What are the treatments for common Sexually Transmitted Diseases (STDs)?

From the Guidelines

The most effective approach to treating common Sexually Transmitted Diseases (STDs) involves a combination of antibiotics for bacterial infections, antiviral medications for viral infections, and ensuring that all sexual partners are notified and treated to prevent reinfection. The treatment for common STDs varies depending on the specific infection. For bacterial STDs, antibiotics are the primary treatment. Chlamydia is typically treated with azithromycin (1g single dose) or doxycycline (100mg twice daily for 7 days) 1. Gonorrhea usually requires ceftriaxone (500mg intramuscular injection) plus azithromycin due to increasing antibiotic resistance. Syphilis treatment involves penicillin G benzathine injections, with dosage and duration depending on the stage of infection. For viral STDs, management differs: genital herpes is 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. HPV infections often resolve on their own, but genital warts can be treated with topical medications like imiquimod or surgical removal. Trichomoniasis, a parasitic infection, responds to metronidazole (2g single dose) or tinidazole. It's crucial to complete the full course of medication even if symptoms improve, abstain from sexual activity until treatment is complete, and ensure all sexual partners are notified and treated to prevent reinfection, as emphasized in the guidelines for the treatment of sexually transmitted diseases 1. Regular STD testing is recommended for sexually active individuals, as many infections can be asymptomatic while still causing complications and transmission. Key considerations in the management of STDs include:

• Notifying and treating sexual partners to prevent reinfection and further transmission 1.
• Completing the full course of medication as prescribed.
• Abstaining from sexual activity until treatment is complete and symptoms have resolved.
• Regular testing for sexually active individuals to identify and treat asymptomatic infections early. Given the importance of recent and high-quality evidence, the 2006 guidelines for the treatment of sexually transmitted diseases provide the most current and comprehensive approach to managing these infections 1.

From the FDA Drug Label

Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections... Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). The treatments for common Sexually Transmitted Diseases (STDs) using azithromycin include:

• Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae
• Genital ulcer disease in men due to Haemophilus ducreyi (chancroid) 2

From the Research

Treatment Options for Common STDs

• The treatment of common Sexually Transmitted Diseases (STDs) has evolved over the years, with various antibiotics and regimens being recommended for different infections 3, 4, 5, 6, 7.
• For gonorrhea, a single dose of azithromycin (1-2g) or ceftriaxone (250mg) is effective in treating uncomplicated genital infection 3, 4.
• Azithromycin has also been shown to be effective in treating chlamydia, with a single oral 1-g dose being a recommended regimen for the treatment of nongonococcal urethritis 5.
• For syphilis, parenteral penicillin continues to be the drug of choice for treatment of all stages, while doxycycline is the preferred recommended second-line agent 5, 7.
• The 2021 CDC STI Treatment Guidelines recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites, with cotreatment with doxycycline 100mg twice daily for 7 days if coinfection with chlamydia has not been excluded 6.

Antibiotic Resistance and Treatment Failures

• Neisseria gonorrhoeae has developed resistance to all first-line recommended therapies, making gonococcal antimicrobial resistance a major public health concern 6.
• Azithromycin, part of the 2015 dual-drug treatment regimen, has had a rapid rise in resistance, with nearly 5% of isolates exhibiting an elevated MIC (≥ 2.0 mcg/mL) in 2018 6.
• Ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States, with < 0.1% exhibiting an "alert value" MIC (> 0.25 mcg/mL) 6.

Alternative Therapies

• Few alternative therapies exist for persons with cephalosporin allergies, and there are no recommended alternative therapies for N gonorrhoeae infection of the throat 6.
• Doxycycline appears to be an effective agent for the treatment of early syphilis, with no serological failures reported in a study of 34 patients treated with doxycycline compared to 4 patients with serological failure in the benzathine penicillin G group 7.