Cervicitis 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.^[7] 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).

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

Ceftriaxone (Rocephin)

First-line therapy for gonococcal cervicitis. Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

Cefixime (Suprax)

Third-generation cephalosporin effective in treating gonorrhea. By binding to one or more of the penicillin-binding proteins, it arrests bacterial cell wall synthesis and inhibits bacterial growth. This medication is once again available in the United States.

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.

Azithromycin (Zithromax)

First-line therapy for chlamydia cervicitis. Semisynthetic macrolide antibiotic effective in treating chlamydia. Treats mild-to-moderate microbial infections.

Doxycycline (Vibramycin)

Long-acting tetracycline derived from oxytetracycline. Effective in treating chlamydia. Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Erythromycin base (E-Mycin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Alternative therapy for chlamydia cervicitis.

Erythromycin ethylsuccinate (E.E.S.)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Alternative regimen for chlamydia cervicitis.

Metronidazole (Flagyl)

Synthetic antibacterial and antiprotozoal agent. First-line therapy for T vaginalis infections.

Class Summary

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV polymerase with 30-50 times the potency of human alpha-DNA polymerase.

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.

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.

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.

Class Summary

Indicated for genital/perianal warts.

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.

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.

Fluorouracil topical (Carac, Efudex, Fluoroplex)

Cycle-specific agent that has activity as single agent and has for many years been combined with biochemical modulator leucovorin. Shown to be effective in adjuvant setting. Classic antimetabolite anticancer drug with chemical structure similar to endogenous intermediates or building blocks of DNA or RNA synthesis. 5-FU inhibits tumor cell growth through at least 3 different mechanisms that ultimately disrupt DNA synthesis or cellular viability. These effects depend on intracellular conversion of 5-FU into 5-FdUMP, 5-FUTP, and 5-FdUTP. 5-FdUMP inhibits thymidylate synthase (key enzyme in DNA synthesis). 5-FUTP is incorporated into RNA and interferes with RNA processing, and 5-FdUTP is incorporated into DNA, leading to cytotoxic DNA strandbreaks.

Trichloroacetic acid topical (Tri-Chlor)

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.

Class Summary

Alternative therapy for trichomonas infections.

Tinidazole (Fasigyn, Tindamax)

5-nitroimidazole derivative used for susceptible protozoal infections. Nitro group is reduced by cell extract of Trichomonas. The free nitro radical generated is thought to be responsible for antiprotozoal activity against T vaginalis. Indicated to treat trichomoniasis caused by T vaginalis in both males and females.