Syndromic Management of Sexually
Transmitted Infections (STIs)
ALTERNATIVES / NOTES | KEY
SYNDROME FIRST-LINE TREATMENT
POINTS
Metronidazole 2 g PO once daily
Vaginal discharge
Metronidazole 500 mg PO every 12 for 5 days ❌ No alcohol 24 h
h for 7 days before and after treatment. Treat
sexual partner(s)
Acyclovir PO (according to Reassess once results are available
Genital ulcer (vesicles present)
regimen) + request VDRL/RPR Counseling and STI screening
Doxycycline 100 mg every 12 h for
Syphilis: Benzathine Penicillin G 2.4 14 days or Tetracycline 500 mg
Genital ulcer (no vesicles)
million IU IM, single dose every 6 h for 14 days
M. Treat H. ducreyi concomitantly
Ciprofloxacin 500 mg PO single
dose.Erythromycin 500 mg every
Haemophilus ducreyi Azithromycin 1 g PO single dosis
6 h for 7 days or Ceftriaxone 250
mg IM single dose
Erythromycin 500 mg PO every 6
Doxycycline 100 mg PO every 12 h
Inguinal bubon h for 21 days. Drainage by
for 21 days
aspiration (NO incision)
Doxycycline 100 mg every 12 h for
Ceftriaxone 500 mg IM single dose
Urethral discharge 7 days (Chlamydia). Treat sexual
+ Azithromycin 1 g PO single dose
partner(s)
Ceftriaxone 500 mg IM single Reassess after 48–72 h. REFER if:
Lower abdominal pain (PID – dose. Doxycycline 100 mg every 12 pregnancy, fever, rigid abdomen,
Pelvic Inflammatory Disease) h for 14 days + Metronidazole 500 non-menstrual bleeding, adnexal
mg every 12 h for 14 days mass
Considerations during pregnancy 🧠 Important antibiotic notes
Avoid doxycycline and tetracycline Treat sexual partner(s) in all
Prefer beta-lactams syndromes
REFER according to guidelines in: Sexual bstinence until completion of
PID and syphilis treatment
Management according to level of Reevaluate if there is no clinical
care response
Based on National Public Health Technical Guidelines – MINSA
Initial syndromic management. DOES NOT replace a complete clinical evaluation.
Transmitted Infections (STIs)
ALTERNATIVES / NOTES | KEY
SYNDROME FIRST-LINE TREATMENT
POINTS
Metronidazole 2 g PO once daily
Vaginal discharge
Metronidazole 500 mg PO every 12 for 5 days ❌ No alcohol 24 h
h for 7 days before and after treatment. Treat
sexual partner(s)
Acyclovir PO (according to Reassess once results are available
Genital ulcer (vesicles present)
regimen) + request VDRL/RPR Counseling and STI screening
Doxycycline 100 mg every 12 h for
Syphilis: Benzathine Penicillin G 2.4 14 days or Tetracycline 500 mg
Genital ulcer (no vesicles)
million IU IM, single dose every 6 h for 14 days
M. Treat H. ducreyi concomitantly
Ciprofloxacin 500 mg PO single
dose.Erythromycin 500 mg every
Haemophilus ducreyi Azithromycin 1 g PO single dosis
6 h for 7 days or Ceftriaxone 250
mg IM single dose
Erythromycin 500 mg PO every 6
Doxycycline 100 mg PO every 12 h
Inguinal bubon h for 21 days. Drainage by
for 21 days
aspiration (NO incision)
Doxycycline 100 mg every 12 h for
Ceftriaxone 500 mg IM single dose
Urethral discharge 7 days (Chlamydia). Treat sexual
+ Azithromycin 1 g PO single dose
partner(s)
Ceftriaxone 500 mg IM single Reassess after 48–72 h. REFER if:
Lower abdominal pain (PID – dose. Doxycycline 100 mg every 12 pregnancy, fever, rigid abdomen,
Pelvic Inflammatory Disease) h for 14 days + Metronidazole 500 non-menstrual bleeding, adnexal
mg every 12 h for 14 days mass
Considerations during pregnancy 🧠 Important antibiotic notes
Avoid doxycycline and tetracycline Treat sexual partner(s) in all
Prefer beta-lactams syndromes
REFER according to guidelines in: Sexual bstinence until completion of
PID and syphilis treatment
Management according to level of Reevaluate if there is no clinical
care response
Based on National Public Health Technical Guidelines – MINSA
Initial syndromic management. DOES NOT replace a complete clinical evaluation.
