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This document is being maintained for historical purposes, but is now out of date.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

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

INTRODUCTION
     
     Physicians and other health-care providers have a critical
role in the effort to prevent and treat sexually transmitted
diseases (STDs). These recommendations for the treatment of STDs
are intended to assist with that effort. They were developed by CDC
staff members in consultation with a group of invited experts.

     This report was produced through a multi-stage process.
Beginning in the spring of 1992, CDC personnel systematically
reviewed literature on each of the major STDs, focusing on data and
reports that have become available since the 1989 STD Treatment
Guidelines were published. Background papers were written and
tables of evidence constructed summarizing the type of study (e.g.,
randomized controlled trial, case series), the study population and
setting, the treatments or other interventions, outcome measures
assessed, reported findings, and weaknesses and biases in study
design and analysis. For these reviews and tables, published
abstracts and peer- reviewed journal articles were considered. CDC
personnel then developed a draft document based on those reviews.

     In January 1993, invited consultants assembled in Atlanta for
a 3-day meeting. CDC personnel presented the key questions on STD
treatment suggested from their literature reviews and presented the
data 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. The
consultants then assessed whether the questions identified were the
appropriate ones, 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 based on the number and types of studies and the quality of
those studies.

     In several areas, the process diverged from that described
above. The section on STD/HIV prevention guidelines was reviewed
for comment by experts who had not been present at the January
meeting, as well as by additional experts on STD/HIV prevention at
CDC. The recommendations for STD screening during pregnancy were
developed after CDC staff reviewed the published recommendations of
other expert groups that were convened by CDC and other
organizations. The sections on HIV infection and early intervention
and hepatitis B virus (HBV) also are principally a compilation of
recommendations developed by other experts and are provided in this
report for the convenience of those who use this document.

     Throughout this document the evidence used as the basis for
specific recommendations is briefly discussed. More comprehensive,
annotated discussions of such evidence will appear in background
papers that will be submitted for publication in 1994.

     These recommendations were developed in consultation with
experts whose experience is primarily with the treatment of
patients in public STD clinics. These recommendations also should
be applicable to other patient-care settings, including family
planning clinics, private doctor's offices, and other primary-care
facilities. When using these guidelines, consideration should be
given to the disease prevalence and to other characteristics of the
practice setting. These recommendations should not be construed as
standards or as inflexible rules, but as a source of clinical
guidance within the United States.

     These recommendations focus on the treatment and counseling of
individual patients and do not address other community services and
interventions that also play important roles 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 STD Clinical Practice
Guidelines, 1991 (1).

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