Treatment of Sexually Transmitted Infections in Older Adults - #86
Take QuizTreatment of sexually transmitted infections in an older adult.
| Chlamydial Infections | Recommended | Alternative |
| Adults |
Azithromycin 1g PO x 1 dose Doxycycline 100mg PO twice per day x 7 days |
Erythomycin base 500mg PO four time per day x 7 days Erythromycin ethylsuccinate 800mg PO four times per day x 7 days Levofloxacin 500mg PO once daily x 7 days Ofloxacin 300mg PO twice per day x 7 days |
|
Gonococcal Infections |
Recommended | Alternative |
|
Adults Uncomplicated gonococcal infections of the cervix, urethra, and rectum |
Ceftriaxone 250mg IM x 1 dose PLUS Azithromycin 1g PO x 1 dose |
Ceftriaxone not available?
Cephalosporin allergy?
|
| - Pharyngeal | Ceftriaxone 250mg IM x 1 dose PLUS Azithromycin 1g PO x 1 dose | |
| - Conjunctivitis | Ceftriaxone 1g IM x 1 dose PLUS Azithromycin 1g PO x 1 dose | |
|
Syphilis |
Recommended | Alternative |
| Primary, secondary, or early latent <1 year | Benzathine penicillin G 2.4 million units IM x 1 dose |
Doxycycline 100mg twice per day x 14 days Tetracycline 500mg PO four times per day x 14 days |
| Latent >1 year, latent of unknown duration | Benzathine penicillin G 2.4 million units IM x 3 doses, each at 1 week intervals (7.2 million units total) |
Doxycycline 100mg twice per day x 28 days Tetracycline 500mg PO four times per day x 28 days |
| Neurosyphilis | Benzathine penicillin G 18-24 million units/day, administered as 3-4 million units IV Q4H or continuous infusion, x 10-14 days | Procaine penicillin G 2.4 million units IM once daily x 10-14 days PLUS Probenecid 500mg PO four times per day x 10-14 days |
Sexually Transmitted Infections (STIs) are increasing among older adults. These infections may include chlamydia, gonococcal infections, and syphilis5. Patients may experience no symptoms or symptoms may be mistaken for a urinary tract infection.
List appropriate recommended and alternative treatment strategies for STIs and choose an appropriate medication strategy for an individual patient.
In 2017 there were 1.7 million cases of chlamydia (a 22% increase since 2013), 555,608 cases of gonorrhea (67% increase since 2013), and 30,644 cases of syphilis (76% increase since 2013)6 in the United States.
Science Principles
- List recommended drug therapy options for sexually transmitted diseases
- List alternative therapy options, including those for patients with penicillin allergy
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
- Marrazzo, J. (2018). Clinical manifestations and diagnosis of chlamydia trachomatis infections. In A. Bloom (Ed.), UpToDate. Retrieved from https://www-uptodate-com.pitt.idm.oclc.org/contents/clinical-manifestati...
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. (2017, October 04). Gonorrhea. Retrieved from https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm
- U.S. Department of Health and Human Services Centers for Disease Control and Prevention. (n.d.). Syphilis Pocket Guide [Brochure]. Author. Retrieved from https://www.cdc.gov/std/syphilis/Syphilis-Pocket-Guide-FINAL-508.pdf
- Workowski KA, Bolan GA; CDC. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(RR-3):1-137.
- Harvard Health Publishing. (2018, February). Sexually transmitted disease? At my age? Retrieved from https://www.health.harvard.edu/diseases-and-conditions/sexually-transmitted-disease-at-my-age
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. (2018, August 23). The State of STDs in 2017 | CDC. Retrieved from https://www.cdc.gov/std/stats17/infographic.htm
- Ghanem, K. (2018). Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents. In A. Bloom (Ed.), UpToDate. Retrieved from https://www-uptodate-com.pitt.idm.oclc.org/contents/clinical-manifestati...
- Hicks, C. (2018). Syphilis: Screening and diagnostic testing. In J. Mitty (Ed.), UpToDate. Retrieved from https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-...