Recommended Treatment Regimens for Syndromic Treatment of STIs

STI Syndrome	Recommended Actions	Preferred drugs	Alternative drugs
Vaginal Discharge	Treat for gonorrhoea	Ceftriaxone 500mg IM Stat (to treat gonococcal infection) Children and Adolescents (≤17 years) Ceftriaxone 25-50mg/kg body weight IM stat. If ≥45kg, use adult dose	Cefixime 400mg PO stat Children/adolescents <17 years Cefixime 8mg/kg body weight PO stat Note: If patient allergic to Cephalosporin use Gentamycin 240mg IV stat
	Treat for chlamydia	Doxycycline 100mg PO BD for 7 days	Azithromycin 1g PO stat OR Erythromycin 500mg PO QID 7 days (in pregnant or lactating woman)
	Treat for Vaginal candidiasis	Fluconazole 150mg PO stat	Clotrimazole vaginal pessaries 200mg OD for 3 days OR Miconazole vaginal pessaries 200mg for 3 days OR Nystatin pessary 100,000 units Nocte for 14 days
	Treat for Bacterial vaginosis	Metronidazole 400mg PO BD for 7 days OR Metronidazole 0.75% 5g gel (full applicator) intravaginally OD for 5 days OR Clindamycin cream 2% one full applicator (5g) intravaginally OD for 7 days	Clindamycin 300mg PO BD for 7 days OR Tinidazole 2g PO BD for 3 days OR Tinidazole 1g PO OD for 5 days
	Treat for trichomoniasis	Metronidazole 2g PO stat OR Metronidazole 400mg PO BD for 7 days For children ≤17 years 5mg/kg PO TDS for 7 days	Tinidazole 2g PO stat
Genital Ulcer	Treat for syphilis	Benzathine penicillin 2.4 MU IM stat as a single injection split as 1.2 MU given in each buttock PLUS Azithromycin 1g PO Stat PLUS Doxycycline 100mg PO BD for 21 days PLUS Acyclovir 400mg PO TDS for 7 days	Erythromycin 500mg PO QID for 14 days (in pregnant or lactating woman)
	Treat for chancroid
	Treat for Lymphogranuloma venerium (LGV) Treat for Herpes simplex
Urethral Discharge Syndrome	Treat for gonorrhoea	Ceftriaxone 500mg IM stat PLUS Doxycycline 100mg PO BD for 7 days, Metronidazole 2g PO stat (to treat Trichomonas vaginalis) PLUS Doxycycline 100mg PO BD for 7 days followed by Azithromycin 1g PO stat, then 500mg PO OD for 3 days (to treat M. genitalium)	Cefixime 400mg PO stat Azithromycin 1g PO Stat OR Erythromycin 500mg PO QID for 7 days
	Treat for chlamydia
	If urethral discharge persists after 7 days despite adequate treatment and no history of re-exposure to STI then treat with
Inguinal Bubo†	Aspirate FLUCTUANT bubo with a large bore needle through normal skin Treat for chancroid Treat for LGV	Azithromycin 1g PO stat PLUS Doxycycline 100mg PO BD for 21 days	Ceftriaxone 500mg IM stat OR Cefixime 400mg PO stat If pregnant or lactating woman use Erythromycin 500mg PO QID 21 days (Note: Do not use Doxycycline)
Female Lower Abdominal Pain (PID) Outpatient	Treat for gonorrhoea, chlamydia and anaerobic bacteria at the same time	Ceftriaxone, 500mg IM stat PLUS Doxycycline 100 mg PO BD for 14 days PLUS Metronidazole 400mg PO TDS 14 days OR Metronidazole 2g PO stat (to treat anaerobic bacteria)	Cefixime 400mg PO stat PLUS Erythromycin 500mg PO QID for 14 days
Female Lower Abdominal Pain (PID) Inpatient	Treat for gonorrhoea, chlamydia, and Anaerobic bacteria at the same time	Ceftriaxone 1g IV stat PLUS Doxycycline 100mg PO BD for 14 days PLUS Metronidazole 500mg PO TDS for 14 days OR Metronidazole 500mg IV BD for 7 days Note: Switch to oral treatment upon clinical improvement and continue up to 14 days	Cefixime 400mg PO stat PLUS Erythromycin 500mg PO QID for 14 days
Genital Growth	Treat for Condylomata acuminata (ano- genital warts	Podophyllin 25% tincture. Apply topically weekly up to 12 weeks (protect surrounding normal skin with Vaseline jelly before application by health care provider) Imiquimod cream 5% applied at bedtime 3 times a week up to a duration of 8-12 weeks	Cauterization, Trichloroacetic Acid (weekly), Cryotherapy (fortnightly) Surgical excision of warts for isolated lesions
Genital Growth	Treat for Condylomata lata	Benzathine Penicillin 2.4 MU IM stat
Scrotal Swelling	Treat for Gonorrhoea	Ceftriaxone 500mg IM stat PLUS Doxycycline 100mg PO BD for 14 days	Cefixime 400mg PO stat
Scrotal Swelling	Treat for Chlamydia		Azithromycin 1g PO weekly for 2 weeks (Total of 2 doses) OR Erythromycin 500mg PO QID for 14 days
Neonatal Conjunctivitis	Treat for gonorrhoea and chlamydia	Ceftriaxone 25 – 50mg/kg body weight (max. 125mg) IM stat PLUS Erythromycin syrup, 50mg/kg body weight PO daily in 4 divided doses for 14 days PLUS Saline lavage of eyes	Cefotaxime 100mg per kg/body weight IV/IM stat

* Risk Assessment. The vaginal discharge algorithm is not very sensitive for predicting presence of cervical infection (Gonorrhoea and Chlamydia). Speculum examination improves its diagnostic utility. However, presence of certain risk factors increases the sensitivity and specificity of the algorithm for predicting cervicitis. Routine use of risk assessment is therefore recommended in all cases of vaginal discharge where speculum examination is not available or feasible. Consider risk assessment to be positive if the client is sexually active and has one or more of the following:
1. Has engaged in sex with multiple partners in last three months
2. Has had a new sex partner in the last three months
3. Has a current partner with an STI
4. Has a history of an inappropriately treated STI
5. Is a victim of sexual assault

Inguinal bubo accompanied with genital ulcer(s) should receive treatment as for genital ulcer disease.

Zambia

Recommended Treatment Regimens for Syndromic Treatment of STIs