The new CDC sexually transmitted treatment guidelines have finally arrived and are available on line at www.cdc.gov/std . These guidelines are evidence based, and although they emphasize treatment, prevention strategies and diagnostic recommendations are also discussed. The guidelines present new information in several areas for both men and women, such as:
- Expanded diagnostic evaluation for cervicitis and trichomoniasis;
- New treatment recommendations for bacterial vaginosis and genital warts;
- Clinical efficacy of azithromycin for chlamydial infection in pregnancy;
- Role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications;
- Lymphogranuloma venereum proctocolitis among men who have sex with men (MSM);
- The criteria for spinal fluid examination to evaluate for neurosyphilis;
- The emergence of azithromycin-resistant Treponema pallidum;
- The increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae;
- The sexual transmission of hepatitis C;
- Diagnostic evaluation after sexual assault; and,
- STD prevention approaches.
This web update will focus on what’s new regarding the diagnosis and treatment of non-gonococcal urethritis in men. However, several webcasts reviewing the Guidelines are available through the CDC’s STD website as well as the National Network of Prevention Training Centers’ website (nnptc.org). In our next web update we will discuss treatment approaches for Neisseria gonorrhoeae infections.
WHERE TO BEGIN: THE FIVE P’s:
The four principal outcomes of STD therapy for each individual disease are treatment of infection based on microbiologic eradication, alleviation of signs and symptoms, prevention of sequelae, and prevention of transmission. Often in the clinical setting, the patient presents for alleviation of signs and symptoms and the clinician’s job is to determine what the infection may be, what tests to order, what treatment to give, and what prevention and risk-reduction messages to impart to the specific client. This process begins with a sexual history which should be taken in a nonjudgmental and empathetic manner which is appropriate to the patient’s culture, language, sex, sexual orientation, age and developmental level. 2010 STD Treatment Guidelines, nicely outlines the five P’s of a good sexual history: Partners, Prevention of pregnancy, Protection from STDs, Practices, and Past history of STDs. Although we usually consider pregnancy prevention questions mainly for women, men should be queried regarding prevention of pregnancy also. Although this may not be pertinent for men who have sex exclusively with other men, assumptions should not be made without asking about partners: “Do you have sex with men, women, or both?” Getting the “Five P’s” information will also inform what interactive counseling approach the clinician will choose that can be directed at the patient’s personal risk, the situations in which risk occurs, and the use of personalized goal-setting strategies that may be effective for his STD/HIV prevention (2,3).
- Lin JS, Whitlock E, OConnor E, et al. Behavioral counseling to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008; 149:497–9.
- U.S. Preventive Services Task Force. Behavioral counseling to prevent sexually transmitted infections: recommendation statement. Ann Intern Med 2008;149:491–6.