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Bacterial STIs are the most common and the most straightforwardly curable. Treatment is typically a single dose or short course; the challenge is more often partner treatment and reinfection prevention than the treatment itself.

Chlamydia: first-line is doxycycline 100mg twice daily for 7 days; alternative is azithromycin 1g single dose (used less frequently now due to emerging resistance). Rectal chlamydia: doxycycline preferred. Test of cure at 3 weeks for rectal cases or where compliance is uncertain. In pregnancy, azithromycin is used instead of doxycycline.

Gonorrhoea: first-line is ceftriaxone 1g intramuscular single dose, combined with doxycycline 100mg twice daily for 7 days (which also covers possible co-infection with chlamydia). Test of cure at 2 weeks, particularly for pharyngeal infection. Increasing antibiotic resistance is closely monitored.

Syphilis: early syphilis (<2 years) is treated with benzathine penicillin 2.4 million units intramuscular, single dose. Late or unknown-duration syphilis: weekly doses for 3 weeks. Follow-up: serology at 3, 6, and 12 months to confirm response. Penicillin allergy is managed with doxycycline alternative.

Trichomoniasis: first-line is metronidazole 2g single oral dose or 500mg twice daily for 7 days. Tinidazole 2g single dose is an alternative. No alcohol for 48 hours after metronidazole. Partner treatment essential.

Across all bacterial STIs: avoid sexual activity for 7 days after treatment (or until completion of longer course); partner notification confidentially supported by Hisential; retest at 3 months because reinfection - particularly with chlamydia - is common.

Viral STIs require different approaches than bacterial. Some are managed with intermittent treatment of outbreaks; some with daily suppressive therapy; some with long-term monitoring; one (hepatitis C) is now curable.

Herpes simplex virus (HSV-1 and HSV-2). Episodic treatment - start a short antiviral course at the very first sign of an outbreak (tingling, before lesions appear). Typically valaciclovir 1g twice daily for 5 days, or aciclovir 400mg three times daily for 5 days.

Suppressive treatment - daily antiviral to prevent outbreaks and reduce transmission to partners. Typically valaciclovir 500mg daily, or aciclovir 400mg twice daily. Suppressive treatment is appropriate for frequent outbreaks (more than 6 per year), transmission concerns in mixed-status couples, or quality-of-life impact. Daily suppressive treatment reduces HSV-2 transmission to partners by approximately 50%.

Hepatitis B. Acute hepatitis B usually resolves on its own; supportive care and monitoring are the main interventions. Sexual partners and household contacts should be vaccinated if not already immune. Chronic hepatitis B (persistent infection beyond 6 months) is managed long-term - not all patients need antiviral treatment, but where indicated, tenofovir or entecavir is taken indefinitely.

Hepatitis C. A dramatic change in the last decade - modern direct-acting antivirals (DAAs) cure hepatitis C in over 95% of cases with 8-12 weeks of oral medication. Cure means the virus is eliminated; immunity does not develop, so reinfection is possible if exposure recurs. Treatment is coordinated through hepatology referral.

HIV. Modern HIV antiretroviral therapy (ART) is highly effective - most patients on treatment achieve undetectable viral load within 3-6 months, and undetectable viral load eliminates sexual transmission risk (U=U). Treatment is typically one or two pills daily with minimal side effects. HIV care is coordinated through expert referral with continuity maintained by your personal health concierge.

HPV (human papillomavirus) is the most common STI worldwide, but most infections are asymptomatic and clear on their own within 1-2 years. Treatment becomes necessary when HPV produces visible warts or when high-risk strains require monitoring for cancer prevention.

Topical immune modulators - imiquimod cream applied 3 times weekly for up to 16 weeks. Activates the local immune response to clear the warts. Patient-applied at home; good for multiple or hard-to-reach lesions.

Cryotherapy - liquid nitrogen freezing applied in-clinic. Quick, effective, sometimes requiring 2-3 sessions. Suitable for accessible external warts.

Surgical excision or electrosurgery - for larger, resistant, or extensive warts. Performed under local anaesthesia in-clinic. Topical podophyllotoxin is also available as a self-applied solution for selected lesions.

Choice depends on lesion location, size, number, and patient preference. Most patients respond well to first-line treatment; recurrence occurs in 20-30% of cases and may require repeat treatment.

For high-risk HPV without visible warts: most cases require monitoring rather than treatment. High-risk HPV strains (16, 18, and others) are associated with cancer of the cervix, anus, penis, throat, and other sites - but most clear spontaneously. Where monitoring is needed, structured follow-up is scheduled.

HPV vaccination. The HPV vaccine (Gardasil 9) is highly effective at preventing infection by the most common high-risk and wart-causing strains. Available for both men and women, ideally before sexual debut but with meaningful benefit at any age.

Treating the index patient without addressing partners means treating reinfection in a loop. Partner notification is core clinical practice for STI care, and it's handled confidentially.

Patient-led notification - most patients prefer to inform partners directly. Hisential supports this with information about how, when, and what to say. Anonymous notification letters can be provided if helpful - a partner receives a letter stating they may have been exposed and should consider testing, without naming the index patient.

Provider-led notification - for partners who would prefer not to make direct contact (or where the relationship has ended difficultly), Hisential can facilitate confidential notification to past partners on the patient's behalf, without revealing the patient's identity.

Anonymous online tools - services like tellyourpartner.org allow anonymous SMS or email notification. We can guide on appropriate use. The choice of approach is the patient's. The clinical priority is that partners get tested and treated.

Follow-up after treatment. Test of cure - for specific infections (gonorrhoea, syphilis, sometimes rectal chlamydia), a follow-up test confirms cure. Timing varies by infection: 2 weeks for gonorrhoea, 3 weeks for rectal chlamydia, 3-12 months for syphilis serology.

Retesting - even after confirmed cure, retesting at 3 months is recommended because reinfection from untreated partners is common. Vaccination review - a positive STI result is an opportunity to update hepatitis B and HPV vaccination if not previously completed.

Confidentiality. Records are encrypted. Hisential does not share information with employers, family, or insurers without your explicit consent. Partner notification is always done in a way that protects your identity unless you specifically choose otherwise.