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.