Urethritis / Cervicitis:  

Chlamydia trachomatis 

Recommended:  Doxycycline 100 mg BID x 7 d (not recommended for pregnant women) 

Alternative: Azithromycin 1 g x 1 or Levofloxacin 500 mg Qd x 7 d or Amoxicillin 500 mg TID x 7 d  

Gonorrhea  

Recommended: Ceftriaxone: 500 mg IM x 1 or 1g if patient is > 150 kg 

Alternative: Gentamicin 240 mg IM x 1 or Azithromycin 2g PO x 1 or Cefixime 800 mg PO x 1 

* remember to treat both GC/CT together given common coinfections 

Trichomoniasis  

Recommended: Metronidazole  

- women:  500 mg BID x 7 day 

- men : 2 mg PO x 1 

Alternative: Tinidazole 2 g PO x 1 

Epididymitis 

Suspect GC/CT? see above treatments 

If you are concerned about enteric organisms, treat with Levofloxacin 500 mg PO Qd x 10 d (in addition to the above if concerned for STI as well) 

Proctitis 

Ceftriaxone 500 mg IM (1g if patient > 150 kg) x 1 and Doxycycline 100 mg PO BID x 7 d 

Pubic Lice  

Recommended: Permethrin 1% rinse or Pyrethrin with piperonyl butoxide 

Alternative: Ivermectin 250 ug/kg OI, repeat in 7-14 d 

Genital Herpes

Acyclovir 

- first time: 400 mg PO TID x 7-10 d 

- recurrence (episodic therapy): 800 mg PO BID x 5 d

- recurrence (suppressive therapy): 400mg PO BID

Alternative: Valacyclovir (less frequent dosing, more expensive)

- first time: 1g BID x7-10 days

- recurrence (episodic therapy): 1g PO daily x5d

- recurrence (suppressive therapy): 500mg - 1g PO BID

* remember, things are more complicated for pregnant women, children, those that are immunocompromised, sexual assault victims, and those that have comorbid infections - look further guidelines up! 

* PID or abscesses will likely require intervention / IV antibiotics / admission 

* don't forget to treat partners too 

* educate / counsel to prevent reinfection and drug side effects! 

Reference: 

Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon.