- Category: Human Papillomavirus (HPV)
- Published on Thursday, 16 July 2015 00:00
- Written by HIVandHepatitis.com
In June the U.S. Centers for Disease Control and Prevention (CDC) published updates guidelines for the treatment of sexually transmitted diseases (STDs). The guidelines include information on more than 2 dozen different sexually transmitted infections, as well as STD complications such as pelvic inflammatory disease and cervical and anal cancer.
The report, authored by Kimberly Workowski and Gail Bolan from the CDC's Division of STD Prevention, was prepared after consultation with a group of STD professionals who met in Atlanta in April 2013.
Notable changes include:
- Alternative treatment regimens for gonorrhea, which is often drug-resistant;
- Screening recommendations for gonorrhea and chlamydia;
- Nucleic acid amplification tests for diagnosing trichomoniasis;
- Updated treatment for chlamydia during pregnancy;
- Updated human papillomavirus (HPV) vaccine recommendations;
- Alternative treatment options for genital warts;
- The role of Mycoplasma genitalium in urethritis and cervicitis;
- Information on the clinical care of transgender men and women.
The 2015 Sexually Transmitted Diseases Treatment Guidelines include information about HIV pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and antiretroviral treatment as prevention (TasP).
Information on sexually transmitted hepatitis C virus (HCV) in an "Emerging Issues" section. The new guidelines now recommend that people with HIV should be tested annually for HCV infection.
Below is an edited excerpt from a press release from the National Coalition of STD Directors describing the gonorrhea treatment guidelines and recommended screening for men who have sex with men in more detail.
Centers for Disease Control and Prevention (CDC) Release Updated STD Treatment Guidelines
2015 STD Treatment Guidelines Respond to Trends and Emerging Issues in STD Prevention
Washington, D.C. -- June 4, 2015 -- Today, the Centers for Disease Control and Prevention (CDC) released the 2015 STD Treatment Guidelines, updating their recommendations for treating persons who have or are at risk for sexually transmitted diseases (STDs). This update was written after a consultation in 2013 with a group of professionals knowledgeable in the field of STDs as well as the release of a document for peer review in 2014. NCSD staff and NCSD members were proud to participate in this consultation.
"The testing, treatment, and the prevention of STDs is constantly evolving and CDC's ongoing investment in this intensive effort through development of these guidelines is commendable," stated William Smith, Executive Director of the National Coalition of STD Directors (NCSD). "This document is a comprehensive and authoritative source for promoting sexual health through STD prevention and treatment and NCSD staff and members were pleased to play a role in its development."
The last full update to the CDC STD Treatment Guidelines was in 2010. There have been a number of changes to the guidelines in this updated version. Some of these changes include:
- Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV is now included in the Clinical Prevention Guidance section, which lists methods for the prevention and control of STDs. The full CDC PrEP Guidelines also include recommendations for frequent testing for other STDs for those on PrEP.
- A change in the front line treatment recommendations for gonorrhea is included in this update. CDC now recommends treating gonorrhea with 250 mg of ceftriaxone delivered intramuscularly plus 1 g of oral azithromycin. Treatment with ceftriaxone plus doxycycline has now been moved to an alternative treatment recommendation for use in case of azithromycin allergy. This change was made due to the convenience of a single-does therapy as well as increased gonococcal resistance to the class of drug that includes doxycycline.
- Oral cefixime is still recommended as an alternative treatment for gonorrhea if ceftriaxone is not available, and for use in Expedited Partner Therapy (EPT) for partners who are unlikely to seek treatment. EPT is the practice of providing medication or a prescription to a patient who tests positive for an STD for their partner (s) without an intervening medical examination of their partner(s).
- The CDC also now explicitly recommends the delivery of EPT by providing patients with appropriately packaged medication as the preferred approach to EPT, as compared to providing prescriptions, as the data on the efficacy of EPT using prescriptions is very limited, and many persons do not fill prescriptions given to them by their partner.
- Language around EPT for gay men and other men who have sex with men (MSM) states that the "data on the use of [EPT] for gonorrhea or chlamydial infection among MSM are limited" and due to the increased risk of co-infection with HIV, EPT "should not be used routinely in MSM." NCSD has long advocated for a change in CDC language around the provision of this STD treatment option for MSM and would encourage entities that provide EPT to MSM to collect data to provide to the CDC for inclusion of this population in future STD Treatment Guidelines.
- Annual extragenital screening (screening in the throat and the rectum) for MSM who report receptive anal or oral sex is now recommended, regardless of reported use of condoms or symptoms, as a result of how infectious STD infections are at these non-genital sites and how often they are without symptoms.
- The new guidelines also highlight that sexual transmission of hepatitis C (HCV) can occur, especially among MSM with HIV infection. As a result, serologic screening for HCV is recommended at initial evaluation of persons with newly diagnosed HIV infection.
- In addition, because of accumulating evidence of acute HCV infection acquisition among persons with HIV infection (especially MSM with HIV infection) and because regular screening for HCV infection is cost effective, the CDC states that MSM with HIV infection should be regularly screened for HCV.
In addition to all of these technical changes, the 2015 STD Treatment Guidelines include a new section for the STD recommendations for transgender men and women, a special population whose unique health care needs have long been overlooked or included in sections with MSM. NCSD applauds the CDC for including this special population in these guidelines for quick access to information STD testing recommendations specifically for this population.
"There are many new updates in these new treatment guidelines," continued Smith. "NCSD encourages our member health departments, all health care providers, and organizations that work with health care providers, to educate themselves on the new guidelines to ensure they are providing the best sexual health care to all their patients."
KA Workowski and GA Bolan. Sexually Transmitted Disease Treatment Guidelines, 2015. Morbidity and Mortality Weekly Report: Recommendations and Reports 64(RR3):1-137. June 5, 2015.
G Bolan, CDC. CDC Releases Sexually Transmitted Diseases Treatment Guidelines, 2015. Dear colleague letter. June 4, 2015.
National Coalition of STD Directors. Centers for Disease Control and Prevention (CDC) Release Updated STD Treatment Guidelines.Press release. June 4, 2015.