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This document is being maintained for historical purposes, but is now out of date.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

Special Considerations

Pregnancy
     Women who are HIV-infected should be specifically informed
about the risk for perinatal infection. Current evidence indicates
that 15%-39% of infants born to HIV- infected mothers are infected
with HIV, and the virus also can be transmitted from an infected
mother by breastfeeding. Pregnancy among HIV-infected patients does
not appear to increase maternal morbidity or mortality.

     Women should be counseled about their options regarding
pregnancy. The objective of counseling is to provide HIV-infected
women with current information for making reproductive decisions,
analogous to the model used in genetic counseling. Contraceptive,
prenatal, and abortion services should be available on site or by
referral.

     Minimal information is available on the use of ZDV or other
antiretroviral drugs during pregnancy. Trials to evaluate its
efficacy in preventing perinatal transmission and its safety during
pregnancy are being conducted. A case series of 43 pregnant women
has been published; dosages of ZDV ranged from 300 to 1,200 mg/day.
ZDV was well tolerated and there were no malformations among the
newborns in this series. Although this observation is encouraging,
this series of negative case reports cannot be used to infer that
ZDV is not teratogenic.

     Burroughs Wellcome Co. and Hoffmann-LaRoche, Inc., in
cooperation with CDC, maintain a registry to assess the effects of
the use of ZDV and DDC during pregnancy. Women who receive either
ZDV or DDC during pregnancy should be reported to this registry
(1-800-722-9292, ext. 58465).

HIV Infection Among Infants and Children
     Infants and young children with HIV infection differ from
adults and adolescents with respect to the diagnosis, clinical
presentation, and management of HIV disease. For example, total
lymphocytes and absolute CD4+ cell counts are much higher in
infants and children than in healthy adults and are age dependent.
Specific indications and dosages for both antiretroviral and
prophylactic therapy have been developed for children (12). Other
modifications must be made in health services that are recommended
for infants and children, such as avoiding vaccination with live
oral polio vaccine when a child (or close household contact) is
infected with HIV.

     State laws differ regarding consent of minor persons ( less
than 18 years of age) for HIV counseling and testing, evaluation,
treatment services, and participation in clinical trials. Although
most adolescents receive adult doses of antiretroviral and
prophylactic therapy, there are no data on modification of these
dosages during puberty. Management of infants, children, and
adolescents -- who are known or suspected to be infected with HIV
-- requires referral to, or close consultation with, physicians
familiar with the manifestations and treatment of pediatric HIV
infection.

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