What are the recommended treatments for common sexually transmitted infections (STIs)?

Recommended Treatments for Common Sexually Transmitted Infections (STIs)

For effective management of common STIs, use ceftriaxone plus doxycycline for gonorrhea and chlamydia, penicillin for syphilis, metronidazole for trichomoniasis, and appropriate topical treatments for genital warts and pubic lice. 1

Gonorrhea Treatment

• First-line treatment:

  • Ceftriaxone 250 mg IM in a single dose 1, 2
  • PLUS Doxycycline 100 mg orally twice daily for 7 days (to cover possible chlamydial co-infection) 1, 3

• Alternative regimen (for cephalosporin allergy):

  • Gentamicin 240mg IM single dose PLUS azithromycin 2g orally single dose 1

• For pharyngeal gonorrhea:

  • Test of cure recommended 1-2 weeks after treatment 2

Chlamydia Treatment

• First-line treatment:

  • Doxycycline 100 mg orally twice daily for 7 days 1, 3, 2

• Alternative regimen:

  • Azithromycin 1 g orally in a single dose 4
  • Note: Doxycycline is now preferred over azithromycin due to higher efficacy 2

• For rectal chlamydia treated with azithromycin:

  • Test of cure recommended 2

Syphilis Treatment

• Primary, secondary, early latent syphilis:

  • Benzathine penicillin G 2.4 million units IM in a single dose 1, 5

• Late latent or unknown duration syphilis:

  • Benzathine penicillin G 2.4 million units IM weekly for 3 weeks 1, 5

• Neurosyphilis:

  • Aqueous crystalline penicillin G 18-24 million units IV daily for 10-14 days 1

Trichomoniasis Treatment

• Recommended regimen:
  • Metronidazole 2g orally in a single dose 1
  • OR Metronidazole 500 mg orally twice daily for 7 days (preferred per recent guidelines) 2

Genital Herpes Treatment

• First episode:

  • Acyclovir 400 mg orally three times daily for 7-10 days
  • OR Valacyclovir 1 g orally twice daily for 7-10 days

• Recurrent episodes:

  • Acyclovir 800 mg orally three times daily for 2 days
  • OR Valacyclovir 500 mg orally twice daily for 3 days

• Note: No cure is available for genital herpes 5

Human Papillomavirus (HPV) Treatment

• Patient-applied treatments:

  • Podofilox 0.5% solution/gel
  • Imiquimod 5% cream 1

• Provider-administered treatments:

  • Cryotherapy
  • Surgical removal
  • Trichloroacetic acid (TCA) 1

Pediculosis Pubis (Pubic Lice) Treatment

• 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, 6

Management of Sex Partners

1. Partner notification:

   • Partners should be notified, examined, and treated for the STI identified in the index patient 1
   • For asymptomatic partners, those whose last sexual contact was within 60 days of diagnosis should be evaluated and treated 6

2. Sexual abstinence:

   • Patients and partners should abstain from sexual intercourse until therapy is completed and both are asymptomatic 6, 1

Special Considerations

Pregnancy

• Gonorrhea: Ceftriaxone 250 mg IM in a single dose
• Chlamydia: Azithromycin 1 g orally in a single dose (preferred in pregnancy)
• Avoid tetracyclines (including doxycycline) and quinolones 6

HIV Co-infection

• Patients with HIV and STIs should generally receive the same treatment regimens as HIV-negative individuals 6, 1
• More frequent monitoring may be necessary

Common Pitfalls to Avoid

1. Failing to test for co-infections:

   • Many STIs occur together; screen for multiple infections 1, 5

2. Inadequate partner treatment:

   • Failure to treat partners leads to reinfection 6, 1

3. Incomplete therapy:

   • Ensure patients complete full course of treatment 1

4. Relying on symptoms alone:

   • Many STIs are asymptomatic; test based on risk factors, not just symptoms 1, 5
   • Up to 70% of HSV and trichomoniasis infections and 53-100% of extragenital gonorrhea and chlamydia infections may be asymptomatic 5

5. Antimicrobial resistance:

   • Be aware of emerging resistance, particularly for gonorrhea and M. genitalium 7
   • Follow the most current treatment guidelines

By following these evidence-based treatment recommendations, healthcare providers can effectively manage STIs, prevent complications, and reduce transmission in the community.