Many infections can be transmitted during sexual contact. The information that follows is limited to treatment of non-HIV infections associated primarily with sexual transmission.

Gonorrhea - Single oral doses of cefixime (Suprax), or ciprofloxacin (Cipro) are highly effective for uncomplicated anogenital or pharyngeal infection, even with penicillin- and tetracycline-resistant strains of Neisseria gonorrhoeae. Ceftriaxone (Rocephin) given in a single injection is also effective.

Pelvic Inflammatory Disease (PID) - C. trachomatis or N. gonorrhoeae cause about two thirds of cases of acute PID, but Mycoplasma hominis and various facultative and anaerobic bacteria may also be involved. Treatment regimens should include antimicrobial agents active against all these pathogens. Parenteral regimens include cefotetan (Cefotan) or cefoxitin (Mefoxin ) plus doxycycline, or clindamycin (Cleocin) with an aminoglycoside (gentamicin, neomycin, etc.) An oral alternative is ofloxacin plus metronidazole (Flagyl ).

Vaginal infections - The role of sexual transmission is important in trichomoniasis, unimportant in vulvovaginal candidiasis and unclear in bacterial vaginosis. Sulfonamide creams and other "broad-spectrum" vaginal preparations are not reliably effective for treatment of any vaginal infection. Douching is also not effective for prevention or treatment of vaginal infection and may cause upper genital tract infection. (See also Brief Reports, p. 8.)

Trichomoniasis - Metronidazole (Flagyl) is the treatment of choice for trichomoniasis. A single oral dose is usually effective; treatment failures may be treated with a repeat single dose or with a longer course. Metronidazole is now believed to be safe during all stages of pregnancy.

Bacterial vaginosis - Normal Lactobacillus species are replaced by overgrowth with Gardnerella vaginalis, M. hominis, Mobiluncus and various anaerobes. Oral metronidazole for seven days is effective for treatment. Vaginal metronidazole or oral or vaginal clindamycin also are effective.

Chlamydia - A single dose of azithromycin (Zithromax) is effective for treatment of uncomplicated urethral or cervical infection causes by Chlamydia trachomatis . Azithromycin capsules and tablets are expensive, and the capsules should be taken on an empty stomach. The single-dose powder formulation mixed with water costs less and, like the tablets, can be taken with food. Seven days' treatment with generic doxycycline or another tetracycline costs less.

Non-Specific Urethritis (non-chlamydial, non-gonococcal) in men caused by Ureaplasma urealyticum, Mycoplasma genitalium or other (unknown) pathogens, usually responds to azithromycin or doxycycline. Urethritis that does not resolve with azithromycin or doxycycline may respond to erythromycin.

In pregnancy - Doxycycline, other tetracyclines and the fluoroquinolones are contraindicated in pregnancy. Amoxicillin appears to be safe and is generally effective against C. trachomatis. Azithromycin is probably safe and effective, but experience with its use in pregnancy is limited.

Syphilis - Parenteral penicillin G remains the drug of choice for treating all stages of syphilis. Primary, secondary or latent syphilis known to be of less than one year's duration can be treated with an intramuscular injection of benzathine penicillin G, a repository formulation.

In Pregnancy - Syphilis in pregnant women should be treated with penicillin in doses appropriate to the stage of the disease. Re-treatment in succeeding pregnancies is unnecessary in the absence of clinical or serological evidence of new or persistent infection.

(Anonymous. Drugs for sexually transmitted infections. The Medical Letter 1999; 41:85-90)

COMMENT: We are all holding our breath as more resistant strains emerge. - R.A.

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