The term sexually transmitted diseases (STDs) is used to refer to a variety of clinical syndromes caused by pathogens that can be acquired and transmitted through sexual activity. Physicians and other health-care providers play a critical role in preventing and treating STDs. These guidelines for the treat- ment of STDs are intended to assist with that effort. Although these guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed. These recommendations should be regarded as a source of clinical guidance and not prescriptive standards; health-care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family- planning clinics, private physicians’ offices, managed care orga- nizations, and other primary-care facilities. These guidelines focus on the treatment and counseling of individual patients and do not address other community services and interven- tions that are essential to STD/human immunodeficiency virus (HIV) prevention efforts.
Methods:
These guidelines were developed using a multistage process. Beginning in 2008, CDC staff members and public and private sector experts knowledgeable in the field of STDs systematically reviewed literature using an evidence-based approach (e.g., published abstracts and peer-reviewed journal articles), focusing on the common STDs and information that had become available since publication of the 2006 Guidelines for Treatment of Sexually Transmitted Diseases (1). CDC staff members and STD experts developed background papers and tables of evidence that summarized 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. CDC staff then developed a draft document on the basis of this evidence-based review. In April 2009, this information was presented at a meeting of invited consultants (including public- and private-sector professionals knowledgeable in the treatment of patients with STDs), where all evidence from the literature reviews pertaining to STD management was discussed. Specifically, participants identified key questions regarding STD treatment that emerged from the literature reviews and discussed the information available to answer those ques- tions. Discussion focused on four principal outcomes of STD therapy for each individual disease:
1) treatment of infection based on microbiologic eradication;
2) alleviation of signs and symptoms;
3) prevention of sequelae; and
4) prevention
of transmission. Cost-effectiveness and other advantages (e.g., single-dose formulations and directly observed therapy [DOT]) of specific regimens also were discussed. The consultants then assessed whether the questions identified were relevant, ranked them in order of priority, and answered the questions 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.
Clinical Prevention Guidance The prevention and control of STDs are based on the following five major strategies:
•education and counseling of persons at risk on ways to avoid STDs through changes in sexual behaviors and use of recommended prevention services;
• identification of asymptomatically infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services;
• effective diagnosis, treatment, and counseling of infected persons;
• evaluation, treatment, and counseling of sex partners of persons who are infected with an STD; and
• pre-exposure vaccination of persons at risk for vaccine- preventable STDs.
