Summary of the 2012 CDC Sexually transmitted diseases (STD) Treatment Guidelines
Maine CDC – HIV, STD and Viral Hepatitis Program

These guidelines for treatment of STDs reflect current recommendations from the Federal CDC STD Treatment Guidelines. This summary highlights STDs encountered in outpatient settings and is not an exhaustive list of effective treatments. Please refer to the complete CDC document for more information. Clinical and epidemiological services are available through the STD Program including staff to assist healthcare providers with confidential notification of sexual partners of patients infected with STDs and/or HIV. For consultation and/or assistance please call the Maine STD Program. PHONE: (207) 287-3747. FAX: (207) 287-3498.  ADDRESS: Maine HIV, STD and Viral Hepatitis Program, State House Station # 11, Augusta, Maine 04333-0011.

DISEASE	RECOMMENDED TREATMENT	ALTERNATIVES
(use only if recommended regimens are contraindicated)	
SYPHILIS	
ADULTS
Primary, secondary or early latent (<1 year)	•	Benzathine penicillin G 2.4 million units IM once	(For penicillin-allergic non-pregnant patients only)
•	Doxycycline 100 mg orally 2 times a day for 14 days OR
•	Tetracycline 500 mg orally 4 times a day for 14 days	
ADULTS
Late latent (>1 year) or latent of unknown duration	•	Benzathine penicillin G 2.4 million units IM for 3 doses at 1 week intervals (total 7.2 million units)	(For penicillin-allergic non-pregnant patients only)
•	Doxycycline 100 mg orally 2 times a day for 28 days OR
•	Tetracycline 500 mg orally 4 times a day for 28 days	
NEUROSYPHILIS	•	Aqueous crystalline penicillin G 18 - 24 million units per day, administered as 3-4 million units IV every 4 hours or continuous infusion, for 10-14 days	•	Procaine penicillin 2.4 million units IM once daily PLUS probenecid 500 mg orally 4 times a day, both for 10-14 days	
CHILDREN
Primary, secondary or early latent (<1 year)	•	Benzathine penicillin G 50,000 units/kg IM once, up to adult dose of 2.4 million units	No specific alternative regimens exist.	
CHILDREN
Late latent (>1 year) or latent of unknown duration	•	Benzathine penicillin G 50,000 units/kg IM (up to adult dose of 2.4 million units) for 3 doses at 1 week intervals (up to total adult dose of 7.2 million units)		
CONGENITAL SYPHILIS	See complete CDC guidelines.	
HIV INFECTION	Same stage-specific recommendations as for HIV-negative persons.	
PREGNANCY	Penicillin is the only recommended treatment for syphilis during pregnancy. Women who are allergic should be desensitized and treated with penicillin. Treatment is the same as in non-pregnant patients for each stage of syphilis.	
Gonococcal Infections	
ADULTS, ADOLESCENTS and CHILDREN 45 kg
Urogenital, Pharyngeal, Rectal	•	Ceftriaxone 250 mg IM once
PLUS
•	Azithromycin 1 g orally once (preferred) OR
•	Doxycycline 100 mg orally 2 times a day for 7 days	Note: Use of any alternative regimens for gonorrhea should be followed by a test-of-cure in one week.
For urogenital or rectal infections ONLY, and ONLY if ceftriaxone is not available:
•	Cefixime 400mg orally once
PLUS2
•	Azithromycin 1 g orally once (preferred) OR
•	Doxycycline3 100 mg orally 2 times a day for 7 days  
For severe cephalosporin allergy:
•	Azithromycin 2 g orally in a single dose 	
ADULTS and ADOLESCENTS
Conjunctival	•	Ceftriaxone 1 g IM once plus lavage the infected eye with saline solution once	No specific alternative regimens exist.	
CHILDREN <45 kg	•	Ceftriaxone 125 mg IM once		
NEONATES
Ophthalmia neonatorum
Infants born to infected mothers	•	Ceftriaxone 25-50 mg/kg IV or IM once (maximum 125 mg)		
CHLAMYDIAL INFECTIONS	
ADULTS and CHILDREN aged >8 years	•	Azithromycin 1 g orally once OR
•	Doxycycline3 100 mg orally 2 times a day for 7 days	•	Erythromycin base 500 mg orally 4 times a day for 7 days OR
•	Erythromycin ethylsuccinate 800 mg orally 4 times a day for 7 days5 OR
•	Levofloxacin 500 mg orally once a day for 7 days OR
•	Ofloxacin6 300 mg orally 2 times a day for 7 days	
CHILDREN <45 kg and NEONATES	•	Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into four doses daily for 14 days	No specific alternative regimens exist.	
PREGNANCY	•	Azithromycin 1 g orally once OR
•	Amoxicillin 500 mg orally 3 times a day for 7 days	•	Erythromycin base 500 mg orally 4 times a day for 7 days (or 250 mg orally 4 times a day for 14 days) OR
•	Erythromycin ethylsuccinate 800 mg orally 4 times a day for 7 days (or 400 mg orally 4 times a day for 14 days)	
NONGONOCOCCAL URETHRITIS	
ADULT MALES	•	Azithromycin 1 g orally once OR
•	Doxycycline3 100 mg orally 2 times a day for 7 days	•	Erythromycin base 500 mg orally 4 times a day for 7 days5 OR 
•	Erythromycin ethylsuccinate 800 mg orally 4 times a day for 7 days5 OR
•	Levofloxacin6 500 mg orally once a day for 7 days OR
•	Ofloxacin6 300 mg orally 2 times a day for 7 days	
Epididymitis	
ADULT MALES
	•	Ceftriaxone 250 mg IM once PLUS
•	Doxycycline 100 mg orally 2 times a day for 10 days	•	Levofloxacin6 500 mg orally once a day for 10 days OR
•	Ofloxacin6 300 mg orally twice daily for 10 days	
Pelvic Inflammatory Disease (outpatient management)	
Adult Females	•	Ceftriaxone 250 mg IM once OR
•	Cefoxitin 2 g IM once plus probenecid 1 g orally once OR
•	Other third generation cephalosporin
PLUS
•	Doxycycline3 100 mg orally 2 times a day for 14 days
WITH OR WITHOUT
•	Metronidazole 500 mg orally twice a day for 14 days	See complete CDC guidelines for alternatives.	
PREGNANCY	Patients should be hospitalized and treated with the appropriate recommended parenteral IV therapy (see complete CDC guidelines).	

DISEASE	RECOMMENDED TREATMENT	ALTERNATIVES
(use only if recommended regimens are contraindicated)	
CHANCROID	
ADULTS
	•	Azithromycin 1 g orally once OR
•	Ceftriaxone11 250 mg IM once OR
•	Ciprofloxacin6 500 mg orally 2 times a day for 3 days OR
•	Erythromycin base 500 mg orally 3 times a day for 7 days 		
BACTERIAL VAGINOSIS (BV)	
ADULT FEMALES	•	Metronidazole10 500 mg orally 2 times a day for 7 days   OR
•	Metronidazole gel 0.75%, 5 g intravag. once a day for 5 days OR
•	Clindamycin cream 2%, 5 g intravag. at bedtime for 7 days	•	Tinidazole 2 g orally once daily for 3 days OR
•	Tinidazole12 1 g orally once daily for 5 days OR
•	Clindamycin 300 mg orally 2 times a day for 7 days OR
•	Clindamycin ovules 100 mg intravag. at bedtime for 3 days	
PREGNANCY	•	Metronidazole10 500 mg orally 2 times a day for 7 days OR
                              250 mg orally 3 times a day for 7 days OR
•	Clindamycin 300 mg orally 2 times a day for 7 days		
TRICHOMONIASIS	
ADULTS	•	Metronidazole10 2 g orally once OR
•	Tinidazole12 2 g orally once	•	Metronidazole10, 500 mg orally 2 times a day for 7 days	
PEDICULOSIS PUBIS	
	•	Permethrin 1% cream rinse applied to affected area and washed off after 10 minutes OR
•	Pyrethrins with piperonyl butoxide applied to affected area and washed off after 10 minutes	•	Malathion 0.5% lotion applied for 8-12 hours and washed off OR
•	Ivermectin 250 mcg/kg orally once, repeated in 2 weeks	
SCABIES	
	•	Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8-14 hours OR
•	Ivermectin16 200 mcg/kg orally, repeated in 2 weeks	•	Lindane 1% 1 oz of lotion or 30 g of cream applied thinly to all areas of the body from neck down and washed off after 8 hours  	
GENITAL HERPES SIMPLEX: See complete CDC guidelines for the management of herpes in pregnancy and in the neonate.	
ADULTS
First clinical episode 	•	Acyclovir    400 mg orally 3 times a day for 7-10 days OR
                       200 mg orally 5 times a day for 7-10 days OR
•	Famciclovir 250 mg orally 3 times a day for 7-10 days OR
•	Valacyclovir 1 g orally 2 times a day for 7-10 days   		
ADULTS
Episodic therapy for recurrence	•	Acyclovir          800 mg orally 2 times a day for 5 days OR 
400 mg orally 3 times a day for 5 days OR
800 mg orally 3 times a day for 2 days OR
•	Famciclovir18 125 mg orally 2 times a day for 5 days OR
1000 mg orally 2 times a day for 1 day OR
•	500 mg orally once, followed by 250 mg orally 2 times a day for 2 days OR
•	Valacyclovir  500 mg orally 2 times a day for 3 days OR
1 g orally once a day for 5 days		
ADULTS
Suppressive therapy for recurrence	•	Acyclovir      400 mg orally 2 times a day OR
•	Famciclovir18 250 mg orally 2 times a day OR
•	Valacyclovir  500 mg orally once a day OR
                         1 g orally once a day		
HIV INFECTION	Higher doses and/or longer therapy recommended. See complete CDC guidelines.	
GENITAL WARTS	
External or Perianal

•	PROVIDER-ADMINISTERED
Cryotherapy with liquid nitrogen or cryoprobe. Repeat applications every 1-2 weeks if necessary OR
Podophyllin resin 10%-25% in a compound tincture of benzoin. Limit application to < 10 cm2 and to < 0.5 ml. No open wounds or lesions should exist in the area of application. Allow to air dry. Wash off 1-4 hours after application. Repeat weekly if necessary OR
Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80% -90%. Apply small amount only to warts. Allow to dry. If excess amount applied, powder with talc, baking soda or liquid soap. Repeat weekly if necessary OR
Surgical removal

•	PATIENT-APPLIED
Podofilox 0.5% solution or gel.19 Apply 2 times a day for 3 days, followed by 4 days of no therapy, 4 cycles max. Total wart area should not exceed 10 cm2 and total volume applied daily not to exceed 0.5 ml. OR
Imiquimod 5% cream. Apply once daily at bedtime 3 times a week for up to 16 weeks. Wash treatment area with soap and water 6-10 hours after application. OR
•	Sinecatechins 15% ointment.19, Applied 3 times a day for up to 16 weeks.  Do not wash off.	Urethral Meatus

Cryotherapy with liquid nitrogen OR
Podophyllin 10%-25%19 in a compound 
tincture of benzoin. Treatment area must be dry before contact with normal mucosa. Repeat weekly if necessary.	Vaginal

Cryotherapy with liquid nitrogen. Cryoprobe not recommended (risk of perforation and fistula formation) OR
TCA or BCA 80%-90%. Apply small amount only to warts. Allow to dry. If excess amount applied, powder with talc, baking soda or liquid soap. Repeat weekly if necessary.	Anal

Cryotherapy with liquid nitrogen OR
TCA or BCA 80%-90%. Apply small amount only to warts. Allow to dry. If excess amount applied, powder with talc, baking soda or liquid soap. Repeat weekly if necessary OR
Surgical removal 

Many persons with anal warts may also have them in the rectal mucosa. Inspect rectal mucosa by digital examination or anoscopy. Warts on the rectal mucosa should be managed in consultation with a specialist.