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  • image A single dose of ceftriaxone is recommended for uncomplicated gonococcal infections. Antimicrobial stewardship concerns over the impact on the microbiome, increasing rates of azithromycin resistance and continued low ceftriaxone resistance rates, led to the move away from dual drug therapy. If chlamydial infection cannot be excluded, doxycycline should be added.

  • image Chlamydia genital tract infections represent the most frequently reported communicable disease in the United States. Females are frequently asymptomatic or minimally symptomatic and, if left untreated, may develop complications such as pelvic inflammatory disease (PID), ectopic pregnancy, or infertility. All sexually active females younger than 25 years and women with multiple sexual partners should be screened annually.

  • image A 7-day course of metronidazole is the preferred treatment for trichomoniasis in women, with single dose tinidazole as an alternative. Single-dose metronidazole remains the recommended therapy for men.

  • image PID treatment should target gonorrhea and chlamydia, with the addition of anaerobic coverage.

  • image Parenteral penicillin is the treatment of choice for all syphilis infections. Alternative therapies for penicillin-allergic patients are usually suboptimal, have insufficient data, require prolonged oral courses, and/or are not recommended for specific populations. When allergies are reported, clarification of the type of reaction is critical to ensure optimal therapy. For true penicillin allergies, penicillin desensitization protocols are available when penicillin is required.

  • image Oral acyclovir, famciclovir, and valacyclovir are effective in reducing viral shedding, duration of symptoms, and time to healing of first-episode genital herpes infections, with maximal benefits seen when therapy is initiated at the earliest stages of infection. Patient-initiated, episodic antiviral therapy started within 1 day of lesion onset or during the prodromal stage preceding an outbreak offers an alternative to continuous suppressive therapy of recurrent infection in some individuals.

  • image Human papilloma virus (HPV) vaccination reduces complications associated with HPV infection, including development of genital warts and HPV-related cancers. Adolescent vaccination, prior to onset of sexual activity is recommended. Despite robust safety and efficacy data, vaccination rates remain below 80% in target populations.


Obtaining a relevant and culturally sensitive sexual history is an important part of ensuring an individual’s optimal health. Patient interviews should include the five Ps: partners, practices, protection, past STIs, and prevention of pregnancy strategies.

Watch the following videos that focus on the importance of collecting a sexual history and understanding at-risk populations. These videos are useful to enhance student understanding regarding the Collect and Assess steps in the patient care process.


Sexually transmitted infections (STIs) encompass a wide variety of pathogens (Table 140-2), diverse presentations, and continually evolving diagnosis, treatment and prevention strategies. STIs impact short- and long-term health of millions in the United States, yet continue to be underfunded, stigmatized, and devalued as a public health priority. Since 2000, rates continue to rise, with chlamydia doubling, gonorrhea increasing 40%, and primary ...

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