CDC issues STD treatment update

Updated information on HIV, STDs

The Centers for Disease Control and Prevention has released new guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs).1

Published Dec. 17, 2010, the guidelines were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 18–30, 2009. The information in the report updates the 2006 Guidelines for Treatment of Sexually Transmitted Diseases. Included in the updated guidelines is new information regarding:

1) the expanded diagnostic evaluation for cervicitis and trichomoniasis;

2) new treatment recommendations for bacterial vaginosis and genital warts;

3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy;

4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications;

5) lymphogranuloma venereum proctocolitis among men who have sex with men;

6) the criteria for spinal fluid examination to evaluate for neurosyphilis;

7) the emergence of azithromycin-resistant Treponema pallidum;

8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C;

10) diagnostic evaluation after sexual assault; and

11) STD prevention approaches.

The guidelines reiterate that early diagnosis of HIV infection is essential to ensuring that patients are referred promptly for evaluation, provided treatment (if indicated), and linked into counseling and related support services to help them reduce their risk for transmitting HIV to others. Diagnosing persons during acute infection is particularly important. It is during this phase that HIV-infected persons are most infectious, but test negative for HIV antibodies and therefore unknowingly continue to engage in those high-risk behaviors associated with HIV transmission.

Providers are in a particularly good position to diagnose persons during acute HIV infection because such persons might present for assessment and treatment of a concomitantly acquired STD during this phase of the disease. Knowing that a patient is infected with HIV has important clinical implications because HIV infection alters the immune system and thereby affects the diagnosis, evaluation, treatment, and follow-up of other STDs, the CDC reports.

Reference

  1. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(RR12):1-110.