CDC

Sexually Transmitted Diseases

Summary of

2015
CDC Treatment Guidelines

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of STD Prevention

Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines

These summary guidelines reflect the 2015 CDC Guidelines for the Treatment of Sexually Transmitted Diseases. They are intended as a source of clinical guidance. An important component of STD treatment is partner management. Providers can arrange
for the evaluation and treatment of sex partners either directly or with assistance from state and local health departments. Complete guidelines can be ordered online at www.cdc.gov/std/treatment or by calling 1 (800) CDC-INFO (1-800-232-4636).

DISEASE

RECOMMENDED Rx

DOSE/ROUTE

ALTERNATIVES

Bacterial Vaginosis

metronidazole oral1
metronidazole gel 0.75%1
clindamycin cream 2%1,2

Cervicitis

azithromycin
doxycycline3

OR

1 g orally in a single dose

100 mg orally 2x/day for 7 days

Chlamydial Infections

azithromycin
doxycycline3

OR

Adults and adolescents

1 g orally in a single dose

100 mg orally 2x/day for 7 days

erythromycin base4 500 mg orally 4x/day for 7 days

erythromycin ethylsuccinate5 800 mg orally 4x/day for 7 days
levofloxacin6 500 mg 1x/day orally for 7 days
ofloxacin6 300 mg orally 2x/day for 7 days

OR
OR
OR

Pregnancy3

azithromycin7

1 g orally in a single dose

amoxicillin 500 mg orally 3x/day for 7 days

erythromycin base4,8 500 mg orally 4x/day for 7 days
erythromycin base 250 mg orally 4x/day for 14 days
erythromycin ethylsuccinate 800 mg orally 4x/day for 7 days
erythromycin ethylsuccinate 400 mg orally 4x/day for 14 days

OR
OR
OR
OR

Infants and Children (<45 kg): urogenital, rectal

erythromycin base9
ethylsuccinate

OR

50 mg/kg/day orally (4 divided doses) daily for 14 days

Data are limited on the effectiveness and optimal dose of azithromycin

for chlamydial infection in infants and children < 45 kg

Neonates: opthalmia neonatorum, pneumonia

erythromycin base9 ethylsuccinate

OR

50 mg/kg/day orally (4 divided doses) daily for 14 days

azithromycin 20 mg/kg/day orally, 1 dose daily for 3 days

ceftriaxone
doxycycline

PLUS

250 mg IM in a single dose

100 mg orally 2x/day for 10 days

PLUS
OR

250 mg IM in a single dose

500 mg orally 1x/day for 10 days
300 mg orally 2x/day for 10 days

OR
OR

500 mg orally 2x/day for 7 days

One 5 g applicator intravaginally 1x/day for 5 days
One 5 g applicator intravaginally at bedtime for 7 days

Treatment is recommended for all symptomatic pregnant women.

tinidazole 2 g orally 1x/day for 2 days

tinidazole 1 g orally 1x/day for 5 days
clindamycin 300 mg orally 2x/day for 7 days
clindamycin ovules 100 mg intravaginally at bedtime for 3 days

OR
OR
OR

Consider concurrent treatment for gonococcal infection if at risk of gonorrhea or lives in a community where the prevalence of
gonorrhea is high. Presumptive treatment with antimicrobials for C. trachomatis and N. gonorrhoeae should be provided for women at
increased risk (e.g., those aged <25 years and those with a new sex partner, a sex partner with concurrent partners, or a sex partner who
has a sexually transmitted infection), especially if follow-up cannot be ensured or if NAAT testing is not possible.

Epididymitis

10,11

For acute epididymitis most likely caused by

sexually transmitted CT and GC
For acute epididymitis most likely caused by
sexually-transmitted chlamydia and gonorrhea
and enteric organisms (men who practice insertive
anal sex)

ceftriaxone
levofloxacin
ofloxacin

For acute epididymitis most likely caused by enteric

organisms

levofloxacin
ofloxacin

OR

500 mg orally 1x/day for 10 days

300 mg orally 2x/day for 10 days

acyclovir
acyclovir
valacyclovir12
famciclovir12

OR
OR
OR

400 mg orally 3x/day for 7-10 days13

200 mg orally 5x/day for 7-10 days13
1 g orally 2x/day for 7-10 days13
250 mg orally 3x/day for 7-10 days13

Episodic therapy for recurrent genital herpes

acyclovir
acyclovir
acyclovir
valacyclovir12
valacyclovir12
famciclovir12
famciclovir12
famciclovir12

OR
OR
OR
OR
OR
OR
OR

400 mg orally 3x/day for 5 days

800 mg orally 2x/day for 5 days
800 mg orally 3x/day for 2 days
500 mg orally 2x/day for 3 days
1 g orally 1x/day for 5 days
125 mg orally 2x/day for 5 days
1000 mg orally 2x/day for 1 day13
500 mg orally once, followed by 250 mg 2x/day for 2 days

Suppressive therapy14 for recurrent genital herpes

acyclovir
valacyclovir12
valacyclovir12
famciclovir12

OR
OR
OR

400 mg orally 2x/day

500 mg orally 1x/day
1 g orally once a day
250 mg orally 2x/day

Recommended regimens for episodic infection in

persons with HIV infection

acyclovir
valacyclovir12
famciclovir12

OR
OR

400 mg orally 3x/day for 5-10 days

1 g orally 2x/day for 5-10 days
500 mg orally 2x/day for 5-10 days

Recommended regimens for daily suppressive

therapy in persons with HIV infection

acyclovir
valacyclovir12
famciclovir12

OR
OR

400-800 mg orally 2-3x/day

500 mg orally 2x/day
500 mg orally 2x/day

Patient Applied
imiquimod 3.75% or 5%12 cream
podofilox 0.5%15 solution or gel
sinecatechins 15% ointment2,12

OR
OR

See complete CDC guidelines.

Provider Administered
Cryotherapy
trichloroacetic acid or bichloroacetic acid 80%-90%
surgical removal

OR
OR

ceftriaxone

PLUS

Genital Herpes Simplex

First clinical episode of genital herpes

Genital Warts15

(Human Papillomavirus)
External genital and perianal warts

Gonococcal Infections16

Adults, adolescents, and

children >45 kg: uncomplicated gonococcal
infections of the cervix, urethra, and rectum

Apply small amount, dry, apply weekly if necessary

250 mg IM in a single dose

1 g orally in a single dose

azithromycin7

podophyllin resin 10%25% in compound tincture of benzoin may be

considered for provider-administered treatment if strict adherence to the
recommendations for application.
intralesional interferon
photodynamic therapy
topical cidofovir
If ceftriaxone is not available:
cefixime17 400 mg orally in a single dose
azithromycin7 1 g orally in a single dose
If cephalosporin allergy:
gemifloxacin 320 mg orally in a single dose
azithromycin 2 g orally in a single dose
gentamicin 240 mg IM single dose
azithromycin 2 g orally in a single dose

Pharyngeal18

ceftriaxone
azithromycin7

Pregnancy

See complete CDC guidelines.

Adults and adolescents:

conjunctivitis

ceftriaxone
azithromycin7

PLUS

250 mg IM in a single dose

1 g orally in a single dose

PLUS

1 g IM in a single dose
1 g orally in a single dose

OR
OR
OR

PLUS

PLUS
OR
PLUS

Children (45 kg): urogenital, rectal, pharyngeal

ceftriaxone19

25-50 mg/kg IV or IM, not to exceed 125 mg IM in a single dose

Lymphogranuloma venereum

doxycycline3

100 mg orally 2x/day for 21 days

erythromycin base 500 mg orally 4x/day for 21 days

Nongonococcal Urethritis (NGU)

azithromycin7
doxycycline3

1 g orally in a single dose

100 mg orally 2x/day for 7 days

erythromycin base4 500 mg orally 4x/day for 7 days

erythromycin ethylsuccinate5 800 mg orally 4x/day for 7 days
levofloxacin 500 mg 1x/day for 7 days
ofloxacin 300 mg 2x/day for 7 days

OR
OR
OR

malathion 0.5% lotion, applied 8-12 hrs then washed off

ivermectin 250 g/kg, orally repeated in 2 weeks

OR

Persistent and recurrent NGU3,20,21

OR

Men initially treated with doxycycline :

azithromycin

1 g orally in a single dose

Men who fail a regimen of azithromycin:

moxifloxacin

400 mg orally 1x/day for 7 days

Heterosexual men who live in areas where T. vaginalis is

highly prevalent:
metronidazole22
tinidazole

OR

2 g orally in a single dose

2 g orally in a single dose

OR

Apply to affected area, wash off after 10 minutes

Apply to affected area, wash off after 10 minutes

PLUS
OR

2 g IV every 12 hours
100 mg orally or IV every 12 hours

PLUS

2 g IV every 6 hours
100 mg orally or IV every 12 hours

PLUS
WITH or
WITHOUT
OR
PLUS
PLUS
WITH or
WITHOUT

250 mg IM in a single dose

100 mg orally twice a day for 14 days
500 mg orally twice a day for 14 days
2 g IM in a single dose
1 g orally administered concurrently in a single dose
100 mg orally twice a day for 14 days
500 mg orally twice a day for 14 days

The complete list of recommended regimens can be found in

CDCs 2015 STD Treatment Guidelines.

OR

Apply to all areas of body from neck down, wash off after 8-14 hours
200 g/kg orally, repeated in 2 weeks

lindane 1%23,24 1 oz. of lotion or 30 g of cream, applied thinly to all

areas of the body from the neck down, wash off after 8 hours

benzathine penicillin G

2.4 million units IM in a single dose

doxycycline3,25 100 mg 2x/day for 14 days

tetracycline3,25 500 mg orally 4x/day for 14 days

OR

Latent >1 year, latent of unknown duration

benzathine penicillin G

2.4 million units IM in 3 doses each at 1 week intervals

(7.2 million units total)

doxycycline3,25 100 mg 2x/day for 28 days

tetracycline3,25 500 mg orally 4x/day for 28 days

OR

Pregnancy

See complete CDC guidelines.

Neurosyphilis

aqueous crystalline penicillin G

1824 million units per day, administered as 34 million units IV

every 4 hours or continuous infusion, for 1014 days

procaine penicillin G 2.4 MU IM 1x daily

probenecid 500 mg orally 4x/day, both for 10-14 days.

PLUS

Pediculosis Pubis
Pelvic Inflammatory
Disease10

permethrin 1% cream rinse

pyrethrins with piperonyl butoxide
Parenteral Regimens
Cefotetan
Doxycycline
Cefoxitin
Doxycycline
Recommended Intramuscular/Oral Regimens
Ceftriaxone
Doxycycline
Metronidazole

Scabies
Syphilis

Cefoxitin
Probenecid,
Doxycycline
Metronidazole
permethrin 5% cream
ivermectin

Primary, secondary, or early latent <1 year

Congenital syphilis

See complete CDC guidelines.

Children: Primary, secondary, or early latent <1 year

benzathine penicillin G

50,000 units/kg IM in a single dose (maximum 2.4 million units)

Children: Latent >1 year, latent of unknown duration

benzathine penicillin G

Trichomoniasis

50,000 units/kg IM for 3 doses at 1 week intervals

(maximum total 7.2 million units)

metronidazole22
tinidazole26

Persistent or recurrent trichomoniasis

OR

metronidazole
If this regimen fails:
metronidazole
tinidazole
If this regimen fails, susceptibility testing is recommended.

2 g orally in a single dose

2 g orally in a single dose
500mg orally 2x/day for 7 days

OR

2g orally for 7 days

2g orally for 7 days

Parenteral Regimen
Ampicillin/Sulbactam 3 g IV every 6 hours

PLUS

Doxycycline 100 mg orally or IV every 12 hours

See CDC STD Treatment guidelines for discussion of alternative therapy in

patients with penicillin allergy.

metronidazole22 500 mg 2x/day for 7 days

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15.

The recommended regimens are equally efcacious.

These creams are oil-based and may weaken latex condoms and diaphragms. Refer to product labeling for
further information.
Should not be administered during pregnancy, lactation, or to children <8 years of age.
If patient cannot tolerate high-dose erythromycin base schedules, change to 250 mg 4x/day for 14 days.
If patient cannot tolerate high-dose erythromycin ethylsuccinate schedules, change to 400 mg orally 4 times a
day for 14 days.
Contraindicated for pregnant or lactating women.
Clinical experience and published studies suggest that azithromycin is safe and effective.
Erythromycin estolate is contraindicated during pregnancy.
Effectiveness of erythromycin treatment is approximately 80%; a second course of therapy may be
required.
Patients who do not respond to therapy (within 72 hours) should be re-evaluated.
For patients with suspected sexually transmitted epididymitis, close follow-up is essential.
No denitive information available on prenatal exposure.
Treatment may be extended if healing is incomplete after 10 days of therapy.
Consider discontinuation of treatment after one year to assess frequency of recurrence.
Vaginal, cervical, urethral meatal, and anal warts may require referral to an appropriate specialist.

16. CDC recommends that treatment for uncomplicated gonococcal infections of the cervix, urethra, and/or
rectum should include dual therapy, i.e., both a cephalosporin (e.g., ceftriaxone) plus azithromycin.
17. CDC recommends that cefixime in combination with azithromycin or doxycycline be used as an alternative
when ceftriaxone is not available.
18. Only ceftriaxone is recommended for the treatment of pharyngeal infection. Providers should inquire
about oral sexual exposure
19. Use with caution in hyperbilirubinemic infants, especially those born prematurely.
20. MSM are unlikely to benefit from the addition of nitroimidazoles.
21. Moxifloxacin 400mg orally 1x/day for 7 days is effective against Mycoplasma genitalium.
22. Pregnant patients can be treated with 2 g single dose.
23. Contraindicated for pregnant or lactating women, or children <2 years of age.
24. Do not use after a bath; should not be used by persons who have extensive dermatitis.
25. Pregnant patients allergic to penicillin should be treated with penicillin after desensitization.
26. Randomized controlled trials comparing single 2 g doses of metronidazole and tinidazole suggest
that tinidazole is equivalent to, or superior to, metronidazole in achieving parasitologic cure and
resolution of symptoms.
Indicates update from the 2010 CDC Guidelines for the Treatment of Sexually Transmitted Diseases.

CS253348

Reviewed by the CDC 6/2015