What are the discharge instructions for a 33-year-old male receiving prophylactic treatment for Sexually Transmitted Diseases (STDs)?

Discharge Instructions for STD Prophylactic Treatment

For a 33-year-old male receiving prophylactic treatment for sexually transmitted diseases (STDs), discharge instructions should include completing the full course of antibiotics, abstaining from sexual activity until treatment is complete, and ensuring all sexual partners from the past 60 days are notified and treated.

Medication Instructions

Antibiotic Regimen

• Complete the full course of prescribed antibiotics even if symptoms improve before completion 1
• For prophylactic treatment of STDs, the recommended regimen typically includes:
  • Ceftriaxone 500 mg IM as a single dose (for gonorrhea coverage) 1
  • PLUS Doxycycline 100 mg orally twice daily for 7 days (for chlamydia coverage) 1, 2
• Alternative regimen if doxycycline cannot be tolerated:
  • Azithromycin 1g orally as a single dose 1, 3
  • Note: Doxycycline is now preferred over azithromycin for chlamydia due to better efficacy 1

Medication Side Effects

• Doxycycline: May cause photosensitivity (avoid direct sunlight), gastrointestinal upset (take with food to minimize), and esophageal irritation (take with plenty of water) 2
• Ceftriaxone: May cause pain at injection site, allergic reactions (report any rash, itching, or difficulty breathing)
• If azithromycin is prescribed: May cause gastrointestinal upset 3

Sexual Activity Guidance

• Abstain from all sexual activity (including oral, vaginal, and anal) until:
  • The full course of treatment is completed (7 days for doxycycline regimen) 1
  • All symptoms have resolved completely 4
  • All sexual partners have been treated 4, 1

Partner Notification

• All sexual partners from the past 60 days should be notified about potential exposure 4, 1
• Partners should seek medical evaluation and treatment regardless of whether they have symptoms 4, 1
• Emphasize that untreated partners create a high risk for reinfection 1

Follow-Up Instructions

• Return for evaluation if symptoms persist or recur after completing therapy 1
• Consider retesting in 3 months due to high risk of reinfection 4, 1
• No test of cure is needed if symptoms resolve after completing the recommended treatment regimen 4

Prevention of Future Infections

• Consistent and correct condom use with all sexual encounters reduces STD risk 1
  • Note: Self-reported condom use may not always correlate with reduced STD incidence, emphasizing the need for consistent and correct use 5
• Limit number of sexual partners
• Consider regular STD screening if sexually active with multiple partners
• Consider HIV testing if not recently tested 1

Warning Signs Requiring Medical Attention

• Return immediately if experiencing:
  • Worsening symptoms despite treatment
  • New rash or allergic reaction to medications
  • Persistent or recurrent discharge
  • Testicular pain or swelling (could indicate epididymitis) 4
  • Fever or severe abdominal pain

Common Pitfalls to Avoid

• Stopping antibiotics early: Even if symptoms improve, incomplete treatment can lead to persistent infection and antibiotic resistance 1
• Resuming sexual activity too soon: This can lead to reinfection or transmission to partners 4, 1
• Failing to ensure partner treatment: Untreated partners are the most common cause of recurrent infections 4, 1
• Alcohol consumption: Avoid alcohol while taking metronidazole (if prescribed) and for 24 hours afterward to prevent disulfiram-like reaction 1

By following these discharge instructions carefully, the patient can maximize treatment effectiveness and minimize the risk of complications or reinfection.