| Chlamydia |
| Best test: |
Men – First void urine (FVU); Women – endocervical swab if performing pelvic examination; Self collected
vaginal swab acceptable for screening; Rectal swab in either sex if indicated by history |
| Drug treatment: |
Azithromycin 1 g stat or
Doxycycline 100 mg bd for 7 days |
| Drug treatment in pregnancy or breast feeding: |
Azithromycin 1 g stat (azithromycin not licensed for use in pregnancy in NZ but clinical experience
and studies overseas suggest it is safe and effective2 ) or
Amoxicillin 500 mg tid for 7 days or if allergic to penicillin use erythromycin
e.g. erythromycin ethyl succinate 800 mg qid for 7 days (14 day regimens are appropriate if GI intolerance is a concern) |
| Other management: |
Contacts of a person who has tested positive for chlamydia should be treated.
For symptomatic rectal infection in men who have sex with men discuss treatment with a sexual health physician.
A test of cure should be done at 4 weeks post treatment in rectal infection, in pregnancy and when amoxicillin or
erythromycin is used.
Repeat STI screen for those with positive results after 3 months. |
|
|
| Gonorrhoea |
| Best test: |
Men – urethral swab; Women – endocervical swab; If appropriate rectal and pharyngeal swabs. |
| Drug treatment |
(including pregnancy and breastfeeding):
Ceftriaxone
250 mg* IM stat AND Azithromycin 1 g stat
Azithromycin is routinely given for treatment of chlamydia as co-infection is so common.
If the isolate is known to be ciprofloxacin sensitive, a 500 mg stat dose of ciprofloxacin can be used. Resistance
rates vary by location. |
| Other management: |
Test of cure is not usually required as standard treatment is >95% effective (provided compliant
and asymptomatic after treatment) |
|
|
| Syphilis |
| Best test: |
Early – examination of chancre exudate by dark ground microscopy (NB this is often impractical because
it needs to be examined within 10 –15 minutes).
After 6 – 12 weeks – serology |
| Drug treatment: |
Do not prescribe antibiotics or apply any solutions to ulcer prior to the patient being seen
by a specialist |
| Other management: |
In the presence of a chancre or rash and/or positive serological finding, urgent referral to a sexual
health or infectious disease physician is recommended.
Advise patient to abstain from sexual activity until seen by a specialist and the diagnosis is confirmed. |
|
|
| Genital Herpes (first episode) |
| Best test: |
Viral swabs. Type specific herpes serology is typically not indicated in an acute presentation as interpretation
can be difficult. |
| Drug treatment: |
Aciclovir 200 mg 5 x/day for 5 days or Aciclovir 400 mg tid for 7 days
Antiviral treatment may still be appropriate if patient presents >72 hours after development of symptoms if new
lesions are developing or symptoms are severe.
Lignocaine gel 2% as required
Paracetamol 1 g qid |
| Drug treatment in pregnancy or breast feeding: |
Aciclovir as above (note aciclovir not licensed for use in pregnancy although extensively used without
significant adverse effects)
All pregnant women should be referred to a sexual health physician or obstetrician. Urgent referral if in the third
trimester |
| Other management: |
Advise increasing fluid intake so urine is dilute and less painful to pass and suggest urinating
in the bath/shower to reduce stinging.
Written information is recommended for all patients. Useful resources can be found at www.herpes.org.nz |
|
|
| Trichomoniasis |
| Best test: |
Men – urethral swab; Women – high vaginal swab. |
| Drug treatment: |
Metronidazole 400 mg bd for 7 days or Metronidazole 2 g stat. The single dose has the advantage of
improved compliance but there is some evidence to suggest that the failure rate is higher. |
| Drug treatment in pregnancy and breastfeeding: |
Metronidazole 400 mg bd for 7 days (NB single high dose regimens are avoided because they may result
in higher serum concentrations which can reach foetal circulation). |
| Other management: |
Avoid alcohol with metronidazole
Partner also requires treatment to prevent re-infection. A male partner of a woman with trichomoniasis should be
treated even if asymptomatic as the culture is seldom positive even if infection present. |
|
|
| Bacterial vaginosis |
| Best test: |
High vaginal swab |
| Drug treatment: |
Metronidazole 2 g stat or Metronidazole 400 mg bd for 7 days |
| Drug treatment in pregnancy and breastfeeding: |
Metronidazole 400 mg bd for 7 days |
| Other management: |
Avoid alcohol with metronidazole
Treatment of asymptomatic woman is unnecessary unless an invasive procedure is planned e.g. IUCD insertion, termination
of pregnancy |
|
|
| Acute non-specific urethritis (NSU) |
| Best test: |
Diagnosis of exclusion. Urethral swab and FVU to exclude gonorrhoea and chlamydia |
| Drug treatment: |
Azithromycin 1 g stat or
Doxycycline 100 mg bd for 7 days
If purulent discharge, treat as for gonorrhoea i.e. *ceftriaxone 250 mg IM stat and azithromycin 1g stat |
| Other management: |
Treat contacts with azithromycin 1 g stat even if the contact’s chlamydia test result is negative |
|
|
| Genital Warts |
| Best test: |
Clinical diagnosis |
| Drug treatment: |
Patient applied: Podophyllotoxin 5 mg/ml bd for 3 consecutive days/week for 5 weeks or
Imiquimod 3 times a week (alternate days followed by 2 treatment free days) for up to 16 weeks
Clinician applied: Cryotherapy, laser, hyfrecation or surgical excision |
| Drug treatment in pregnancy and breastfeeding: |
Cryotherapy only
Specialist referral may be required |
| Other management: |
Barrier contraception may reduce transmission to partners Treatment is cosmetic not curative
For patient resources see www.hpv.org.nz |
|
|
| Acute candidiasis |
| Best test: |
Women – vaginal swab; Men – subprepucial or glans penis swab |
| Drug treatment: |
Women: Intravaginal antifungal (imidazole) or fluconazole 150 mg stat
Men: Topical antifungal (imidazole) |
| Drug treatment in pregnancy and breastfeeding: |
Intravaginal antifungal (imidazole) |
| Other management: |
Treatment of asymptomatic women is not generally necessary
Although candidiasis is not an STI it can be transferred with sexual contact. The partner should be treated if symptomatic
or in some cases of recurrent candidiasis |
|
|
| Pelvic inflammatory disease |
| Best test: |
Pelvic exam, endocervical swabs for chlamydia and gonorrhoea, HVS for trichomonas, temperature, pregnancy
test, consider FBC, CRP |
| Drug treatment: |
Ceftriaxone
250 mg* IM stat AND Doxycycline 100 mg bd for 2 weeks
When symptoms are moderate/severe add metronidazole 400 mg bd for 2 weeks
Alternatively if compliance is likely to be poor:
Ceftriaxone 250 mg* IM stat AND azithromycin 1 g stat |
| Drug treatment in pregnancy: |
Referral for specialist assessment is indicated. Admission may be required for IV antibiotics. |
| Other management: |
Decision to remove IUCD should be made depending on the individual patient. Evidence suggests that
treatment of PID can be successful in the presence of an IUCD. |
|
|
| Epididymo-orchitis |
| Best test: |
FVU for chlamydia, urethral swab for gonorrhoea, dipstick urine, MSU if suspect UTI |
| Drug treatment: |
If STI pathogens suspected:
Ceftriaxone 250 mg* IM stat AND doxycycline 100 mg bd for at least 2 weeks
If UTI pathogens suspected:
Amoxycillin/clavulanic acid 500 mg tid for 2 to 3 weeks or
Ciprofloxacin 500 mg bd for 10–14 days |
| Other management: |
Bed rest, analgesics and scrotal elevation are recommended |
|
|
| Molluscum Contagiosum |
| Best test: |
Clinical observation – look for firm flesh coloured bumps, often with waxy centres. |
| Treatment options: |
Reassure and observe – in many cases no specific treatment is necessary.
Cryotherapy / curettage / diathermy.
Sterile sharp stick to remove contents (iodine or phenol may be applied).
Podophyllotoxin or imiquimod. |
| Treatment in pregnancy: |
Podophyllotoxin is contraindicated and imiquimod should also be avoided. |
| Other management: |
If infection occurs, topical antibiotics may be required |