Doxycycline and ofloxacin are contraindicated in pregnant women. In addition, the safety and efficacy of azithromycin in pregnant women has not been established; therefore, a seven-day course of either erythromycin or amoxicillin is recommended in this group. Since neither regimen is considered highly effective, cultures should be repeated in three weeks. Men with a gonococcal infection experience symptoms that require treatment, but women often are asymptomatic until complications of the infection, such as PID, occur.
For this reason, screening is recommended in high-risk patients. Co-infection with C. The cost of doxycycline therapy for C. Also, dual therapy with doxycycline and azithromycin may decrease the development of antimicrobial-resistant N.
Quinolone-resistant N. At this time, fluoroquinolone regimens can be used with confidence, but continued monitoring of emerging resistance will be important. Table 2 outlines therapy for gonococcal infections. Four single-dose regimens are now available for treatment of uncomplicated gonococcal infections of the cervix, urethra and rectum. They include cefixime Suprax , ceftriaxone, ciprofloxacin and ofloxacin.
Cefixime, ciprofloxacin and ofloxacin are given orally, while ceftriaxone is administered intramuscularly. Gonococcal infections of the pharynx are more difficult to eradicate but, with the exception of cefixime, the recommended therapy is the same as for urogenital and anorectal infections, and should include concomitant treatment for chlamydial infection.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Woodward received her doctor of pharmacy degree from the University of North Carolina at Chapel Hill.
Byrd Health Sciences Center, Morgantown. She received her medical degree from the Pennsylvania State University College of Medicine, Hershey, and completed an internship and a residency in internal medicine at West Virginia University Medical Center. She has also completed a clinical and research fellowship in infectious diseases at the University of Pennsylvania School of Medicine, Philadelphia, and earned a master of science degree in epidemiology at the Harvard School of Public Health, Boston.
Address correspondence to Carol Woodward, Pharm. Reprints are not available from the authors. Centers for Disease Control and Prevention. Rose VL. CDC releases the guidelines for the treatment of sexually transmitted diseases. Am Fam Physician. Valaciclovir versus acyclovir in the treatment of first-episode genital herpes infection.
Results of an international, multicenter, double-blind, randomized clinical trial. Sex Transm Dis. Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women.
A multicenter, double-blind, placebo-controlled trial. Arch Intern Med. Single-dose oral azithromycin versus seven-day doxycycline in the treatment of non-gonococcal urethritis in males. J Antimicrob Chemother. Comparison of azithromycin and doxycycline in the treatment of non-gonococcal urethritis in men. Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men. A randomized double-blind study. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
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Herpes, Syphilis, Urethritis, Chlamydia and Gonorrhea. Oct 1, Issue. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Penicillin G benzathine was administered at its conventional dose 2.
Healing in three months: Three studies have compared azithromycin with benzathine penicillin in the period of three months. One hundred and ninety-five patients in the study group and patients in the control group didn't heal in this period.
Healing in six months: Three studies have compared azithromycin with benzathine penicillin in a follow-up of six months. One hundred and fifty-six patients in the study group and patients in the control group didn't heal in this period.
Healing in nine months: Two studies 2,3 have compared azithromycin with benzathine penicillin in a follow-up of nine months. Thirty two patients in the study group and 44 in the control group had no cure in this period. Figure 1. This review showed clearly that a single dose of azithromycin, orally, is as effective as the 2.
This fact as well as bacterial resistance to macrolides and to penicillin should be considered on the treatment of syphilis. Abrir menu Brasil. Abrir menu. Adverse effects, primarily gastrointestinal, were more common in the azithromycin group. Single-dose azithromycin is an attractive treatment option for syphilis: It can be given under observation, is generally well tolerated, and can also be effective against chancroid, chlamydia, and gonorrhea.
This study adds to the evidence that it works for syphilis, but concerns remain. Among them: efficacy in HIV infection, efficacy in pregnancy, and the observation that a mutation encoding for macrolide resistance is rapidly emerging in Treponema pallidum isolates.
A phase III equivalence trial of azithromycin versus benzathine penicillin for treatment of early syphilis.
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