Updated Guidelines for Treatment of STDs

-- Abigail Zuger, MD

Published in AIDS Clinical Care August 28, 2006

Citation(s): Sexually transmitted diseases treatment guidelines, 2006. MMWR
Recomm Rep 2006 Aug 4; 55:1-94.

Changes reflect increasing antibiotic resistance for some infections and new treatment options for others.

The CDC has issued a new set of sexually transmitted disease (STD) treatment guidelines that replace those issued in 2002. The updated guidelines reflect new patterns in disease prevalence, new treatment studies, and evolving drug resistance. Several changes are especially noteworthy:

Azithromycin is now one of the drugs of choice for chlamydia infections during pregnancy, replacing erythromycin. Single-dose tinidazole (Tindamax) joins single-dose metronidazole as a
preferred treatment for trichomoniasis.

Infections with Ureaplasma ureolyticum and Mycoplasma genitalium, both recognized causes of nongonococcal urethritis among men, might respond better to azithromycin than to doxycycline.

Lymphogranuloma venereum, once uncommon in the U.S., should be included in the differential diagnosis of genital ulcer disease in patients of both sexes. This condition can cause severe, refractory proctocolitis in women and in men who have sex with men (MSM).

Quinolone-resistant Neisseria gonorrhoeae continues to cause disease in the western U.S. and among MSM throughout the country. Quinolones should no longer be used to treat gonorrhea in MSM anywhere in the country or in anyone whose infection was acquired in an area with known high rates of resistance.

The new guidelines also contain revised discussions of diagnostic considerations in cervicitis, trichomoniasis, and neurosyphilis; updates on the sexual transmission of hepatitis C virus and the treatment of sexual assault victims; and an overview of STD prevention.