Quick Clinical Reference

Symptoms, tests, treatment & reporting

Reporting: 24 hours Urgent
STI	Common Symptoms	Recommended Tests	First-Line Treatment
Syphilis Primary/Secondary	Painless ulcer/chancre Rash on palms/soles Lymphadenopathy Fever, malaise	Screening: RPR or VDRL Confirmatory: TP-PA or FTA-ABS	Benzathine penicillin G 2.4 million units IM single dose Alt: Doxycycline 100mg PO BID × 14 days
Syphilis Late Latent / Unknown Duration	No clinical signs or symptoms Serologic evidence of infection Stage using history and prior results	Screening: RPR or VDRL Confirmatory: TP-PA or FTA-ABS	Benzathine penicillin G 2.4 million units IM weekly × 3 weeks Alt: Doxycycline 100mg PO BID × 28 days Outside this regimen: Neurologic, ocular, or hearing symptoms need separate evaluation. Gummas or cardiovascular disease suggest tertiary disease. See CDC neurosyphilis/ocular/otic guidance and tertiary syphilis guidance.
HIV New Diagnosis	Often asymptomatic Acute: flu-like illness Fever, rash Lymphadenopathy	Screening: 4th gen Ag/Ab test Confirmatory: HIV-1/2 differentiation + NAT	Refer to HIV specialist Initiate ART same day if possible Link to care within 72 hours
Gonorrhea Urogenital/Rectal	Dysuria Purulent discharge Pelvic pain (women) Often asymptomatic	Preferred: NAAT (urine, swab) Urogenital, rectal, pharyngeal sites	Ceftriaxone 500mg IM Single dose · 1g if ≥150kg Cephalosporin allergy: Gentamicin 240mg IM + Azithromycin 2g PO · If ceftriaxone unavailable: Cefixime 800mg PO + Treat for chlamydia if not excluded (Doxycycline 100mg PO BID × 7d)
Chlamydia Urogenital/Rectal	Often asymptomatic Dysuria Discharge Pelvic pain (women)	Preferred: NAAT (urine, swab) Urogenital, rectal, pharyngeal sites	Doxycycline 100mg PO Twice daily × 7 days Alt: Azithromycin 1g PO single dose
Hepatitis C Chronic	Often asymptomatic Fatigue Jaundice (rare) Elevated liver enzymes	Screening: HCV antibody Confirmatory: HCV RNA (viral load)	Refer to specialist Direct-acting antivirals (DAAs) 8-12 weeks treatment, >95% cure rate

Reporting: none Not required
STI	Common Symptoms	Recommended Tests	First-Line Treatment
Trichomoniasis Vaginal/Urethral	Frothy discharge Vaginal odor Itching, irritation Dysuria	Preferred: NAAT Alternative: Wet mount microscopy	Women: Metronidazole 500mg PO BID × 7 days Men: Metronidazole 2g PO single dose Alt: Tinidazole 2g PO single dose
HSV Genital Herpes	Painful vesicles/ulcers Prodrome: tingling, burning Fever, malaise (primary) Recurrent outbreaks	Active lesions: PCR or viral culture Serology: Type-specific HSV-2 IgG when indicated; not routine screening	Primary episode: Acyclovir 400mg PO TID × 7-10 days Recurrent: Acyclovir 800mg PO BID × 5 days
HPV Genital Warts	Visible warts (genital/anal) Usually painless May be cauliflower-like Often asymptomatic	Diagnosis: Clinical (visual inspection) Biopsy if diagnosis uncertain	Patient-applied: Imiquimod 5% cream or Podofilox 0.5% solution Provider-applied: Cryotherapy or TCA 80-90%

Key points to share with patients

Many STIs do not cause symptoms, so you may not know you have one. Getting tested is the best way to protect your health.

Quick things to watchWatch for symptoms such as unusual discharge, sores, itching, pain, or burning during urination. If you notice any changes, contact a healthcare provider.

ContraindicationsSome medications may not be safe for everyone. Always tell your healthcare provider about your medical conditions and any medicines you take.

AllergiesTell your healthcare provider if you have any allergies, especially to medications. This helps them choose the safest treatment for you.

Follow-upFollow your provider’s instructions and take all medications as prescribed. You may need follow-up testing to make sure the infection is gone or being properly managed.

Talking with your partnerBe honest with your partner about your STI status and encourage them to get tested. Follow your provider’s waiting period before sex, including after single-dose treatment and until partners are treated.

If you are pregnantTell your healthcare provider if you are pregnant or think you may be pregnant. Early testing and treatment can help protect both you and your baby.

Important Clinical Notes

PregnancyScreen all pregnant patients for syphilis, HIV, hepatitis B and hepatitis C at the first prenatal visit; screen for gonorrhea and chlamydia according to age and risk. Per ACOG/ARPQC, screen every pregnant patient for syphilis at three time points — the first prenatal visit, the third trimester, and at birth (universal, not risk-based).

Partner notificationUse infection-specific partner windows. Chlamydia/gonorrhea: evaluate partners from the prior 60 days, including the most recent partner if earlier. Syphilis: primary, 3 months plus symptom duration; secondary, 6 months plus symptom duration; early latent, 1 year. Evaluation and presumptive treatment depend on timing and test results. EPT is an option for eligible gonorrhea/chlamydia partners, not syphilis. CDC syphilis partner management

Co-infectionAssess for co-infections and select additional tests by diagnosis, exposure sites, age, and risk. Patients with one STI are at higher risk for others.

Follow-upSchedule test-of-cure and retest appointments according to CDC guidelines. High reinfection rates in SUD populations require vigilant follow-up.

AllergiesDocument penicillin allergies carefully. Pregnant women with syphilis and penicillin allergy require desensitization.

ContraindicationsReview contraindications and drug interactions before prescribing — e.g. doxycycline and tetracyclines are contraindicated in pregnancy; for metronidazole, review product labeling and discuss alcohol use; CDC guidance and some product labels differ. Confirm renal/hepatic function and current medications for each patient.

Adapted from current CDC guidance.

Symptoms, tests, treatment & reporting

Key points to share with patients

Important Clinical Notes

Sources / CDC references