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California STD Initiatives 2002

STD TREATMENT GUIDELINES FOR ADULTS AND ADOLESCENTS

These guidelines for the treatment of patients with STDs reflect the 1998 CDC STD Treatment Guidelines and the Region IX Infertility Clinical Guidelines. The focus is primarily on STDs encountered in office practice. These guidelines are intended as a source of clinical guidance; they are not a comprehensive list of all effective regimens. To report STD infections; request assistance with confidential notification of sexual partners of patients with syphilis, gonorrhea, chlamydia or HIV infection; or to obtain additional information on the medical management of STD patients, call the County Health Department. The California STD/HIV Prevention Training Center is an additional resource for training and consultation in the area of STD clinical management and prevention (510-883-6600).

DISEASE	RECOMMENDED REGIMENS	DOSE/ROUTE	ALTERNATIVE REGIMENS
CHLAMYDIA
Uncomplicated Infections Adults/Adolescents1	• Azithromycin or • Doxycycline2	1 g po 100 mg po bid x 7 d	Erythromycin base 500 mg po qid x 7 d or Erythromycin ethylsuccinate 800 mg po qid x 7 d or Ofloxacin3 300 mg po bid x 7 d
Pregnant Women4	• Amoxicillin or • Azithromycin or • Erythromycin base	500 mg po tid x 7 d l g po 500 mg po qid x 7 d	Erythromycin base 250 mg po qid x 14 d or Erythromycin ethylsuccinate 800 mg po qid x 7 d or Erythromycin ethylsuccinate 400 mg po qid x 14 d
GONORRHEA5
Uncomplicated Infections Adults/Adolescents	• Cefixime6 or • Ceftriaxone or • Ciprofloxacin3 or • Ofloxacin3 plus5 • a chlamydia recommended regimen listed above	400 mg po 125 mg IM 500 mg po 400 mg po	Spectinomycin7 2 g IM plus5 a chlamydia recommended regimen
Pregnant Women	• Ceftriaxone or • Cefixime6 plus5 • a chlamydia recommended regimen listed above	125 mg IM 400 mg po	Spectinomycin7 2 g IM plus5 a chlamydia recommended regimen
PELVIC INFLAMMATORY DISEASE	Parenteral8 • Cefotetan or Cefoxitin plus Doxycycline2 or • Clindamycin plus Gentamicin Oral Treatment • Ofloxacin3 plus Metronidazole or • Ceftriaxone or Cefoxitin and Probenecid plus Doxycycline2	2 g IV q 12 hrs 2 g IV q 6 hrs 100 mg po or IM q 12 hrs 900 mg IV q 8 hrs 2 mg/kg IV or IM followed by 1.5 mg/kg IV or IM q 8 hrs 400 mg po bid x 14 d 500 mg po bid x 14 d 250 mg IM 2 g IM 1 g po 100 mg po bid x 14 d	Parenteral Ofloxacin3 400 mg IV q 12 hrs plus Metronidazole 500 mg IV q 8 hrs or Ampicillin/Sulbactam 3 g IV q 6 hrs plus Doxycycline2 100 mg po or IV q 12 hrs or Ciprofloxacin3 200 mg IV q 12 hrs plus Doxycycline2 100 mg po or IV q 12 hrs plus Metronidazole 500 mg IV q 8 hrs
MUCOPURULENT CERVICITIS9	• Azithromycin or • Doxycycline2	1 g po 100 mg po bid x 7 d	Erythromycin base 500 mg po qid x 7 d or Erythromycin ethylsuccinate 800 mg po qid x 7 d or Ofloxacin3 300 mg po bid x 7 d
NONGONOCOCCAL URETHRITIS9	• Azithromycin or • Doxycycline2	1 g po 100 mg po bid x 7 d	Erythromycin base 500 mg po qid x 7 d or Erythromycin ethylsuccinate 800 mg po qid x 7 d or Ofloxacin3 300 mg po bid x 7 d
EPIDIDYMITIS	Likely due to Gonorrhea or Chlamydia • Ceftriaxone plus Doxycycline Likely due to enteric organisms • Ofloxacin3	250 mg IM 100 mg po bid x 10 d 300 mg po bid x 10 d
TRICHOMONIASIS	• Metronidazole	2 g po	Metronidazole 500 mg po bid x 7 d
BACTERIAL VAGINOSIS
Adults/Adolescents	• Metronidazole or • Clindamycin cream10 or • Metronidazole gel	500 mg po bid x 7 d 2%, one full applicator (5g) intravaginally at bedtime x 7 d 0.75%, one full applicator (5g) intravaginally, bid x 5 d	Metronidazole 2 g po or Clindamycin 300 mg po bid x 7 d
Pregnant Women	• Metronidazole	250 mg po tid x 7 d	Metronidazole 2 g po or Clindamycin 300 mg po bid x 7 d
CHANCROID	• Azithromycin or • Ceftriaxone or • Ciprofloxacin3 or • Erythromycin base	1 g po 250 mg IM 500 mg po bid x 3 d 500 mg po qid x 7 d
LYMPHOGRANULOMA VENEREUM	• Doxycycline2	100 mg po bid x 21 d	Erythromycin base 500 mg po qid x 21 d

1. Screen adolescents annually and women 20-24 years, especially if new or multiple partners.
2. Contraindicated for pregnant and nursing women.
3. Contraindicated for pregnant and nursing women and children < 18 years of age.
4. Test-of-cure follow-up is recommended because the regimens are not highly efficacious (Amoxicillin and Erythromycin) or the data on safety and efficacy are limited (Azithromycin)
5. Co-treatment for chlamydia infection is indicated if co-infection rates are high (>20%), less sensitive or no chlamydia test is done, or follow-up is uncertain.
6. Not recommended for pharyngeal gonococcal infection.
7. For patients who cannot tolerate cephalosporins or quinolones; not recommended for pharyngeal gonococcal infection.
8. Discontinue 24 hours after patient improves clinically and continue with oral therapy for a total course of 14 days.
9. Testing for gonorrhea and chlamydia is recommended beause a specific diagnosis may improve compliance and partner management and these   infections are reportable by CA State Law.
10. Might weaken latex condoms and diaphragms because oil-based; not recommended in pregnancy.
11. Contraindicated during pregnancy.
12. Safety in pregnancy has not been established.
13. Counseling especially about natural history, asymptomatic shedding, and sexual transmission is an essential component of herpes management.
14. Patients allergic to penicillin should be treated with penicillin after desensitization.
15. Some experts recommend a second dose of 2.4 million.