PathAdvantage Journal

We’re proud to announce the release of the ninth edition of The Bug Book; PathAdvantage’s comprehensive clinical reference for treating gynecologic infections, STIs and urinary tract infections.

We published the first edition of our clinical gynecologic reference The Bug Book more than 15 years ago to give clinicians an accurate, practical reference for the infections they see every day. That mission hasn’t changed.

 

You can purchase The Bug Book in print and app format here.

 

“Keeping The Bug Book current isn’t just a commitment we make to our clients; it’s an extension of our clinical responsibility,” says Dr. Alexandra Gillespie, MD, Medical Director at PathAdvantage. ‟The organisms and their treatments are changing, the guidelines are changing, and our patients deserve providers who have the most accurate information in hand.”

What’s New in the 2026 Edition of The Bug Book

• Two new FDA-approved oral drugs for gonorrhea: In December 2025, the FDA approved Nuzolvence (zoliflodacin) and Blujepa (gepotidacin) for uncomplicated urogenital gonorrhea. Both offer efficacy comparable to standard treatment. Full coverage in the 9th edition, including dosing and patient selection.
• 2025 ACOG update for treating partners in recurrent BV: ACOG now says that treatment of male sexual partners of women with recurrent, symptomatic BV should be considered for male partners. Shared decision-making guidance for patients with same-sex partners is also covered.
• New chapter on antibiotic resistance (ABR) gene testing: This edition introduces a dedicated ABR chapter covering 33 resistance genes across eight antibiotic classes.
• Oteseconazole (Vivjoa) for recurrent VVC: Vivjoa is now approved to reduce the incidence of VVC recurrence in patients with a history of recurrent vulvovaginal candidiasis (who are not of reproductive potential.) A meaningful option for patients who haven’t responded to standard suppression.
• pHyph: an antibiotic-free approach to BV and VVC: pHyph is an intravaginal tablet intended to treat both BV and VVC without antibiotics. Not yet available in the US; the company holds a US patent and is currently in trials; but patients may already be asking about it.
• Expanded pregnancy-specific guidance: Many antibiotics commonly used to treat gynecologic infections are contraindicated in pregnancy. This edition expands pregnancy guidance across multiple conditions, including Mycoplasma, Ureaplasma, chlamydia, trichomoniasis, and syphilis.
• GBS management in penicillin-allergic patients: A new section addresses GBS prophylaxis when the organism cannot be cultured which is most common in patients with a reported penicillin allergy.

Who Should Have The Bug Book Clinical Gynecological Reference?

The Bug Book is designed for any clinician who manages vaginal infections, STIs or UTIs; OB/GYNs, family practice physicians, nurse practitioners and telemedicine providers. This clinical gynecological reference is equally useful for those who see these conditions daily and those who encounter them less often but need a reliable reference when they do.

‟The Bug Book doesn’t replace clinical judgment,” says Dr. Gillespie. ‟It gives clinicians a convenient guide to current evidence and treatment options so they can act with all of the information in their hands.”

For interpretation questions or to speak with one of our pathologists, visit our consultations page.