Duration of Sexual Abstinence After Treatment for STIs
Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen for gonorrhea, chlamydia, or trichomoniasis to prevent transmission and reinfection. 1
General Abstinence Guidelines
- Patients treated for chlamydia should abstain from sexual intercourse for 7 days after single-dose azithromycin therapy or until completion of the full 7-day doxycycline regimen 1
- For gonorrhea treatment, patients should abstain from sexual activity for 7 days after receiving treatment, provided their symptoms have resolved 1
- Patients treated for trichomoniasis should follow the same abstinence guidelines of 7 days after single-dose therapy or until completion of a multi-day regimen 1
- Sexual abstinence should continue until all sex partners have been treated to minimize the risk of reinfection 1, 2
Rationale for Abstinence Period
- The 7-day abstinence period allows time for the antibiotics to effectively clear the infection 1
- Even with condom use during treatment, there is still risk of transmission or reinfection as condoms may not provide complete protection during acute bacterial STI treatment 3
- Studies show that sexual activity between treatment and test of cure is common (37% of patients in one study), with 88% reporting inconsistent condom use 4
- Sexual contact before completing treatment increases the risk of treatment failure and ongoing transmission 3, 4
Partner Management
- All sex partners from the previous 60 days should be referred for evaluation, testing, and treatment 1
- Partners should receive the same treatment as the index patient to prevent reinfection 5
- If the most recent sexual contact was more than 60 days before symptom onset or diagnosis, that partner should still be evaluated and treated 1
- Expedited partner treatment is an alternative approach when partners are unlikely to seek medical care 1
Follow-Up Recommendations
- Test-of-cure is NOT routinely recommended for non-pregnant patients treated with recommended regimens for chlamydia or gonorrhea 1, 2
- Test-of-cure IS recommended for:
- All patients treated for chlamydia, gonorrhea, or trichomoniasis should be retested approximately 3 months after treatment due to high rates of reinfection 2, 6
- Diagnostic testing performed less than 3 weeks after treatment may yield false results due to persistent dead organisms 2
Special Considerations
- For patients with persistent symptoms after treatment, evaluation for reinfection, treatment compliance issues, or other causes should be conducted 5
- Pregnant patients require special attention with test-of-cure 3-4 weeks after treatment completion 2
- HIV-positive patients should receive the same treatment and abstinence recommendations as HIV-negative patients 5