What is the recommended management for patients with abnormal Pap results and/or genital infections like gonorrhea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis)?

From the Guidelines

Management of abnormal Pap results and genital infections requires prompt treatment and appropriate follow-up, with the most recent guidelines from 2021 recommending that all persons with a cervix receive cervical cancer screening, regardless of sexual orientation or gender identity 1. For abnormal Pap results, management depends on the severity of the findings.

• Low-grade abnormalities (ASCUS, LSIL) often warrant repeat testing in 12 months or HPV testing,
• while high-grade abnormalities (HSIL, ASC-H) typically require colposcopy for further evaluation. For gonorrhea, the recommended treatment is ceftriaxone 500 mg intramuscularly as a single dose. For chlamydia, doxycycline 100 mg orally twice daily for 7 days is preferred, with azithromycin 1 gram orally as a single dose as an alternative. Both infections often occur together, so dual treatment is common. All sexual partners from the previous 60 days should be notified, tested, and treated. Patients should abstain from sexual activity until they and their partners complete treatment and symptoms resolve. Follow-up testing is recommended 3 months after treatment to ensure cure, especially in high-risk populations. These infections require treatment because they can lead to serious complications including pelvic inflammatory disease, infertility, and increased risk of HIV transmission if left untreated. It's also important to note that HPV testing can be performed either as a separate test or by using material from the liquid-based cytology specimen, and that the presence of external genital warts does not warrant more frequent cervical cancer screening 1. Additionally, the sequence of cytology testing in relation to collection of other endocervical specimens does not influence Pap test results or their interpretation 1. The use of instruments designed to sample the cervical transformation zone (e.g., cytobrushes) improves the accuracy of cytology tests 1. Both liquid-based and conventional cytology are acceptable because they have similar test-performance characteristics 1. At an initial visit, providers should ask patients about their recent cytology test and HPV results and any history of evaluation and treatment to assist with management 1. Effort should be made to obtain copies of recent results, and the importance and frequency of screening should be reinforced 1. It's worth noting that the 2021 guidelines are the most recent and should be followed for the management of abnormal Pap results and genital infections 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of ofloxacin tablets, USP and other antibacterial drugs, ofloxacin tablets, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria Uncomplicated Urethral and Cervical Gonorrhea due to Neisseria gonorrhoeae Nongonococcal Urethritis and Cervicitis due to Chlamydia trachomatis Mixed Infections of the Urethra and Cervix due to Chlamydia trachomatis and Neisseria gonorrhoeae Acute Pelvic Inflammatory Disease (including severe infection) due to Chlamydia trachomatis and/or Neisseria gonorrhoeae

The recommended management for patients with abnormal Pap results and/or genital infections like gonorrhea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) includes:

• Antibiotic treatment: Ofloxacin tablets, USP are indicated for the treatment of adults with mild to moderate infections caused by susceptible strains of the designated microorganisms, including Neisseria gonorrhoeae and Chlamydia trachomatis.
• Specific treatment regimens: The dosage and duration of treatment may vary depending on the specific infection and patient population.
• Importance of susceptibility testing: Appropriate culture and susceptibility tests should be performed before treatment to determine the causative organism and its susceptibility to ofloxacin. 2

From the Research

Recommendations for Pap and Pap with HPV or GC/CT

• For patients with abnormal Pap results, the addition of a high-risk HPV DNA assay to cytologic examination appears to provide excellent sensitivity and negative predictive value for early detection of high-grade CIN or cancer in older women with minimally abnormal Pap smears 3.
• High-risk HPV DNA testing can improve the detection of cervical intraepithelial neoplasia (CIN) and cancer in older women (> or = 50 years old) with mildly abnormal results on conventional cytology 3.
• For patients with genital infections like gonorrhea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis), the following recommendations apply:
  • All sexually active people with a cervix who are younger than 25 years and older people with a cervix who have risk factors should be screened annually for chlamydial and gonococcal infections 4.
  • Sexually active men who have sex with men should be screened at least annually 4.
  • Uncomplicated gonococcal infection should be treated with a single 500-mg dose of intramuscular ceftriaxone in people weighing less than 331 lb (150 kg) 4.
  • Preferred chlamydia treatment is a seven-day course of doxycycline, 100 mg taken by mouth twice per day 4.
• Patients diagnosed with chlamydia or gonorrhea should have a test of cure four weeks after treatment if pregnant, or be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment if nonpregnant 4.