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 |
|---|---|---|---|---|
|
Syphilis, adolescent treatment See separate Congenital Syphilis section |
Treponema pallidum |
Primary, secondary, or early latent: Benzathine Penicillin G 50,000 units/kg (max 2.4 million units/dose) IM x 1 dose ------------------------ Late latent, or latent of unknown duration: Benzathine Penicillin G 50,000 units/kg/dose (max 2.4 million units/dose) IM qweek x 3 doses |
Penicillin allergy with higher risk for allergic reaction, patient not pregnant: Doxycycline Consult ID/ASP for other options if doxycycline contraindicated |
Sexual partners should be notified and evaluated per linked SFDPH City Clinic guidelines below, following recommendations based on the patient’s stage of infection RPR titer should be checked on the day of treatment to provide baseline for follow-up serology monitoring Refer to SFDPH City Clinic STI protocols section on syphilis for recommended laboratory evaluation (including testing for other STIs), and further recommendations on partner treatment, counseling (including abstinence from sex during patient and partner treatment), and follow up (including retesting recommendations based on stage of infection) Patients who are receiving three doses of penicillin must restart their treatment if more than 10 days elapse since the last dose. They should also receive each dose no sooner than five days since the preceding one. |
References:
Workowski KA, et al. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70:1-187.