What are the treatments for different types of Sexually Transmitted Diseases (STDs)?

Treatment of Sexually Transmitted Diseases (STDs)

The most effective treatment for STDs requires specific antimicrobial therapy targeting the causative organism, with regimens such as ceftriaxone plus doxycycline for gonorrhea and chlamydia, valacyclovir for herpes, and appropriate partner treatment to prevent reinfection. 1

Common STD Treatments by Organism

Bacterial STDs

Chlamydia (C. trachomatis)

• First-line treatment:
  • Doxycycline 100 mg orally twice daily for 7 days 1
• Alternative regimen (pregnancy, intolerance):
  • Azithromycin 1g orally in a single dose 2

Gonorrhea (N. gonorrhoeae)

• First-line treatment:
  • Ceftriaxone 125-250 mg IM in a single dose PLUS
  • Doxycycline 100 mg orally twice daily for 7 days (to cover possible chlamydial co-infection) 1
• Alternative regimen (cephalosporin allergy):
  • Gentamicin 240mg IM single dose PLUS azithromycin 2g orally single dose 1

Syphilis (T. pallidum)

• Primary, secondary, early latent:
  • Benzathine penicillin G 2.4 million units IM in a single dose 1
• Late latent or unknown duration:
  • Benzathine penicillin G 2.4 million units IM weekly for 3 weeks 1
• Neurosyphilis:
  • Aqueous crystalline penicillin G 18-24 million units IV daily (3-4 million units every 4 hours) for 10-14 days 1

Viral STDs

Genital Herpes (HSV)

• First episode:
  • Valacyclovir 1g orally twice daily for 7-10 days 3
• Recurrent episodes:
  • Valacyclovir 500 mg orally twice daily for 3-5 days 3
• Suppressive therapy:
  • Valacyclovir 1g orally once daily (for frequent recurrences) 3

Human Papillomavirus (HPV)

• Treatment focuses on removing visible warts:
  • Patient-applied: Podofilox 0.5% solution/gel or Imiquimod 5% cream
  • Provider-administered: Cryotherapy, surgical removal, or trichloroacetic acid (TCA)

Parasitic STDs

Trichomoniasis (T. vaginalis)

• Recommended regimen:
  • Metronidazole 2g orally in a single dose 1

Pubic Lice (Pediculosis pubis)

• Recommended regimens:
  • Permethrin 1% cream rinse applied for 10 minutes then washed off, OR
  • Pyrethrins with piperonyl butoxide applied for 10 minutes then washed off 1

Special Clinical Presentations

Mucopurulent Cervicitis (MPC)

• Test for both C. trachomatis and N. gonorrhoeae
• Treatment based on test results or epidemiologic risk:
  • High prevalence areas: Treat for both gonorrhea and chlamydia
  • Low gonorrhea prevalence: Treat for chlamydia only
  • Low prevalence of both: Await test results if follow-up likely 1

Epididymo-Orchitis

• Sexually transmitted (men <35 years):
  • Ceftriaxone 250mg IM single dose PLUS
  • Doxycycline 100mg orally twice daily for 10 days 4
• Enteric organisms (men >35 years):
  • Levofloxacin 500mg orally once daily for 10 days OR
  • Ofloxacin 200mg orally twice daily for 10 days 4

Proctitis

• Acute proctitis in MSM:
  • Ceftriaxone 125mg IM single dose PLUS
  • Doxycycline 100mg orally twice daily for 7 days 1

Partner Management

• Partners should be notified, examined, and treated for the STD identified in the index patient 1
• For asymptomatic partners:
  • Partners whose last sexual contact was within 60 days of diagnosis should be evaluated and treated
  • If last contact was >60 days before diagnosis, most recent partner should be treated 1
• Patients and partners should abstain from sexual intercourse until therapy is completed and both are asymptomatic 1

Prevention Strategies

• Consistent and correct condom use is highly effective in preventing many STDs, including HIV 1
• Key condom usage instructions:
  • Use a new condom with each act of intercourse
  • Put on before any genital contact
  • Use water-based lubricants only with latex condoms
  • Hold the condom at the base during withdrawal 1
• Preexposure vaccination is available for:
  • Hepatitis B (recommended for all unvaccinated STD patients)
  • Hepatitis A (recommended for MSM and drug users)
  • HPV 1

Special Considerations

HIV Co-infection

• Patients with HIV and STDs should generally receive the same treatment regimens as HIV-negative individuals 1
• More frequent monitoring may be necessary to ensure cure

Sexual Assault Victims

• Empiric prophylactic treatment recommended:
  • Ceftriaxone 125mg IM single dose PLUS
  • Metronidazole 2g orally single dose PLUS
  • Doxycycline 100mg orally twice daily for 7 days 1
• Hepatitis B vaccination should be offered
• HIV counseling and testing should be offered 1

Common Pitfalls in STD Management

1. Failing to test for co-infections: Many STDs occur together; screen comprehensively
2. Inadequate partner treatment: Without treating partners, reinfection is common
3. Incomplete therapy: Emphasize importance of completing full course of antibiotics even if symptoms resolve
4. Relying on symptoms alone: Many STDs are asymptomatic; testing is essential
5. Not considering antimicrobial resistance: Especially important for gonorrhea treatment 5
6. Inadequate follow-up: Particularly important for syphilis and complicated infections

Remember that early diagnosis and appropriate treatment not only cure infection but also prevent transmission to partners and reduce the risk of complications like PID, infertility, and increased HIV transmission 6.