Sexually Transmitted Diseases Treatment Guidelines, 2006

Abstract

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.

Serologic Response to Treatment in Syphilis

“…Also, the risk associated with these parameters is independent of previous syphilis therapy and stage of syphilis (Marra et al, 2004a). If CSF pleocytosis was present initially, a CSF examination should be repeated every 6 months until the cell count turn to normal (Workowski & Berman, 2010). The success of therapy in patients with symptomatic neurosyphilis is assessed by resolution of symptoms and signs, and normalization of CSF abnormalities, including pleocytosis, elevated protein concentration or a reactive CSF VDRL test.…”

“…The success of therapy in patients with symptomatic neurosyphilis is assessed by resolution of symptoms and signs, and normalization of CSF abnormalities, including pleocytosis, elevated protein concentration or a reactive CSF VDRL test. If neurosyphilis is asymptomatic, normalization of CSF measures is the only means of assessing treatment success (Workowski & Berman, 2010). After therapy, the changes in CSF VDRL or CSF protein occur more slowly than cell counts, and persistent abnormalities might be less important.…”

“…For patients whose nontreponemal test titers do not decrease fourfold within 6-12 months therapy, CSF examination and retreatment also should be strongly considered (Workowski & Berman, 2010).…”

“…Serologic titers can be checked monthly in women at high risk for reinfection or in geographic areas in which the prevalence of syphilis is high. If serological screening was performed by treponemal antibody testing, pregnant with reactive results for treponemal antibodies should have confirmatory testing with nontreponemal tests with titers (Workowski & Berman, 2010). Transplacental infection can occur at any stage pregnancy (Wicher & Wicher, 2001).…”

“…The CSF FTA-abs test is less specific than the VDRL for diagnosis of neurosyphilis, but it is highly sensitive. A negative CSF FTA-abs test excludes the diagnosis of neurosyphilis (Workowski & Berman, 2010). An alternative CSF tests to diagnose neurosyphilis in HIV infected patients had been proposed when the CSF VDRL is nonreactive.…”