CDC releases new treatment guidelines for STDs
Any patient who tests positive for chlamydia, gonorrhea, or trichomoniasis should be rescreened 3 months after treatment, according to the guidelines.
The CDC has updated its 2010 clinical guidelines for preventing and treating sexually transmitted diseases (STDs).
Changes include management of transgender patients, tests for repeat infections, annual screening for hepatitis C virus (HCV) for HIV-positive patients, new recommendations for human papillomavirus (HPV) vaccines, and alternative treatments for gonorrhea. The update was published June 5 in Morbidity and Mortality Weekly Report.
Gender identity is independent from sexual orientation, so transgender people might have sex with men, women, or both and consider themselves to be heterosexual, gay, lesbian, or bisexual, according to the report. The CDC recommends that clinicians assess STD- and HIV-related risks for transgender patients based on current anatomy and sexual behaviors. Clinicians should remain aware of common STD symptoms and screen transgender patients for asymptomatic STDs according to behavioral and sexual patterns, the guidelines advised.
Any patient who tests positive for chlamydia, gonorrhea, or trichomoniasis should be rescreened 3 months after treatment, according to the guidelines. The guidelines recommend serologic screening for HCV at initial evaluation of patients newly diagnosed with HIV. HIV-positive men who have sex with men should be screened for HCV at least yearly—and more frequently depending on specific circumstances—using HCV antibody assays, followed by HCV RNA testing for those with a positive antibody result, the CDC recommends. HCV screening is cost-effective, and there is accumulating evidence of acute HCV infection acquisition among those with HIV infection, according to the guidelines.
One of the most effective methods of preventing transmission of HPV is pre-exposure vaccination, according to the guidelines. HPV vaccination is recommended routinely for boys and girls aged 11 or 12 years old and can be administered beginning at 9 years old, the CDC says. The agency recommends bivalent, quadrivalent, or 9-valent HPV vaccine for females and quadrivalent or 9-valent vaccine for males. Vaccination is recommended through age 26 for all women, through age 21 for all men, and through age 26 for men who have sex with men and men or women with HIV.
The CDC's recommended regimen for gonorrhea is a single injection of ceftriaxone, 250 mg, plus a single oral dose of azithromycin, 1 g, administered together on the same day, preferably simultaneously and under direct observation. If ceftriaxone is not available, a single oral 400-mg dose of cefixime can be considered as an alternative regimen, although it does not provide as high or sustained bactericidal blood levels as an injected 250-mg dose of ceftriaxone, according to the guidelines.
Other updates discussed in the guidelines include the use of nucleic acid amplification tests for the diagnosis of trichomoniasis, alternative treatment options for genital warts, the role of Mycoplasma genitalium in urethritis and cervicitis, and updated recommendations for diagnostic evaluation of urethritis.