Empirical STD Treatment for Unknown Exposure

Introduction to Empirical Treatment

The Centers for Disease Control and Prevention recommends empirical treatment for STD exposure when the specific STD diagnosis in the partner is unknown, the patient may be difficult to locate for follow-up after test results, or the prevalence of gonorrhea and chlamydia is high in the patient population 1, 2

The American College of Physicians and the Centers for Disease Control and Prevention recommend ceftriaxone 250 mg intramuscularly as a single dose for dual coverage of gonorrhea and chlamydia 3
The Centers for Disease Control and Prevention recommends doxycycline 100 mg orally twice daily for 7 days for dual coverage of gonorrhea and chlamydia 4
Azithromycin 1 g orally as a single dose can be used for chlamydia coverage, but doxycycline is preferred as it provides better coverage for potential Mycoplasma genitalium and other non-gonococcal urethritis pathogens 4, 5

The Centers for Disease Control and Prevention recommends testing for Neisseria gonorrhoeae using nucleic acid amplification test (NAAT) before or concurrent with treatment 1, 2
The Centers for Disease Control and Prevention recommends testing for Chlamydia trachomatis using NAAT before or concurrent with treatment 1, 2
The Centers for Disease Control and Prevention recommends syphilis serology testing before or concurrent with treatment 3
The Centers for Disease Control and Prevention recommends HIV testing with counseling before or concurrent with treatment 3

The Centers for Disease Control and Prevention recommends that all sex partners within the preceding 60 days must be evaluated and treated with treatment effective against both gonorrhea and chlamydia regardless of symptoms 1, 2, 4
The patient should abstain from sexual intercourse until 7 days after completing therapy, and partners must also abstain until they complete their own 7-day treatment course 1, 2

The Centers for Disease Control and Prevention recommends instructing the patient to return if symptoms persist or recur after completing therapy, or if new symptoms develop 4, 5
The Centers for Disease Control and Prevention recommends considering repeat testing at 3-6 months due to high reinfection rates 5