This and other STI sections are not meant to be comprehensive references for all STI treatment but primarily focused on the most commonly used initial empiric antimicrobial therapy. Users should refer to linked resources (SFDPH City Clinic protocols, CDC guidelines) or other local resources to provide patients and their partners appropriate counseling and follow-up. For non-adolescent age patients, patients with STIs not addressed in these guidelines, or patients with contraindications to the listed therapies, we recommend referring to the linked resources, or Lexi-Comp for medication information, or consulting ID/ASP for individualized recommendations.
| Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
|
Gonorrhea (uncomplicated infections of the cervix, urethra, rectum, or pharynx) See Pelvic Inflammatory Disease section for patients with consistent clinical findings |
Neisseria gonorrhoeae |
Ceftriaxone Weight >45 kg and <150kg: 500 mg IM x 1 dose Weight >=150kg: If chlamydia has not been excluded: ADD Doxycycline |
If chlamydia hhas not been excluded, AND pregnancy has not been excluded, or anticipate significant challenges to adherence: Replace Doxycycline with Azithromycin 1000 mg enterally x 1 dose *Doxycycline is likely superior to azithromycin for treatment of chlamydia in all sites, and particularly for rectal and urethral chlamydia Penicillin or cephalosporin allergy with higher risk for allergic reaction: Consult ID/ASP |
All sexual partners within preceding 60 days should be notified, tested, and treated; if not feasible then expedited partner therapy is recommended Refer to SFDPH City Clinic STI protocols section on gonorrhea for recommended laboratory evaluation (including testing for other STIs), and further recommendations on partner treatment, counseling (including abstinence from sex for at least 7 days following patient treatment and until partner treatment), and follow up (including retesting at 7-14 days for patients with pharyngeal gonorrhea and in 3 months for all patients) |
References:
Workowski KA, et al. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70:1-187.
St. Cyr S, et al. Update to CDC’s treatment guidelines for gonococcal infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916.