Epididymitis

• Affected age group: < 35 years old

  • Causative agent(s):

    • Chlamydia trachomatis (more often)

    • Neisseria gonorrhoeae

• Older age group or those who have had urinary tract instrumentation:

  • Causative agents:

    • Enteric gram-negative bacilli

      • May also cause urethritis or epididymitis in men practicing unprotected, inserted anal intercourse

    • Pseudomonas

• Drug of choice:

  • Ofloxacin (Floxin)

    •  May be used in the absence of culture data

• Alternative agent:

  • Ceftriaxone (Rocephin) (single IM dose followed by 10 day treatment with doxycycline (Vibramycin, Doryx)

Pelvic Inflammatory Disease

• Causative Agents

  • Chlamydia trachomatis and Neisseria gonorrhoeae: responsible for about 2/3 of active cases

  • Other organisms included Mycoplasma hominis (other facultative agents and anaerobic bacteria can be present)

• Inpatients:

  • Drugs of choice:

    •  Cefotetan (Cefotan) or cefoxitin (Mefoxin) plus doxycycline (Vibramycin, Doryx, contraindicated in pregnancy)

    •  Doxycycline (Vibramycin, Doryx) alone -- contraindicated in pregnancy

    • Or

    • Clindamycin (Cleocin) +gentamicin (Garamycin), followed by doxycycline (Vibramycin, Doryx)

  •  Alternative agents:

    • Ofloxacin (Floxin) + metronidazole (Flagyl)

    • Ampicillin (Principen, Omnipen)/sulbactam + doxycycline (Vibramycin, Doryx)

    • Ciprofloxacin + doxycycline (Vibramycin, Doryx,contraindicated in pregnancy) + metronidazole (Flagyl)

    • All combinations continued until improvement is observed: then doxycycline (Vibramycin, Doryx, contradicted in pregnancy) for a 14 day time course

• Outpatients

  • Drugs of choice:

    • Ofloxacin (Floxin, contraindicated in pregnancy) + metronidazole (Flagyl)

    • Or

    • Ceftriaxone (Rocephin) Or

    • Cefoxitin (Mefoxin) + probenecid (Benemid)-- either cephalosporin, ceftriaxone (Rocephin) or cefoxitin (Mefoxin), followed by doxycycline (Vibramycin, Doryx, contraindicated in pregnancy)

     

    Reference:"Drugs for Sexually Transmitted Infections", The Medical Letter, vol. 41 (issue 1063), September, 24, 1999, Published by the Medical Letter, Inc, New Rochelle, N.Y.