Recommended Prophylactic Treatment for Sexually Transmitted Diseases in Females
The primary recommended prophylactic approach for STDs in females is consistent and correct use of latex condoms, as they are highly effective in preventing many STDs including HIV infection. 1, 2
Prevention Strategies
- Consistent and correct use of male latex condoms provides strong protection against various STDs, as demonstrated by multiple cohort studies, including those of serodiscordant couples 1
- Female condoms (Reality™) should be considered when male condoms cannot be used appropriately, as laboratory studies indicate they are effective mechanical barriers to viruses, including HIV 1, 2
- Condom failure usually results from inconsistent or incorrect use rather than breakage, with failure rates of approximately 2 per 100 condoms used 1
- Only water-based lubricants (e.g., K-Y Jelly, Astroglide, AquaLube) should be used with latex condoms, as oil-based lubricants can weaken latex and increase risk of failure 1, 3
Empiric Antibiotic Treatment
- For women at high risk of STDs (age <25 years, new or multiple sex partners, unprotected sex), especially when follow-up cannot be ensured, empiric treatment may be considered 1
- The recommended regimen for presumptive treatment is:
- Azithromycin 1 g orally in a single dose OR
- Doxycycline 100 mg orally twice a day for 7 days 1
- Concurrent treatment for N. gonorrhoeae should be considered if prevalence is high (>5%) in the patient population 1
- Concomitant trichomoniasis or symptomatic bacterial vaginosis should also be treated if detected 1
Screening Recommendations
- Annual screening is recommended for all sexually active women aged <25 years, even without symptoms 1, 2
- Older women with risk factors (new or multiple sex partners) should also be screened 1, 2
- Testing should include screening for chlamydia, gonorrhea, and syphilis 2
- Women should also be screened for trichomoniasis and bacterial vaginosis when possible 2
Partner Management
- Sexual partners should be notified, examined, and treated for the identified or suspected STD 1, 2
- Both patient and partners should abstain from sexual intercourse until therapy is completed (7 days after a single-dose regimen or after completion of a 7-day regimen) 1
- Partner notification is essential to prevent reinfection and further transmission 2
Additional Prevention Methods
- Vaginal spermicides used alone (without condoms) reduce the risk for cervical gonorrhea and chlamydia but have not been established to protect against HIV infection 1
- Diaphragm use has been shown to protect against cervical gonorrhea, chlamydia, and trichomoniasis in case-control and cross-sectional studies 1
- Women using hormonal contraception (oral contraceptives, Norplant, Depo-Provera), who have been surgically sterilized, or who have had hysterectomies should be counseled that these methods offer no protection against STDs 1
- Hepatitis B vaccination is recommended for all unvaccinated patients being evaluated for an STD 1
Important Considerations and Pitfalls
- Nonbarrier contraceptive methods offer no protection against STDs, including HIV infection 2
- Individuals at high risk for both unwanted pregnancy and STDs should be counseled to use both hormonal and barrier contraceptives 4
- Spermicide-coated condoms have been associated with Escherichia coli urinary tract infections in young women and should be used with caution 1
- Azithromycin, at the recommended dose for STD prophylaxis, should not be relied upon to treat syphilis 5
- All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis 5