Sexually transmitted diseases

• Metronidazole 500 mg PO BID for 7 days OR
• Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days OR
• Clindamycin cream 2%, one full applicator (5 g) intravaginally qHS for 7 days

• Tinidazole 2 g PO qd for 2 days OR
• Tinidazole 1 g PO qd for 5 days OR
• Clindamycin 300 mg PO BID for 7 days OR
• Clindamycin ovules 100 mg intravaginally qHS for 3 days (do not use if patient has used latex condom in last 72 hrs)

• Metronidazole 250mg PO q8h x 7 days[3]
• Metronidazole 2g PO x 1 dose is also acceptable[3]
• Multiple studies have not demonstrated teratogenicity from metronidazole use[3]

• Metronidazole 2 g PO x 1 OR
• Tinidazole 2 g PO x 1

• Ceftriaxone 250mg IM once PLUS
  • Azithromycin 1g PO once OR
  • Doxycycline 100mg PO BID x 14 days (7 days for gonorrhea, 14 days for chlamydia)[4]

• Azithromycin 2g PO once PLUS
  • Gentamicin 240mg IM once[5]
  • In theory this high dose macrolide will provide treatment for both GC and Chlamydia

• Cefixime 400mg PO once PLUS
  • Azithromycin 1g PO once OR
  • Doxycycline 100mg PO BID x 7 days

• Metronidazole 2g PO once OR 500mg PO BID for 7 days [6]
• Tinidazole 2g PO once

Only treat if the patient is symptomatic and avoid breast feeding until 24-hrs after last dose

• Metronidazole 2g PO once[7]

• Metronidazole 500mg PO BID x 7 days OR
• Tinidazole 2g PO once

• Metronidazole 500 mg PO BID x 7 days[8]

• Doxycycline 100mg PO BID for 7 days OR
• Azithromycin 1g (20mg/kg) PO one time dose
• Newborn Treatment: Azithromycin 20mg/kg PO once daily x 3 days
  • Disease manifests 5 days post-birth to 2 weeks (late onset)

• Due to increasing resistance, CDC recommends dual therapy with Ceftriaxone and Azithromycin (even if patient is negative for Chlamydia).
• Ceftriaxone 250mg IM one dose PLUS
• Azithromycin 1g PO one dose
• Newborn Treatment:
  • Prophylaxis: Erythromycin ophthalmic 0.5% x1
  • Disease manifests 1st 5 days post delivery (early onset)
  • Treatment Ceftriaxone 25-50mg IV or IM, max 125mg

• Acyclovir OR
  • 400mg PO q8hrs x 7-10 days
  • or 200mg PO 5x/day x 7-10 days
• Valacyclovir 1g PO q12hrs x 7-10 days OR
• Famciclovir 250mg PO q8hrs x 7-10 days

• Acyclovir OR
  • 400mg PO q8hrs x 5 days
  • or 800mg PO q12hrs x 5 days
  • or 800mg PO q8hrs x 2 days
• Valacyclovir OR
  • 500mg PO q12hrs x 3 days
  • or 1g PO qd x 5 days
• Famciclovir
  • 125mg PO q12hrs for 5 days
  • or 1g PO q12hrs for 1 day
  • or 500mg PO once, followed by 250mg PO q12hrs for 2 days

• Acyclovir 400mg PO q12hrs daily OR
• Famciclovir 250mg PO q12hrs daily OR
• Valacyclovir 500mg-1g PO daily (500mg may be less effective)

• Ceftriaxone 250mg IM (or IV)[10] x1 + doxycycline 100mg PO BID x14d +/- metronidazole 500mg PO BID x14d [11]
  • Metronidazole based upon assessment of risk for anaerobes; consider in:
    • Pelvic abscess
    • Proven or suspected infection w/ Trichomonas or Bacterial Vaginosis
    • History of gynecological instrumentation in the preceding 2-3wks
• Cefoxitin 2 g IM in a single dose and Probenecid, 1 g PO administered concurrently in a single dose[12] + Doxycycline 100 mg PO BID x 14 days +/- flagyl based on above criteria

• Ceftriaxone 250mg IM x1 + 1 g of azithromycin per week, x 2 weeks[13] +/- flagyl based on above criteria
  • A single randomized controlled trial shows that azithromycin is superior to doxycycline even when compliance in taking doxycycline is excellent (98.2% vs 87.5%)[13]

• Cefoxitin 2gm IV q6hr OR cefotetan 2gm IV q12hr) + doxycycline PO or IV 100 mg q12hr OR
• Clindamycin 900mg IV q8h + gentamicin 2mg/kg QD OR
• Ampicillin-sulbactam 3gm IV q6hr + doxycycline 100mg IV/PO q12hr

This is classified as primary, secondary, and early latent syphilis less than one year.

Treatment Options:

• Penicillin G Benzathine 2.4 million units IM x 1
  • Repeat dose after 7 days for pregnant patients and HIV infection
• Doxycycline 100mg oral twice daily for 14 days as alternative

Late stage is greater than one year duration, presence of gummas, or cardiovascular disease

Treatment Options:

• Penicillin G Benzathine 2.4 million units IM weekly x 3 weeks
• Doxycycline 100mg oral twice daily for 4 weeks as alternative

There are 3 Major options with none showing greater efficacy than others:

• Penicillin G 3-4 million units IV every 4 hours x 10-14 days
• Penicillin G 24 million units continuous IV infusion x 10-14 days
• Penicillin G Procaine2.4 million units IM daily + probenecid 500mg oral every 6 hours for 10-14 days.
• Alternative:
  • Ceftriaxone 2gm IV once daily for 10-14 days

• Desensitization to the penicillin allergy is still the preferred method of treatment for patients with early and late stage disease (especially during pregnancy)

• Penicillin, dosage depends on stage [14]

• Metronidazole 2g PO once OR 500mg PO BID for 7 days [15]
• Tinidazole 2g PO once

Only treat if the patient is symptomatic and avoid breast feeding until 24-hrs after last dose

• Metronidazole 2g PO once[16]

• Metronidazole 500mg PO BID x 7 days OR
• Tinidazole 2g PO once

• Metronidazole 500 mg PO BID x 7 days[17]

• Ceftriaxone 250mg IM once, PLUS
  • Azithromycin 1g PO once OR
  • Doxycycline 100mg PO BID x 7 days

• Azithromycin 2g PO once, PLUS
  • Gentamicin 240mg IM once[18]
  • In theory this high dose macrolide will provide treatment for both GC and Chlamydia

• Cefixime 400mg PO once, PLUS
  • Azithromycin 1g PO once, OR
  • Doxycycline 100mg PO BID x 7 days

Target M. genitalium

• Moxifloxacin 400 mg daily x 7 days

Consider coverage of trichomonas, among men who have sex with women

• Metronidazole 2 gm PO x 1, OR
• Tinidazole 2 gm PO x 1