Nongonococcal urethritis; Nongonococcal cervicitis - Acute
Rahul Soman, M. Pharm
Definition
Inflammation of the urethra or cervix caused by a nongonococcal infection and characterized by a mucopurulent or purulent discharge that may produce dysuria or urethral pruritus, although in many cases, the infection is asymptomatic
Medical History
* Sexual intercourse
Findings
* Urethral discharge
* Cervical discharge
* Intermenstrual bleeding - irregular
* Blood at uterine os cervix
* Dysuria
* Finding of frequency of urination
* Increased body temperature
Tests
Suspected nongonococcal urethritis
* Gram stain microscopy, Urethral swab: Five or more WBCs per oil immersion field in the absence of Gram-negative intracellular diplococci indicates nongonococcal urethritis .
Suspected nongonococcal cervicitis
* Gram stain microscopy, Vaginal secretions, Cervical secretion sample: A finding of 10 or more WBC in vaginal fluid, in the absence of trichomoniasis, might indicate endocervical inflammation caused specifically by Chlamydia trachomatis.
Suspected urethritis
* Urine Microscopy: white cells: Microscopic examination of first-void urine sediment demonstrating ?10 WBC per high power field indicates urethritis and the need for further testing .
Suspected urethritis
* Urine dipstick for leukocyte esterase: A positive leukocyte esterase test on first-void urine indicates the presence of urethritis and the need for further testing for gonorrhea and chlamydia .
Suspected urogenital Chlamydia trachomatis infection
* Chlamydia trachomatis nucleic acid amplification test: Nucleic acid amplification testing provides a rapid and accurate diagnosis of Chlamydia trachomatis infections using either cervical or urine samples .
Suspected Chlamydia trachomatis infection
* Chlamydia trachomatis nucleic acid hybridization test: A positive nucleic acid hybridization test provides presumptive evidence of Chlamydia trachomatis infection .
Differential Diagnosis
* Chlamydial urethritis
* Chlamydial cervicitis
* Trichomoniasis
* Gonorrhea - Acute
* Syphilis - Acute
* Genital herpes simplex
* Urinary tract infectious disease - Acute
Treatment
Drug Therapy
Nongonococcal urethritis
AZITHROMYCIN
Adults: 1 g orally as a single dose
DOXYCYCLINE
Adults: 100 mg orally twice daily for 7 days
ERYTHROMYCIN
Adults (alternative): 500 mg orally 4 times daily for 7 days
ERYTHROMYCIN ETHYLSUCCINATE
Adults (alternative): 800 mg orally 4 times daily for 7 days
OFLOXACIN
Adults (alternative): 300 mg orally twice daily for 7 days
LEVOFLOXACIN
Adults (alternative): 500 mg orally once daily for 7 days
Presumptive treatment for nongonococcal cervicitis
AZITHROMYCIN
Adults: 1 g orally as a single dose (consider concurrent treatment for gonococcal infection if prevalence of gonorrhea is high in the patient population under assessment)
DOXYCYCLINE
Adults: 100 mg orally twice daily for 7 days (consider concurrent treatment for gonococcal infection if prevalence of gonorrhea is high in the patient population under assessment)
Chlamydial infection in men and women
AZITHROMYCIN
Adults: 1 g orally as a single dose
DOXYCYCLINE
Adults: 100 mg orally twice daily for 7 days
ERYTHROMYCIN
Adults: 500 mg orally 4 times daily for 7 days
ERYTHROMYCIN ETHYLSUCCINATE
Adults (alternative): 800 mg orally 4 times daily for 7 days
OFLOXACIN
Adults: 300 mg orally twice daily for 7 days
LEVOFLOXACIN
Adults: 500 mg orally once daily for 7 days
Chlamydial infection in pregnant women
AZITHROMYCIN
Adults: 1 g orally as a single dose
AMOXICILLIN
Adults: 500 mg orally 3 times daily for 7 days
ERYTHROMYCIN
Adults (alternative): 500 mg orally 4 times daily for 7 days or 250 mg orally 4 times daily for 14 days
ERYTHROMYCIN ETHYLSUCCINATE
Adults (alternative): 800 mg orally 4 times daily for 7 days
Recurrent and persistent nongonococcal urethritis
METRONIDAZOLE - AZITHROMYCIN
Adults: Metronidazole 2 g orally in a single dose AND azithromycin 1 g orally in a single dose (if not used for initial episode)
TINIDAZOLE - AZITHROMYCIN
Adults: Tinidazole 2 g orally in a single dose AND azithromycin 1 g orally in a single dose (if not used for initial episode)
Chlamydial infection in preadolescent children
ERYTHROMYCIN
Pediatrics (<45 kg): 50 mg/kg/day orally in 4 divided doses for 14 days
ERYTHROMYCIN ETHYLSUCCINATE
Pediatrics (<45 kg): 50 mg/kg/day orally in 4 divided doses for 14 days
AZITHROMYCIN
Pediatrics (?45 kg): 1 g orally as a single dose
DOXYCYCLINE
Pediatrics (>8 years): 100 mg orally twice daily for 7 days
Procedural Therapy
Sexual contacts of patients with a sexually transmitted disease
* Sexual partner notification: Patients with certain sexually transmitted diseases need to refer their partners for evaluation and treatment .
Reportable infectious diseases
* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .
At risk for sexually transmitted disease
* Infection prevention education: Patient education and counseling is one of the essential strategies for the prevention and control of sexually transmitted diseases (STDs) .
Non-Procedural Therapy
Nongonococcal urethritis
* Sexual abstinence
Among “alternative,” Natural Treatment for Urethritis , a well-known aid in preventing UTIs in women is drinking unsweetened cranberry juice, which appear to have the effect of dropping the bacteria’s adhesion to bladder cells.
ReplyDeleteWhile medications are definitely helpful at fighting an infection but various people prefer more natural remedies. Let’s look at how to cure urethritis naturally. Here are some of the best Natural Remedies for Urethritis .
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