This article includes recommendations for management of most sexually transmitted infections (STIs) other than HIV and viral hepatitis. Some of the indications and dosages recommended here have not been approved by the FDA (see Table 1).

The US Advisory Committee on Immunization Practices (ACIP) recommends routine use of the following vaccines in adults residing in the US: influenza, tetanus/diphtheria alone (Td) and in combination with acellular pertussis (Tdap), measles/mumps/rubella (MMR), varicella (VAR), herpes zoster (RZV; ZVL), human papillomavirus (HPV), and pneumococcal conjugate (PCV13) and polysaccharide (PPSV23) vaccines. For adults with certain medical conditions or occupational, behavioral, or other risk factors, hepatitis A (HepA), hepatitis B (HepB), meningococcal (MenACWY; MenB), and Haemophilus influenzae type b (Hib) vaccines are also recommended. Recommendations for vaccination against seasonal influenza and vaccination of travelers are reviewed separately.

The text and tables that follow include recommendations for management of sexually transmitted infections (STIs) other than HIV and viral hepatitis. Some of the indications and dosages recommended here have not been approved by the FDA.

Vaccines recommended for routine use in US adults are reviewed here. Vaccines for travel have been reviewed separately.

The FDA has approved a new indication for prevention of anal cancer and anal intraepithelial neoplasia in both sexes for the human papillomavirus (HPV) vaccine Gardasil (Merck). This vaccine is already FDA-approved for prevention of cervical cancer and genital warts in females 9-26 years old and for prevention of genital warts in males 9-26 years old. HPV types 6 and 11 cause about 90% of genital warts. Types 16 and 18 cause more than 70% of cervical cancer and about 80% of anal cancer.1 Gardasil is highly effective in preventing infection with HPV types 6, 11, 16 and 18 in both males and females.2,3 (A second HPV vaccine, Cervarix, is also effective in preventing infection with types 16 and 18, but has no activity against types 6 and 11; it has not been approved for any indication in males.4)

Since 40% of women become infected with HPV within 16 months after initiation of sexual activity and neither vaccine prevents cancer if it is given after infection, vaccination against HPV is now recommended routinely for girls 11-12 years old. Routine vaccination of boys with Gardasil would benefit unvaccinated girls as well as the boys themselves.

1. H De Vuyst et al. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer 2009; 124:1626.

2. A human papillomavirus vaccine. Med Lett Drugs Ther 2006; 48:65.

3. AR Giuliano et al. Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males. N Engl J Med 2011; 364:401.<

4. Cervarix – A second HPV vaccine. Med Lett Drugs Ther 2010; 52:37.

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The drugs of choice for treatment of non-HIV viral infections and their dosages are listed in Tables 1-6 on the pages that follow. Some of the indications and dosages recommended here have not been approved by the FDA. Vaccines used for the prevention of viral infections are discussed in another issue of Treatment Guidelines.

Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric infections. The drugs of choice, their dosages and alternatives are listed in a table that begins on page 54. A table listing the adverse effects of some of these antimicrobials begins on page 58.

Although immunization programs have produced high vaccination rates in US infants and children, similar successes have not been achieved in adults. Vaccines recommended for routine use in adults are reviewed here. Vaccines for travel are reviewed separately.

The FDA has approved the marketing of sinecatechins (Veregen - Bradley/Medigene), a botanical drug product, for treatment of external genital and perianal warts. Sinecatechins is a water extract of green tea leaves from Camellia sinensis. It is a mixture of catechins and other green tea components.

Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric infections. Guidelines are available from the US Centers for Disease Control and Prevention (CDC) with detailed recommendations for treatment of these diseases.

The drugs of choice for treatment of non-HIV viral infections with their dosages and cost are listed in Tables 1-6. Some of the indications and dosages recommended here have not been approved by the FDA. Vaccines used in the prevention of viral infections are discussed in the "Adult Immunization" issue of Treatment Guidelines.

A recombinant quadrivalent human-papillomavirus-like particle vaccine, Gardasil (Merck), has been approved by the FDA for use in girls and women 9-26 years old to prevent diseases associated with infection with human papillomavirus (HPV) types 6, 11, 16, and 18, including genital warts, precancerous cervical, vaginal or vulvar lesions, and cervical cancer.

The drugs of choice for non-HIV viral infections with their dosages and cost are listed in the tables that begin on page 24. Some of the indications and dosages recommended here have not been approved by the FDA.

Many infections can be transmitted during sexual contact. The text and tables that follow are limited to management of sexually transmitted infections (STIs) other than HIV, viral hepatitis and enteric infections. Guidelines are available from the US Centers for Disease Control and Prevention (CDC) with detailed recommendations for treatment of these diseases (MMWR Recomm Rep 2002; 51, RR-6:1). New guidelines are expected soon.

Imiquimod cream 5% (Aldara - 3M), an immune modifier previously approved for treatment of genital and perianal warts (Medical Letter 1997; 39:118), has now been approved by the FDA for treatment of actinic keratoses (AKs) on the face or scalp, and may also be approved soon for treatment of basal cell carcinoma. It produces apoptosis in malignant, but not normal, human keratinocytes (M Sch÷n et al, J Natl Cancer Inst 2003; 95:1138).

Many infections can be transmitted during sexual contact. The text and tables [in this article] are limited to treatment of non-HIV infections associated primarily with sexual transmission.

Recombinant interferon alfa-2b (Intron A - Schering) was recently approved by the US Food and Drug Administration (FDA) for intralesional treatment of genital warts (condylomata acuminata). Interferon was previously available only for treatment of hairy-cell leukemia (Medical Letter, 28:78, 1986).