Cervicitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Antimicrobial therapy with adequate coverage against C. trachomatis should be provided for women at increased risk for C. trachomatis or if follow-up cannot be ensured and if a relatively insensitive diagnostic test is used in place of NAAT. Patients may also require concomitant therapy against N. gonorrhea. Medical therapies include either azithromycin, doxycycline, or a fluoroquinolone. Treatment of sexual partners is also indicated. Follow-up after completion of antimicrobial therapy regimen is required to evaluate for microbial resistance.^[1]

• Antimicrobial therapy with adequate coverage against C. trachomatis should be provided for women at increased risk for C. trachomatis or if follow-up cannot be ensured and if a relatively insensitive diagnostic test is used in place of NAAT.
• The following patients are at increased risk of C. trachomatis:^[2]
  • Age < 25 years
  • New or multiple sex partners
  • Patients who engage in unprotected sex
  • Sex partner with concurrent partners
  • Sex partner who has an STI

• Concomitant therapy for N. gonorrhea (gonococcal cervicitis) is recommended among the following patients:^[3]

• Patients in regions with high incidence of gonococcal infections
• Patients at high risk of gonococcal infections

• Cervicitis, Chlamydial^[2]

• Recommended Regimen for Cervicitis:
  • Doxycycline 100 mg PO bid for 7 days
• Alternative regimen:
  • Azithromycin 1 g PO in a single dose
• Other Alternative Therapy:
  • Erythromycin base 500 mg PO qid for 7 days
  • Erythromycin ethysuccinate 800 mg PO qid for 7 days
  • Ofloxacin 300 mg PO bid for 7 days
  • Levofloxacin 500 mg PO qd for 7 days
  • Pregnancy: Azithromycin 1 g PO in a single dose OR Amoxicillin 500 mg PO tid for 7 days OR Erythromycin base 500 mg PO qid for 7 days OR Erythromycin base 250 mg PO qid for 14 days OR Erythromycin ethylsuccinate 800 mg PO qid for 14 days OR Erythromycin ethylsuccinate 400 mg PO qid for 14 days
• A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
• Sexual activity should be withheld for 1 week until the antimicrobial regimen is complete.
• Avoid doxycycline and fluoroquinolones among pregnant women

• Cervicitis, Gonococcal^[3]

• Preferred regimen: Cephalosporin IM in a single dose AND (Azithromycin 1 g PO in a single dose OR Doxycycline mg PO bid for 7 days)
• Alternative regimen, cephalosporin allergic: Azithromycin 2 g PO in a single dose
• Note (1): A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
• Note (2): Sexual activity should be withheld for 1 week until the antimicrobial regimen is complete.

• The partner’s sexual activity should be withheld until the antimicrobial regimen is complete.
• All sex partners during the previous 60 days should be referred for evaluation, testing, and presumptive treatment if chlamydia, gonorrhea, or trichomoniasis was identified.
• Sexual partners should also be treated for the pathogens as listed above.
• A test of cure is also recommended 1 week after the first dose of antimicrobial therapy.
• EPT and other effective partner referral strategies are alternative approaches for treating male partners of women who have chlamydial or gonococcal infection.

• A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
• If symptoms persist, women should be instructed to return for re-evaluation because women with documented chlamydial or gonococcal infections have a high rate of reinfection within 6 months after treatment.
• For untreated women, a follow-up visit gives an opportunity to communicate test results obtained as part of the cervicitis evaluation.
• Women with a specific diagnosis of chlamydia, gonorrhea, or trichomoniasis should be offered partner services and instructed to return in 3 months after treatment for repeat testing because of high rates of reinfection, regardless of whether their sex partners were treated.

First line antibiotic used to be azithromycin however recent anitibiotic resistance strains has made moxifloxacin more preferred.^[4]

Trichomonas vaginalis cervicitis is treated with metronidazole.

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