Abstract
Since the advent of the antimicrobial era, single-dose therapy has been a valuable tool in the management of genital infection. Most of the common sexually transmitted infections (STIs) such as gonorrhoea, syphilis, trichomoniasis and chancroid can be treated in this way, as can genital infections which are not sexually transmitted such as bacterial vaginosis and genital tract candidiasis. Until recently, treatment for Chlamydia trachomatis infection required a multidose regimen, but single-dose azithromycin has now been shown to be an effective and acceptable alternative to this. Unfortunately, eradicative therapy has proven to be elusive for the viral STIs such as genital herpes simplex infection, human papilloma virus infection and human immunodeficiency virus (HIV) infection.
The main advantage of single-dose therapy lies in its convenience and in its ability to ensure virtually 100% compliance. This addresses the problems of reduced clinical efficacy and the difficulties in assessing the response to therapy which complicates poor treatment compliance.
However, some single-dose regimens for STIs do have drawbacks, particularly in certain situations. This may be with respect to efficacy, for example in syphilis with single-dose benzathine penicillin therapy, particularly for pregnant women and individuals infected with HI. Alternatively, it may involve toxicity, for example with single-dose metronidazole therapy for trichomoniasis or bacterial vaginosis where a higher rate of gastrointestinal adverse effects may be expected than if a lower multi-dose regimen is used. In addition, single-dose therapy, for example with nevirapine, given to the mother in labour and to the baby after delivery significantly reduces the risk of mother to child HIV transmission, but resistance mutations are frequently detected in the viral genome after the brief exposure to the drug, which could jeopardise its future use.
Single-dose therapy clearly has both advantages and disadvantages. We have reviewed a range of these in a variety of situations, focussing on their applications, effectiveness, compliance and toxicity, highlighting how single-dose therapy may be a double-edged sword.
Similar content being viewed by others
References
Martin DH, Mroczkowski TF, Dalu ZA, et al. and the Azithromycin for Chlamydial Infections Study Group. A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. N Engl J Med 1992; 327: 921–5
George CF, Peveler RC, Heiliger S, et al. Compliance with tricyclic antidepressants: the value of four different methods of assessment. Br J Clin Pharmacol 2000; 50: 166–71
Jonasson G, Kai-Hakon C, Mowinckel P. Asthma drug adherence in a long term clinical trial. Arch Dis Child 2000; 83: 330–3
Cramer JA, Mattson RH, Prevey ML, et al. How often is medication taken as prescribed?. A novel assessment technique. JAMA 1989; 261: 3273–7
Bachmann LH, Stephens J, Richey CM, et al. Measured versus self-reported compliance with doxycycline therapy for chlamydia associated syndromes: high therapeutic success rates despite poor compliance. Sex Transm Dis 1999; 26: 279–80
Augenbraun M, Bachmann L, Wallace T, et al. Compliance with doxycycline therapy in sexually transmitted diseases clinics. Sex Transm Dis 1998; 25: 1–4
Katz BP, Zwickl BW, Caine VA, et al. Compliance with antibiotic therapy for Chlamydia trachomatis and Neisseria gonorrhoeae. Sex Transm Dis 1992; 19: 351–4
Hillis SD, Coles FB, Litchfield B, et al. Doxycycline or Azithromycin for prevention of chlamydial persistence or recurrence one month after treatment in women: a use effectiveness study in public health settings. Sex Transm Dis 1998; 25: 5–11
Carlin EM, Barton SE. Azithromycin as the first line treatment of non-gonococcal urethritis (NGU): a study of follow-up rates, contact attendance and patient’s treatment preference. Int J STD AIDS 1996; 7: 185–9
Somani J, Bhullar VB, Workowski KA, et al. Multiple drug resistant Chlamydia trachomatis associated with clinical treatment failure. J Infect Dis 2000; 181: 421–7
Guidelines for Treatment of Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep 47 (RR-1): 1–118
Clinical Effectiveness Group (Association of Genitourinary Medicine and Medical Society for the Study of Venereal Diseases). National guideline for the management of early syphilis. Sex Transm Infect 1999; 75 Suppl. 1: S29–33
Crowe G, Theodore C, Forster GE, et al. Acceptability and compliance with daily injections of procaine penicillin in the outpatient treatment of syphilis-treponemal infection. Sex Transm Dis 1997; 24: 127–30
Donders GG, Desmyter J, Hooft P, et al. Apparent failure of one injection of benzathine penicillin G for syphilis during pregnancy in human immunodeficiency virus-seronegative African women. Sex Transm Dis 1997; 24: 94–101
Dibber DA, Ray SC. Recrudescence of treated neurosyphilis in a patient with human immunodeficiency virus. Mayo Clin Proc 1999; 74: 53–6
Rolfs RT, Joesoef RM, Hendershot EF, et al. A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. N Engl J Med 1997; 337: 307–14
Clinical Effectiveness Group (Association of Genitourinary Medicine and Medical Society for the Study of Venereal Diseases). National guideline for the management of gonorrhoea. Sex Transm Infect 1999; 75 Suppl. 1: S13–5
PHLS. Epidemiology of STIs in the United Kingdom. Gonorrhoea [online]. Available from URL: http://www.phls.co.uk [Accessed 2002 Jan 7]
Malonza IM, Tyndall MW, Ndinya-Achola JO, et al. A randomised, double-blind, placebo controlled trial of single-dose ciprofloxacin versus erythromycin for the treatment of chancroid in Nairobi, Kenya. J Infect Dis 1999; 180: 186–93
Clinical Effectiveness Group (Association of Genitourinary Medicine and Medical Society for the Study of Venereal Diseases). National guideline for the management of Trichomonas vaginalis. Sex Transm Infect 1999; 75 Suppl. 1: S21–3
Thin RN, Symonds MAE, Booker R, et al. Double blind comparison of a single dose and a five day course of metronidazole in the treatment of trichomoniasis. Br J Vener Dis 1979; 55: 345–6
Hager WD, Brown ST, Kraus SJ, et al. Metronidazole for vaginal trichomoniasis seven day vs single-dose regimens. JAMA 1980; 244: 1219–20
Colli E, Landoni M, Parazzini F Treatment of male partners and recurrence of bacterial vaginosis: a randomised trial. Genitourin Med 1997; 73: 267–70
Clinical Effectiveness Group (Association of Genitourinary Medicine and Medical Society for the Study of Venereal Diseases). National guideline for the management of bacterial vaginosis. Sex Transm Infect 1999; 75 Suppl. 1: S16–8
Blackwell AL, Fox AR, Phillips I, et al. Anaerobic Vaginosis (Non-specific vaginitis): Clinical, Microbiological, and Therapeutic Findings. Lancet 1983; 2(8364): 1379–82
Clinical Effectiveness Group (Association of Genitourinary Medicine and Medical Society for the Study of Venereal Diseases). National guideline for the management of vulvovaginal candidiasis. Sex Transm Infect 1999; 75 Suppl. 1: S19–20
Horowitz BJ, Giaquinta D, Ito S. Evolving pathogens in vulvovaginal candidiasis: implications for patient care. J Clin Pharmacol 1992; 32: 248–55
Walker PP, Reynolds MT, Ashbee HR, et al. Vaginal yeasts in the era of ‘over the counter’ antifungals. Sex Transm Infect 2000; 76: 437–8
Wehbeh HA, Ruggeirio RM, Shahem S, et al. Single-dose azithromycin for chlamydia in pregnant women. J Reprod Med 1998; 43: 509–14
Adair CD, Gunter M, Stovall TG, et al. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynaecol 1998; 91: 165–8
Magid D, Douglas JM, Schwartz JS. Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental cost-effective analysis. Ann Intern Med 1996; 124: 389–99
Stamm WE, Handsfield HH, Rompalo AM, et al. The association between genital ulcer disease and acquisition of HIV infection in homosexual men. JAMA 1988; 260: 1429–33
Cameron DW, Simonsen JN, D’Costa LJ, et al. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet 1989; II: 403–7
Plummer FA, Simonsen JN, Cameron DW, et al. Co-factors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis 1991; 163: 233–9
Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS 1993; 7: 95–102
Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997; 349: 1868–73
Ghys PD, Fransen K, Diallo MO, et al. The associations between cervicovaginal HIV shedding, sexually transmitted diseases and immunosuppression in female sex workers in Abidjan, Cote d’Ivoire. AIDS 1997; 11: F85–93
Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomized controlled trial. Lancet 1995; 346: 530–6
Wawer MJ, Sewankambo N, Serwadda D, et al. Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Lancet 1999; 353: 525–35
Grosskurth H, Gray R, Hayes R, et al. Control of sexually transmitted diseases for HIV-1 prevention: understanding the implications of the Mwanza and Rakai trials. Lancet 2000; 355 Suppl.: WA8–14
Korenromp EL, Van Vliet C, Grosskurth H, et al. Model-based evaluation of single-round mass treatment of sexually transmitted diseases for HIV control in a rural African population. AIDS 2000; 14: 573–93
Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994; 331: 1173–80
Guay LA, Mussoke P, Fleming T, et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 1999; 354(9181): 795–802
Jackson JB, Mracna M, Gavy L, et al. Selection of nevirapine resistant mutations in Ugandan women and infants receiving nevirapine prophylaxis to prevent HIV-1 vertical transmission (HIVNET 012) [abstract no. LbOrl3]. Programme and abstracts of the XIII International AIDS Conference; 2000 Jul 9–14; Durban, South Africa
Acknowledgements
No sources of funding or conflicts of interest to declare in relation to the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kingston, M., Carlin, E. Treatment of Sexually Transmitted Infections with Single-Dose Therapy. Drugs 62, 871–878 (2002). https://doi.org/10.2165/00003495-200262060-00001
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-200262060-00001