The CDC on Thursday published updated clinical guidelines for the treatment of STIs amid a sustained national increase in cases of chlamydia, gonorrhea and syphilis.
The guidance, updated for the first time since 2015, also includes prevention strategies and diagnostic recommendations.
“There are several important updates, but I would highlight the updates that build upon the adjustments to gonorrhea treatment that were made in December 2020 to ensure effective treatment and minimize the threat of drug resistance,” Kimberly A. Workowski, MD, a medical officer in CDC’s Division of STD Prevention, told Healio. “Effectively treating gonorrhea remains a public health priority.”
Gonorrhea, which has consistently developed resistance against the antibiotics used to treat it, is the second most commonly reported bacterial STD in the United States, with cases increasing 56% from 2015 to 2019 to more than 1 million diagnosed and undiagnosed infections per year, according to Workowski.
The CDC now recommends treating gonorrhea with a single 500 mg injection of ceftriaxone. If chlamydia testing has not been performed, doxycycline 100 mg orally twice a day for 7 days is also recommended.
Workowski noted additional updates to the treatment guidelines regarding gonorrhea, including that a test of cure is not needed for patients who receive a diagnosis of uncomplicated urogenital or rectal gonorrhea unless symptoms persist. A test of cure is recommended for patients with pharyngeal gonorrhea using either culture or nucleic acid amplification tests 7 to 14 days after the initial treatment, regardless of the regimen, Workowski said.
She said patients who have been treated for gonorrhea should be retested 3 months after treatment to ensure reinfection has not occurred. If retesting at 3 months is not possible, patients should be retested within 12 months after initial treatment and providers should facilitate partners’ treatment, Workowski said.
The new guidelines note that there are now FDA-cleared rectal and oral tests to diagnose chlamydia and gonorrhea that have been validated for clinical use — an important development “because infection at these sites is often without symptoms,” Workowski said.
The guidelines also include updates for hepatitis C virus testing and HPV vaccination.
The CDC recommends that all adults aged 18 years or older be screened for HCV at least once in their lifetime, and that all women be screened during pregnancy — recommendations that do not apply in settings where the prevalence of HCV infection is below 0.1%.
The new guidelines align with the latest Advisory Committee on Immunization Practices recommendations for HPV vaccination, which raised the upper age for catch-up vaccination in men to 26 years, matching the recommendation for women, and said unvaccinated patients aged 27 to 45 years should speak with their physicians about receiving the vaccine.
As expected, the guidance now recommends 100 mg of oral doxycycline as first-line treatment for chlamydia at any site, based on studies demonstrating that it is superior to azithromycin.
The guidance updates recommendations for other infections, including trichomoniasis and pelvic inflammatory disease, as well as uncomplicated gonorrhea infection in neonates, children and other clinical situations, including proctitis, epididymitis and cases of sexual assault.
Workowski said that with 26 million new STIs occurring each year, totaling nearly $16 billion in medical costs, “evidence-based prevention, diagnostic, and treatment recommendations are critical to halting continued increases.”
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