Hesperian Health Guides

Sexually Transmitted Infections: Medicines

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HealthWiki > New Where There Is No Doctor > Sexually Transmitted Infections > Antibiotics


Most STIs can be successfully treated with antibiotics. Anti-fungal medicines and medicines to relieve pain are also used. Although not curable, HIV and herpes can be controlled with medicines that will help you feel better and stay healthy. To learn about medicines for HIV, see the chapter HIV and AIDS (in development).

STI medicines only work when you take all the medicine as recommended. Even if your signs go away, you will not be cured until all the medicine has time to work. If the signs do not begin to go away by 3 days after taking the medicines, see a health worker. Pain or vaginal discharge could also be caused by another problem, or you may need a different medicine.

Note: All doses given are for adults and children over 12 years old.

Antibiotics

Antibiotic medicines fight infection from bacteria. Different antibiotics fight different bacteria. Antibiotics that share the same chemical make-up are said to be from the same family. It is important to know about the families of antibiotics because:

  1. Antibiotics from the same family can often treat the same problems. This means you can sometimes use a different medicine from the same family.
  2. If you are allergic to an antibiotic, you will also be allergic to the other members of the same family of antibiotics. This means you will have to take not just a different medicine, but a medicine from a different family instead.

Antibiotics must be given for their full course. Stopping early, even if you feel better, can make the infection return in a form that is even harder to stop. However, if there are serious side effects from the antibiotic, like frequent diarrhea or an itchy rash that spreads throughout the body quickly, you may need to stop using the antibiotic. For help deciding, see a health worker right away.

Amoxicillin


Amoxicillin is an antibiotic of the penicillin family used to treat STIs and other infections. Because of drug resistance, it is less useful than previously.

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Amoxicillin may cause diarrhea, rash, nausea, or vomiting. It may cause yeast infection in women or diaper rash in children.

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Do not use if allergic to medicines of the penicillin family.

If you do not start to get better in 3 days, you may need a different medicine.

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Take with food.

For chlamydia:

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Give 500 mg by mouth 3 times a day for 7 days. Do not use amoxicillin to treat chlamydia unless neither azithromycin or doxycycline is available.


For pelvic inflammatory disease (PID):

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Give 500 mg by mouth 3 times a day for 14 days (also give ceftriaxone or spectinomycin to treat PID). Do not use amoxicillin to treat PID unless none of the following is available: azithromycin, doxycycline, or erythromycin.

Azithromycin


Azithromycin is an antibiotic of the macrolide family used to treat many STIs. It is safe during pregnancy and breastfeeding.

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Azithromycin can cause diarrhea, nausea, vomiting, and abdominal pain.

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Do not use this antibiotic if you have allergies to erythromycin or other antibiotics of the macrolide family.

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For gonorrhea, chlamydia, or chancroid:

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Give 1 gram (1000 mg) by mouth 1 time only. (To treat gonorrhea, also give ceftriaxone or another medicine).


For pelvic inflammatory disease (PID):

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Give 1 gram (1000 mg) by mouth as a single dose. Give a second dose 1 week later. (To treat PID, also give ceftriaxone or spectinomycin).

Benzathine penicillin


Benzathine penicillin is a long-acting antibiotic of the penicillin family used to treat syphilis. It is always given as an injection into muscle.

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Do not take if you are allergic to medicines of the penicillin family.

Have epinephrine on hand whenever you inject penicillin. Watch for allergic reactions and allergic shock which could start within 30 minutes.

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Can be painful to inject. Mix with 1% lidocaine if you know how.

For syphilis:

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If there is a sore or body rash or another sign of syphilis in the early stages, inject 2.4 million Units into muscle 1 time only. A person who had a test result showing no syphilis and then a test showing syphilis less than a year later also needs this dose.


If it is likely that the person has had syphilis for more than a year or has mental or other problems that come after many years of syphilis, a single dose will not be enough. When a test shows syphilis and it is possible that infection was at least 2 years ago or more, inject 2.4 million Units into muscle once a week for 3 weeks. Help the person get the right tests and treatment from an experienced health worker.

Cefixime


Cefixime is an antibiotic of the cephalosporin family used to treat many infections, including gonorrhea.

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Cefixime can cause upset stomach, diarrhea, and headaches.

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Do not take if you are allergic to medicines of the cephalosporin family. Watch for allergic reaction. Always be prepared to treat for allergic reaction and shock when injecting antibiotics.

People who have liver problems should be careful when taking cefixime

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For gonorrhea

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Give 400 mg by mouth 1 time only (also take azithromycin or another medicine to treat gonorrhea).

Ceftriaxone


Ceftriaxone is an antibiotic of the cephalosporin family that is injected into muscle or vein. It is used for many infections, including gonorrhea.

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Do not take if you are allergic to medicines of the cephalosporin family. Watch for allergic reaction. Always be prepared to treat for allergic reaction and shock when injecting antibiotics.

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Can be painful to inject. Mix with 1% lidocaine if you know how.

For gonorrhea in adults:
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Inject 250 mg into muscle 1 time only. (To treat gonorrhea, also give azithromycin or another medicine).


For Pelvic Inflammatory Disease (PID):
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Inject 250 mg into muscle 1 time only. (To treat PID, also give doxycycline or another medicine).


For chancroid:
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Inject 250 mg into muscle 1 time only

Ciprofloxacin


Ciprofloxacin is an antibiotic of the quinolone family that is used for different infections including chancroid.

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Ciprofloxacin can cause nausea, diarrhea, vomiting, or headache.

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Do not use if you are pregnant, breastfeeding or younger than 16 years old.

Do not take with dairy products.

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Drink a glass of water after taking this medicine.

For chancroid:

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Give 500 mg by mouth, 2 times a day for 3 days. Give for 7 days if the person also has HIV.

Clindamycin


Clindamycin is an antibiotic used for different infections including bacterial vaginosis.

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Nausea, vomiting, and diarrhea can happen within a few weeks of using clindamycin. If you get a skin rash, stop using it and see your health worker.

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If you are breastfeeding and this medicine gives your baby diarrhea, stop using it.

Using for more than 30 days can lead to thrush and yeast infections, and harm people with kidney or liver problems. The vaginal cream can weaken condoms for up to 3 days after use.

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It comes in both capsules to take by mouth and as a cream.

For bacterial vaginosis:

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Give 300 mg by mouth, 2 times a day for 7 days
OR
Insert 5 g of 2% cream (1 full applicator) high in the vagina each night for 7 days

Doxycycline


Doxycycline is an antibiotic of the tetracycline family used to treat many different STIs. It can be used in place of tetracycline and is easier to use because it is taken fewer times each day.

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Doxycycline can cause diarrhea or upset stomach. Some people get a rash after staying a long time in the sun.

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Do not take if allergic to antibiotics of the tetracycline family.

Do not take doxycycline if pregnant and try to avoid if breastfeeding.

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Avoid milk, iron pills, and antacids for 2 hours before or after taking. Do not take just before lying down. Sit up while taking pills and drink lots of water to prevent the irritation that swallowing this medicine can cause.


For gonorrhea or chlamydia:
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Give 100 mg by mouth, 2 times a day for 7 days (this will treat chlamydia but to also treat gonorrhea an additional medicine is needed).

For early syphilis:
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Give 100 mg by mouth, 2 times a day for 14 days. It is better to use benzathine penicillin for syphilis unless it is not available or the person is allergic to penicillin.

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For pelvic inflammatory disease (PID):
Give 100 mg by mouth 2 times a day for 14 days (also give ceftriaxone or spectinomycin).

Erythromycin


Erythromycin is an antibiotic of the macrolide family used to treat many infections, including some STIs. It is safe to use during pregnancy and is widely available, but for most STIs it is no longer as effective as other antibiotics.

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Erythromycin may upset stomach or cause nausea, vomiting, and diarrhea.

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Do not use if you are allergic to antibiotics of the macrolide family.

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Erythromycin works best when taken 1 hour before or 2 hours after a meal. If this upsets your stomach too much, take with a little food. Do not break up tablets because they are coated to protect it against strong stomach juices before it can begin to work in the intestine.

For chlamydia:
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Give 500 mg by mouth, 4 times a day for 7 days.

For chancroid:
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Give 500 mg by mouth, 4 times a day for 7 days.

For syphilis:
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Give 500 mg by mouth, 4 times a day for 15 days. It is better to use benzathine penicillin for syphilis unless it is not available or the person is allergic to penicillin. Or, if available, doxycycline will work better for syphilis than erythromycin.

For pelvic inflammatory disease (PID):
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Give 500 mg by mouth 4 times a day for 14 days. (To treat PID, also give ceftriaxone or spectinomycin).

Metronidazole


Metronidazole is an antibiotic used to treat bacterial vaginosis (BV), trichomonas, or PID.

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Metronidazole can cause a metallic taste in mouth, dark urine, upset stomach or nausea, and headaches.

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Do not take this medicine if you have jaundice (yellow eyes) or other liver problems.

Stop taking it if you feel numb.

Do not drink alcohol, not even 1 beer, while you are taking metronidazole. It will make you feel very nauseous.

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It comes as inserts for the vagina and tablets to take by mouth.

For bacterial vaginosis or trichomonas:
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Give 2 grams (2000 mg) by mouth 1 time only (not recommended for pregnant women)
OR
Give 400 to 500 mg by mouth, 2 times a day for 7 days
OR
Insert one 500 mg insert high in the vagina, every night for 7 nights


For pelvic inflammatory disease (PID):
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Give 400 to 500 mg by mouth, 3 times a day for 14 days. (To treat PID, also give 2 other medicines).

Spectinomycin


Spectinomycin is an aminocyclitol antibiotic used to treat PID and gonorrhea, but it does not work for gonorrhea of the throat. It is especially useful for people allergic to penicillin and cephalosporin antibiotics.

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It can cause chills, pain or redness at injection site, dizziness, and nausea.

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It comes in vials for injection of 2 g.

For gonorrhea or pelvic inflammatory disease (PID):
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Inject 2 g (2000 mg) into muscle, 1 time only. (To treat PID, also give doxycycline or another medicine).

Tetracycline


Tetracycline is an antibiotic of the tetracycline family, used to treat many infections including chlamydia. Doxycycline works for the same infections, may cost less, and is easier to take.

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If you spend time in the sun, it can cause skin rashes. It may cause diarrhea or upset stomach.

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Do not take if allergic to antibiotics of the tetracycline family.

Do not use tetracycline if you are pregnant or breastfeeding.

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Avoid milk, iron pills, and antacids for 2 hours before or after taking.

For chlamydia:
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Give 500 mg by mouth, 4 times a day for 7 days

Tinidazole


Tinidazole is an antibiotic, similar to metronidazole, used to treat some vaginal infections.

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Tinidazole can cause a metallic taste in mouth, upset stomach or nausea, or headache.

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Do not take this medicine if pregnant.

Do not drink alcohol, not even one beer, while you are taking tinidazole or for 3 days after. It will make you feel very nauseous.

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Drink a glass of water after taking this medicine.

For bacterial vaginosis or trichomonas:
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Give 2 grams (2000 mg) by mouth, 1 time only.
OR
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Give 500 mg by mouth 2 times a day for 5 days

With trichomonas, also treat the person’s sexual partner but this is not necessary with bacterial vaginosis.




This page was updated:12 Jun 2019