STD Treatment guidelines are for the persons who have or are at risk for sexually transmitted diseases (STDs); they were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs on December 20, 2010.
Some of the key changes include the prevention and treatment of HPV, gonorrhea, and lymphogranuloma venereum proctocolitis.
These guidelines highlight expanded prevention recommendations for sexually transmitted infections, including preexposure vaccination for human papillomavirus virus (HPV).Preexposure vaccination is one of the most effective methods to prevent transmission of HPV. There are 2 HPV vaccines licensed for females aged 9 through 26 years to prevent cervical precancer and cancer: the quadrivalent HPV vaccine Gardasil® and the bivalent HPV vaccine Cervarix®. Gardasil will also prevent genital warts. Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is the catch-up vaccination for females aged 13 through 26 years. Gardasil may also be given to males aged 9 through 26 years to prevent genital warts.
Neisseria gonorrhoeae, has developed resistance to many classes of antimicrobials recommended for treatment. Quinolone-resistant Neisseria gonorrhoeae strains are now widely disseminated throughout the United States and the world, and as a result, quinolones are not recommended for the treatment of gonorrhea. Although currently recommended regimens are effective for gonorrhea within the United States, the susceptibility of gonococcal isolates to cephalosporins has been decreasing and treatment failures with oral cephalosporins have been documented in Southeast Asia. Based on prior experience with quinolone-resistant N gonorrhoeae, it is probable that such isolates may spread to the Unites States. Due to these reports, ceftriaxone 250 mg intramuscularly or cefixime 400 mg orally are recommended for urogenital infection. Since many with gonorrhea are coinfected with chlamydia, therapy with azithromycin or doxycycline is recommended.
Lymphogranuloma venereum proctocolitis (LGV) is being increasingly recognized especially among HIV-positive men who have sex with men. In persons with painful perianal ulcers or those detected on anoscopy, presumptive therapy should include treatment for LGV, which is doxycycline 100 mg twice daily for 21 days.
A new patient-applied treatment for genital warts is available. The treatment of 15% sinecatechins ointment should be applied by the patient 3 times daily until complete clearance of the warts.
There is also a new alternative treatment for bacterial vaginosis: 2 g of tinidazole taken daily for 3 days or 1 g taken daily for 5 days. For episodic outbreaks of herpes simplex virus, an additional treatment option is 500 mg of famciclovir followed by 2 days of 250 mg taken twice daily. There are also some data that moxifloxacin — 400 mg daily for 7 days — is effective in nongonococcal urethritis treatment failures due to Mycoplasma genitalium.