Sexually Transmitted Infections in the PReP Era. Are Family Doctors Ready to Give Advice?

Table 4: Considerations and treatment of sexually transmitted infections (STI).

STI	Treatment	Alternative regimens
Nongonococcal sexual transmitted infection	Azithromycin 1 g, orally, in a single dose Doxycycline 100 mg, orally, twice a day for 7 days	Erythromycin base 500 mg, orally, 4 times a day for 7 days Erythromycin ethyl succinate 800 mg, orally, 4 times a day for 7 days Ofloxacin 300 mg, orally, twice a day for 7 days Levofloxacin 500 mg, orally, once a day for 7 days
Gonococcal sexual transmitted infection (uncomplicated)	^ACeftriaxone 250 mg, IM, in a single dose, plus ^B Azithromycin 1 g, orally, in a single dose	Cefixime 400 mg, orally, in a single dose, plus ^B Azithromycin 2 g, orally, in a single dose
Gonococcal sexual transmitted Infection (complicated)	Ceftriaxone 1 g, IV, every 24 hours	Ceftriaxone 1 g, IV, every 24 hours; Cefotaxime 1 g, IV, every 8 hours; Ceftriaxone 1 g, IV, every 24 hours; or Cefotaxime 1 g, IV, every 8 hours
Trichomoniasis	Metronidazole¹ 2 g, orally, in a single dose, or Tinidazole 2 g, orally, in a single dose	Metronidazole 500 mg, orally, twice a day for 7 days
^CBacterial vaginosis	Metronidazole¹ 500 mg, orally, twice a day for 7 days, or Metronidazole gel, 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days, or Clindamycin cream, 2%, one full applicator (5 g) intravaginally	Tinidazole 2 g, orally, once daily for 2 days, or Tinidazole 1 g, orally, daily for 5 days, or ⁴Clindamycin 300 mg, orally, twice a day for 7 days, or Clindamycin ovules 100 mg, intravaginally, at bedtime for 3 days
^CVulvovaginal candidiasis	Orally: Fluconazole 150 mg, orally, in a single dose Intravaginally Butoconazole 2% cream (single dose, bioadhesive product), 5 g, intravaginally, for 1 day, or Clotrimazole 2% cream 5 g, intravaginally, daily for 3 days OR Miconazle 2% cream 5 g, intravaginally, daily for 7 days, or Miconazle 1,200 mg vaginal suppository, one suppository for 1 day ^ATerconazole 0.4% cream 5 g, intravaginally, for 7 days, or Terconazole 0.8% cream 5 g, intravaginally, for 3 days Terconazole 80 mg vaginal suppository, daily, for 3 days,
²Genital herpes	Acyclovir 400 mg, orally, 3 times a day for 7–10 days OR Acyclovir 200 mg, orally, 5 times a day for 7–10 days OR Valacyclovir 1 g, orally, twice a day for 7–10 days OR Famciclovir 250 mg, orally, 3 times a day for 7–10 days
³Primary syphilis infection	Benzathine penicillin G 2.4 million units, IM, as a single dose If allergic to penicillin, consider desensitization, particularly if the patient is pregnant Recommended regimen for infants and children Benzathine penicillin G 50,000 units/kg, IM, up to the adult dose of 2.4 million units in a single dose	Doxycycline 100 mg, orally, twice a day for 28 days Tetracycline 500 mg, orally, 4 times a day for 28 days
Chancroid	First episode: Azithromycin 1 g, orally, in a single dose, or Ceftriaxone 250 mg, IM, in a single dose, or Ciprofloxacin 500 mg, orally, twice a day for 3 days., or Erythromycin base 500 mg, orally, 3 times a day for 7 days	Recurrence: Acyclovir 800 mg, orally, twice a day for 5 days, or Acyclovir 800 mg, orally, 3 times a day for 2 days, or Valacyclovir 500 mg, orally, twice a day for 3 days, or Valacyclovir 1 g, orally, once a day for 5 days, or Famciclovir 125 mg, orally, twice daily for 5 days, or Famciclovir 1 gram, orally, twice daily for 1 day
Lymphogranuloma venereum	Doxycycline 100 mg, orally, twice a day for 21 days	^AErythromycin base 500 mg, orally, 4 times a day for 21 days
⁴Genital warts (external)	Imiquimod 5% cream applied to warts, once daily at bedtime, for 3 times a week up to 16 weeks Sinecatechins 15% ointment applied to warts, 3 times a day for up to 16 weeks Podophyllinresin 10%–25%, trichloroacetic acid or bichloroacetic acid 80%–90% Cryotherapy	Intralesional interferon Podofilox 0.5% solution or gel applied to visible warts twice a day for 3 days, followed by no therapy for 4 days. Repeat up to 4 cycles Laser surgery

IM: intramuscular; IV: intravenous.
^ARecommended treatment in pregnancy.
^BAs dual therapy, ceftriaxone and azithromycin must be administered together at the same time and day, and under direct observation.
¹Although metronidazole crosses the placenta, data suggest that it poses a low risk to pregnant women. Recently studies have demonstrated that women can be treated with 2 g metronidazole in a single dose at any stage of pregnancy.
^C Uncomplicated VVC and bacterial vaginosis is not usually acquired through sexual intercourse; hence, data do not support the treatment of sex partners.
²Treatment can be extended if disease is active after 10 days of therapy.
³Persons with HIV infection who have primary syphilis should be treated as those without HIV infection.
³Pregnant women with syphilis at any stage, who report penicillin allergy should be desensitized and treated with penicillin.
⁴Podofilox (podophyllotoxin), podophyllin, and sinecatechins use is not permitted during pregnancy. Imiquimod appears to pose a low risk but further investigation of its use in pregnancy is required.