DISEASE RECOMMENDED REGIMEN ALTERNATIVE REGIMEN

Bacterial Vaginosis metronidazole 500 mg orally 2x/day for 7 days 

OR metronidazole gel 0.75%, one 5 gm applicator 

intravaginally, 1x/day for 5 days 

OR clindamycin cream 2%, one 5 gm applicator 

intravaginally, at bedtime for 7 days 

clindamycin 300 mg orally 2x/day for 7 days 

OR clindamycin ovules 100 mg intravaginally at bedtime 

for 3 days1

OR secnidazole 2 gm orally in a single dose2

OR tinidazole 2 gm orally 1x/day for 2 days 

OR tinidazole 1 gm orally 1x/day for 5 days

Cervicitis3 doxycycline 100 mg orally 2x/day for 7 days azithromycin 1 gm orally in a single dose

Chlamydial Infections

Adults and adolescents doxycycline 100 mg orally 2x/day for 7 days azithromycin 1 gm orally in a single dose 

OR levofloxacin 500 mg orally 1x/day for 7 days

Pregnancy azithromycin 1 gm orally in a single dose amoxicillin 500 mg orally 3x/day for 7 days

Infant and children <45 kg4 (nasopharynx, 

urogenital, and rectal)

 erythromycin base, 50 mg/kg body weight/day 

orally, divided into 4 doses daily for 14 days 

OR ethylsuccinate, 50 mg/kg body weight/day orally, 

divided into 4 doses daily for 14 days

Children who weigh ≥45 kg, but who 

are aged <8 years (nasopharynx, 

urogenital, and rectal)

azithromycin 1 gm orally in a single dose

Children aged ≥8 years (nasopharynx, 

urogenital, and rectal)

azithromycin 1 gm orally in a single dose 

OR doxycycline 100 mg orally 2x/day for 7 days

Neonates:5 ophthalmia and pneumonia erythromycin base, 50 mg/kg body weight/day 

orally, divided into 4 doses daily for 14 days 

OR ethylsuccinate, 50 mg/kg body weight/day orally, 

divided into 4 doses daily for 14 days

 azithromycin suspension 20 mg/kg body weight/day 

orally, 1x/day for 3 days

Epididymitis

For acute epididymitis most likely caused 

by sexually transmitted chlamydia and 

gonorrhea

 ceftriaxone 500 mg IM in a single dose6 PLUS

doxycycline 100 mg orally 2x/day for 10 days

For acute epididymitis most likely caused 

by chlamydia, gonorrhea, or enteric 

organisms (men who practice insertive 

anal sex)

 ceftriaxone 500 mg IM in a single dose6 PLUS

levofloxacin 500 mg orally 1x/day for 10 days

For acute epididymitis most likely caused 

by enteric organisms only

levofloxacin 500 mg orally 1x/day for 10 days

Genital Herpes Simplex

First clinical episode of genital herpes7 acyclovir 400 mg orally 3x/day for 7–10 days8

OR famciclovir 250 mg orally 3x/day for 7–10 days 

OR valacyclovir 1 gm orally 2x/day for 7–10 days

Suppressive therapy for recurrent genital 

herpes (HSV-2)

acyclovir 400 mg orally 2x/day 

OR valacyclovir 500 mg orally 1x/day9

OR valacyclovir 1 gm orally 1x/day 

OR famciclovir 250 mg orally 2x/day

Episodic therapy for recurrent genital 

herpes (HSV-2)10

acyclovir 800 mg orally 2x/day for 5 days 

OR acyclovir 800 mg orally 3x/day for 2 days 

OR famciclovir 1 gm orally 2x/day for 1 day 

OR famciclovir 500 mg once, FOLLOWED BY

250 mg 2x/day for 2 days 

OR famciclovir 125 mg 2x/day for 5 days 

OR valacyclovir 500 mg orally 2x/day for 3 days 

OR valacyclovir 1 gm orally 1x/day for 5 days

Daily suppressive therapy for persons with 

HIV infection

acyclovir 400-800 mg orally 2x–3x/day 

OR famciclovir 500 mg orally 2x/day

OR valacyclovir 500 mg orally 2x/day

Episodic therapy for persons with HIV 

infection

acyclovir 400 mg orally 3x/day for 5–10 days 

OR famciclovir 500 mg orally 2x/day for 5–10 days 

OR valacyclovir 1 gm orally 2x/day for 5–10 days

Daily suppressive therapy of recurrent 

genital herpes in pregnant women11

acyclovir 400 mg orally 3x/day 

OR valacyclovir 500 mg orally 2x/day

Genital Warts (Human 

Papillomavirus)

External anogenital warts12 Patient-applied

imiquimod 3.75% or 5% cream13

OR podofilox 0.5% solution or gel 

OR sinecatechins 15% ointment13

Provider–administered

cryotherapy with liquid nitrogen or cryoprobe 

OR surgical removal either by tangential scissor 

excision, tangential shave excision, curettage, 

laser, or electrosurgery 

OR trichloroacetic acid (TCA) or bichloroacetic acid 

(BCA) 80%–90% solution

Urethral meatus warts cryotherapy with liquid nitrogen 

OR surgical removal

Vaginal warts,14 Cervical warts,15

Intra-anal warts16

cryotherapy with liquid nitrogen 

OR surgical removal 

OR TCA or BCA 80%–90% solution

Gonococcal Infections

Uncomplicated infections of the 

cervix, urethra, and rectum: adults 

and adolescents <150 kg6

ceftriaxone 500 mg IM in a single dose17 If cephalosporin allergy: 

 gentamicin 240 mg IM in a single dose PLUS

azithromycin 2 gm orally in a single dose

If ceftriaxone administration is not available or 

not feasible:

cefixime 800 mg orally in a single dose17

Uncomplicated infection of the pharynx: 

adults and adolescents <150 kg6

ceftriaxone 500 mg IM in a single dose17

Pregnancy ceftriaxone 500 mg IM in a single dose17

Conjunctivitis ceftriaxone 1 gm IM in a single dose18

Disseminated gonococcal infections (DGI)19 ceftriaxone 1 gm IM or by IV every 24 hours17 cefotaxime 1 gm by IV every 8 hours

OR ceftizoxime 1 gm every 8 hours

Uncomplicated gonococcal vulvovaginitis, 

cervicitis, urethritis, pharyngitis, or 

proctitis: infants and children ≤45 kg

 ceftriaxone 25–50 mg/kg body weight by IV or 

IM in a single dose, not to exceed 250 mg IM

Uncomplicated gonococcal vulvovaginitis, 

cervicitis, urethritis, pharyngitis, or 

proctitis: children >45 kg

 Treat with the regimen recommended for adults 

(see above)

Ocular prophylaxis in neonates erythromycin (0.5%) ophthalmic ointment in each 

eye in a single application at birth

Ophthalmia in neonates and infants ceftriaxone 25–50 mg/kg body weight by IV or 

IM in a single dose, not to exceed 250 mg

For neonates unable to receive ceftriaxone due to 

simultaneous administration of intravenous calcium:

 cefotaxime 100 mg/kg body weight by IV or IM as a 

single dose

DISEASE RECOMMENDED REGIMEN ALTERNATIVE REGIMEN

Lymphogranuloma Venereum doxycycline 100 mg orally 2x/day for 21 days azithromycin 1 gm orally 1x/week for 3 weeks 20

OR erythromycin base 500 mg orally 4x/day for 

21 days 

Nongonococcal Urethritis (NGU) doxycycline 100 mg orally 2x/day for 7 days azithromycin 1 gm orally in a single dose

OR azithromycin 500 mg orally in a single dose, THEN

250 mg 1x/day for 4 days

Persistent or Recurrent NGU: test for Mycoplasma genitalium: 

If M. genitalium resistance testing is 

unavailable but M. genitalium is detected 

by an FDA-cleared NAAT

 doxycycline 100 mg orally 2x/day for 7 days, 

FOLLOWED BY moxifloxacin 400 mg 1x/day for 

7 days

For settings without resistance testing and when 

moxifloxacin cannot be used:

 doxycycline 100 mg orally 2x/day for 7 days, 

FOLLOWED BY azithromycin 1 gm orally on first day, 

FOLLOWED BY azithromycin 500 mg orally 1x/day 

for 3 days and a test-of-cure 21 days after completion 

of therapy

If resistance testing is available, use 

resistance-guided therapy

Macrolide sensitive

 doxycycline 100 mg orally 2x/day for 7 days, 

FOLLOWED BY azithromycin 1 gm orally initial dose, 

FOLLOWED BY azithromycin 500 mg orally 1x/day 

for 3 additional days (2.5 gm total) 

Macrolide resistance

 doxycycline 100 mg orally 2x/day for 7 days, 

FOLLOWED BY moxifloxacin 400 mg orally 

1x/day for 7 days 

Test for Trichomonas vaginalis in 

heterosexual men in areas where 

infection is prevalent

metronidazole 2 gm orally in a single dose 

OR tinidazole 2 gm orally in a single dose

Pediculosis Pubis permethrin 1% cream rinse applied to affected 

areas, wash after 10 minutes 

OR pyrethrin with piperonyl butoxide applied to 

affected areas, wash after 10 minutes

 malathion 0.5% lotion applied to affected areas, 

wash after 8–12 hours 

OR ivermectin 250 μg/kg body weight repeated in 

7–14 days

Pelvic Inflammatory Disease

Parenteral treatment ceftriaxone 1 gm by IV every 24 hours PLUS

doxycycline 100 mg orally or by IV every 12 hours 

PLUS metronidazole 500 mg orally or by IV every 

12 hours

OR cefotetan 2 gm by IV every 12 hours PLUS

doxycycline 100 mg orally or by IV every 12 hours

OR cefoxitin 2 gm by IV every 6 hours PLUS

doxycycline 100 mg orally or by IV every 12 hours

 ampicillin-sulbactam 3 gm by IV every 6 hours PLUS

doxycycline 100 mg orally or by IV every 12 hours 

OR clindamycin 900 mg by IV every 8 hours PLUS

gentamicin 2 mg/kg body weight by IV or IM 

FOLLOWED BY 1.5 mg/kg body weight every 8 hours. 

Can substitute with 3–5 mg/kg body weight 1x/day

Intramuscular or oral treatment ceftriaxone 500 mg IM in a single dose6 PLUS

doxycycline 100 mg orally 2x/day for 14 days WITH

metronidazole 500 mg orally 2x/day for 14 days 

OR cefoxitin 2 gm IM in a single dose AND

probenecid 1 gm orally, administered concurrently 

in a single dose PLUS doxycycline 100 mg orally 

2x/day for 14 days WITH metronidazole 500 mg 

orally 2x/day for 14 days 

OR Other parenteral third-generation cephalosporin 

(e.g., ceftizoxime or cefotaxime) PLUS

doxycycline 100 mg orally 2x/day for 14 days WITH

metronidazole 500 mg orally 2x/day for 14 days

The complete list of recommended regimens can be found in Sexually Transmitted Infections Treatment Guidelines, 2021.

Scabies permethrin 5% cream applied to all areas of the 

body (from neck down), wash after 8–14 hours21

OR ivermectin 200ug/kg body weight orally, repeated 

in 14 days22

OR ivermectin 1% lotion applied to all areas of the 

body (from neck down), wash after 8–14 hours; 

repeat treatment in 1 week if symptoms persist

 lindane 1% 1 oz of lotion or 30 gm of cream applied 

thinly to all areas of the body (from neck down), wash 

after 8 hours23

Syphilis24

Primary, secondary, and early latent: adults 

(including pregnant women and people 

with HIV infection)

 benzathine penicillin G 2.4 million units IM in a 

single dose

Late latent adults (including pregnant 

women and people with HIV infection)

 benzathine penicillin G 7.2 million units total, 

administered as 3 doses of 2.4 million units IM 

each at 1-week intervals

Neurosyphilis, ocular syphilis, and 

otosyphilis

 aqueous crystalline penicillin G 18–24 million 

units per day, administered as 3–4 million units 

by IV every 4 hours or continuous infusion, for 

10–14 days

 procaine penicillin G 2.4 million units IM 1x/day 

PLUS probenecid 500 mg orally 4x/day, both for 

10–14 days

For children or congenital syphilis See Sexually Transmitted Infections Treatment 

Guidelines, 2021.

Trichomoniasis25

Women metronidazole 500 mg orally 2x/day for 7 days tinidazole 2 gm orally in a single dose

Men metronidazole 2 gm orally in a single dose tinidazole 2 gm orally in a single dose

1. Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and diaphragms). Use of such products within 72 hours following treatment with clindamycin 

ovules is not recommended.

2. Oral granules should be sprinkled onto unsweetened applesauce, yogurt, or pudding before ingestion. A glass of water can be taken after administration to aid in swallowing.

3. Consider concurrent treatment for gonococcal infection if the patient is at risk for gonorrhea or lives in a community where the prevalence of gonorrhea is high (see Gonorrhea section).

4. Data are limited regarding the effectiveness and optimal dose of azithromycin for treating chlamydial infection among infants and children who weigh <45 kg.

5. An association between oral erythromycin and azithromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported among infants aged <6 weeks. Infants treated with either of these 

antimicrobials should be followed for IHPS signs and symptoms.

6. For persons weighing ≥150 kg, 1 gm ceftriaxone should be administered.

7. Treatment can be extended if healing is incomplete after 10 days of therapy.

8. Acyclovir 200 mg orally five times/day is also effective but is not recommended because of the frequency of dosing.

9. Valacyclovir 500 mg once a day might be less effective than other valacyclovir or acyclovir dosing regimens for persons who have frequent recurrences (i.e., ≥10 episodes/year).

10. Acyclovir 400 mg orally three times/day is also effective but is not recommended because of frequency of dosing.

11. Treatment recommended starting at 36 weeks’ gestation. (Source: American College of Obstetricians and Gynecologists. Clinical management guidelines for obstetrician-gynecologists. 

Management of herpes in pregnancy. ACOG Practice Bulletin No. 82. Obstet Gynecol 2007;109:1489–98.)

12. Persons with external anal or peri-anal warts might also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, 

standard anoscopy, or high-resolution anoscopy.

13. Might weaken condoms and vaginal diaphragms.

14. The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation.

15. Management of cervical warts should include consultation with a specialist. For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade squamous intraepithelial 

lesion should be performed before treatment is initiated.

16. Management of intra-anal warts should include consultation with a specialist.

17. If chlamydial infection has not been excluded, treat for chlamydia with doxycycline 100 mg orally two times/day for 7 days (if pregnant, treat with azithromycin 1 gm orally in a single dose).

18. Providers should consider one-time lavage of the infected eye with saline solution.

19. When treating for the arthritis-dermatitis syndrome, the provider can switch to an oral agent guided by antimicrobial susceptibility testing (AST) 24–48 hours after substantial clinical improvement, 

for a total treatment course of at least 7 days.

20. Because this regimen has not been validated rigorously, a test-of-cure with Chlamydia trachomatis nucleic acid amplification test (NAAT) 4 weeks after completion of treatment can be considered.

21. Infants and young children (aged <5 years) should be treated with permethrin.

22. Oral ivermectin has limited ovicidal activity; a second dose is required for cure.

23. Infants and children aged <10 years should not be treated with lindane.

24. The complete list of recommendations on treating syphilis among people with HIV infection and pregnant women, as well as discussion of alternative therapy in people with penicillin allergy, can be 

found in Sexually Transmitted Infections Treatment Guidelines, 2021.

25. For management of persistent or recurrent infection, refer to Sexually Transmitted Infections Treatment Guidelines, 2021.

Summary of CDC STI Treatment Guidelines, 2021

This wall chart reflects recommended regimens found in CDC’s Sexually Transmitted Infections Treatment Guidelines, 2021. This summary is intended as a source of clinical guidance. When more than one 

therapeutic regimen is recommended, the sequence is in alphabetical order unless the choices for therapy are prioritized based on efficacy, cost, or convenience. The recommended regimens should be used 

primarily; alternative regimens can be considered in instances of substantial drug allergy or other contraindications. An important component of STI treatment is partner management. Providers can arrange for 

the evaluation and treatment of sex partners either directly or with assistance from state and local health departments. Complete guidelines can be found online at www.cdc.gov/std/treatment.

PubNo. 222107

CS325034-A

Accessible version: https://www.cdc.gov/std/treatment-guidelines/default.htm