• 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.