Treatment Options for Sexually Transmitted Diseases (STDs)
The most effective treatment for STDs depends on the specific pathogen, with antibiotics being the primary treatment for bacterial infections like chlamydia, gonorrhea, and syphilis, while antiviral medications are used for viral STDs like herpes. 1
Bacterial STD Treatments
Chlamydia
- Doxycycline is a first-line treatment for chlamydia infections 1
- Azithromycin is an effective alternative, particularly valuable as a single-dose therapy ensuring 100% compliance 2, 3
- Treatment should be initiated promptly, even before laboratory test results are available when diagnosis is likely 4
Gonorrhea
- Ceftriaxone is the recommended treatment due to increasing antimicrobial resistance limiting oral treatment options 1
- Patients with gonorrhea should be tested for other STDs, particularly chlamydia, which frequently co-occurs 2
- Azithromycin is indicated for urethritis and cervicitis due to Neisseria gonorrhoeae 2
Syphilis
- Penicillin remains the treatment of choice for all stages of syphilis 1
- Benzathine penicillin G as a single dose is effective for early syphilis, though efficacy may be reduced in HIV-infected individuals 3
- Serologic testing for syphilis should be performed for all patients with sexually-transmitted urethritis or cervicitis 2
Other Bacterial STDs
- Chancroid (caused by Haemophilus ducreyi) can be treated with azithromycin 2
- Mycoplasma genitalium infections respond to moxifloxacin, though antimicrobial resistance is increasing 1
- Bacterial vaginosis can be treated with metronidazole, though single-dose regimens may cause more gastrointestinal side effects than multi-dose regimens 3
Viral STD Treatments
Genital Herpes
- No cure exists for genital herpes (HSV-1 and HSV-2), but antiviral medications can manage symptoms 1
- Valacyclovir is indicated for:
- Treatment is most effective when initiated within 72 hours of symptom onset for initial episodes and within 24 hours for recurrent episodes 5
Human Papillomavirus (HPV)
- No specific antiviral target exists for HPV treatment 6
- Treatment options include antimitotic agents or immunomodulators 6
- Vaccination is available for prevention 4
Parasitic STD Treatments
Trichomoniasis
- Metronidazole and other nitroimidazoles are effective treatments 1
- Single-dose therapy is available but may cause more gastrointestinal side effects than multi-dose regimens 3
Treatment Considerations
Partner Management
- Sex partners of patients with STDs should be examined and treated even if asymptomatic 4
- Partner notification can be accomplished through:
Treatment Compliance
- Single-dose therapy offers the advantage of ensuring nearly 100% compliance 3
- This is particularly important for populations at high risk of poor follow-up 3
- For multi-dose regimens, emphasize the importance of completing the full course of treatment 4
Antimicrobial Resistance
- Increasing antimicrobial resistance limits treatment options for gonorrhea and M. genitalium 1
- Culture and susceptibility testing should be performed when possible to guide therapy 2
- Treatment may be initiated empirically before test results are available, then adjusted based on results 2
Prevention Strategies
Behavioral Interventions
- Abstinence from sexual activity during treatment and until partners are treated 4
- Consistent and correct condom use for every sexual encounter 4
- Testing for STDs, including HIV, before initiating sexual relationships 4
Vaccination
- Hepatitis B vaccination is recommended for all unvaccinated patients being evaluated for an STD 4
- Hepatitis A vaccination is recommended for men who have sex with men and people who use illegal drugs 4
- HPV vaccination is available for eligible individuals 4