CDC Expert Commentary

The Latest STD Treatment Guidelines

Kimberly Workowski, MD

Disclosures

December 20, 2010

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Hello, I am Dr. Kimberly Workowski, Infectious Diseases Specialist in the Division of STD Prevention at the Centers for Disease Control and Prevention and lead author of the recently-released 2010 STD Treatment guidelines. I am speaking to you as part of the CDC Expert Series on Medscape.

Over the next few minutes, I will highlight new information from the 2010 STD guidelines. These guidelines are intended to assist the clinician with the management of persons who have, or are at risk for, sexually transmitted diseases. Although these guidelines emphasize treatment, prevention strategies and diagnostic evaluation are also discussed.

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, or GC, 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.

The complete treatment guidelines can be viewed and downloaded at cdc.gov/std/treatment/2010.

Related Resource

Sexually Transmitted Diseases

Kimberly Workowski, MD, is a Professor of Medicine in the Division of Infectious Diseases at Emory University. Dr Workowski is also the coordinator of the CDC STD Treatment Guidelines in the Division of STD Prevention at CDC. These treatment guidelines are the international standard for the evaluation and management of sexually transmitted diseases. Current research interests include the pathogenesis, antimicrobial resistance, and clinical management of sexually transmitted infections, translational research on the immunologic aspects of hepatitis C persistence, HIV and hepatitis C antiviral clinical trials, T vaginalis antimicrobial resistance, and vaginal microbicides.

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