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Warning:
This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:
- STD Treatment Guidelines at http://www.cdc.gov/STD/treatment
1998 Guidelines for Treatment of Sexually Transmitted Disease
Date: 01/23/98
Source: 47(RR-1);1-118
SUGGESTED CITATION: Centers for Disease Control and Prevention. 1998 Guidelines for Treatment of Sexually Transmitted Diseases. MMWR 1998;47(No. RR-1): {inclusive page numbers}.
The material in this report was prepared for publication by: National Center for HIV, STD and TB Prevention, Division of Sexually Transmitted Diseases Prevention
ECTOPARASITIC INFECTIONS
Pediculosis Pubis
Patients who have pediculosis pubis (i.e., pubic lice) usually seek medical attention because of pruritus. Such patients also usually notice lice or nits on their pubic hair.
Recommended Regimens
Permethrin 1% creme rinse applied to affected areas and washed off after 10 minutes.
OR
Lindane 1% shampoo applied for 4 minutes to the affected area, and then thoroughly washed off. This regimen is not recommended for pregnant or lactating women or for children aged less than 2 years.
OR
Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes.
The lindane regimen is the least expensive therapy; toxicity, as indicated by seizure and aplastic anemia, has not been reported when treatment was limited to the recommended 4-minute period. Permethrin has less potential for toxicity than lindane.
Other Management Considerations
The recommended regimens should not be applied to the eyes. Pediculosis of the eyelashes should be treated by applying occlusive ophthalmic ointment to the eyelid margins twice a day for 10 days.
Bedding and clothing should be decontaminated (i.e., either machine-washed or machine-dried using the heat cycle or dry-cleaned) or removed from body contact for at least 72 hours. Fumigation of living areas is not necessary.
Follow-Up
Patients should be evaluated after 1 week if symptoms persist. Re-treatment may be necessary if lice are found or if eggs are observed at the hair-skin junction. Patients who do not respond to one of the recommended regimens should be re-treated with an alternative regimen.
Management of Sex Partners
Sex partners within the preceding month should be treated.
Special Considerations
Pregnancy
Pregnant and lactating women should be treated with either permethrin or pyrethrins with piperonyl butoxide.
HIV Infection
Patients who have pediculosis pubis and also are infected with HIV should receive the same treatment regimen as those who are HIV-negative.
Scabies
The predominant symptom of scabies is pruritus. Sensitization to Sarcoptes scabiei must occur before pruritus begins. The first time a person is infected with S. scabiei, sensitization takes several weeks to develop. Pruritus might occur within 24 hours after a subsequent reinfestation. Scabies in adults may be sexually transmitted, although scabies in children usually is not.
Recommended Regimen
Permethrin cream (5%) applied to all areas of the body from the neck down and washed off after 8-14 hours.
Alternative Regimens
Lindane (1%) 1 oz. of lotion or 30 g of cream applied thinly to all areas of the body from the neck down and thoroughly washed off after 8 hours.
OR
Sulfur (6%) precipitated in ointment applied thinly to all areas nightly for 3 nights. Previous applications should be washed off before new applications are applied. Thoroughly wash off 24 hours after the last application.
Permethrin is effective and safe but costs more than lindane. Lindane is effective in most areas of the country, but lindane resistance has been reported in some areas of the world, including parts of the United States. Seizures have occurred when lindane was applied after a bath or used by patients who had extensive dermatitis. Aplastic anemia following lindane use also has been reported.
NOTE: Lindane should not be used after a bath, and it should not be used by a) persons who have extensive dermatitis, b) pregnant or lactating women, and c) children aged less than 2 years.
Ivermectin (single oral dose of 200 ug/kg or 0.8% topical solution) is a potential new therapeutic modality. However, no controlled clinical trials have been conducted to compare ivermectin with the currently recommended therapies.
Other Management Considerations
Bedding and clothing should be decontaminated (i.e., either machine-washed or machine-dried using the hot cycle or dry-cleaned) or removed from body contact for at least 72 hours. Fumigation of living areas is unnecessary.
Follow-Up
Pruritus may persist for several weeks. Some experts recommend re-treatment after 1 week for patients who are still symptomatic; other experts recommend re-treatment only if live mites are observed. Patients who do not respond to the recommended treatment should be retreated with an alternative regimen.
Management of Sex Partners and Household Contacts
Both sexual and close personal or household contacts within the preceding month should be examined and treated.
Management of Outbreaks in Communities, Nursing Homes, and Other Institutional Settings
Scabies epidemics often occur in nursing homes, acute- and chronic-care hospitals, residential facilities, and communities. Control of an epidemic can only be achieved by treatment of the entire population at risk. Epidemics should be managed in consultation with an expert.
Special Considerations
Infants, Young Children, and Pregnant or Lactating Women
Infants, young children, and pregnant or lactating women should not be treated with lindane. They may be treated with permethrin.
HIV Infection
Patients who have uncomplicated scabies and also are infected with HIV should receive the same treatment regimen as those who are HIV-negative. HIV-infected patients and others who are immunosuppressed are at increased risk for Norwegian scabies, a disseminated dermatologic infection. Such patients should be managed in consultation with an expert.
