What treatment should be given to the male partner of a woman with recurrent pelvic inflammatory disease (PID) due to chlamydia and gonorrhea?

Treatment for Male Partner of a Woman with Recurrent PID

The male partner should be treated with ceftriaxone 500 mg IM in a single dose PLUS azithromycin 1 g orally in a single dose to cover both gonorrhea and chlamydia, regardless of whether pathogens were isolated from the female partner. 1

Rationale for Treatment

• Male partners of women with PID should be examined and treated if they had sexual contact with the patient during the 60 days preceding the patient's onset of symptoms 1
• Treatment is imperative because of the risk for reinfection of the female partner and the strong likelihood of urethral gonococcal or chlamydial infection in the male partner, even if asymptomatic 1
• Sex partners should be treated empirically with regimens effective against both chlamydia and gonorrhea, regardless of the etiology of PID or pathogens isolated from the infected woman 1

Treatment Regimen Details

First-line Treatment:

• Ceftriaxone 500 mg IM in a single dose 2
  • Effective against gonorrhea, including penicillinase-producing strains
  • Recommended due to increasing antimicrobial resistance in gonorrhea 3
• PLUS
• Azithromycin 1 g orally in a single dose 4
  • Effective against chlamydia
  • Also provides some coverage against Mycoplasma genitalium 1

Alternative Regimens (if first-line cannot be used):

• For patients who cannot tolerate cephalosporins:
  • Spectinomycin (if available) with appropriate chlamydia coverage 1
• For chlamydia coverage alternatives:
  • Doxycycline 100 mg orally twice daily for 7 days 1
  • Erythromycin base 500 mg orally four times a day for 7 days 1
  • Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days 1
  • Levofloxacin 500 mg orally once daily for 7 days 1
  • Ofloxacin 300 mg orally twice a day for 7 days 1

Important Considerations

• Even though the female partner's vaginal swab was negative, empiric treatment is still recommended due to:

  • Possibility of false-negative test results 1
  • High likelihood of asymptomatic infection in male partners 1
  • The pattern of recurrent infection in the female partner strongly suggests ongoing transmission from an untreated partner 1, 5

• After treatment, the couple should:

  • Abstain from sexual intercourse until both partners have completed treatment 1
  • Continue abstinence for 7 days after single-dose therapy or until completion of a multi-day regimen 1
  • Both partners should be symptom-free before resuming sexual activity 1

Follow-up Recommendations

• Testing for cure is not routinely recommended if recommended treatment is provided and symptoms resolve 1
• Consider rescreening both partners 3 months after treatment due to high risk of reinfection 1
• If symptoms persist or recur in either partner, they should return for evaluation 1
• Both partners should be tested for other STIs including syphilis and HIV 1

Common Pitfalls to Avoid

• Failing to treat partners empirically even when tests are negative 1
• Treating only for the organism identified in the female partner rather than providing coverage for both gonorrhea and chlamydia 1
• Not emphasizing the importance of abstinence during treatment and for 7 days after completion 1
• Assuming condom use during treatment is sufficient protection (condoms may fail even with experienced users) 5
• Not considering the possibility of extragenital infections (rectal, pharyngeal) which may be missed by standard testing 6