What is the recommended treatment for a penile infection caused by Streptococcus agalactiae (Group B Strep)?

Treatment for Penile Infection Caused by Streptococcus agalactiae (Group B Strep)

For penile infections caused by Group B Streptococcus (GBS), penicillin is the first-line treatment, with clindamycin 300 mg four times daily for 10 days recommended for non-pharyngeal infections or when penicillin treatment fails. 1

First-Line Treatment Options

For non-pregnant adults with GBS penile infections, the recommended treatment regimens include:

• Penicillin-based options:

  • Oral penicillin V: 500 mg four times daily for 10 days 1
  • Amoxicillin: 500 mg three times daily for 10 days 1, 2

• For penicillin-allergic patients:

  • Clindamycin: 300 mg four times daily for 10 days 1, 2
  • Azithromycin: 500 mg once daily for 5 days 1

Treatment Considerations for Non-Pharyngeal Infections

Since penile infections are non-pharyngeal, it's important to note that:

• Penicillin treatment alone may not be sufficient for non-pharyngeal GBS infections 1
• Clindamycin is particularly effective for non-pharyngeal carriage sites 1
• For persistent or difficult-to-treat cases, combination therapy may be necessary 1

Monitoring and Follow-up

After treatment:

• Clearance cultures should be taken 24 hours after completing treatment
• Additional follow-up cultures at 1,3,6, and 12 weeks are recommended to ensure complete eradication 1

Management of Treatment Failure

If initial treatment fails:

1. Consider clindamycin 300 mg four times daily for 10 days if penicillin was used initially 1
2. For persistent infections, consider combination therapy options:
   • Penicillin plus rifampicin 1
   • Clindamycin with rifampicin 1

Special Considerations

• Partner evaluation: Consider screening sexual partners, as GBS can be transmitted between partners 3
• Recurrent infections: May require more aggressive treatment approaches and investigation of colonization in sexual partners 3
• Risk factors: Patients with urinary tract abnormalities or compromised immune systems may require more aggressive treatment 2

Antibiotic Resistance Concerns

Be aware of increasing resistance patterns:

• Penicillin resistance up to 18.3%
• Clindamycin resistance rates of 14-26.6% 2

When selecting antibiotics, consider local resistance patterns and perform susceptibility testing when possible, especially for recurrent or persistent infections.