Treatment of Sexually Transmitted Infections That Cause Stinging Sensations
For sexually transmitted infections causing stinging sensations, prompt diagnosis and appropriate antimicrobial therapy are essential to relieve symptoms, prevent complications, and reduce transmission. The treatment depends on the specific pathogen causing the infection.
Common STIs Causing Stinging Sensations
Gonococcal and Chlamydial Urethritis
Urethritis caused by Neisseria gonorrhoeae or Chlamydia trachomatis commonly presents with stinging or burning during urination.
Diagnosis
- Obtain a Gram-stained smear of urethral exudate for diagnosis of urethritis (≥5 polymorphonuclear leukocytes per oil immersion field) 1
- Perform nucleic acid amplification tests (NAATs) for N. gonorrhoeae and C. trachomatis 1
- Examine first-void urine for leukocytes if urethral Gram stain is negative 1
Treatment for Uncomplicated Gonococcal Infection
- Recommended regimen: Ceftriaxone 500 mg IM as a single dose 2, 3
- If chlamydial infection has not been excluded, add doxycycline 100 mg orally twice daily for 7 days 2
Treatment for Non-Gonococcal Urethritis (Primarily Chlamydial)
Recommended regimens:
- Azithromycin 1 g orally in a single dose, OR
- Doxycycline 100 mg orally twice daily for 7 days 1
Alternative regimens:
- Erythromycin base 500 mg orally four times daily for 7 days, OR
- Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days, OR
- Levofloxacin 500 mg orally once daily for 7 days, OR
- Ofloxacin 300 mg orally twice daily for 7 days 1
Genital Herpes
Herpes simplex virus infections often cause painful stinging or tingling sensations during outbreaks.
Treatment for First Episode
Treatment for Recurrent Episodes
- Initiate treatment at the first sign of recurrence (tingling, itching, burning) 4, 5
- Valacyclovir options:
- Famciclovir options:
Suppressive Therapy for Frequent Recurrences
- Famciclovir 250 mg twice daily 5
- Valacyclovir for suppressive therapy can reduce asymptomatic viral shedding 4
Epididymitis
Often presents with testicular pain and stinging during urination.
Treatment
For likely gonococcal or chlamydial infection:
- Ceftriaxone 250 mg IM in a single dose, PLUS
- Doxycycline 100 mg orally twice daily for 10 days 1
For likely enteric organisms or patients allergic to cephalosporins/tetracyclines:
- Ofloxacin 300 mg orally twice daily for 10 days, OR
- Levofloxacin 500 mg orally once daily for 10 days 1
Adjunctive measures: Bed rest, scrotal elevation, and analgesics until fever and local inflammation subside 1
Follow-Up Recommendations
For Urethritis
- Return for evaluation if symptoms persist or recur after completing therapy 1
- Repeat testing 3-6 months after treatment for patients with documented chlamydial or gonococcal infections due to high reinfection rates 1
For Epididymitis
- Reevaluate diagnosis and therapy if no improvement within 3 days 1
- Evaluate persistent swelling and tenderness comprehensively after completing antimicrobial therapy 1
For Genital Herpes
Partner Management
- Partners of patients with gonococcal or chlamydial infections should be referred for evaluation and treatment 1
- For epididymitis, refer sex partners if contact occurred within 60 days preceding symptom onset 1
- For genital herpes, inform partners that transmission can occur during asymptomatic viral shedding 4
Important Considerations
- Abstain from sexual intercourse until therapy is completed and symptoms have resolved 1
- Test for other STIs including syphilis and HIV when diagnosing any STI 1
- Antimicrobial resistance is an increasing concern, particularly for gonorrhea treatment 2, 3
- For herpes infections, treatment is most effective when initiated at the earliest symptoms 4, 5