STIs (Sexually Transmitted Infections) are infections passed from one person to another through sexual contact. They are caused by bacteria, viruses, or parasites and can affect various parts of the body. Common STIs include chlamydia, gonorrhea, syphilis, HIV/AIDS, genital herpes, HPV (human papillomavirus), and trichomoniasis. STIs can often be asymptomatic, but may lead to many serious health complications if left untreated.
STIs can affect anyone regardless of sexual orientation or hygiene practices. Various bacteria can cause these infections, often requiring antibiotic treatment as prescribed by a healthcare professional.
Azithromycin is one such antibiotic that has been found to be effective in treating sexually transmitted infections like chlamydia and other associated complications such as urethritis and cervicitis. It has further been found that azithromycin can also help in the management of gonorrhea.
Azithromycin is one of the recommended antibiotics for several STIs. For example, it serves as a common remedy for chlamydia and its potential complications, such as nongonococcal urethritis, cervicitis, or lymphogranuloma venereum.
Let us look deeper into azithromycin’s role in treating STIs.
How Effective is Azithromycin in Treating Various STIs?
Azithromycin, endorsed by the US Centers for Disease Control and Prevention (CDC) as a primary treatment for chlamydia, nongonococcal urethritis, and cervicitis, serves as an effective treatment option. In cases where ceftriaxone is unsuitable due to allergies, health experts may even combine azithromycin with gentamicin for the treatment of gonorrhea.(1,2,3)
Research from a 2015 study indicates that azithromycin can effectively resolves around 97 percent of chlamydia cases.(4) However, contrasting studies have also suggested that doxycycline might actually show superior efficacy against chlamydia in both males and females.(5,6)
Despite this, the British Association for Sexual Health and HIV continues to emphasize azithromycin’s importance as an alternative for individuals allergic or intolerant to doxycycline, especially among pregnant individuals.(7)
Moreover, according to the CDC’s Sexually Transmitted Infections Treatment Guidelines, azithromycin is also effective in the management of other STIs like chancroid, donovanosis, and Mycoplasma genitalium infections.(8)
Administration Guidelines for Azithromycin Use
Azithromycin is available in both tablet or powder form, with the dosage varying based on the specific infection being treated.(9) A doctor will determine the appropriate dosage and duration of treatment. Some of the guidelines for using azithromycin for certain sexually transmitted infections are as follows:
- Chlamydia Treatment: Typically, a single oral dose of 1 gram (g) of azithromycin is recommended.(2)
- Dual Gonorrhea Treatment: For dual treatment alongside gonorrhea, a single oral dose of 2 g of azithromycin is advised, complemented by a single intramuscular injection of 240 milligrams (mg) of gentamicin.(3)
- Nongonococcal Urethritis: Treatment may involve a single oral dose of 1 g of azithromycin. Alternatively, a regimen of 500 mg orally in a single dose followed by 250 mg orally daily for 4 days may be recommended.(10)
- Cervicitis Treatment: For cervicitis, the usual recommendation is a single oral dose of 1 g of azithromycin.(11)
These dosage guidelines are indicative, and it is crucial to adhere strictly to the advice and prescription provided by a healthcare professional.
Potential Risks and Side Effects of using Azithromycin for STIs
As with any medication, azithromycin may also lead to certain side effects. It is important to seek medical advice if you experience any kind of severe or persistent reaction. Some of these are given below.(12)
Common side effects that might occur and should be monitored include:
On rare occasions, more severe side effects might manifest, which require immediate medical attention. These can include:
- Fast, irregular, or pounding heartbeat
- Dizziness leading to fainting
- Rash accompanied by fever
- Development of blisters or skin peeling
- Presence of fever with pus-filled blister-like sores, skin redness, and swelling
- Hives
- Itching
- Difficulty in breathing or swallowing
- Swelling of facial features (face, throat, tongue, lips, eyes), hands, feet, ankles, or lower legs
- Hoarseness
Should any of these severe symptoms occur, seeking prompt medical attention is crucial. It’s essential to report any side effects experienced while taking azithromycin to your healthcare provider.
Being Aware of the STI Testing Guidelines
For individuals who are sexually active or engaging in sexual practices that involves being potentially exposed to sexually transmitted infections, regular STI testing is crucial in order to safeguard their overall health. Here are some of the recommended STI testing guidelines:(13,14)
- Adults and Adolescents (Aged 13–64): It is advisable to undergo at least one HIV test.
- Sexually Active Females:
- Females under 25: Annual testing for gonorrhea and chlamydia is recommended.
- Females over 25 with risk factors (e.g., new or multiple sexual partners, partner with an STI): Annual gonorrhea and chlamydia testing is advised.
- Pregnant Individuals: Consider testing for syphilis, HIV, hepatitis B, hepatitis C, chlamydia, and gonorrhea early in pregnancy.
- Sexually Active Males who have Sex with Males:
- Test annually for syphilis, chlamydia, and gonorrhea.
- HIV testing should be done annually.
- Consider hepatitis C testing every year if living with HIV. Frequent testing (e.g., every 3–6 months) might be warranted for those with multiple or anonymous partners.
- Sexually Active Males who have Sex with Females: While evidence for screening at low risk is limited, considering testing upon becoming sexually active might be beneficial.
- Transgender and Gender Diverse Individuals: Follow screening recommendations based on anatomy. Annual testing may be considered based on risk factors.
- Individuals Engaging in Oral or Anal Sex: Discuss throat and rectal testing options with a healthcare professional.
It is important to understand that these recommendations only provide a general guideline. It is, however, important to consult a healthcare provider for seeking personalized advice based on your individual risk factors and sexual practices. Testing frequency and scope may vary depending on your specific circumstances and potential exposure.
Things you should know about Using Azithromycin for STIs
Azithromycin’s Effectiveness and Timeframe
- Treatment Duration with Azithromycin: Azithromycin typically takes around one week to start effectively treating an STI. Complete clearance of the infection may take up to two weeks, with potential symptom relief within two to three days.
- Preventing Transmission During Treatment: To prevent transmission, it’s advisable to avoid sexual contact until the infection completely clears.
Consequences of Untreated STIs
- Worsening Symptoms and Severity: If left untreated, symptoms of STIs may worsen and lead to severe complications.(15,16)
- Specific Risks: For example, untreated chlamydia can result in pelvic inflammatory disease in females, leading to infertility and chronic abdominal pain.(17) In males, it may cause testicular pain and infertility.(18) Additionally, untreated STIs can pose risks during pregnancy, potentially transmitting infections to the baby during delivery.
Tips to Prevent STIs
Here are some important tips to help prevent the transmission and contraction of sexually transmitted infections (STIs).
- Adhere to Safe Sexual Practices: Practice safer sex by correctly and consistently using condoms (external or internal) during vaginal, anal, or oral sex. This significantly reduces the risk of STI transmission.
- Undergo Regular STI Testing: Get tested regularly for STIs, especially if sexually active or engaging in new sexual relationships. Early detection allows for timely treatment and prevents the spread of infections.
- Limit your Sexual Partners: Reducing the number of sexual partners can lower the risk of exposure to STIs. Maintaining a monogamous relationship with a partner who is also STI-free drastically lowers your transmission risk.
- Open Communication with Partners: Discuss sexual health and STI status with potential partners before engaging in sexual activities. Open communication helps in making informed decisions.
- Get your Vaccinations: Receive recommended vaccinations for STIs such as HPV (Human Papillomavirus). Vaccination can prevent the transmission of certain infections and is often recommended for adolescents and young adults.
- Undergo Regular Health Check-ups: Undergo routine check-ups with healthcare providers to monitor sexual health and discuss any concerns or symptoms.
- Avoid Sharing Needles: Refrain from sharing needles or other injection equipment, as this can spread blood-borne infections like HIV or hepatitis.(19)
- Practice Good Hygiene: Keep genital areas clean and maintain proper hygiene practices to reduce the risk of certain infections.
- Stay Informed about STDs and STIs: Educate yourself about STIs, their modes of transmission, and prevention methods. Knowledge empowers individuals to make informed choices about sexual health.
- Seek Treatment Promptly: If diagnosed with an STI or experiencing symptoms, seek immediate medical attention, adhere to prescribed treatment, and complete the entire course of medication as directed.
By incorporating these preventive measures into your lifestyle, you can significantly reduce the risk of contracting and spreading sexually transmitted infections.
Conclusion
Azithromycin, a widely prescribed antibiotic, is as an effective remedy for bacterial sexually transmitted infections (STIs) like chlamydia. Its common use often underscores its efficacy in managing these infections effectively.
However, it is important to know that untreated STIs can lead to a variety of severe health complications, making preventive measures crucial for sexually active individuals. Embracing safer sex practices, consistent condom use, limiting sexual partners, and undergoing regular screenings play pivotal roles in reducing the risk of contracting STIs.
So, while azithromycin can prove to be a valuable tool in the treatment of bacterial STIs, prevention still remains paramount. Combining effective treatments with proactive preventive measures ensures better sexual health outcomes, minimizing the risk of STIs and their potential long-term consequences.
- Bakheit, A.H., Al-Hadiya, B.M. and Abd-Elgalil, A.A., 2014. Azithromycin. Profiles of drug substances, excipients and related methodology, 39, pp.1-40.
- Chlamydial infections – STI treatment guidelines (2021) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm (Accessed: 01 December 2023).
- Gonococcal infections among adolescents and adults – STI treatment guidelines (2022) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm (Accessed: 01 December 2023).
- Geisler, W.M., Uniyal, A., Lee, J.Y., Lensing, S.Y., Johnson, S., Perry, R.C., Kadrnka, C.M. and Kerndt, P.R., 2015. Azithromycin versus doxycycline for urogenital Chlamydia trachomatis infection. New England Journal of Medicine, 373(26), pp.2512-2521.
- Dombrowski, J.C., Wierzbicki, M.R., Newman, L.M., Powell, J.A., Miller, A., Dithmer, D., Soge, O.O. and Mayer, K.H., 2021. Doxycycline versus azithromycin for the treatment of rectal chlamydia in men who have sex with men: a randomized controlled trial. Clinical Infectious Diseases, 73(5), pp.824-831.
- Dukers-Muijrers, N.H., Wolffs, P.F., De Vries, H., Götz, H.M., Heijman, T., Bruisten, S., Eppings, L., Hogewoning, A., Steenbakkers, M., Lucchesi, M. and Schim van der Loeff, M.F., 2019. Treatment effectiveness of azithromycin and doxycycline in uncomplicated rectal and vaginal Chlamydia trachomatis infections in women: a multicenter observational study (FemCure). Clinical Infectious Diseases, 69(11), pp.1946-1954.
- (No date) Bashh Clinical Effectiveness Group – BASHH guidelines. Available at: https://www.bashhguidelines.org/media/1191/update-on-the-treatment-of-chlamydia-trachomatis-infection-final-16-9-18.pdf (Accessed: 01 December 2023).
- (No date a) Sexually transmitted infections treatment guidelines, 2021. Available at: https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf (Accessed: 01 December 2023).
- DailyMed – azithromycin tablet, film coated azithromycin powder, for suspension (no date) U.S. National Library of Medicine. Available at: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f5b6daad-b5a9-462d-8e10-db22a7af1c72 (Accessed: 01 December 2023).
- Nongonococcal urethritis (NGU) (2021) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/stiapp/ngu.html (Accessed: 01 December 2023).
- Urethritis and Cervicitis – STI treatment guidelines (2022) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/std/treatment-guidelines/urethritis-and-cervicitis.htm (Accessed: 01 December 2023).
- Bakheit, A.H., Al-Hadiya, B.M. and Abd-Elgalil, A.A., 2014. Azithromycin. Profiles of drug substances, excipients and related methodology, 39, pp.1-40.
- CDC (2021). STI Screening Recommendations. [online] www.cdc.gov. Available at: https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm.
- National Academies of Sciences, E., Division, H. and M., Practice, B. on P.H. and P.H., States, C. on P. and C. of S.T.I. in the U., Crowley, J.S., Geller, A.B. and Vermund, S.H. (2021). STI Screening and Treatment Guidelines Issued by Health Professional Societies. [online] www.ncbi.nlm.nih.gov. National Academies Press (US). Available at: https://www.ncbi.nlm.nih.gov/books/NBK573163/.
- Aral, S.O., 2001. Sexually transmitted diseases: magnitude, determinants and consequences. International journal of STD & AIDS, 12(4), pp.211-215.
- Henkel, R., 2021. Long-term consequences of sexually transmitted infections on men’s sexual function: A systematic review. Arab Journal of Urology, 19(3), pp.411-418.
- Geisler, W.M., Wang, C., Morrison, S.G., Black, C.M., Bandea, C.I. and HOOK III, E.W., 2008. The natural history of untreated Chlamydia trachomatis infection in the interval between screening and returning for treatment. Sexually transmitted diseases, pp.119-123.
- Golden, M.R., Schillinger, J.A., Markowitz, L. and ST. LOUIS, M.E., 2000. Duration of untreated genital infections with Chlamydia trachomatis: a review of the literature. Sexually transmitted diseases, pp.329-337.
- Strathdee, S.A., Abramovitz, D., Lozada, R., Martinez, G., Rangel, M.G., Vera, A., Staines, H., Magis-Rodriguez, C. and Patterson, T.L., 2013. Reductions in HIV/STI incidence and sharing of injection equipment among female sex workers who inject drugs: results from a randomized controlled trial. PloS one, 8(6), p.e65812.
