The Centers for Disease Control and Prevention (CDC) updated its guidelines for the treatment of sexually transmitted infections (STIs), notably for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and pelvic inflammatory disease (PID).
“With rising rates of STIs, appropriate treatment is essential,” said Contemporary OB/GYN® Editor in Chief, Catherine Y. Spong, MD.
The CDC continues to recommend routine screenings for common STIs for all sexually active adolescents and young adults. The guidelines also recommend opt-out screening for chlamydia and gonorrhea for female adolescent and young adult patients, which could increase screening significantly, save costs, and identify STIs among youths who do not wish to disclose their sexual activity.
The new guidelines also include a change to doxycycline as the first treatment for chlamydia in place of azithromycin. Specifically, they recommend doxycycline 100 milligrams (mg) orally twice a day for seven days as first-line chlamydia infection treatment. For doxycycline allergy or pregnancy patients, alternatives include azithromycin 1 gram (g) orally in a single dose or levofloxacin 500 mg orally once daily for seven days.
Antibiotic resistance complicates gonorrhea treatment. The recommended treatment for cervical, urethral, and rectal gonorrhea is intramuscular ceftriaxone 500 mg in a single dose. For patients over 150 kilograms (kg), the ceftriaxone dose should be increased to 1 g. If ceftriaxone is unavailable, alternatives include intramuscular gentamicin 240 mg in a single dose plus azithromycin 2 g orally in a single dose; or cefixime 800 mg orally in a single dose.
If chlamydial co-infection cannot be excluded, doxycycline 100 mg orally twice daily for seven days should be added.
The new guidelines for trichomoniasis treatment are metronidazole 500 mg orally twice daily for seven days.