Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

Abstract

Sexually transmitted diseases (STDs) constitute an epidemic of tremendous magnitude, with an estimated 18.9 million persons acquiring a new STD each year [1]. Reported disease rates underestimate the true burden of infection because the majority of STDs are asymptomatic and because of underreporting. STDs have far-reaching public health consequences for the sexual and reproductive health of individual persons, as well as for the long-term health and health care costs of the community. The accurate identification and the effective clinical management of STDs represent an important combined strategy necessary to improve reproductive and sexual health and to improve HIV prevention efforts. This is especially relevant to women, adolescents, and infants, because untreated infections frequently result in severe, long-term complications, including facilitation of HIV infection, tubal infertility, adverse pregnancy outcomes, and cancer. For >20 years, the publication of national guidelines by the Centers for Disease Control and Prevention (CDC) for the management of STDs has assisted clinicians with effective guidance on the delivery of optimal STD care. The CDC STD treatment guidelines are the most widely referenced and authoritative source of information on STD treatment and prevention strategies for clinicians who evaluate persons with STDs or those at risk for STDs. The 2006 CDC guidelines for the treatment of sexually transmitted diseases were developed in consultation with public- and private-sector professionals knowledgeable in the management of STDs [2]. An evidence-based systematic review was performed, focusing on peer-reviewed journal articles and abstracts that had become available since publication of the 2002 CDC STD treatment guidelines. Evidence tables were developed from systematic reviews that summarized the study type, population and setting, treatment regimens or other interventions, outcome measures, and potential limitations of the reported findings. This supplement to Clinical Infectious Diseases contains 9 background articles that describe the available evidence in several topic areas included in the 2006 CDC STD treatment guidelines. Current advances and controversies are described in the diagnosis, management, and treatment of various sexually transmitted pathogens and syndromes that have important implications for clinical practice. Chlamydia trachomatis infection is the most common bacterial STD in the United States, with an estimated 3 million cases occurring annually [3]. Reported rates of chlamydial infection have increased dramatically over the past decade, reflecting expansion of chlamydial screening activities, highly sensitive nucleic acid amplification tests, and improvements in information systems used for reporting. However, many women who are at risk for this infection are still not being screened appropriately, reflecting, in part, a lack of awareness among some providers, as well as limited resources. Health care providers frequently rely on screening tests, because asymptomatic infection is common among both men and women. Annual screening of all sexually active women ⩽25 years of age is recommended [4], as is screening of older women with risk factors (e.g., those who have a new sex partner or multiple sex partners). There is insufficient evidence to recommend routine screening for C. trachomatis in sexually active young men on the basis of feasibility, efficacy, and cost-effectiveness; however, screening should be considered in high-prevalence areas, such as adolescent clinics, correctional facilities, and STD clinics. Efficacious therapeutic regimens for chlamydia include azithromycin or doxycycline. Because of the high probability of repeat infection, women should be retested for chlamydial infection 3–4 months after treatment [5]. Clinical experience and limited studies are available to support the efficacy and safety of azithromycin as a recommended regimen in pregnant women. Infections with Neisseria gonorrhoeae account for the second most commonly notifiable disease in the United States [3] and are an important cause of cervicitis, urethritis, proctitis, and pelvic inflammatory disease. Selection of appropriate therapy for gonorrhea is guided by a CDC-sponsored surveillance system (Gonococcal Isolate Surveillance Project) that has monitored gonococcal antimicrobial susceptibility for the past 20 years. Of recent concern, the prevalence of quinolone-resistant N. gonorrhoeae has increased in many areas of the United States and among men who have sex with men, resulting in changes in recommended treatment regimens. The CDC Web site [6] or state and local health departments can provide the most current information on quinolone-resistant N. gonorrhoeae prevalence. Because prevalence can vary greatly by location, state and local public health officials should maintain the capacity to detect and monitor the prevalence of resistant strains. Oral alternatives to quinolones