Treatment Options for Sexually Transmitted Infections (STIs)

Sexually transmitted infection (STI) treatments depend on the type of sexually transmitted infection you have. Bacterial infections, such as gonorrhea and chlamydia, are treated with antibiotics. Viral infections, such as herpes, are managed with antivirals. A viral infection often does not go entirely away. However, medications can manage symptoms and help prevent outbreaks of the condition.

While STIs are treatable, it is also possible to become reinfected. Take your medications as prescribed—even if you feel better. Since STIs are contagious, complete screenings per your healthcare provider’s advice. Also, ensure that if you or your partner is positive for an STI, both of you receive treatment.

Antibiotics for Bacterial STIs

STIs caused by bacterial infections include syphilis, chlamydia, and gonorrhea. These infections are curable when treated with the right antibiotics. Your healthcare provider will determine the course of treatment based on local and current rates of antibiotic resistance.

Resistance is a growing problem for STIs—especially gonorrhea—and is often a consequence of individuals not completing the entire course of their medications.

Antibiotics used to treat bacterial STIs may include an injection in a healthcare clinic or a prescription for pills you take at home.

If you are being treated for a bacterial infection such as chlamydia, gonorrhea, syphilis, or chancroid, healthcare providers will generally advise you to wait one week after completing treatment before having sex. With syphilis, it is usually recommended to wait to have sex until a follow-up blood test confirms that the infection has cleared.

If you are at risk for STIs, consider talking with your healthcare provider about doxycycline post-exposure prophylactic (doxy-PEP) antibiotic treatment. In some instances, it may be recommended to take a dose of doxycycline within 72 hours after unprotected sex.

The antibiotic prescribed depends on the bacteria that causes the infection and the patient’s allergies. Here are common antibiotics prescribed for different infections:

Chlamydia

Chlamydia is a bacterial infection caused by the bacteria Chlamydia trachomatis. It is common and is spread through oral, vaginal, and anal sex. Many individuals with chlamydia don’t experience any symptoms. When symptoms are present, common ones include vaginal or penile discharge and pain or burning with urination.

Antibiotics for chlamydia: Doxycycline is the recommended treatment. However, azithromycin and levofloxacin can be used as alternative regiments. You might hear azithromycin called a Z-pack.

Gonorrhea

Gonorrhea is caused by the bacteria Neisseria gonorrhea. It is also common. While oral, vaginal, and anal sex can all spread gonorrhea, the bacteria can also be present in the eyes and urethra.

Symptoms are mild and may not occur in every case. When they do occur, they vary depending on where the infection is present. For example, an infection in the throat may cause a sore throat. A genital infection may cause a green or yellow discharge. A urinary tract infection caused by gonorrhea may cause burning and pain with urination.

However, if left untreated, gonorrhea can lead to a condition called pelvic inflammatory disease (PID) in females. PID often presents with abdominal pain and a fever. It is also common for STI infections to co-occur, and up to 50% of individuals with a gonorrhea infection also have chlamydia.

Antibiotics for gonorrhea: The primary antibiotic is ceftriaxon. However, if an individual is allergic to ceftriaxone, a provider may use gentamicin with azithromycin.

Syphilis

Syphilis is caused by the bacteria Treponema pallidum. While it is typically spread sexually via genital contact, technically, it can spread through contact with broken skin or any mucus membrane.

Unlike other STIs, syphilis progresses in three phases.

Primary syphilis: 14-21 days after exposure, a small, open sore called a chancre develops that is painless and heals on its own in three to six weeks. The chancre may be on the anus, genitals, mouth, or skin. Swollen lymph nodes may also be present near the sore.

Secondary syphilis: Six to eight weeks after primary syphilis, secondary syphilis symptoms begin. Symptoms may include:

• A rash on the palms of the hands or soles of the feet
• Sores on the mouth, vagina, penis, or anus
• Warty patches on genitals or in skin folds
• Fever
• Feelings of malaise
• Appetite loss
• Joint and muscle pain
• Swollen lymph nodes
• Changes to vision
• Hair loss

If syphilis isn’t treated in the primary or secondary phases, the symptoms can resolve on their own, but the infection becomes latent. This means it is still in the body. During this time, it can cause organ damage.

Tertiary syphilis: If syphilis isn’t treated, it may progress to tertiary syphilis. This condition is challenging to diagnose and typically shows as:

• Heart damage
• Nervous system disorders
• Skin, bone, or liver tumors

Antibiotics for syphilis: Regardless of the stage, Penicillin G is the preferred treatment. If an individual is allergic to penicillin, a provider may consider using doxycycline, azithromycin, or other antibiotics. While other treatments are used, they have not been studied as well. For latent or tertiary infections, a more extended treatment duration may be necessary to clear the infection.

Chancroid

Chancroid is an uncommon STI in the United States. It is more common in Africa and southwest Asia. The bacteria Haemophilus ducreyi causes chancroid. The primary symptom is painful genital ulcers. Males tend to have only one, while females tend to have four or more. The ulcers are sometimes mistaken for the chancre that develops in primary syphilis.

Females may also experience pain when urinating and with sex.

Antibiotics for chancroid: Chancroid is treated with Azithromycin, ceftriaxone, erythromycin, or ciprofloxacin.

Antiviral Medications for STIs

STIs caused by viruses include herpes, human papillomavirus (HPV), and HIV. Most viral STIs are treated with oral antiviral or antiretroviral medications. While viral STIs can be managed, generally, they are not cured.

Herpes

Herpes is caused by the herpes simplex virus (HSV). It can cause sores on the genitals, bottom, anus, and thighs. Vaginal, anal, and oral sex can spread it.

Sometimes, individuals aren’t aware they have an infection. However, the virus can spread without any active sores present. Additionally, it can spread from a mother to her newborn during childbirth.

Generally, the worst and most frequent outbreaks occur in the first year after infection. While the virus stays in your body, outbreaks after the first year are less frequent and milder.

Antivirals for herpes: Several oral antivirals are available to keep viral counts low and minimize outbreaks. They include acyclovir, famciclovir, and valacyclovir.

Additionally, your provider may also prescribe you an acyclovir ointment that is safe to use on genital outbreaks—especially the first outbreak, as these are often more painful.

Hepatitis B

Hepatitis B is one of several types of hepatitis. It causes inflammation in the liver and may damage it, negatively affecting its function. Hepatitis B spreads through blood, semen, and other bodily fluids.

There are two forms: acute and chronic. With acute hepatitis B, liver failure rarely occurs, and the infection typically resolves on its own. Chronic hepatitis can cause more long-term healthcare challenges, such as scarring of the liver or liver cancer.

Those with the chronic form of hepatitis B are more likely to require treatment.

In adults with an acute hepatitis B infection, 95% will recover and become immune to the virus. However, some go on to develop chronic hepatitis B. In infants, however, approximately 90% of those infected with acute hepatitis B go on to develop a chronic infection.

In the United States, Hepatitis B vaccines are typically given at birth and are part of the regular immunization schedule for children. The incidence of the virus in the United States is small.

Antivirals for hepatitis B: The antivirals used for hepatitis B include alpha-2b or pegylated interferon, entecavir, and tenofovir. Other antivirals are also available but may not be as effective.

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)

HIV is a type of virus called a retrovirus that attacks an individual’s immune system. HIV may eventually develop into AIDS (the more severe form of the condition) if an individual does not seek treatment for HIV or stops regularly taking treatment.

With treatment, most individuals can control their HIV and significantly reduce their body’s viral load.

Several different bodily fluids can transmit HIV, including semen, vaginal fluids, blood, and breast milk. Early symptoms of the virus often feel like the flu and happen two to four weeks after exposure. Some individuals don’t experience any symptoms.

Antivirals for HIV and AIDS: Antiretroviral therapy (ART) is used to treat HIV, and several different medication options and treatments are available. Which ones your healthcare provider considers will depend on the availability and cost of the medications, any underlying health condition, and your body’s response.

In addition to treatment for HIV, there are also two other prescription forms of prevention: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

PrEP is a medication that can significantly reduce the risk of HIV for individuals who have a partner with HIV or engage in drug use that involves needle sharing. It is most effective when taken regularly.

PEP can significantly reduce the risk of HIV transmission after an unexpected exposure. It is most effective when taken within 72 hours of the event.

Human Papilloma Virus

Human Papillomavirus (HPV) is a group of over 200 viruses that are responsible for warts (including genital warts) and several cancers. The cancers caused by HPV include:

• Cervical
• Anal
• Penile
• Oral and throat
• Vulvar
• Vaginal

HPV infections are common and most clear on their own. If you do acquire HPV, you may not have any symptoms.

Since HPV can cause genital warts, providers often diagnose the condition based on their presence. Additionally, PAP and HPV tests that are performed by swabbing the cervix in a female help to detect cervical cancers caused by HPV.

Treatment for HPV: There is no specific treatment for HPV. However, there is a vaccine that can protect against several of the most common types of HPV.

If HPV causes cancer, treatment typically focuses on cancer treatment.

If you have a wart caused by HPV, your healthcare provider may prescribe a medication that you can put on the wart to get rid of it. Some medicines are put on in the provider’s office, and others can apply at home. If topical medications don’t work, the provider can perform other procedures to remove the wart.

Additionally, if you test positive for a high-risk strain of HPV, there are medications your provider may offer for you to apply topically to the area, as well as surgical procedures to consider.

Treatment for Parasitic STIs

Sometimes, STIs are caused by a parasite. Two common parasitic STI infections are trichomoniasis and public lice.

Trichomoniasis

Trichomoniasis is caused by the protozoan parasite Trichomonas vaginalis. More than half of individuals with this condition do not have any symptoms. When symptoms do occur, they may include burning and pain with urinating. Females may experience vaginal discharge with a fishy smell. Males may have penile discharge and pain with ejaculation.

Medications for trichomoniasis: The condition is commonly treated with oral antibiotics such as metronidazole and tinidazole. In addition, over-the-counter anti-itch creams designed for genital use can help ease symptoms.

Pubic Lice

Pubic lice, sometimes called “crabs,” are caused by a parasitic insect that resembles crabs when looked at closely.

Pubic lice are spread by sexual contact and cause itching and irritation. If you have pubic lice, you may also find them in other parts of your body with hair, such as facial hair or armpit hair.

Medications for public lice: Effective over-the-counter (OTC) treatments are available. OTC options include a lice-killing lotion containing 1% permethrin or a mousse containing both pyrethrins and piperonyl butoxide.

Surgical and Medical Procedures for STIs

Medical and surgical procedures are sometimes recommended for the treatment of viral STIs:

HPV: There are several procedures to treat the warts caused by HPV.

• Cryotherapy (freezing)
• Electrocautery (burning)
• Interferon injection into warts
• Laser treatment
• Surgery

In some cases, HPV may cause cervical dysplasia (a pre-cancerous condition). A loop electrosurgical excision procedure (LEEP) can remove the pre-cancerous tissue from the cervix.

Hepatitis: In some cases, significant liver damage can occur from hepatitis infections, and a liver transplant may be needed.

Home Remedies for Symptom Relief

Prescriptions are needed to manage or cure STIs. In addition, following a healthy diet, reducing stress, getting moderate exercise, and avoiding alcohol and tobacco can help keep you feeling your best and reduce outbreaks of symptoms from viral STIs.

Home remedies for STIs depend on symptoms:

• Herpes: Apply a cold compress to the area during an outbreak; do not touch or scratch sores, keep sores clean; and reduce stress to prevent reoccurrences.
• Hepatitis B: Take care of your liver by avoiding alcohol and being careful about the use of medications that can harm the liver, such as acetaminophen. 
• HIV/AIDS: Because HIV can impact your immune system, it is important to stay up-to-date with vaccinations and preventative care.

Complementary and Alternative Treatments

If you have a viral STI, talk to your healthcare provider or pharmacist before taking any herbal medicines or nutritional supplements to ensure doing so is safe given any other medications you may be taking.

There are a few complementary treatments that are being explored for the treatment of certain viral STIs:

• Herpes: Propolis, a sticky substance bees produce from tree sap, is found to speed the healing of herpes lesions. Algae extract is being studied as a possible herpes treatment. Some people also find relief from herpes pain with acupuncture. 
• HIV/AIDS: Medical marijuana may help with pain, reduce nausea, and stimulate your appetite. (Check your state laws regarding medical marijuana.) In addition, yoga and meditation can help ease pain and alleviate feelings of stress and depression that often come with an HIV diagnosis.

Summary

Medications used to treat STIs vary depending on which infection you have. If the infection is caused by a bacteria, your healthcare provider will prescribe an antibiotic. If it’s caused by a virus, your healthcare provider may prescribe an antiviral medication, though these are typically used to manage the infection since most viral STIs can’t be cured.

You should not try to treat an STI on your own or avoid seeking treatment. Untreated STIs can cause long-term problems like infertility, pelvic inflammatory disease, and even life-threatening health problems.