Clinical Manual for Management of the HIV-Infected ... - myCME.com

Treatment: Alternative regimens
♦ Clindamycin 300 mg orally twice daily for 7 days
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Clindamycin ovules 100 g intravaginally at bedtime
for 3 days
Treatment during pregnancy
♦ Pregnant women should be treated with oral
metronidazole or oral clindamycin.
Note: Patients must avoid alcohol while taking
metronidazole. This combination may cause a
disulfiram-like reaction. Patients taking ritonavir or
tipranavir may also experience symptoms because of the
small amount of alcohol in the capsules.
Treatment Failure
Multiple conditions or pathogens may present
concurrently. Perform testing for other conditions
as suggested by symptoms, or if symptoms to do not
resolve with initial treatment:
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Perform herpes culture if indicated by lesions; see
chapter Herpes Simplex, Mucocutaneous.
Test for chlamydia and gonorrhea if indicated; see
chapter Chlamydia and Gonorrhea.
Perform urinalysis (with or without culture and
sensitivities) if urinary symptoms are prominent.
If an irritant or allergen is suspected, including N-9,
discontinue use.
If symptoms are related to the use of latex condoms,
switch to polyurethane male or female condoms.
For tenderness on cervical motion or other
symptoms of PID, see chapter Pelvic Inflammatory
Disease.
Perform workup or obtain referral as needed for
other abnormalities found on bimanual examination.
For information on other STIs or related conditions,
see the CDC’s treatment guidelines at http://www.cdc.
gov/std/treatment.
Section 5—Complaint-Specific Workups | 5–47
Patient Education
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Patients must avoid any form of alcohol while taking
metronidazole and for 24 hours after the last dose.
Alcohol and metronidazole together can cause severe
nausea, vomiting, and other immobilizing symptoms.
Patients taking ritonavir may experience symptoms
because of the small amount of alcohol in the
capsules and should call their health care providers if
nausea and vomiting occur.
Clindamycin cream and ovules are oil based and will
weaken latex condoms, diaphragms, and cervical
caps. Patients should use alternative methods to
prevent pregnancy and HIV transmission.
Recurrence of BV is common. Patients should
contact their health care providers and return for
repeat treatment if symptoms recur.
Instruct patients to avoid douching.
To avoid being reinfected by Trichomonas, patients
should bring their sex partners to the clinic for
evaluation and treatment.