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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This document is being maintained for historical purposes, but is now out of date.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
INTRODUCTION
Physicians and other health-care providers have a critical role in preventing and treating sexually transmitted diseases (STDs). These recommendations for the treatment of STDs, which were developed by CDC staff members in consultation with a group of invited experts, are intended to assist with that effort.
This report was produced through a multi-stage process. Beginning in the spring of 1996, CDC personnel and invited experts systematically reviewed literature concerning each of the major STDs, focusing on information that had become available since the "1993 Sexually Transmitted Diseases Treatment Guidelines" (MMWR 1993;42{no. RR-14}) were published. Background papers were written and tables of evidence constructed summarizing the type of study (e.g., randomized controlled trial or case series), study population and setting, treatments or other interventions, outcome measures assessed, reported findings, and weaknesses and biases in study design and analysis. For these reviews, published abstracts and peer-reviewed journal articles were considered. A draft document was developed on the basis of the reviews.
In February 1997, invited consultants assembled in Atlanta for a 3-day meeting. CDC personnel and invited experts presented the key questions on STD treatment suggested from the literature reviews and presented the information available to answer those questions. Where relevant, the questions focused on four principal outcomes of STD therapy: a) microbiologic cure, b) alleviation of signs and symptoms, c) prevention of sequelae, and d) prevention of transmission. Cost-effectiveness and other advantages (e.g., single-dose formulations and directly observed therapy) of specific regimens also were considered. The consultants then assessed whether the questions identified were appropriate, ranked them in order of priority, and attempted to arrive at answers using the available evidence. In addition, the consultants evaluated the quality of evidence supporting the answers on the basis of the number, type, and quality of the studies.
In several areas, the process diverged from that described previously. The sections concerning adolescents, congenital syphilis, and partner notification were reviewed by other CDC experts on prevention of STDs and human immunodeficiency virus (HIV) infection. The recommendations for STD screening during pregnancy were developed after CDC staff reviewed the published recommendations of other expert groups. The sections concerning early HIV infection are a compilation of recommendations developed by CDC experts in HIV infection. The sections on hepatitis B virus (HBV) (1) and hepatitis A virus (HAV) (2) infections are based on previously published recommendations of the Advisory Committee on Immunization Practices (ACIP).
Throughout this report, the evidence used as the basis for specific recommendations is discussed briefly. More comprehensive, annotated discussions of such evidence will appear in background papers that will be published in 1998. When more than one therapeutic regimen is recommended, the sequence is alphabetized unless there is priority of choice (i.e., based on efficacy, convenience, and cost). Almost all recommended regimens have similar efficacy and similar rates of intolerance or toxicity unless otherwise specified.
These recommendations were developed in consultation with experts whose experience is primarily with the treatment of patients in public STD clinics. Nevertheless, these recommendations also should be applicable to other patient-care settings, including family planning clinics, private physicians' offices, managed care organizations, and other primary-care facilities. When using these guidelines, the disease prevalence and other characteristics of the medical practice setting should be considered. These recommendations should be regarded as a source of clinical guidance and not as standards or inflexible rules.
These recommendations focus on the treatment and counseling of individual patients and do not address other community services and interventions that are important in STD/HIV prevention. Clinical and laboratory diagnoses are described when such information is related to therapy. For a more comprehensive discussion of diagnosis, refer to CDC's Sexually Transmitted Diseases Clinical Practice Guidelines, 1991 (3).
