Description
The term non-gonococcal urethritis is used to describe other causes of urethritis apart from Neisseria
gonorrhoeae. The organisms commonly responsible are Chlamydia trachomatis and Ureaplasma urealyticum. Symptoms usually occur 7 to 28 days after intercourse
Signs and Symptoms
• Mild dysuria
• Discomfort in the urethra
• A clear to purulent mucoid discharge.
• The lips of the meatus are often stuck together with dried secretions.
• The meatus may be red, with evidence of dried secretion on underwear
Investigations
This is based on bacteriological examination of the discharge to exclude gonorrhoea.
Treatment
Table 134: Recommended Treatment Regimens for Syndromic Treatment of STIs
|
STI
Syndrome
|
Recommended Actions
|
Preferred drugs
|
Alternative drugs
|
|
Vaginal Discharge
|
Treat for gonorrhoea
|
Ceftriaxone 500mg IM
Stat (to treat gonococcal infection) Children and Adolescents (≤17 years) Ceftriaxone
25-50mg/kg body weight IM stat
If ≥45kg, use adult
dose
|
Cefixime 400mg PO stat Children/adolescents <17 years Cefixime 8mg/kg body
weight PO stat
Note: If patient allergic to Cephalosporin use
Gentamycin 240mg IV stat
|
|
|
Treat for chlamydia
|
Doxycycline 100mg PO BD for 7 days
|
Azithromycin 1g PO stat
OR
Erythromycin 500mg PO QID 7 days (in pregnant or lactating woman)
|
|
STI
Syndrome
|
Recommended Actions
|
Preferred drugs
|
Alternative drugs
|
|
|
Treat for Vaginal candidiasis
|
Fluconazole 150mg PO stat
|
Clotrimazole vaginal
pessaries 200mg OD for 3 days
OR
Miconazole vaginal pessaries 200mg for 3 days
OR
Nystatin pessary 100,000 units Nocte for 14 days
|
|
Treat for Bacterial vaginosis
|
Metronidazole 400mg PO BD for 7 days OR
Metronidazole 0.75% 5g gel (full applicator) intravaginally OD for 5 days
OR
Clindamycin cream 2% one full applicator (5g) intravaginally OD for 7 days
|
Clindamycin 300mg PO BD for 7 days
OR
Tinidazole 2g PO BD for 3 days
OR
Tinidazole 1g PO OD for 5 days
|
|
Treat for trichomoniasis
|
Metronidazole 2g PO stat
OR
Metronidazole 400mg PO BD for 7 days
For children ≤17 years
5mg/kg PO TDS for 7 days
|
Tinidazole 2g PO stat
|
|
Genital Ulcer
|
Treat for syphilis
|
Benzathine penicillin
2.4 MU IM stat as a
single injection split as 1.2 MU given in each buttock
PLUS
Azithromycin 1g PO Stat
PLUS
Doxycycline 100mg PO BD for 21 days PLUS
Acyclovir 400mg PO TDS for 7 days
|
Erythromycin 500mg PO QID for 14 days (in pregnant or lactating woman)
|
|
Treat for chancroid
|
|
Treat for Lymphogranuloma venerium (LGV) Treat for Herpes simplex
|
|
Urethral Discharge Syndrome
|
Treat for gonorrhoea
|
Ceftriaxone 500mg IM stat
PLUS
Doxycycline 100mg PO BD for 7 days,
Metronidazole 2g PO stat (to treat Trichomonas vaginalis)
PLUS
Doxycycline 100mg PO BD for 7 days followed by
Azithromycin 1g PO stat, then 500mg PO OD for 3 days (to treat M. genitalium)
|
Cefixime 400mg PO stat Azithromycin 1g PO Stat OR
Erythromycin 500mg PO QID for 7 days
|
|
Treat for chlamydia
|
|
If urethral discharge persists after 7 days despite adequate treatment and no history of re-exposure to STI then treat with
|
|
STI
Syndrome
|
Recommended Actions
|
Preferred drugs
|
Alternative drugs
|
|
Inguinal Bubo†
|
Aspirate FLUCTUANT bubo
with a large bore needle through normal skin Treat for chancroid Treat for LGV
|
Azithromycin 1g PO stat
PLUS
Doxycycline 100mg PO BD for 21 days
|
Ceftriaxone 500mg IM stat
OR
Cefixime 400mg PO stat If pregnant or lactating woman use Erythromycin 500mg PO QID 21 days (Note: Do not use Doxycycline)
|
|
Female Lower Abdominal Pain
(PID)
Outpatient
|
Treat for gonorrhoea, chlamydia and anaerobic bacteria at the same time
|
Ceftriaxone, 500mg IM stat
PLUS
Doxycycline 100 mg PO BD for 14 days PLUS
Metronidazole 400mg PO TDS 14 days
OR
Metronidazole
2g PO stat (to treat anaerobic bacteria)
|
Cefixime 400mg PO stat
PLUS
Erythromycin 500mg PO QID for 14 days
|
|
Female Lower Abdominal Pain
(PID)
Inpatient
|
Treat for gonorrhoea, chlamydia, and Anaerobic bacteria at the same time
|
Ceftriaxone 1g IV stat
PLUS
Doxycycline 100mg PO BD for 14 days
PLUS
Metronidazole 500mg PO TDS for 14 days OR
Metronidazole 500mg IV BD for 7 days Note: Switch to oral treatment upon clinical
improvement and continue up to 14 days
|
Cefixime 400mg PO stat
PLUS
Erythromycin 500mg PO QID for 14 days
|
|
Genital Growth
|
Treat for Condylomata acuminata (ano- genital warts
|
Podophyllin 25%
tincture. Apply topically weekly up to 12 weeks (protect surrounding normal skin with Vaseline jelly before application by health care provider)
Imiquimod cream 5% applied at bedtime 3 times a week up to a duration of 8-12
weeks
|
Cauterization, Trichloroacetic Acid (weekly), Cryotherapy
(fortnightly) Surgical excision of warts for isolated lesions
|
|
|
Treat for Condylomata lata
|
Benzathine Penicillin 2.4 MU IM stat
|
|
|
STI
Syndrome
|
Recommended Actions
|
Preferred drugs
|
Alternative drugs
|
|
Scrotal Swelling
|
Treat for donorrhoea
|
Ceftriaxone 500mg IM stat
PLUS
Doxycycline 100mg PO BD for 14 days
|
Cefixime 400mg PO stat
|
|
|
Treat for Chlamydia
|
Azithromycin 1g PO weekly for 2 weeks (Total of 2 doses)
OR
Erythromycin 500mg PO QID for 14 days
|
|
Neonatal Conjunctivitis
|
Treat for gonorrhoea and chlamydia
|
Ceftriaxone 25 – 50mg/kg body weight (max. 125mg) IM stat PLUS
Erythromycin syrup, 50mg/kg body weight PO daily in 4 divided doses for 14 days
PLUS
Saline lavage of eyes
|
Cefotaxime 100mg per kg/body weight IV/IM stat
|
NB: Persistent urethral discharge one week after treatment consider Trichomonas vaginalis, then treatment
with Metronidazole 2g PO single dose for adults and 5mg/kg body weight for children.
• Prevention
o Avoiding multiple sexual partners and unprotected casual sexual intercourse. Condom use is advised.
Complications
- These include epididymitis and urethral Perihepatitis could also occur.
