Diagnosis

Common

Pathogens

Drug(s) of

First Choice¹

Alternative

Drug(s)¹

Comments

SEXUALLY TRANSMITTED DISEASES (STDs)

Syphilis

Early

T. pallidum

Benzathine penicillin G 2.4 MU IM X 1 dose (early)

Doxycycline 100 mg PO BID X 2 weeks

Sexual partners must be treated.

Latent

Benzathine penicillin G 2.4 MU IM Q week X 3 doses (latent)

Gonorrhea

N. gonorrhea

Ceftriaxone 250 mg IM X 1

Plus

Azithromycin 1 g PO X 1

OR

Doxycycline 100 mg BID  PO X 7 days

Cefixime 400 mg PO X 1 dose

dose if patient can not receive IM ceftriaxone

Plus

Azithromycin 1 g PO X 1

OR

Doxycycline 100 mg BID  PO X 7 days

For severe PCN allergy³:

Azithromycin 2 g PO X 1

All cases of syphilis and Gonococcus must be reported to the San Francisco Public Health Department at 554-2830.

Sexual partners must be treated.

Pharyngeal Gonococcus must be treated with Ceftriaxone.

Fluoroquinolones should not be used due to increasing resistance and treatment failures.

Chlamydia cervicitis

Chlamydia trachomatis

Azithromycin 1g PO once

Doxycycline 100 mg PO q12h x 7 days

PID

(Pelvic Inflammatory Disease)

N.gonorrhoeae C.trachomatis anaerobes

Gram-negative facultative bacteria streptococci

Ceftriaxone 250 mg IM in a single dose

Plus

Doxycycline 100 mg PO BID x 14 days

Both WITH OR WITHOUT*:

Cefoxitin⁵ 2gm IM in a single dose and probenecid, 1g po single dose

Plus

Doxycycline 100 mg PO BID x 14 days

Both WITH OR WITHOUT*:

Follow-up examination should be performed within 72 hours when PID is treated with these regimens

Fluoroquinolones should not be used due to increasing resistance and treatment failures.