Standard Dosages for Common STD Medications
For most common sexually transmitted diseases (STDs), azithromycin 1g orally in a single dose or doxycycline 100mg orally twice daily for 7 days are the recommended first-line treatments. 1
Chlamydia Treatment
Recommended Regimens:
Alternative Regimens:
- Erythromycin base 500mg orally four times daily for 7 days 1
- Erythromycin ethylsuccinate 800mg orally four times daily for 7 days 1
- Ofloxacin 300mg orally twice daily for 7 days 1
- Levofloxacin 500mg orally once daily for 7 days 1
Clinical considerations:
- Azithromycin and doxycycline are equally efficacious for chlamydial infections 1, 3
- Single-dose azithromycin offers the advantage of directly observed therapy and improved compliance 4, 5
- Doxycycline is less expensive but requires a 7-day regimen 1
- For patients with poor compliance, azithromycin is preferred 1, 6
Gonorrhea Treatment
Recommended Regimens:
- Ceftriaxone (intramuscular) plus azithromycin or doxycycline (for possible co-infection with chlamydia) 1, 7
- Dual therapy is recommended due to high rates of co-infection with chlamydia 1
Nongonococcal Urethritis (NGU)
Recommended Regimens:
Alternative Regimens:
- Erythromycin base 500mg orally four times daily for 7 days 1
- Erythromycin ethylsuccinate 800mg orally four times daily for 7 days 1
- Ofloxacin 300mg orally twice daily for 7 days 1
- Levofloxacin 500mg orally once daily for 7 days 1
Recurrent/Persistent Urethritis
Recommended Treatment:
- Metronidazole 2g orally in a single dose, PLUS 1
- Erythromycin base 500mg orally four times daily for 7 days, OR 1
- Erythromycin ethylsuccinate 800mg orally four times daily for 7 days 1
Important Clinical Considerations
Patient Compliance:
- Single-dose regimens (like azithromycin) ensure nearly 100% compliance 4, 5
- For multi-dose regimens, medication should ideally be provided in the clinic with the first dose directly observed 1
Post-Treatment Instructions:
- Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 1
- Partners should be referred for evaluation and treatment 1
- For NGU, all sex partners within the preceding 60 days should be referred for evaluation and treatment 1
Follow-Up:
- Patients treated with doxycycline or azithromycin generally don't need retesting unless symptoms persist or reinfection is suspected 1
- Patients should return for evaluation if symptoms persist or recur after completing therapy 1
Special Populations:
- For patients unlikely to return for follow-up, single-dose regimens are preferred 1, 4
- For pregnant patients, azithromycin is generally preferred over doxycycline 1
Common Pitfalls to Avoid
- Treating symptoms without confirming diagnosis - always test for both gonorrhea and chlamydia 1
- Inadequate partner treatment leading to reinfection 1
- Underestimating the importance of abstinence during treatment 1
- Using fluoroquinolones in areas with known resistance 7
- Failing to consider co-infections when treating STDs 1