How STDs Are Treated: Current Guidelines by Infection

STD treatment depends on whether the infection is bacterial or viral. Bacterial STDs are curable with antibiotics. Viral STDs are managed with antivirals or, in some cases, through immune clearance. Here is what the current evidence and CDC guidelines say about treatment for each major infection.

Quick answer: Chlamydia: doxycycline 7 days or azithromycin single dose. Gonorrhea: ceftriaxone IM single injection. Syphilis: penicillin G. Trichomoniasis: metronidazole. Herpes: acyclovir or valacyclovir (suppresses, does not cure). HIV: antiretroviral therapy (suppresses to undetectable, does not cure). HPV: no antiviral treatment for the virus itself; treatment targets warts and pre-cancerous lesions. All bacterial STDs are curable. Viral STDs are manageable but not currently curable. Testing available in Los Angeles, Dallas, Orlando, New York City, and Atlanta.

Bacterial STDs: Curable with Antibiotics

Chlamydia: CDC first-line treatment is doxycycline 100mg twice daily for 7 days. This regimen has higher efficacy than azithromycin for rectal chlamydia and is preferred for most presentations. Azithromycin 1g single dose is an alternative when adherence is a concern, and is the preferred regimen in pregnancy. Abstain from sex for 7 days after completing treatment; both partners must be treated simultaneously.

Gonorrhea: Ceftriaxone 500mg IM single injection (or 1g for weight >150kg). Dual therapy with azithromycin is no longer routinely recommended due to azithromycin resistance. Treatment resistance is monitored actively. Test of cure is recommended for pharyngeal gonorrhea and in any case of suspected treatment failure. Do not accept oral antibiotics alone as definitive gonorrhea treatment in 2025.

Syphilis: Penicillin G is the treatment of choice at all stages. Primary, secondary, and early latent syphilis: benzathine penicillin G 2.4 million units IM single dose. Late latent or unknown duration: 3 weekly doses. Neurosyphilis: aqueous crystalline penicillin G IV for 10–14 days. In pregnancy: penicillin G is mandatory even in penicillin-allergic patients (desensitisation required).

Trichomoniasis: Metronidazole 500mg twice daily for 7 days (women); single 2g dose (men). Tinidazole 2g single dose is an alternative. Both partners must be treated simultaneously. Reinfection rates are high — retest 3 months after treatment.

Viral STDs: Managed, Not Cured

Herpes (HSV-1/2): Antivirals — acyclovir, valacyclovir, famciclovir — suppress replication, reduce outbreak frequency by 70–80%, and reduce asymptomatic shedding and transmission risk by approximately 50%. They do not eliminate the virus. Suppressive therapy (daily dosing) is recommended for people with frequent outbreaks or in serodiscordant relationships. Episodic therapy (treatment at outbreak onset) reduces duration and severity.

HIV: Antiretroviral therapy (ART) — typically 1–2 pills daily — suppresses viral replication to undetectable levels, preventing progression to AIDS and eliminating sexual transmissibility per U=U. Modern regimens have minimal side effects. The goal is sustained undetectable viral load. ART does not cure HIV; the virus remains in latent reservoirs.

HPV: No antiviral treatment exists for HPV itself. The immune system clears most infections within 1–2 years. Treatment targets the consequences of infection: topical agents or procedures for genital warts, and colposcopy/LEEP/cryotherapy for cervical dysplasia. The Gardasil 9 vaccine prevents infection with nine strains but does not treat existing infection.

Hepatitis B (chronic): Tenofovir or entecavir suppress HBV replication, reducing liver damage and cirrhosis risk. These are not curative — most people require long-term treatment. Acute hepatitis B in adults clears spontaneously in approximately 95% of cases.

Hepatitis C: Direct-acting antiviral (DAA) regimens achieve sustained virological response (functional cure) in over 95% of patients after 8–12 weeks of treatment. Hepatitis C is the only major viral STD that is functionally curable with current medications.

When to Seek Urgent Care

• Pelvic pain or fever during gonorrhea or chlamydia treatment: possible PID developing — same-day evaluation, may require IV antibiotics.

• HIV exposure in last 72 hours: go to ER for PEP immediately.

• Syphilis with eye symptoms, neurological symptoms, or pregnancy: same-day evaluation.

Frequently Asked Questions

How do I know if my STD treatment worked?

For bacterial STDs, a test of cure (repeat NAAT at 3–4 weeks after treatment) is recommended for gonorrhea, for chlamydia in pregnancy, and whenever symptoms persist. For syphilis, follow-up RPR/VDRL at 6 and 12 months confirms adequate serological response. For HIV, viral load testing at 4–8 weeks after starting ART confirms that the regimen is suppressing the virus.

Related: Chlamydia Treatment · Bacterial vs Viral STDs · When Can You Have Sex After Treatment? · Get tested today →