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In an update to its 2006 recommendations (JW Womens Health Sep 28 2006), the CDC has published 2010 guidelines for treating sexually transmitted diseases (STDs).
Key changes include:
The “Partners” section of “The Five P's” approach to obtaining sexual histories has a new question: “Is it possible that any of your sex partners in the past 12 months had sex with someone else while they were still in a sexual relationship with you?”
STDs in the “Adolescents” section has been expanded: Recommendations include annual chlamydia screening for all sexually active females aged ≤25; annual gonorrhea screening for at-risk females aged <25 (e.g., previous gonorrheal infection, other STDs, new or multiple partners); and discussion of HIV screening with all teens, encouraging testing for those who are sexually active or who inject drugs.
Nucleic acid amplification testing (NAAT) is the preferred test for chlamydia.
Retesting 3 months after diagnosis of chlamydia or gonorrhea is recommended in all women to detect possible reinfection.
For uncomplicated gonorrhea, the recommended intramuscular ceftriaxone dose is 250 mg, with routine addition of oral azithromycin (1 g, single dose) or doxycycline (100 mg daily for 7 days).
Recommended regimens for suppressing recurrent episodes of genital herpes simplex virus remain unchanged, except to note that famciclovir is somewhat less effective than acyclovir or valacyclovir for suppressing viral shedding.
Bacterial vaginosis should be treated only in symptomatic women. Vaginal metronidazole gel twice weekly for 4 to 6 months lowers risk for recurrence; oral nitroimidazole followed by intravaginal boric acid and metronidazole gel also is an option.
Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010 Dec 17; 59:1.
Comment
Although this long-awaited document is entitled “Treatment Guidelines,” it addresses much more than therapeutic regimens. The “Five P's” offer a simple, efficient way to assess risk, target resources, and focus prevention messages. A “yes” or “not sure” answer to the new risk assessment question has a high predictive value for STD incidence. Notably, 3-month retesting after treatment for chlamydia or gonorrhea is not a “test of cure,” but rather an evaluation for reinfection; this is appropriate, given that women who are treated for either of these infections are at high risk for recurrence. When bacterial vaginosis is identified in reportedly asymptomatic women, we should ask specifically about symptoms; women who consider vaginal odor to be normal could benefit from treatment.