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CDC STD Guidelines for 2015

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CDC STD Guidelines for 2015 Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 64 / No. 3 June 5, 2015 Sexually Transmitted Diseases Treatment Guidelines, 2015 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS CONTENTS (Continued) Introduction ............................................................................................................1 Gonococcal Infections ...................................................................................... 60 Methods ....................................................................................................................1 Diseases Characterized by Vaginal Discharge .......................................... 69 Clinical Prevention Guidance ............................................................................2 Bacterial Vaginosis .......................................................................................... 69 Special Populations ..............................................................................................9 Trichomoniasis ................................................................................................. 72 Emerging Issues .................................................................................................. 17 Vulvovaginal Candidiasis ............................................................................. 75 Hepatitis C ......................................................................................................... 17 Pelvic Inflammatory Disease .......................................................................... 78 Mycoplasma genitalium ................................................................................ 20 Epididymitis .......................................................................................................... 82 HIV Infection: Detection, Counseling, and Referral ................................ 21 Human Papillomavirus Infection .................................................................. 84 Diseases Characterized by Genital, Anal, or Perianal Ulcers ............... 25 Anogenital Warts ................................................................................................ 86 Chancroid .......................................................................................................... 26 HPV-Associated Cancers and Precancers ................................................... 90 Genital HSV Infections .................................................................................. 27 Viral Hepatitis ....................................................................................................... 94 Granuloma Inguinale (Donovanosis) ....................................................... 32 Hepatitis A ......................................................................................................... 94 Lymphogranuloma Venereum ................................................................... 33 Hepatitis B ......................................................................................................... 95 Syphilis ................................................................................................................... 34 Proctitis, Proctocolitis, and Enteritis ..........................................................100 Management of Persons Who Have a History of Penicillin Allergy .. 49 Ectoparasitic Infections ..................................................................................101 Diseases Characterized by Urethritis and Cervicitis ............................... 51 Pediculosis Pubis ...........................................................................................101 Urethritis ............................................................................................................ 51 Scabies ..............................................................................................................102 Nongonococcal Urethritis ............................................................................ 52 Sexual Assault and Abuse and STDs ..........................................................104 Cervicitis ............................................................................................................. 53 References ...........................................................................................................110 Chlamydial Infections ....................................................................................... 55 Terms and Abbreviations Used in This Report .......................................135 The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, then et al., if more than six.] [Title]. MMWR Recomm Rep 2015;64(No. RR-#):[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science Joanne Cono, MD, ScM, Director, Office of Science Quality Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific Services Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff (Serials) Sonja A. Rasmussen, MD, MS, Editor-in-Chief Martha F. Boyd, Lead Visual Information Specialist Charlotte K. Kent, PhD, MPH, Executive Editor Maureen A. Leahy, Julia C. Martinroe, Christine G. Casey, MD, Editor Stephen R. Spriggs, Visual Information Specialists Teresa F. Rutledge, Managing Editor Quang M. Doan, MBA, Phyllis H. King David C. Johnson, Lead Technical Writer-Editor Terraye M. Starr, Information Technology Specialists Rachel J. Wilson, Project Editor MMWR Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman King K. Holmes, MD, PhD, Seattle, WA Matthew L. Boulton, MD, MPH, Ann Arbor, MI Timothy F. Jones, MD, Nashville, TN Virginia A. Caine, MD, Indianapolis, IN Rima F. Khabbaz, MD, Atlanta, GA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patricia Quinlisk, MD, MPH, Des Moines, IA David W. Fleming, MD, Seattle, WA Patrick L. Remington, MD, MPH, Madison, WI William E. Halperin, MD, DrPH, MPH, Newark, NJ William Schaffner, MD, Nashville, TN Recommendations and Reports Sexually Transmitted Diseases Treatment Guidelines, 2015 Prepared by Kimberly A. Workowski, MD1,2 Gail A. Bolan, MD1 1Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 2Emory University, Atlanta, Georgia Summary These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR–12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs. Introduction on the basis of their expertise in the clinical management of STDs. Members of the multidisciplinary workgroup included The term sexually transmitted diseases (STDs) refers to representatives from federal, state, and local health departments; a variety of clinical syndromes and infections caused by public- and private-sector clinical providers; clinical and basic pathogens that can be acquired and transmitted through sexual science researchers; and numerous professional organizations. activity. Physicians and other health-care providers play a All workgroup members disclosed potential conflicts of interest; critical role in preventing and treating STDs. These guidelines several members of the workgroup acknowledged receiving for the treatment of STDs are intended to assist with that effort. financial support for clinical research from commercial Although these guidelines emphasize treatment, prevention companies. All potential conflicts of interest are listed at the strategies and diagnostic recommendations also are discussed. end of the workgroup member section. Sexually Transmitted Diseases This document updates CDC’s In 2012, CDC staff and workgroup members were charged Treatment Guidelines, 2010 1 ( ). These recommendations should with identifying key questions regarding treatment and be regarded as a source of clinical guidance rather than prescriptive clinical management that were not addressed in the 2010 standards; health-care providers should always consider the STD Treatment Guidelines (1). To answer these questions clinical circumstances of each person in the context of local disease and synthesize new information available since publication of prevalence. These guidelines are applicable
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