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Sexually Transmitted Diseases Treatment …

Recommendations and Reports / Vol. 64 / No. 3 June 5, 2015 Department of Health and Human ServicesCenters for disease control and PreventionMorbidity and Mortality Weekly ReportSexually Transmitted Diseases Treatment Guidelines, 2015 Recommendations and ReportsCONTENTS (Continued)The MMWR series of publications is published by the center for Surveillance, Epidemiology, and Laboratory Services, centers for disease control and prevention (CDC), Department of Health and Human Services, Atlanta, GA 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 PreventionThomas 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.

Recommendations and Reports CONTENTS (Continued) The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),

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1 Recommendations and Reports / Vol. 64 / No. 3 June 5, 2015 Department of Health and Human ServicesCenters for disease control and PreventionMorbidity and Mortality Weekly ReportSexually Transmitted Diseases Treatment Guidelines, 2015 Recommendations and ReportsCONTENTS (Continued)The MMWR series of publications is published by the center for Surveillance, Epidemiology, and Laboratory Services, centers for disease control and prevention (CDC), Department of Health and Human Services, Atlanta, GA 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 PreventionThomas 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.

2 Richards, MD, MPH, Deputy Director for Public Health Scientific ServicesMichael 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-ChiefCharlotte K. Kent, PhD, MPH, Executive Editor Christine G. Casey, MD, EditorTeresa F. Rutledge, Managing EditorDavid C. Johnson, Lead Technical Writer-EditorRachel J. Wilson, Project EditorMartha F. Boyd, Lead Visual Information SpecialistMaureen A. Leahy, Julia C. Martinroe, Stephen R. Spriggs, Visual Information SpecialistsQuang M. Doan, MBA, Phyllis H. KingTerraye M. Starr, Information Technology SpecialistsMMWR Editorial BoardWilliam L. Roper, MD, MPH, Chapel Hill, NC, ChairmanMatthew L.

3 Boulton, MD, MPH, Ann Arbor, MIVirginia A. Caine, MD, Indianapolis, INJonathan E. Fielding, MD, MPH, MBA, Los Angeles, CADavid W. Fleming, MD, Seattle, WAWilliam E. Halperin, MD, DrPH, MPH, Newark, NJKing K. Holmes, MD, PhD, Seattle, WATimothy F. Jones, MD, Nashville, TNRima F. Khabbaz, MD, Atlanta, GAPatricia Quinlisk, MD, MPH, Des Moines, IAPatrick L. Remington, MD, MPH, Madison, WIWilliam Schaffner, MD, Nashville, TNCONTENTSI ntroduction ..1 Methods ..1 Clinical prevention Guidance ..2 Special Populations ..9 Emerging Issues ..17 Hepatitis C ..17 Mycoplasma genitalium ..20 HIV Infection: Detection, Counseling, and Referral ..21 Diseases Characterized by Genital, Anal, or Perianal Ulcers ..25 Chancroid ..26 Genital HSV Infections.

4 27 Granuloma Inguinale (Donovanosis) ..32 Lymphogranuloma Venereum ..33 Syphilis ..34 Management of Persons Who Have a History of Penicillin Allergy .. 49 Diseases Characterized by Urethritis and Cervicitis ..51 Urethritis ..51 Nongonococcal Urethritis ..52 Cervicitis ..53 Chlamydial Infections ..55 Gonococcal Infections ..60 Diseases Characterized by Vaginal Discharge ..69 Bacterial Vaginosis ..69 Trichomoniasis ..72 Vulvovaginal Candidiasis ..75 Pelvic Inflammatory disease ..78 Epididymitis ..82 Human Papillomavirus Infection ..84 Anogenital Warts ..86 HPV-Associated Cancers and Precancers ..90 Viral Hepatitis ..94 Hepatitis A ..94 Hepatitis B ..95 Proctitis, Proctocolitis, and Enteritis ..100 Ectoparasitic Infections ..101 Pediculosis Pubis.

5 101 Scabies ..102 Sexual Assault and Abuse and STDs ..104 References ..110 Terms and Abbreviations Used in This Report ..135 Recommendations and ReportsMMWR / June 5, 2015 / Vol. 64 / No. 3 1 IntroductionThe term Sexually Transmitted Diseases (STDs) refers to a variety of clinical syndromes and infections caused by pathogens that can be acquired and Transmitted through sexual activity. Physicians and other health-care providers play a critical role in preventing and treating STDs. These guidelines for the Treatment of STDs are intended to assist with that effort. Although these guidelines emphasize Treatment , prevention strategies and diagnostic recommendations also are document updates CDC s Sexually Transmitted Diseases Treatment Guidelines, 2010 (1).

6 These recommendations should be regarded as a source of clinical guidance rather than prescriptive standards; health-care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. These guidelines are applicable to any patient-care setting that serves persons at risk for STDs, including family-planning clinics, HIV-care clinics, correctional health-care settings, private physicians offices, Federally Qualified Health Centers (FQHCs), and other primary-care facilities. These guidelines focus on Treatment and counseling and do not address other community services and interventions that are essential to STD/HIV prevention guidelines were developed by CDC staff and an independent workgroup for which members were selected on the basis of their expertise in the clinical management of STDs.

7 Members of the multidisciplinary workgroup included representatives from federal, state, and local health departments; public- and private-sector clinical providers; clinical and basic science researchers; and numerous professional organizations. All workgroup members disclosed potential conflicts of interest; several members of the workgroup acknowledged receiving financial support for clinical research from commercial companies. All potential conflicts of interest are listed at the end of the workgroup member 2012, CDC staff and workgroup members were charged with identifying key questions regarding Treatment and clinical management that were not addressed in the 2010 STD Treatment Guidelines (1).

8 To answer these questions and synthesize new information available since publication of the 2010 Guidelines, workgroup members collaborated with CDC staff to conduct a systematic literature review using an extensive MEDLINE database evidence-based approach ( , using published abstracts and peer-reviewed journal articles). These reviews also focused on four principal outcomes of STD therapy for each individual disease or infection: 1) Treatment of infection based on microbiologic eradication; 2) alleviation of signs and symptoms; 3) prevention of sequelae; 4) prevention of transmission, including advantages such as cost-effectiveness and other advantages ( , single-dose formulations and directly observed therapy) and disadvantages ( , side effects) of specific regimens.

9 The outcome of the literature review informed development of background materials, including tables of evidence from peer-reviewed publications summarizing the type of study ( , randomized controlled trial or case series), study population and setting, Sexually Transmitted Diseases Treatment Guidelines, 2015 Prepared by Kimberly A. Workowski, MD1,2 Gail A. Bolan, MD11 Division of STD PreventionNational center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention2 Emory University, Atlanta, GeorgiaSummaryThese 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.

10 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.


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