Antimicrobial therapy of non-viral sexually transmitted diseases--an update

Azithromycin is an azalide antibiotic with important properties which allow it to be used as a single-dose treatment for genital Chlamydia trachomatic infections. A single 1 g dose is as effective as a standard seven-day course of doxycycline. Ofloxacin 400 mg bid for seven days is also effective against Chlamydia trachomatis. Both azithromycin 2 g and ofloxacin are also effective against uncomplicated gonorrhoea. Neisseria gonorrhoeae continues to be sensitive to third generation cephalosporins, e.g. ceftriaxone 125 mg. Oral single dose cephalosporins offer ease of administration and safety, e.g. cefixime (400 mg), cefuroxime axetil (1 g) and cefpodoxime proxetil (200 mg). The fluoroquinolones, e.g. ciprofloxacin (500 mg) and ofloxacin (400 mg), are being increasingly used as first-line medications, however, caution is recommended as the development of resistance is anticipated and already being detected in many areas. Syphilis continues to be sensitive to penicillin. This should be administered parenterally. Coexistent human immunodeficiency virus infection may make standard therapy inadequate, and closer follow-up is recommended. Therapy with non-penicillin antibiotics is still inadequately studied. Chancroid is treated with ceftriaxone, ciprofloxacin, azithromycin, or erythromycin. In some areas, resistance to tetracyclines and TMP-SMX has made these drugs ineffective as first-line treatments. Bacterial vaginosis is effectively treated with a single dose of metronidazole 1 g or 500 mg bid over seven days. Similar regimens are also effective against trichomoniasis. Vulvovaginal candidiasis can be treated with topical imidazole preparations or oral antifungal medications.