Sexually Transmitted Infections Treatment Guidelines, 2021

Abstract

These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics — 14 Sites, STD Surveillance Network, United States, 2010–2018

“…Among females screened, chlamydia positivity was higher among those aged 15–19 years than among those aged 20–24 years, which highlights the importance of screening and prevention education among this population. Because of the high risk for reinfection, rescreening for reinfection is recommended 3 months after treatment ( 11 ). In this analysis, approximately 15% of females were rescreened 8–16 weeks after a positive test result.…”

“…Because the majority of chlamydial infections among women are asymptomatic, USPSTF recommends that all sexually active females aged ≤24 years be screened for chlamydia ( 10 ). In addition, the CDC Sexually Transmitted Infections Treatment Guidelines, 2021 , encourage rescreening at 3 months after a chlamydia diagnosis to identify and manage reinfections ( 11 ). Although the guidance is recommended for all sexually active females aged ≤24 years, the highest burden of chlamydia is among females aged 15–24 years.…”

“…CDC recommends that all MSM who have anal intercourse be screened annually for rectal chlamydia and gonorrhea and that all MSM who have receptive oral intercourse be screened for pharyngeal gonorrhea ( 11 ). Rectal gonorrhea screening coverage was estimated as the percentage of MSM who had received a rectal gonorrhea test during a calendar year divided by the total number of MSM seeking care that calendar year.…”

Pelvic inflammatory disease and causative pathogens in older women in a medical center in eastern Taiwan: A retrospective cross-sectional study

“…According to the CDC 2021 STD Treatment Guidelines for PID, empirical antibiotics with ceftriaxone and doxycycline are advised to treat infection of sexually transmitted pathogens [ 12 ]. However, routine treatment for aerobic pathogens and other pathogens remains controversial [ 12 ]. The current recommendation for the management of PID is focused on STD-related pathogens in younger patients.…”

“…The management for PID follows the 2021 CDC (center for disease control and prevention) sexually transmitted disease (STD) guidelines [ 12 ]. Intravenous, intramuscular or oral antibiotics are the primary treatment.…”