Sexually Transmitted Diseases (STDs)

Comprehensive Comparison Table – Sexually Transmitted Diseases (Clinical Pharmacist Focus)

Infection Pathogen Incubation Period Symptoms / Clinical Features Diagnostics 1st-Line Therapy (Adults) Pregnancy Therapy Partner Treatment Vaccine / Doses / Eligible Age Resistance Notes Key Pharmacist Tips
Chlamydia Chlamydia trachomatis 1–3 wks Often asymptomatic; cervicitis, urethritis, PID NAAT urine/swab Doxycycline 100 mg PO BID ×7 d Azithromycin 1 g PO ×1 YES – treat partners ❌ None Azithromycin resistance increasing Reinfection common; EPT recommended; screen for other STIs
Gonorrhea Neisseria gonorrhoeae 2–7 days Purulent discharge, dysuria, PID NAAT; culture for resistance Ceftriaxone 500 mg IM ×1 ± doxycycline if Chlamydia not excluded Ceftriaxone safe YES – treat partners ❌ None Fluoroquinolone resistance common Co-testing for Chlamydia essential; EPT recommended
Syphilis Treponema pallidum 3–6 wks (primary) Chancre, rash, condyloma lata; tertiary: neurologic, CV disease RPR/VDRL + TP-PA confirm Penicillin G benzathine IM 2.4M units ×1 (primary/secondary) Penicillin only Screen & treat exposed partners ❌ None Penicillin still effective Monitor titers; counsel about Jarisch-Herxheimer reaction
Trichomoniasis Trichomonas vaginalis 5–28 days Frothy yellow-green discharge, vaginal irritation, strawberry cervix NAAT (gold standard); wet mount low sensitivity Metronidazole 2 g PO ×1 or 500 mg PO BID ×7 d 500 mg BID ×7 d YES – treat partners ❌ None Resistance uncommon Advise abstinence until treatment complete; screen for other STIs
Genital Herpes (HSV-1/HSV-2) HSV-1 / HSV-2 2–12 days Painful vesicles, recurrent outbreaks, dysuria PCR / viral culture Acyclovir 400 mg TID ×7–10 d (first episode) Acyclovir safe Symptomatic guidance only ❌ None Rare acyclovir resistance in immunocompromised Chronic condition; educate on recurrence & neonatal risk
HPV (Anogenital warts / high-risk types) HPV types 6, 11, 16, 18 Months–years Painless warts; anogenital cancers (high-risk types) Clinical exam; HPV DNA testing Imiquimod 5% cream TIW ×16 wks or cryotherapy Cryotherapy preferred Not required HPV vaccine – 2-dose (9–14 y), 3-dose (15–45 y if not previously vaccinated) — Vaccinate eligible patients; emphasize series completion; monitor for lesions
HIV HIV-1 Weeks–years Flu-like illness → chronic immunosuppression HIV Ag/Ab test ART: 2 NRTIs + INSTI ART safe Required counseling; PrEP for partners ❌ None Resistance possible; genotype testing if treatment failure Emphasize adherence, PrEP/PEP for high-risk contacts
Hepatitis B HBV 6 wks–6 months Often asymptomatic; chronic hepatitis, cirrhosis risk HBsAg, anti-HBs, HBV DNA N/A Vaccine safe Household / sexual contacts HepB vaccine – 3-dose series (0,1,6 mo); birth dose for newborns — Screen high-risk adults; document immunization
Hepatitis A HAV 15–50 days Fever, jaundice, fatigue Anti-HAV IgM N/A Vaccine safe Household / sexual contacts HepA vaccine – 2-dose series (0,6–12 mo) — Vaccinate travelers, MSM, outbreak situations
 

Clinical Pharmacist Quick-Tips

  • PID suspicion = refer immediately → fever, pelvic pain, cervical motion tenderness
  • Co-testing is essential → 40–50% of gonorrhea cases co-infected with Chlamydia
  • Always screen for HIV, syphilis, and hepatitis B when an STI is diagnosed
  • Expedited Partner Therapy (EPT) is recommended in many regions for chlamydia/gonorrhea
  • Antibiotic stewardship alert: azithromycin monotherapy no longer recommended for Chlamydia due to resistance trends

Extra STI-Relevant Pharmacologic Notes

Scenario Pharmacist Consideration
Metronidazole + alcohol Avoid ethanol during therapy & 72 hrs after (disulfiram-like reaction)
Syphilis penicillin allergy Desensitization recommended in pregnancy
HSV maintenance Acyclovir 400 mg BID or Valacyclovir 500 mg daily
HIV PrEP TDF/FTC once daily for high-risk patients
HIV PEP Must start within 72 hours

 

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