Postexposure management of sexually transmitted diseases
| Disease and source individual | Exposed individual | Postexposure prophylactic regimen | Initial and follow-up evaluation |
|---|---|---|---|
| Chlamydia: Symptomatic or asymptom-atic patients with infection confirmed by microbiologic testing (NAAT or culture) | Sexual contact with the index case within 60 days before onset of symptoms or diagnosis a | Azithromycin 1 g orally as single dose or doxycycline 100 mg orally twice daily for 7 days or ofloxacin 300 mg orally twice daily for 7 days | Symptom screening and testing of partner for chlamydia by NAAT of genital and extragenital, if indicated, sites or first-catch urineb Treat partner for chlamydiac Counsel confirmed cases and partner(s) to abstain from sexual intercourse until 7 days after a single-dose regimen or after completion of a multiple-dose regimen, with resolution of symptoms and partner treatment Test of cure for pregnant women |
| Gonorrhea: Patient with any type of gonococcal infection, including asymptomatic infection, confirmed by microbiologic testing (NAAT or culture) | Sexual contact with the index case within 60 days prior to onset of symptoms or diagnosisa | Ceftriaxone 250 mg IM, single dose, plus either single dose azithromycin 1 g orally or doxycycline 100 mg orally twice daily for 7 days or cefixime 400–800 mg orally, single dose, plus either single dose azithromycin 1 g orally or doxycycline 100 mg orally twice daily for 7 days | Symptom screening and testing of partner for gonorrhea by NAAT of genital and extragenital, if indicated, sites or first-catch urineb Treat partner for gonorrheac Counsel index case with confirmed infection and partner(s) to abstain from sexual intercourse until 3 days after completion of therapy, with resolution of symptoms and partner treatment Test of cure for pregnant women and those treated with cefixime or azithromycin |
| Pediculosis pubis: Patient with active infestation | Sexual contact with index case within 30 days before onset of symptoms or diagnosis | Permethrin 1% cream, single application to the affected areas and washed off after 10 minutes (preferred regimen) or pyrethrins with piperonyl butoxide (0.33%), single application to the af-fected area and washed off after 10 minutes or ivermectin 250 μg/kg orally two doses, 2 weeks apart | Counsel index case with confirmed infestation and partner(s) to abstain from sexual intercourse until completion of treatment, with resolution of symptoms and partner treatment No work or school restriction for either infested or exposed individuals |
| Syphilis: Patient with early syphilis (primary, secondary or early latent syphilis)d | Sexual contact with the index case within: Primary: preceding 90 days plus duration of symptoms Secondary: preceding 6 months plus duration of symptoms Early latent: preceding 12 months | Benzathine penicillin G 2.4 MU IM single dose (preferred regimen) or doxycycline 100 mg orally twice daily for 14 days | Symptom screening and testing of partner with nontreponemal assays at baseline, 3, and 6 months Treat partner for syphilise Counsel partner and index case with confirmed infection to abstain from sexual intercourse until completion of treatment, documented serologic response and partner treatment |
| Trichomoniasis: Patient with active trichomoniasis | Sexual contact with the index case within 4 weeks before onset of symptoms or diagnosis | Metronidazole 2 g orally, single dose or metronidazole 500 mg orally twice daily for 7 days (preferred in HIV-infected women) or tinidazole 2 g orally, single dose | Symptom screening of partner Test index case and partner for bacterial vaginosis Treat partner, regardless of symptoms, simultaneously with index case Counsel partner and index case with confirmed infection to abstain from sexual intercourse until 1 week after treatment, with resolution of symptoms and partner treatment |
↵a If index case had no sexual contacts within 60 days or if a partner within the 60-day period tests negative, then the index case’s last sexual partner should be screened and treated for chlamydia or gonorrhea, even if contact was > 60 days before symptom onset or diagnosis.
↵b Genital mucosal sites include urethra for men and vagina and endocervix for women. Extragenital mucosal sites include oropharynx and rectum. Testing of extragenital sites is indicated when the exposed individual has symptoms or signs suggestive of infection of these sites (eg, pharyngitis, proctitis), has a history of unprotected oral or anal sex, or is a man who has sex with men.
↵c Empiric treatment should be given to the partner while awaiting the results of screening, particularly when the exposure is recent (within 1 week), patient follow-up is in question, or the screening test used is not NAAT.
↵d Early latent syphilis can be diagnosed with seroconversion of nontreponemal antibody testing, a fourfold increase in the nontreponemal antibody titer, documented primary or secondary syphilis, sex partner with documented primary or secondary syphilis, or positive treponemal test and nontreponemal antibody testing and exposure to infectious index case, all within the previous 12 months.
↵e Individuals whose last sexual contact with the index case was within 90 days of diagnosis of early syphilis or more than 90 days if follow-up is uncertain should be treated empirically for syphilis without waiting for, or regardless of, serologic test results.
IM = intramuscular; MU = million units; NAAT = nucleic acid amplification testing