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Treatment of all causes of cervicitis is medical. Treatment must include the patient's
sexual partners to prevent reinfection. Treatment for infectious causes of cervicitis can be
done presumptively (treatment with azithromycin or doxycycline) or with specific
antibiotic treatment once the etiology is known.
Activity
No sexual activity for 7 days after initiating treatment
No sexual activity until partner has been treated
Medication
Oral antibiotics effectively cure gonorrhea, chlamydia, and T vaginalis infections. Oral
antivirals reduce duration of symptoms, lesions, and viral shedding in the first and
recurrent episodes of genital herpes infections. Initially, topical therapy is used for
symptomatic genital wart removal. Other options include intralesional injection and
surgery.
In April 2007, the Centers for Disease Control and Prevention (CDC) updated treatment
guidelines for gonococcal infection and associated conditions.5 Fluoroquinolone
antibiotics are no longer recommended to treat gonorrhea in the United States. The
recommendation was based on analysis of new data from the CDC’s Gonococcal Isolate
Surveillance Project (GISP). The data from GISP showed the proportion of
fluoroquinolone-resistant gonorrhea (QRNG) cases in heterosexual men reached 6.7%, an
11-fold increase from 0.6% in 2001. The data were published in the April 13, 2007 issue
of the Morbidity and Mortality Weekly Report. This limits treatment of gonorrhea to
drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose).
Fluoroquinolones may be an alternative treatment option for disseminated gonococcal
infection if antimicrobial susceptibility can be documented.
For more information, see the CDC’s Antibiotic-Resistant Gonorrhea Web site or
Updated Gonococcal treatment recommendations (April 2007).
Antibiotics
Therapy must be comprehensive and cover all likely pathogens in the context of this
clinical setting.
Ceftriaxone (Rocephin)
125 mg IM once
Pediatric
Administer as in adults
Cefixime (Suprax)
400 mg PO once
Pediatric
Spectinomycin (Trobicin)
Inhibits protein synthesis in bacterial cells. Site of action is 30S ribosomal subunit and is
structurally different from related aminoglycosides. Use if allergic to penicillin and
quinolones. Alternative regimen for treatment of gonorrhea. Do not use if oropharyngeal
gonorrhea is suspected.
Dosing
Interactions
Contraindications
Precautions
Adult 2 g IM once
Pediatric
<45 kg: 40 mg/kg IM once
>45 kg: Administer as in adults
Azithromycin (Zithromax)
1 g PO once
Pediatric
Doxycycline (Vibramycin)
Metronidazole (Flagyl)
Acyclovir (Zovirax)
Synthetic purine nucleoside analog indicated for genital HSV infections. First episode,
begin treating within 6 d after appearance of first symptoms. If recurrent attack, begin
treating during prodrome or within 1 d after onset of lesions. Suppression requires daily
treatment for 1 y.
Dosing
Interactions
Contraindications
Precautions
Adult
First episode: 400 mg PO tid for 7-10 d; alternatively 200 mg PO 5 times qd for 7-10 d
Recurrent attack: 200 mg PO 5 times qd for 5 d; alternatively 400 mg PO tid for 5 d or
800 mg PO bid for 5 d
Suppression: 400 mg PO bid for 1 y
Pediatric
Famciclovir (Famvir)
Prodrug for penciclovir (active moiety) indicated for genital HSV infections. For first
episode, begin treating within 6 d after appearance of first symptoms. For recurrent
attack, begin treating during prodrome or within 1 d after onset of lesions. Suppression
requires daily treatment for 1 y.
Dosing
Interactions
Contraindications
Precautions
Adult
Not established
Valacyclovir (Valtrex)
Indicated for genital HSV infections. For first episode, begin treating within 6 d after
appearance of first symptoms. For recurrent attack, begin treating during prodrome or
within 1 d after onset of lesions. Suppression requires daily treatment for 1 y.
Adult
First episode: 1 g PO bid for 7-10 d
Recurrent attack: 500 mg PO bid for 5 d
Suppression: 1 g PO qd for 1 y; alternatively, 500 mg PO qd for 1 y or 250 mg PO bid for
1y
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Topical skin products
Imiquimod (Aldara)
Indicated for genital/perianal warts. Induces secretion of interferon alpha and other
cytokines; mechanism of action are unknown. May be more effective in women than in
men.
Dosing
Interactions
Contraindications
Precautions
Adult
Apply to warts qhs 3 times/wk for up to 16 wk, rinse treatment area with soap and water
6-10 h after application
Pediatric
Podofilox (Condylox)
Topical antimitotic which can be chemically synthesized or purified from plant families
Coniferae and Berberidaceae (eg, species of Juniperus and Podophyllum). Exact
mechanism of action is unknown.
Dosing
Interactions
Contraindications
Precautions
Adult
Not established
Not established
Cauterizes skin, keratin, and other tissues. Although caustic, causes less local irritation
and systemic toxicity than others in the same class. However, response is often
incomplete and recurrence occurs frequently.
Adult Apply to warts and powder with talc or sodium bicarbonate (baking soda) to
remove unreacted acid; may repeat weekly
Pediatric Not established
Antiprotozoal