Recommended Treatments for Sexually Transmitted Diseases (STDs)
The recommended treatments for sexually transmitted diseases vary by pathogen, with single-dose regimens preferred when possible to ensure compliance and treatment efficacy. 1, 2
Common STDs and Their Treatments
Gonorrhea
- Recommended regimen: Ceftriaxone 1g IM in a single dose 1
- For pharyngeal infection: Ceftriaxone 1g IM in a single dose (particularly important as pharyngeal infections are harder to eradicate) 1
- Alternative regimens (for cephalosporin allergy):
Chlamydia
- Recommended regimens:
- Alternative regimens:
Syphilis
- Primary, secondary, or early latent (<1 year):
- Benzathine penicillin G 2.4 million units IM in a single dose 1
- Late latent (>1 year) or syphilis of unknown duration:
- Benzathine penicillin G 2.4 million units IM weekly for 3 weeks 1
- For penicillin allergy:
Trichomoniasis
- Recommended regimen:
- Metronidazole 2g orally in a single dose 1
- Alternative regimen:
- Metronidazole 500mg orally twice daily for 7 days 5
Genital Herpes
- First clinical episode:
- Recurrent episodes:
- Note: No cure is available for genital herpes, only symptom management 6
Mycoplasma genitalium
- Recommended regimen:
- Moxifloxacin 400mg orally once daily for 7-14 days 6
Chancroid (Haemophilus ducreyi)
- Recommended regimen:
Special Populations
Pregnant Women
- Gonorrhea: Ceftriaxone 1g IM in a single dose (quinolones contraindicated) 1, 5
- Chlamydia: Azithromycin 1g orally in a single dose (preferred over erythromycin due to better compliance) 5
- Syphilis: Benzathine penicillin G (only effective treatment for preventing congenital syphilis) 5
- Trichomoniasis: Metronidazole 500mg twice daily for 7 days (previously feared teratogenic but now considered safe) 5
HIV-Infected Persons
- Patients with HIV infection and STDs should generally receive the same treatment as those without HIV 1
- For herpes proctitis, treatment may need to be more aggressive as it can be especially severe in HIV-positive patients 1
Syndromic Management
Urethritis/Cervicitis
- When both gonorrhea and chlamydia are suspected:
- Ceftriaxone 1g IM in a single dose PLUS Doxycycline 100mg orally twice daily for 7 days 1
- When only chlamydia is suspected:
- Azithromycin 1g orally in a single dose OR Doxycycline 100mg orally twice daily for 7 days 1
Proctitis
- Recommended regimen:
- Ceftriaxone 125mg IM in a single dose PLUS Doxycycline 100mg orally twice daily for 7 days 1
Partner Management
- Sex partners should be referred for evaluation and treatment 1
- For gonorrhea and chlamydia, partners whose last sexual contact with the index patient was within 60 days of diagnosis should be treated 1
- Patients and partners should abstain from sexual intercourse until therapy is completed and both are asymptomatic 1
Important Considerations
- Single-dose therapy has the advantage of ensuring nearly 100% compliance but may have drawbacks in certain situations 2
- Antimicrobial resistance is increasing, particularly for gonorrhea and M. genitalium, limiting oral treatment options 6
- Testing for and treating STDs in pregnant women deserves special attention due to potential risks to the developing fetus 5
- Many STIs are asymptomatic (70% of HSV and trichomoniasis infections, 53-100% of extragenital gonorrhea and chlamydia) 6
Remember that STD screening and prompt treatment are essential to prevent complications such as pelvic inflammatory disease, infertility, and increased risk of HIV acquisition and transmission 6.