What are the treatment options for Sexually Transmitted Infections (STIs) in males?

From the Guidelines

Treatment for sexually transmitted infections (STIs) in males typically involves antibiotics or antiviral medications depending on the specific infection, with the goal of minimizing morbidity, mortality, and improving quality of life. For bacterial STIs like chlamydia, a single 1-gram dose of azithromycin or 7 days of doxycycline (100mg twice daily) is usually effective, as seen in various treatment guidelines 1. Gonorrhea requires ceftriaxine (500mg) as a single intramuscular injection, often combined with azithromycin to address potential co-infection. Syphilis treatment involves penicillin G benzathine (2.4 million units) as an intramuscular injection, with the number of doses depending on the stage of infection. For viral STIs like genital herpes, antiviral medications such as acyclovir (400mg three times daily for 7-10 days) or valacyclovir (1g twice daily for 7-10 days) are prescribed, with ongoing suppressive therapy available for recurrent outbreaks.

Key Considerations

• It's crucial for males to complete the full course of treatment even if symptoms improve, abstain from sexual activity until treatment is complete, and ensure all sexual partners are notified and treated to prevent reinfection 1.
• Regular STI testing is recommended for sexually active individuals, especially those with multiple partners, as emphasized in guidelines for HIV prevention through early detection and treatment of other sexually transmitted diseases 1.
• Alternative regimens for STI treatment include erythromycin base 500 mg orally four times a day for 7 days, erythromycin ethylsuccinate 800 mg orally four times a day for 7 days, levofloxacin 500 mg orally once daily for 7 days, or ofloxacin 300 mg orally twice a day for 7 days, as outlined in the 2010 sexually transmitted diseases treatment guidelines 1.

Treatment Approach

• The most effective approach to STI treatment in males involves a combination of antibiotics, antiviral medications, and behavioral modifications, such as abstaining from sexual activity until treatment is complete and ensuring all sexual partners are notified and treated.
• HIV requires lifelong antiretroviral therapy with various medication combinations, and it is essential to address co-infections and prevent reinfection 1.

From the FDA Drug Label

Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid).

Azithromycin is used to treat STIs in males, including:

• Urethritis caused by Chlamydia trachomatis or Neisseria gonorrhoeae
• Cervicitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae
• Genital ulcer disease (chancroid) caused by Haemophilus ducreyi 2

From the Research

STI Treatment for Males

• The recommended treatment for gonorrhea is ceftriaxone monotherapy given intramuscularly, with dosing based on the patient's body weight 3.
• For chlamydia, doxycycline is the preferred treatment 3.
• A single 500 mg IM dose of ceftriaxone is recommended for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 4.
• If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 4.
• Azithromycin in a single oral 1-g dose is now a recommended regimen for the treatment of nongonococcal urethritis 5.

Treatment of Other STIs

• Syphilis of less than one year's duration should be treated with a single dose of intramuscular penicillin G benzathine, 2.4 million units 3.
• Syphilis of more than one year's or unknown duration should be treated with three consecutive weekly doses of intramuscular penicillin G benzathine, 2.4 million units each 3.
• Vaginal trichomoniasis should be treated with a seven-day regimen of metronidazole 3.
• Treatment of pelvic inflammatory disease routinely includes metronidazole with doxycycline and an increased dosage of ceftriaxone 3.

Prostatitis Treatment

• Antimicrobials are the first line agents for the treatment of bacterial prostatitis 6.
• The success of antimicrobial treatment depends on the antibacterial activity and the pharmacokinetic characteristics of the drug which must reach high concentrations in prostate secretion and prostate tissue 6.
• Acute bacterial prostatitis can be a serious infection with a potential risk for urosepsis, and initial treatment of severely ill patients should include intravenous administration of high doses of bactericidal antimicrobials 6.