What is the plan of care for a married female exposed to a Sexually Transmitted Infection (STI)?

From the Guidelines

For a married female exposed to a sexually transmitted infection (STI), the plan of care should prioritize prompt evaluation, testing, and treatment, as well as partner notification and treatment, to prevent complications and reinfection, as recommended by the CDC guidelines 1. The patient should undergo testing for common STIs including chlamydia, gonorrhea, syphilis, HIV, hepatitis B, and trichomoniasis.

• Empiric treatment may be warranted depending on the specific exposure and symptoms, with treatment options including doxycycline 100mg twice daily for 7 days or azithromycin 1g as a single dose for chlamydia, and ceftriaxone 500mg intramuscularly as a single dose for gonorrhea.
• The patient should abstain from sexual activity until treatment is completed and partners are treated.
• Partner notification and treatment are crucial to prevent reinfection; her husband should be evaluated and treated simultaneously, with options including expedited partner therapy (EPT) as permissible by state laws 1.
• Counseling about safe sex practices, including condom use, is important even within marriage.
• Follow-up testing should be conducted 3 months after treatment to ensure cure, with rescreening for chlamydia or gonorrhea, and consideration of hepatitis B and HPV vaccination if needed 1. The patient may experience psychological distress related to STI exposure within marriage, so supportive counseling addressing relationship concerns and potential infidelity issues should be offered. This comprehensive approach addresses both the medical treatment of the infection and the unique psychosocial aspects of STI exposure within a marriage, prioritizing the patient's morbidity, mortality, and quality of life.

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. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.

The plan of care for a married female exposed to a Sexually Transmitted Infection (STI) may include:

• Doxycycline 100 mg, by mouth, twice a day for 7 days for uncomplicated gonococcal or chlamydial infections 2
• Azithromycin as an alternative treatment option for chlamydial infections, however the dosage is not specified in the provided text for this specific condition 3 It is essential to note that the treatment plan should be determined by a healthcare professional based on the specific STI diagnosed and other individual factors.

From the Research

Plan of Care for a Married Female Exposed to a Sexually Transmitted Infection (STI)

• The plan of care for a married female exposed to an STI involves testing and treatment based on the type of STI diagnosed 4, 5, 6.
• According to the 2021 CDC STI guidelines, the recommended treatment for gonorrhea is ceftriaxone monotherapy given intramuscularly, with dosing based on the patient's body weight 4.
• For chlamydia, doxycycline is the preferred treatment, and a test-of-cure is recommended for all cases of pharyngeal gonorrhea and for rectal chlamydia if treated with azithromycin 4.
• Vaginal trichomoniasis should be treated with a seven-day regimen of metronidazole 4.
• A study found that married men and women were more likely to be appropriately treated with antibiotics for gonorrhea and chlamydia in the ED compared to non-married men and women 7.
• The diagnosis of STIs is typically done using nucleic acid amplification tests, which have high sensitivities and specificities for the diagnosis of gonorrhea, chlamydia, and trichomoniasis 5.
• Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception 5.

Factors Associated with STIs in Married Women

• A study found that women who had a prior infection of Chlamydia were more likely to have a repeat infection 8.
• Using no type of birth control measures was a significant predictor of the number of sexual partners, but was negatively associated with condom use 8.
• Over one-third of individuals had a prior STI, indicating that individuals do not perceive themselves to be at risk for another STI, and choose not to use condoms 8.
• Married women who are exposed to an STI should be screened and treated promptly to prevent complications and transmission to their partner 7, 4, 5.