Treat sexually transmitted infections with antibiotics, antivirals

February 1, 2005

Sexually Transmitted infections (STIs) such as syphilis, gonorrhea, herpes and chlamydia are a major health concern in the United States.

Ideally, treatment for STIs would include testing sexual partners of infected persons, and treating them if they're infected as well. However, this can be difficult to accomplish. "Empiric or expedited partner treatment is gaining popularity," says Gianna Zuccotti, MD, MPH, deputy editor of The Medical Letter on Drugs and Therapeutics, a nonprofit newsletter that critically appraises drugs. "This approach means that the physician gives medication to the infected person to give to their partner, rather than requiring the partner to come in. Expedited partner treatment is increasingly used by physicians who care for people with STIs. It means you can't do partner counseling or HIV testing, but it has the advantage of increasing treatment access for people who might not come in on their own."

GONORRHEA AND SYPHILIS The number of gonorrhea cases in the U.S. currently is at an all-time low. The number varies dramatically among the states, ranging from 265 per 100,000 in Louisiana, to 5 per 100,000 in Idaho. Single doses of oral antibiotics are highly effective for gonorrhea, but untreated cases can lead to epididymitis in men, pelvic inflammatory disease and ectopic pregnancy in women, and infertility in both men and women.

GENITAL HERPES Genital herpes is a very common viral infection, causing recurrent clusters of blisters or bumps in the genital area. Many people carry the infection without any symptoms, and can unknowingly transmit the virus to a sexual partner. Between the late 1970s and the early 1990s, the number of Americans with genital herpes increased 30%. Currently about 45 million people have genital herpes; that's one out of every five adolescents and adults. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over time.

The severity and duration of herpes symptoms and the frequency of attacks can be reduced by antiviral agents such as Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir). These medicines are taken orally for 7 to 10 days to shorten the initial herpes outbreak, and can be used in lower doses to prevent or suppress recurrences. "Some people keep the medicine on hand and start treatment when they feel the first signs of an outbreak," Dr. Zuccotti says.