) is 25-50 mg/kg as a single dose (Maximum: 125 mg).

Question 13

What is the recommended dosage for Azithromycin in this scenario?

Answer 13

The recommended dosage for Azithromycin is 10-15 mg/kg as a single dose (Maximum: 1 g).

Question 14

When should a test of cure be performed after completing therapy, and what are the considerations when using nucleic acid amplification tests (NAATs)?

Answer 14

A test of cure should be performed using cultures 1-2 weeks after completing therapy. If an NAAT is used, it should be done no earlier than 3-4 weeks post-treatment to avoid false-positive results.

Question 15

Why is it recommended to routinely treat for both N. gonorrhoeae and C. trachomatis in this context?

Answer 15

Routine treatment is advised because these two pathogens often coexist. Even if there are no apparent symptoms, treating for both is recommended.

Question 16

What are the first-line treatment options for nongonococcal urethritis in adolescents and adults (≥ 9 years), and what are the recommended dosages?

Answer 16

Azithromycin (450 mg stat then 250 mg daily for 4 days or 1 g single dose) and Doxycycline (100 mg twice daily for 7 days).

Question 17

What are the second-line treatment options for this condition, and what are the dosages and duration for erythromycin?

Answer 17

Erythromycin (500 mg/day divided four times daily for 7 days, or 1 g/day divided four times daily for 14 days) and Moxifloxacin (400 mg daily for 7-14 days).

Question 18

What is the first-line treatment for children under 9 years with nongonococcal urethritis, and what is the maximum recommended dosage?

Answer 18

Azithromycin (10-15 mg/kg as a single dose, Maximum: 1 g).

Question 19

Why is it important to report cases of nongonococcal urethritis to the Medical Officer of Health, and what actions should be taken regarding sexual contacts?

Answer 19

Reporting is necessary, and all sexual contacts within 60 days preceding symptom onset should be tested and empirically treated without waiting for test results.

Question 20

When can a test of cure be considered, and what are the recommended conditions for testing?

Answer 20

A routine test of cure is not recommended, but it may be considered in specific situations, such as when M. genitalium is detected, in children under 14 years, in pregnancy, or when non-genital sites are involved.

Question 21

What treatment options are recommended for pregnant individuals with nongonococcal urethritis, and what is the alternative?

Answer 21

Recommended options are azithromycin 1 g single dose or erythromycin (adult dosage). The alternative is amoxicillin.

Question 22

Why might recurrent or persistent cases of nongonococcal urethritis occur, and how should they be managed?

Answer 22

Recurrent or persistent cases may occur due to compliance issues or other causes. Investigation and potential treatment options include metronidazole and erythromycin or azithromycin.

Question 23

What should be considered when using azithromycin 1 g single dose for nongonococcal urethritis, and why is it not routinely recommended?

Answer 23

Azithromycin 1 g single dose can be considered but is not routinely recommended due to concerns over macrolide-resistant M. genitalium.

Question 24

What is the first-line treatment option for cervicitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae, and what is the recommended dosage?

Answer 24

Cefixime (400-800 mg as a single dose).

Question 25

What are the first-line co-treatment options for cervicitis along with cefixime?

Answer 25

Either Azithromycin (1 g in a single dose) or Doxycycline (100 mg twice daily for 7 days).

Question 26

What are the second-line treatment options for cervicitis, and what are the recommended dosages for Ciprofloxacin and Ceftriaxone?

Answer 26

Ciprofloxacin (500 mg as a single dose, not approved for children under 18 years) and Ceftriaxone (250 mg as a single dose via intramuscular administration).

Question 27

What are the second-line co-treatment options for cervicitis along with ciprofloxacin or ceftriaxone?

Answer 27

Either Azithromycin (1 g single dose) or Doxycycline (100 mg twice daily for 7 days) or Erythromycin (2 g/day divided four times daily for 7 days, or 1 g/day divided four times daily for 14 days).

Question 28

Why is reporting to the Medical Officer of Health necessary in cases of cervicitis, and what actions should be taken regarding sexual partners?

Answer 28

Reporting is necessary, and sexual partners within 60 days preceding symptom onset should be evaluated and treated.

Question 29

What are the criteria for defining cervicitis, and why might treatment be deferred in “at-risk” patients?

Answer 29

Cervicitis is defined by inflammation of the cervix with specific characteristics. Treatment may be deferred in “at-risk” patients until microbiological results are available.

Question 30

What are the treatment options for cervicitis in pregnancy, and what is the contraindication?

Answer 30

Options include cefixime, ceftriaxone, azithromycin, or erythromycin. Erythromycin estolate is contraindicated in pregnancy.

Question 31

When might ciprofloxacin be considered for the treatment of cervicitis, and what caution should be exercised when using quinolones?

Answer 31

Ciprofloxacin can be considered if Pseudomonas infection is documented or suspected. Quinolones should be used cautiously, especially if there is a possibility the infection was acquired in areas with increased resistance.

Question 32

What is advised after treatment with erythromycin for cervicitis?

Answer 32

Repeat testing after treatment with erythromycin is recommended.