Morbidity and Mortality Weekly Report Recommendations and Reports May 10, 2002 / Vol. 51 / No. RR-6 Sexually Transmitted Diseases Treatment Guidelines 2002 Centers for Disease Control and Prevention SAFER • HEALTHIER • PEOPLETM MMWR CONTENTS Introduction ..................................................................................................... 1 Clinical Prevention Guidelines .......................................................................... 2 The MMWR series of publications is published by the Prevention Messages .................................................................................... 2 Prevention Methods ...................................................................................... 3 Epidemiology Program Office, Centers for Disease STD/HIV Prevention Counseling .................................................................... 4 Control and Prevention (CDC), U.S. Department of Partner Notification ...................................................................................... 4 Reporting and Confidentiality ....................................................................... 4 Health and Human Services, Atlanta, GA 30333. Special Populations .......................................................................................... 5 Pregnant Women ......................................................................................... 5 Adolescents .................................................................................................. 6 Children ....................................................................................................... 7 Men Who Have Sex with Men ....................................................................... 7 HIV Infection: Detection, Counseling, and Referral ........................................... 7 Detection of HIV Infection: Diagnostic Testing ............................................... 8 SUGGESTED CITATION Counseling for Patients with HIV Infection and Referral to Support Services ... 9 Management of Sex Partners and Injection-Drug Partners ........................... 10 Centers for Disease Control and Prevention. Sexually Special Considerations ............................................................................... 10 Diseases Characterized by Genital Ulcers ....................................................... 11 transmitted diseases treatment guidelines 2002. Management of Patients Who Have Genital Ulcers ..................................... 11 MMWR 2002;51(No. RR-6):[inclusive page Chancroid .................................................................................................. 11 Genital Herpes Simplex Virus Infections ...................................................... 12 numbers]. Granuloma Inguinale (Donovanosis) .......................................................... 17 Lymphogranuloma Venereum ..................................................................... 18 Syphilis ...................................................................................................... 18 Congenital Syphilis ........................................................................................ 26 Evaluation and Treatment of Infants in the First Month of Life ..................... 26 Evaluation and Treatment of Older Infants and Children ............................. 28 Follow-Up .................................................................................................. 28 Special Considerations ............................................................................... 28 Centers for Disease Control and Prevention Management of Patients Who Have a History of Penicillin Allergy ................... 28 Recommendations ...................................................................................... 29 David W. Fleming, M.D. Penicillin Allergy Skin Testing ...................................................................... 29 Diseases Characterized by Urethritis and Cervicitis ......................................... 30 Acting Director Management of Male Patients Who Have Urethritis .................................... 30 Etiology ...................................................................................................... 30 Confirmed Urethritis ................................................................................... 30 Julie L. Gerberding, M.D. Management of Patients Who Have Nongonococcal Urethritis .................... 31 Acting Deputy Director for Science and Public Health Management of Patients Who Have Mucopurulent Cervicitis (MPC) ............. 32 Chlamydial Infections ................................................................................. 32 Gonococcal Infections ................................................................................ 36 Dixie E. Snider, Jr., M.D., M.P.H. Diseases Characterized by Vaginal Discharge ................................................. 42 Management of Patients Who Have Vaginal Infections ................................ 42 Associate Director for Science Bacterial Vaginosis ..................................................................................... 42 Trichomoniasis ........................................................................................... 44 Epidemiology Program Office Vulvovaginal Candidiasis ............................................................................ 45 Pelvic Inflammatory Disease ........................................................................... 48 Stephen B. Thacker, M.D., M.Sc. Diagnostic Considerations .......................................................................... 48 Treatment .................................................................................................. 49 Director Follow-Up .................................................................................................. 51 Management of Sex Partners ...................................................................... 51 Prevention .................................................................................................. 51 Office of Scientific and Health Communications Special Considerations ............................................................................... 51 Epididymitis ................................................................................................... 52 John W. Ward, M.D. Diagnostic Considerations .......................................................................... 52 Treatment .................................................................................................. 52 Director Follow-Up .................................................................................................. 53 Editor, MMWR Series Management of Sex Partners ...................................................................... 53 Special Considerations ............................................................................... 53 Human Papillomavirus Infection ..................................................................... 53 Suzanne M. Hewitt, M.P.A. Genital Warts ............................................................................................. 53 Subclinical Genital HPV Infection (Without Exophytic Warts) ........................ 57 Managing Editor Cervical Cancer Screening for Women Who Attend STD Clinics or Have a History of STDs ............................................................................ 57 Rachel J. Wilson Recommendations ...................................................................................... 58 Special Considerations ............................................................................... 59 Project Editor Vaccine Preventable STDs .............................................................................. 59 Hepatitis A ................................................................................................. 59 Hepatitis B ................................................................................................. 61 Malbea A. Heilman Hepatitis C .................................................................................................... 64 Beverly J. Holland Sexual Activity ............................................................................................ 65 Diagnosis and Treatment ............................................................................ 65 Visual Information Specialists Prevention .................................................................................................. 65 Postexposure Follow-Up ............................................................................. 66 Proctitis, Proctocolitis, and Enteritis ................................................................. 66 Michele D. Renshaw Treatment .................................................................................................. 67 Follow-Up .................................................................................................. 67 Erica R. Shaver Management of Sex Partners ...................................................................... 67 Information Technology Specialists Ectoparasitic Infections ................................................................................... 67 Pediculosis Pubis ........................................................................................ 67 Scabies ...................................................................................................... 68 Sexual Assault and STDs ...............................................................................