STI update: Testing, treatment, and emerging threats

Matifadza Hlatshwayo; Hilary E. L. Reno; Melanie L. Yarbrough

doi:10.3949/ccjm.86a.18098

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TABLE 1

Screening recommendations and laboratory testing for common sexually transmitted infections

Organism	Disease	Screening recommendations	Optimal testing method	Specimen types
**Neisseria gonorrhoeae and Chlamydia trachomatis**	Females: cervicitis Males: urethritis	Females ≤ 25 years old, annually Men who have sex with men; consider in young males in high-prevalence areas, annually	Nucleic acid amplification test (NAAT)	Females: vaginal or endocervical swab, first-void urine Males: urethral, rectal, or throat swab; first-void urine
*Mycoplasma genitalium*	Females: cervicitis Males: urethritis	Routine screening not recommended	NAAT	Females: vaginal or endocervical swab, first-void urine Males: first-void urine
*Trichomonas vaginalis*	Females: vaginitis Males: urethritis, epididymitis, prostatitis	Routine screening not recommended; but women with human immunodeficiency virus infection should be screened annually	NAAT	Females: vaginal or urine swab, first-void urine Males: first-void urine

Adapted from the US Centers for Disease Control and Prevention, reference 12.

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TABLE 2

Treatment recommendations for common sexually transmitted infections

Organism	Treatment	Alternatives
*Chlamydia trachomatis*	Azithromycin 1 g by mouth, 1 dose or Doxycycline 100 mg by mouth twice daily for 7 days	Erythromycin base 500 mg by mouth every 6 hours for 7 days or Erythromycin ethylsuccinate 800 mg by mouth every 6 hours for 7 days or Ofloxacin 300 mg by mouth twice daily for 7 days or Levofloxacin 500 mg by mouth daily for 7 days
*Neisseria gonorrhoeae* (uncomplicated infection)	Ceftriaxone 250 mg intramuscularly, 1 dose and Azithromycin 1 g by mouth Gonococcal conjunctivitis: ceftriaxone 1 g intramuscularly, 1 dose	History of severe cephalosporin allergy: Gentamicin 240 mg intramuscularly plus Azithromycin 2 g by mouth, 1 dose
*N gonorrhoeae* (disseminated infection)	Ceftriaxone 1 g intravenously or intramuscularly every 24 hours or Cefotaxime 1 g intravenously every 8 hours or Ceftizoxime 1 g intravenously every 8 hours plus concurrent treatment for chlamydia	Can switch to an oral antibiotic based on susceptibilities 24–48 hours after clinical improvement for 7 days of treatment
*Mycoplasma genitalium*	Azithromycin 1 g by mouth, 1 dose or Azithromycin 500 mg by mouth, 1 dose and then 250 mg by mouth for 4 more days (limited by resistance)	Moxifloxacin 400 mg by mouth for 7–14 days
*Trichomonas vaginalis*	Metronidazole 500 mg by mouth twice a day for 7 days or Metronidazole 2 g by mouth, 1 dose	Tinidazole 2 g by mouth, 1 dose; or 1 g by mouth every day for 5 days

Adapted from US Centers for Disease Control and Prevention, reference 7

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