What is the recommended treatment for sexual partners of patients with Sexually Transmitted Infections (STIs)?

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From the Guidelines

Partner treatment for sexually transmitted infections (STIs) is essential and should include expedited partner therapy (EPT) whenever possible, as well as the use of doxycycline postexposure prophylaxis (doxy PEP) for high-risk individuals, as recommended by the CDC in 2024 1.

Importance of Partner Treatment

Partner treatment is crucial in preventing reinfection and ongoing transmission of STIs. Without partner treatment, reinfection rates can be as high as 20-30% within months of initial treatment, undermining individual treatment efforts and contributing to community spread of STIs.

Recommended Treatment Regimens

For chlamydia, partners should receive azithromycin 1 gram orally as a single dose or doxycycline 100 mg orally twice daily for 7 days. For gonorrhea, the recommended treatment is ceftriaxone 500 mg intramuscularly as a single dose (for persons weighing <150 kg) or 1 gram for those weighing ≥150 kg. For trichomoniasis, metronidazole 2 grams orally as a single dose is recommended.

Doxycycline Postexposure Prophylaxis (Doxy PEP)

The CDC recommends doxy PEP for men who have sex with men (MSM) and transgender women (TGW) who have had a bacterial STI diagnosed in the past 12 months 1. The recommended dose of doxy PEP is 200 mg, taken within 72 hours after sex, and should not exceed a maximum dose of 200 mg every 24 hours.

Key Considerations

  • Partners should abstain from sexual activity for 7 days after completing treatment, even if symptoms resolve earlier.
  • It's essential to treat all sexual partners from the past 60 days for most STIs to prevent reinfection and ongoing transmission.
  • Doxy PEP should be implemented in the context of a comprehensive sexual health approach, including risk reduction counseling, STI screening and treatment, recommended vaccination, and linkage to HIV PrEP, HIV care, or other services as appropriate 1.

From the FDA Drug Label

Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed

The treatment for partner of patients with sexually transmitted infections (STIs) such as Chlamydia trachomatis or Neisseria gonorrhoeae should include:

  • Antimicrobial therapy as prescribed by a healthcare provider
  • Serologic test for syphilis
  • Appropriate cultures for gonorrhea Partner treatment is essential to prevent the spread of STIs and to ensure that both partners are properly treated 2.

From the Research

Partner Treatment for Sexually Transmitted Infections

  • The Centers for Disease Control and Prevention recommended Expedited Partner Therapy (EPT) as a clinical option for assuring treatment of sex partners of persons infected with sexually transmitted infections 3.
  • EPT enables the obstetrician-gynecologist or other provider to give prescriptions or medications to patients to take to their partners without first examining these partners 4.
  • The American College of Obstetricians and Gynecologists supports the use of EPT as a method of preventing gonorrhea and chlamydial reinfection when a patient's partners are unable or unwilling to seek medical care 4.

Effectiveness of EPT

  • Controlled trials in the United States and United Kingdom have presented increasing variety in intervention approaches, with trials and program evaluations typically demonstrating increased partner treatment rates 3.
  • However, only some studies show reductions in follow-up infection rates, and the prospect of cephalosporin-resistant gonorrhea raises the prospect that EPT may become less feasible as a partner treatment approach for gonorrhea patients 3.
  • The effectiveness of doxycycline is high and exceeds that of azithromycin for the treatment of rectal CT infections in women 5.

Guidance on EPT

  • State health departments release guidance on EPT for providers, but it is unclear if information is available for other key stakeholders, such as pharmacists, patients, and partners 6.
  • A content analysis of 84 EPT informational materials found that only 64% of states where EPT is allowable had informational materials available, with most materials targeting providers and partners 6.
  • The average reading level of the materials was 11th grade, and most provider and pharmacist materials did not meet the content criteria 6.

Treatment Options

  • Azithromycin and doxycycline are commonly used treatments for chlamydia, with doxycycline showing a slightly higher efficacy rate in some studies 5, 7.
  • A meta-analysis of randomized controlled trials found a pooled efficacy difference in favor of doxycycline of 1.5% to 2.6% compared to azithromycin 7.
  • However, the quality of the evidence varies considerably, and further well-designed and statistically powered double-blind, placebo-controlled trials are needed to determine the most effective treatment option 7.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Expedited partner therapy for sexually transmitted infections.

Current opinion in obstetrics & gynecology, 2012

7
Research

Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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