From the Guidelines
The most effective approach to treating sexually transmitted diseases (STDs) involves early detection and treatment, with a focus on preventing the transmission of HIV and other complications. For bacterial STDs, antibiotics are the primary treatment: chlamydia typically requires azithromycin 1g as a single dose or doxycycline 100mg twice daily for 7 days; gonorrhea is treated with ceftriaxone 500mg as an intramuscular injection plus azithromycin; and syphilis requires benzathine penicillin G injections, with dosage and duration based on the stage of infection 1.
Key Considerations for Treatment
- For viral STDs, management differs: herpes outbreaks can be treated with antiviral medications like acyclovir (400mg three times daily for 7-10 days for initial outbreaks, shorter for recurrences), valacyclovir, or famciclovir; HIV requires lifelong antiretroviral therapy with various drug combinations; and HPV has no specific treatment, though genital warts can be removed through various procedures.
- For trichomoniasis, metronidazole 2g as a single dose or 500mg twice daily for 7 days is effective, as noted in comprehensive approaches to STD prevention 1.
- All sexual partners should be notified and treated simultaneously to prevent reinfection, and patients should abstain from sexual activity until treatment is complete.
- Regular STD testing, condom use, and limiting sexual partners are crucial preventive measures, as many STDs can be asymptomatic but still cause complications like infertility or increased HIV risk if left untreated.
Preventive Measures
- Early detection and treatment of STDs should be a central component of national, state, and local strategies to prevent HIV infection and AIDS, as recommended by the Advisory Committee for HIV and STD Prevention 1.
- A comprehensive national program for STD prevention must address other health concerns, such as STD-related infertility or adverse outcomes of pregnancy, and requires diverse activities beyond early STD detection and treatment 1.
From the FDA Drug Label
Uncomplicated gonococcal infections in adults (except anorectal infections in men):100 mg, by mouth, twice a day for 7 days. As an alternate single visit dose, administer 300 mg stat followed in one hour by a second 300 mg dose. Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days. Nongonococcal urethritis (NGU) caused by C. trachomatis or U. urealyticum: 100 mg, by mouth, twice a day for 7 days. Syphilis–early: Patients who are allergic to penicillin should be treated with doxycycline 100 mg, by mouth, twice a day for 2 weeks Syphilis of more than one year’s duration: Patients who are allergic to penicillin should be treated with doxycycline 100 mg, by mouth, twice a day for 4 weeks. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid).
The recommended treatments for sexually transmitted diseases (STDs) are:
- Gonococcal infections: doxycycline 100 mg, by mouth, twice a day for 7 days 2
- Chlamydia trachomatis: doxycycline 100 mg, by mouth, twice a day for 7 days 2 or azithromycin 3
- Nongonococcal urethritis (NGU): doxycycline 100 mg, by mouth, twice a day for 7 days 2
- Syphilis: doxycycline 100 mg, by mouth, twice a day for 2 weeks (early) or 4 weeks (more than one year’s duration) 2
- Urethritis and cervicitis: azithromycin 3
- Genital ulcer disease: azithromycin 3
From the Research
Treatment Options for Sexually Transmitted Diseases (STDs)
The treatment of STDs has evolved over the years with advancements in drug therapy. According to 4, the Centers for Disease Control and Prevention (CDC) released guidelines for the treatment of STDs in 1998, which included effective single-dose regimens for many sexually transmitted diseases and improved therapies for herpes infections.
Recommended Treatments for Specific STDs
- For chancroid, two single-dose regimens, 1 g of oral azithromycin and 250 mg of intramuscular ceftriaxone, are effective treatments 4.
- For syphilis, parenteral penicillin continues to be the drug of choice for treatment of all stages 4.
- For genital herpes, three antiviral medications have been shown to provide clinical benefit: acyclovir, valacyclovir, and famciclovir 4.
- For nongonococcal urethritis, azithromycin in a single oral 1-g dose is now a recommended regimen 4.
- For gonorrhea, a single dose of azithromycin showed similar effectiveness as a 7-day regimen of doxycycline 5.
- For uncomplicated gonorrhea, ceftriaxone 250 mg intramuscularly once is recommended, and if coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added 6.
Comparison of Treatment Regimens
- A study comparing azithromycin 2.0 g orally and ceftriaxone 250 mg intramuscularly found that both treatments were equally effective in eradicating Neisseria gonorrhoeae and Chlamydia trachomatis 7.
- Another study found that retreatment rates for uncomplicated gonorrhea infection were similar between patients receiving ceftriaxone plus azithromycin and those receiving ceftriaxone plus doxycycline 8.