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Recommended regimens for non-pregnant women Metronidazole 500 mg orally twice a day for 7 days OR Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days OR Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days Alternative regimens for non-pregnant women† Metronidazole 2 g orally in a single dose OR Clindamycin 300 mg orally twice a day for 7 days OR Clindamycin ovules 100 g intravaginally once at bedtime for 3 days‡ Recommended regimens for pregnant women Metronidazole 250 mg orally three times a day for 7 days OR Clindamycin 300 mg orally twice a day for 7 days
*HIV-infected women should receive the same treatment as non-infected women. †Alternative regimens have a lower efficacy for BV treatment. ‡New in the 2002 STD Treatment Guidelines.
Recommended regimens for non-pregnant women Azithromycin 1 g orally in a single dose OR Doxycycline 100 mg orally twice a day for 7 days Alternative regimens for non-pregnant women Erythromycin base 500 mg orally four times a day for 7 days OR Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days OR Ofloxacin 300 mg orally twice a day for 7 days OR Levofloxacin* 500 mg orally for 7 days Recommended regimens for pregnant women Erythromycin base 500 mg orally four times a day for 7 days OR Amoxicillin 500 mg orally three times daily for 7 days Alternative regimens for pregnant women Erythromycin base 250 mg orally four times a day for 14 days OR Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days OR Erythromycin ethylsuccinate 400 mg orally four times a day for 14 days OR Azithromycin 1 g orally, single dose
*New in the 2002 STD Treatment Guidelines.
Oral regimen A
- Ofloxacin 400 mg orally twice a day for 14 days with or without Metronidazole 500 mg orally twice a day for 14 days OR
- Levofloxacin† 500 mg orally once daily for 14 days with or without Metronidazole 500 mg orally twice a day for 14 days
Regimen B
- Ceftriaxone 250 mg IM in a single dose with or without Metronidazole 500 mg orally twice a day for 14 days OR
- Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose with or without Metronidazole 500 mg orally twice a day for 14 days OR
- Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime) plus Doxycycline‡ 100 mg orally twice a day for 14 days with or without Metronidazole 500 mg orally twice aday for 14 days
Parenteral regimen A
- Cefotetan 2 g IV every 12 hours OR
- Cefoxitin 2 g IV every 6 hours plus Doxycycline 100 mg orally or IV every 12 hours†
Parenteral regimen B
- Clindamycin 900 mg IV every 8 hours plus Gentamicin loading dose IV or IM (2 mg/kg of body weight) followed by a maintenance dose (1.5 mg/kg) every 8 hours; single daily dosing may be substituted
*HIV-infected women should receive the same treatment as non-infected women. †Preliminary data suggest levofloxacin is as effective as ofloxacin, and its single daily dosing has advantages for compliance reasons. ‡When possible, doxycycline should be administered orally (even with hospitalization), because of pain associated with infusion.
Recommended regimen for non-pregnant women Metronidazole 2 g orally in a single dose Alternative regimen Metronidazole 500 mg twice a day for 7 days Recommended regimen for pregnant women Metronidazole 2 g orally, single dose†
*HIV-infected women should receive the same treatment as non-infected women. †For symptomatic women only; asymptomatic pregnant women need not be treated.
Uncomplicated VVC Complicated VVC Sporadic or infrequent VVC OR Recurrent VVC OR Mild-to-moderate VVC OR Severe VVC OR Likely to be C. albicans OR Non-albicans candidiasis OR Non-immunocompromised women Women with uncontrolled diabetes, debilitation, or immunosuppression or those who are pregnant
Recommended regimens-intravaginal agents Butoconazole 2% cream or 5 g intravaginally for 3 days* OR Butoconazole 2% cream 5 g (Butaconazole 1-sustained release), single intravaginal application OR Clotrimazole 1% cream 5 g intravaginally for 7 to 14 days OR Clotrimazole 100 mg vaginal tablet for 7 days OR Clotrimazole 100 mg vaginal tablet, two tablets for 3 days OR Clotrimazole 500 mg vaginal tablet, one tablet in a single application OR Miconazole 2% cream 5 g intravaginally for 7 days* OR Miconazole 100 mg vaginal suppository, one suppository for 7 days* OR Miconazole 200 mg vaginal suppository, one suppository for 3 days* OR Nystatin 100,000 unit vaginal tablet, one tablet for 14 days OR Tioconazole 6.5% ointment 5 g intravaginally in a single application* OR Terconazole 0.4% cream 5 g intravaginally for 7 days OR Terconazole 0.8% cream 5 g intravaginally for 3 days OR Terconazole 80 mg vaginal suppository, one suppository for 3 days Recommended regimens-oral agent Fluconazole 150 mg oral tablet, one tablet in single dose
*Over-the-counter preparations.
Recommended regimens for first clinical episode Acyclovir 400 mg orally three times a day for 7 to 10 days OR Acyclovir 200 mg orally five times a day for 7 to 10 days OR Famciclovir 250 mg orally three times a day for 7 to 10 days OR Valacyclovir 1 g orally twice a day for 7 to 10 days Recommended regimens for episodic therapy Acyclovir 400 mg orally three times a day for 5 days OR Acyclovir 200 mg orally five times a day for 5 days OR Acyclovir 800 mg orally twice a day for 5 days OR Famciclovir 125 mg orally twice a day for 5 days OR Valacyclovir 500 mg orally twice a day for 3 to 5 days* OR Valacyclovir 1 g orally once a day for 5 days† Recommended regimens for suppressive therapy Acyclovir 400 mg orally twice a day OR Famciclovir 250 mg orally twice a day OR Valacyclovir 500 mg orally once a day OR Valacyclovir 1 g orally once a day Recommended regimens for neonatal herpes† Acyclovir 20 mg/kg body weight IV every 8 hours for 21 days (for disseminated and CNS disease) Acyclovir 20 mg/kg body weight IV every 8 hours for 14 days (when limited to skin and mucous membranes)
*2002 STD Treatment Guidelines state 3 days is as effective as 5 days. †New in the 2002 STD Treatment Guidelines.
Patient-applied Podofilox 0.5% solution or gel OR Imiquimod 5% cream Provider-administered Cryotherapy with liquid nitrogen or cryoprobe. Repeat every 1 to 2 weeks OR Podophyllin resin 10% to 25% in a compound tincture of benzoin OR Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80% to 90% OR Surgical removal Alternative regimens Intralesional interferon OR Laser surgery
*See 2002 STD Treatment Guidelines for detailed application instructions.