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This document is being maintained for historical purposes, but is now out of date.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

Prevention Methods

Condoms
     When used consistently and correctly, condoms are very
effective in preventing a variety of STDs, including HIV infection.
Multiple cohort studies, including those of serodiscordant couples,
have demonstrated a strong protective effect of condom use against
HIV infection. Condoms are regulated as medical devices and subject
to random sampling and testing by the Food and Drug Administration
(FDA). Each latex condom manufactured in the United States is
tested electronically for holes before packaging. Condom breakage
rates during use are low in the United States ( less than or equal
to 2 per 100 condoms tested). Condom failure usually results from
inconsistent or incorrect use rather than condom breakage.

     Patients should be advised that condoms must be used
consistently and correctly to be effective in preventing STDs.
Patients should also be instructed in the correct use of condoms.
The following recommendations ensure the proper use of condoms:

--   Use a new condom with each act of intercourse.

--   Carefully handle the condom to avoid damaging it with
     fingernails, teeth, or other sharp objects.

--   Put the condom on after the penis is erect and before any
     genital contact with the partner.

--   Ensure that no air is trapped in the tip of the condom.

--   Ensure that there is adequate lubrication during intercourse,
     possibly requiring the use of exogenous lubricants.

--   Use only water-based lubricants (e.g., K-Y JellyTM or
     glycerine) with latex condoms (oil-based lubricants {e.g.,
     petroleum jelly, shortening, mineral oil, massage oils, body
     lotions, or cooking oil} that can weaken latex should never be
     used).

--   Hold the condom firmly against the base of the penis during
     withdrawal, and withdraw while the penis is still erect to prevent
     slippage.

Condoms and Spermicides
     The effectiveness of spermicides in preventing HIV
transmission is unknown. No data exist to indicate that condoms
lubricated with spermicides are more effective than other
lubricated condoms in protecting against the transmission of HIV
infection and other STDs. Therefore, latex condoms with or without
spermicides are recommended.

Female Condoms
     Laboratory studies indicate that the female condom
(RealityTM) -- a lubricated polyurethane sheath with a ring on each
end that is inserted into the vagina--is an effective mechanical
barrier to viruses, including HIV. Aside from a small study of
trichomoniasis, no clinical studies have been completed to evaluate
protection from HIV infection or other STDs. However, an evaluation
of the female condom's effectiveness in pregnancy prevention was
conducted during a 6-month period for 147 women in the United
States. The estimated 12-month failure rate for pregnancy
prevention among the 147 women was 26%.

Vaginal Spermicides, Sponges, Diaphragms
     As demonstrated in several cohort studies, vaginal spermicides
(i.e., film, gel, suppositories; contraceptive foam has not been
studied) used alone without condoms reduce the risk for cervical
gonorrhea and chlamydia, but protection against HIV infection has
not been established in human studies. The vaginal contraceptive
sponge protects against cervical gonorrhea and chlamydia, but
increases the risk for candidiasis as evidenced by cohort studies.
Diaphragm use has been demonstrated to protect against cervical
gonorrhea, chlamydia, and trichomoniasis, but only in case-control
and cross-sectional studies; no cohort studies have been performed.
Gonorrhea and chlamydia among women usually involve the cervix as
a portal of entry, whereas other STD pathogens (including HIV) may
infect women through the vagina or vulva, as well as the cervix.
Protection of women against HIV infection should not be assumed
from the use of vaginal spermicides, vaginal sponges, or
diaphragms. The role of spermicides, sponges, and diaphragms for
preventing STDs among men has not been studied.

Nonbarrier Contraception, Surgical Sterilization, Hysterectomy
     Women who are not at risk for pregnancy may incorrectly
perceive themselves to be at no risk for STDs, including HIV
infection. Nonbarrier contraceptive methods offer no protection
against HIV or other STDs. Women using hormonal contraception (oral
contraceptives, NorplantTM, Depo-ProveraTM), who have been
surgically sterilized or who have had hysterectomies should be
counseled regarding the use of condoms and the risk for STDs,
including HIV infection.

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