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Updated Guidelines for Treatment of Sexually Transmitted Diseases
 The
term STDs is used to refer to a variety of clinical syndromes caused by
pathogens that can be acquired and transmitted through sexual activity.
The present guidelines represent an update of CDC's 2006 recommendations, based
on consultation with a group of experts knowledgeable in the area of STDs who
were convened in Atlanta on April 18 to 30, 2009.
These guidelines were developed to offer recommendations for the treatment
of persons who have or who are at risk for STDs, including human papillomavirus
(HPV) infection and gonorrhoea, with updated information regarding the most
effective treatment regimens, screening strategies, prevention, and vaccination
schedules.
Prevention and control of STDs are based on 5 major strategies:
-
Educating and counseling persons at risk on strategies to reduce risk
for STDs by changing sexual behaviors and using recommended prevention
services;
-
Diagnosing asymptomatic infected persons and symptomatic persons who are
unlikely to obtain diagnostic and management services;
-
Accurately diagnosing and effectively treating and counseling persons
infected with STDs;
-
Evaluating, treating, and counseling sex partners of persons infected
with an STD; and
-
Pre-exposure vaccination of persons at risk for vaccine-preventable
STDs.
Although HPV is the most prevalent STD, most infected individuals remain
asymptomatic, and in 90% of cases, the infection resolves spontaneously within 2
years. In other cases, genital
warts or
cervical cancer may result, depending on the HPV strain. HPV testing can be
incorporated into cervical cancer screening among women older than 30 years but
is not recommended for women younger than 20 years or for men.
Updated information and recommendations in the new guidelines also include
the following:
-
expanded diagnostic evaluation for cervicitis, including testing for
C trachomatis and N gonorrhoeae by nucleic acid amplification,
and testing for bacterial vaginosis (BV) and trichomoniasis;
-
new treatment recommendations for BV (metronidazole 500 mg orally twice
a day for 7 days, or metronidazole gel 0.75%, 1 full applicator [5 g]
intra-vaginally, once a day for 5 days, or clindamycin cream 2%, 1 full
applicator [5 g] intravaginally, at bedtime for 7 days) and for genital
warts (including waiting for spontaneous resolution, or podofilox 0.5%
solution or gel, or imiquimod 5% cream, or sinecatechins 15% ointment);
-
the role of Mycoplasma genitalium and trichomoniasis in
urethritis/cervicitis and treatment-related implications (for nongonococcal
urethritis not caused by C trachomatis, single-dose azithromycin or
doxycycline for 7 days, followed by single-dose metronidazole or tinidazole
if symptoms persist);
-
lymphogranuloma venereum proctocolitis among men who have sex with men;
-
criteria for spinal fluid examination to evaluate for neurosyphilis;
-
emergence of azithromycin-resistant Treponema pallidum —
azithromycin should not be routinely used to treat syphilis, which is still
best treated with penicillin or with a 14-day course of doxycycline in
penicillin-allergic patients;
-
recognition of an increased role for sexual transmission of hepatitis C,
especially in individuals coinfected with
HIV;
-
diagnostic evaluation after sexual assault by an experienced clinician
in a manner that minimizes further trauma, with the decision to obtain
genital or other specimens for STD diagnosis to be made on an individual
basis;
-
prophylaxis and treatment after sexual assault including postexposure
hepatitis B vaccination without hepatitis B immune globulin, and one-time
antibiotic treatment with ceftriaxone or cefixime, metronidazole, and
azithromycin; and
-
STD prevention approaches, including abstinence and reduction of number
of
sex partners, pre-exposure vaccination (including against hepatitis A
and B), barrier methods, male circumcision, and high-intensity behavioral
counseling for all sexually active adolescents and for adults at increased
risk for STDs and HIV.
"These recommendations should be regarded as a source of clinical guidance
and not prescriptive standards; health-care providers should always consider the
clinical circumstances of each person in the context of local disease
prevalence," the guidelines authors write. "They are applicable to various
patient-care settings, including family-planning clinics, private physicians'
offices, managed care organizations, and other primary-care facilities. These
guidelines focus on the treatment and counseling of individual patients and do
not address other community services and interventions that are essential to
STD/human immunodeficiency virus (HIV) prevention efforts."
Content support: medscape.com
Dated 15 December 2011
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