STDs: A Comprehensive New Guideline

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STDs: A Comprehensive New Guideline

The Centers for Disease Control and Prevention present comprehensive recommendations for diagnosing and treating sexually transmitted diseases.

Knowledge about sexually transmitted diseases (STDs) is increasingly important in the care of adolescents. In the recently released STD treatment guidelines from the CDC, therapy is the main focus, but diagnosis is also discussed. Therapeutic highlights include:

Bacterial Vaginosis:

metronidazole: 500 mg orally twice a day for 7 days, or
metronidazole gel: 0.75%, 1 full applicator intravaginally, once a day for 5 days, or
clindamycin cream: 20%, 1 full applicator intravaginally at bedtime for 7 days

Trichomoniasis:

metronidazole: 2 g orally in a single dose, or
metronidazole: 500 mg twice a day for 7 days

Uncomplicated Vulvovaginal Candidiasis:

various intravaginal agents, or
fluconazole: 150-mg oral tablet as a single dose

Recurrent Vulvovaginal Candidiasis (4 or more annual episodes of symptomatic disease):

7-14 days of topical therapy, or
fluconazole: 150-mg oral dose initially and repeated 3 days later. (Both treatments may achieve mycologic remission.)

Severe Vulvovaginal Candidiasis (extensive vulvar erythema, edema, excoriation, fissure formation):

7-14 days of topical azole, or
fluconazole: 150-mg oral dose in 2 sequential doses

Pelvic Inflammatory Disease:

Indications for hospitalization:

surgical emergencies
pregnancy, no clinical response to oral antimicrobial therapy, inability to follow or tolerate outpatient oral regimen, severe disease, or tubo-ovarian abscess
No data indicate adolescents benefit from hospitalization.

Parenteral regimen:

cefotetan: 2 g by IV every 12 hours, or
cefoxitin: 2 g by IV every 6 hours, plus doxycycline 100 mg orally or by IV every 12 hours
Various other parenteral regimens are discussed.

Oral treatment:

ofloxacin: 400 mg orally twice a day for 14 days, or
levofloxacin: 500 mg orally once daily for 14 days, with or without metronidazole 500 mg orally twice a day for 14 days.
Various other oral regimens are discussed.

Comment: This extraordinary guide to STDs is a wonderful resource. It is more comprehensive than the Red Book, contains a remarkable amount of helpful information, and is easy to use. Congenital syphilis, HIV, and hepatitis are also discussed. At the time of publication, this guide was available free of charge at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5106a1.htm.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 12, 2002