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Drugs and Treatment for STDs

By Jill Grimes, M.D., FAAFP ; Updated August 14, 2017

Sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), are caused by a variety of bacteria, viruses and parasites. STI treatment is specific to each infection.

Bacterial STD Treatment

Chlamydia, gonorrhea and syphilis are all caused by bacterial infections, so they can potentially be treated and cured with antibiotics.

The bacteria that causes gonorrhea, however, has become frighteningly resistant to many antibiotics. We have gone from having multiple classes of medications to treat gonorrhea to now having only one antibiotic regimen that still works against this infection.

Uncomplicated gonorrhea infections are treated with the combination of an injection of ceftriaxone (an antibiotic cousin of penicillin) and a single oral dose of azithromycin. The second antibiotic serves two purposes. First, using two medications that work through different mechanisms improves treatment success rates and potentially slows down the spread of more antibiotic-resistant strains of gonorrhea. Secondly, the azithromycin treats uncomplicated chlamydia infections, which very commonly occur at the same time as gonorrhea infections.

It is important to note that bacterial STI treatment failures are often due to re-infection. If partners are not notified and treated at the same time, these infections can be passed back and forth. Unlike some childhood viral infections, such as measles, where you typically can only have that specific infection once in your lifetime, there is no immunity built up for bacterial STIs. Every time you are exposed to gonorrhea, chlamydia or syphilis you can be re-infected and will need full treatment again.

Viral STD Treatment (HSV and HIV)

Antibiotics cure bacterial infections, but antiviral medications are not yet advanced enough to eliminate viral infections. Antiviral therapy typically works to help reduce the severity and duration of viral illnesses, whether it is influenza or a viral STI, such as herpes simplex virus (HSV) and human immunodeficiency virus (HIV).

HSV antiviral therapy can be used episodically during outbreaks or taken daily as suppressive therapy to prevent outbreaks and reduce the chance of passing on this infection to partners.

HIV medications, called antiretrovirals (ARVs) or highly active antiretroviral therapy (HAART), are more complicated because at least three different drugs must be used at all times to best control HIV infections and avoid drug resistance. If your partner has the HIV infection and you do not, there is now pre-exposure prophylaxis (PrEP) medication that, when combined with consistent condom use, will help decrease your risk of contracting HIV.

Viral STD Treatment (HPV)

Human papillomavirus (HPV) has many different strains, but may generally be broken down into strains that cause genital warts and those that cause cancers. No oral medications treat this infection at this time. Treatments target the affected area directly. The vast majority of HPV infections are silent, never causing obvious disease, but CDC statistics indicate more than 360,000 new cases of genital warts and more than 33,000 HPV-related cancers occur each year in the United States. Prevention is now the key to HPV “treatment,” ideally administering the HPV vaccinations before the start of sexual activity.

HPV may cause genital warts to multiply and grow. These warts may resolve on their own, although that may take up to a year or more. No single treatment option is superior to others, and decisions regarding treatment depend on wart size, location, numbers, provider and patient preferences as well as cost. Topical creams, ointments, gels, acids and liquid nitrogen may be used for treatment, and most crops of warts require multiple applications over the span of several weeks. Surgical options are more costly, but may be necessary for more extensive or internal lesions.

HPV-related cancers include cervical, vulvar, vaginal, anal, penile and oral cancers. Again, treatments are site specific and range from simple topical procedures to more extensive surgeries and chemotherapy.

Parasitic STD Treatment

Trichomoniasis is three times more common than chlamydia or HIV, yet many have never heard of this microscopic protozoan parasitic infection. This infection is particularly important to detect and treat because people infected with “trich” are much more susceptible to contracting other STIs, especially HIV. “Trich” can be cured with specific antibiotics, such as metronidazole or tinidazole. “Trich” will not be eliminated by using more common antibiotics, such as penicillin or azithromycin, therefore treatment for other bacterial STIs do not automatically also treat this infection.

Pubic lice and scabies are parasites that create infestations externally on the body, on the pubic hair shafts and in the skin. These STIs are highly contagious and can be spread via linens or clothing, in addition to direct contact during sexual intimacy. Treatment is primarily with over-the-counter topical creams and includes a follow-up treatment one week later. Resistant cases may require prescription creams or pills. Partners must be simultaneously treated. Bedding, towels and clothing must be machine washed with hot water and detergent and machine dried in high heat. If the items cannot be cleaned in this manner, they can be placed in a plastic sealed bag for two weeks.

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