CDC Releases Updated STI Treatment Guidelines

The US Centers for Disease Control and Prevention (CDC) released their updated STI Guidelines this past week. The guidelines provide the most up-to-date evidence-based diagnostic, management, and treatment recommendations.

In the latest CDC statistics analyzed in 2018, there were nearly 68 million infections in prevalence, 26 million STIs acquired that year, and the federal agency estimating an overall 1 in 5 Americans with an STI.

During the COVID-19 pandemic, there was a transient, downward incidence trend reported. Data provided by the CDC in mid-July shows that during March-April 2020, the number of reported STD cases dramatically decreased compared to the same time in 2019. However, there was a resurgence in gonorrhea and syphilis cases later in the year, suggesting overall that STDs may have increased during 2020.

With millions of Americans suffering with STIs, the goal is for the guidelines to serve as a source for clinicians to provide assistance for managing STIs.

These guidelines were developed by the CDC staff who worked with subject matter experts with expertise in STI clinical management from other federal agencies, nongovernmental academic and research institutions, and professional medical organizations the CDC wrote in its Morbidity and Mortality Weekly Report.

“CDC staff identified governmental and nongovernmental subject matter experts on the basis of their expertise and assisted them in developing questions to guide individual literature reviews,” CDC wrote.

The last guidance was done in 2015 and the most recent updates include:

• Updated treatment recommendations for chlamydia, trichomoniasis, and pelvic inflammatory disease
• Updated treatment recommendations for uncomplicated gonorrhea in neonates, children, and other specific clinical situations (e.g., proctitis, epididymitis, sexual assault)
• Information on FDA-cleared diagnostic tests for Mycoplasma genitalium and rectal and pharyngeal chlamydia and gonorrhea
• Expanded risk factors for syphilis testing among pregnant women
• Recommended two-step serologic testing for diagnosing genital herpes simplex virus
• Aligned recommendations for human papillomavirus (HPV) vaccination with the Advisory Committee on Immunization Practices
• Recommended universal hepatitis C testing in alignment with CDC’s 2020 hepatitis C testing recommendations

Prevention and Control Strategies

In this update, an emphasis was placed on creating prevention and control guidance. The prevention and control measures were based on 5 strategies including the following:

• Accurate risk assessment and education and counseling of persons at risk regarding ways to avoid STIs through changes in sexual behaviors and use of recommended prevention services
• Pre-exposure vaccination for vaccine-preventable STIs
• Identification of persons with an asymptomatic infection and persons with symptoms associated with an STI
• Effective diagnosis, treatment, counseling, and follow-up of persons who are infected with an STI
• Evaluation, treatment, and counseling of sex partners of persons who are infected with an STI

“The burden of STIs is staggering,” Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said. “At a time when STIs are at an all-time high, they have fallen out of the national conversation. Yet, STIs are a preventable and treatable national health threat with substantial personal and economic impact. There is an urgent need to reverse the trend of increasing STIs, especially in the wake of the COVID-19 pandemic, which has affected many STI prevention services.”

The treatment guidelines can be accessed by going here.