CDC Revamps STI Treatment Guidelines

Lucy Hicks

July 22, 2021

The Centers for Disease Control and Prevention (CDC) today released updated sexually transmitted infection (STI) treatment guidelines to reflect current screening, testing, and treatment recommendations. The guidelines were last updated in 2015.

Dr Kimberly Workowski

The new recommendations come at a pivotal moment in the field's history, Kimberly Workowski, MD, a medical officer at the CDC's Division of STD Prevention, told Medscape Medical News in an email. "The COVID-19 pandemic has caused decreased clinic capacity and drug and diagnostic test kit shortages," she says. Many of these shortages have been resolved, she added, and it is important that healthcare professionals use the most current evidence-based recommendations for screening and management of STIs.

Dr Jeffrey Klausner

Updates to these guidelines were necessary to reflect "continued advances in research in the prevention of STIs, new interventions in terms of STI prevention, and thirdly, changing epidemiology," Jeffrey Klausner, MD, MPH, an STI specialist with the Keck School of Medicine at the University of Southern California, in Los Angeles, told Medscape in an interview. "There's been increased concern about antimicrobial resistance, and that's really driven some of the key changes in these new STI treatment guidelines."

Notable updates to the guidelines include the following:

  • Updated treatment recommendations for gonorrhea, chlamydia, trichomoniasis, and pelvic inflammatory disease

  • Two-step testing for diagnosing genital herpes simplex virus

  • Expanded risk factors for syphilis testing in pregnant women

  • Information on FDA-cleared rectal and oral tests to diagnose chlamydia and gonorrhea

  • A recommendation that universal hepatitis C screening be conducted at least once in a lifetime for adults aged 18 years and older

Workowski emphasized updates to gonorrhea treatment that built on the recommendation published in December 2020 in Morbidity and Mortality Weekly Report. The CDC now recommends that gonorrhea be treated with a single 500-mg injection of ceftriaxone, and if chlamydial infection is not ruled out, treating with a regimen of 100 mg of oral doxycycline taken twice daily for 7 days. Other gonorrhea treatment recommendations include retesting patients 3 months after treatment and that a test of cure be conducted for people with pharyngeal gonorrhea 1 to 2 weeks after treatment, using either culture or nucleic-acid amplification tests.

"Effectively treating gonorrhea remains a public health priority," Workowski said. "Gonorrhea can rapidly develop antibiotic resistance and is the second most commonly reported bacterial STI in the US, increasing 56% from 2015 to 2019.”

The updates to syphilis screening for pregnant women are also important, added Klausner. "We've seen a dramatic and shameful rise in congenital syphilis," he said. In addition to screening all pregnant women at the first prenatal visit, the CDC recommends retesting for syphilis at 28 weeks' gestation and at delivery if the mother lives in an area where the prevalence of syphilis is high or if she is at risk of acquiring syphilis during pregnancy. An expectant mother is at higher risk if she has multiple sex partners, has an STI during pregnancy, has a partner with an STI, has a new sex partner, or misuses drugs, the recommendations state.

Klausner also noted that the updates provide more robust guidelines for treating transgender individuals and incarcerated people.

The treatment guidelines are available online along with a wall chart and a pocket guide that summarizes these updates. The mobile app with the 2015 guidelines will be retired at the end of July 2021, Workowski said. An app with these updated treatment recommendations is in development and will be available later this year.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.