Skip to main content

Advertisement

SpringerLink
Log in

The 1998 CDC sexually transmitted diseases treatment guidelines

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Health care providers who evaluate persons who have or are at risk for sexually transmitted diseases (STDs) should be aware of current national guidelines for STD treatment and should provide assessment and treatment according to these recommendations. The Centers for Disease Control and Prevention STD Treatment Guidelines were developed by using an evidence-based approach incorporating available scientific evidence, specialist knowledge, and consultation with professional organizations and other agencies with diverse perspectives on STD treatment. The guidelines provide recommendations about new antimicrobial agents for the treatment of primary and recurrent genital herpes, a novel patient-applied therapy for genital warts, additional parenteral alternative regimens for the treatment of pelvic inflammatory disease, oral therapy for vaginal candidiasis, and alternative regimens for treatment of chlamydia in pregnancy. Expanded sections in the guidelines also address the management of urethritis, recognition of the acute retroviral syndrome, and the emergence of quinolone-resistant Neisseria gonorrhoeae. Prevention of sexually transmitted hepatitis A and hepatitis B through the use of preexposure vaccinations is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Cates W and the American Social Health Association Panel to Estimate STD Incidence and Cost: Estimates of the incidence and prevalence of STDs in the United States in 1996. Sex Transm Dis 1999, 26:S2-S7.

    Article  Google Scholar 

  2. Institute of Medicine: The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy of Sciences, National Academy Press; 1997:1–432.

    Google Scholar 

  3. Centers for Disease Control and Prevention: 1998 guidelines for treatment of sexually transmitted diseases. MMWR Morb Mortal Wkly Rep 1998, 47(RR-1):1–116. This paper gives current recommendations for the evaluation and treatment of STDs.

    Google Scholar 

  4. Centers for Disease Control and Prevention: HIV prevention through early detection and treatment of other sexually transmitted diseases—United States. MMWR Morb Mortal Wkly Rep 1998, 47(RR-12):1–24.

    Google Scholar 

  5. Kinloch-de Loes S, Hirschel BJ, Hoen B, et al.: A controlled trial of zidovudine in primary human immunodeficiency virus infection. N Engl J Med 1995, 333:408–413.

    Article  Google Scholar 

  6. Mertz K, Trees D, Levine WC, et al.: Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. J Infect Dis 1998, 178:1795–1798.

    Article  PubMed  CAS  Google Scholar 

  7. DiCarlo RP, Martin DH: The clinical diagnosis of genital ulcer disease in men. Clin Infect Dis 1997, 25:292–298.

    PubMed  CAS  Google Scholar 

  8. Fleming DT, McQuillan GM, Johnson RE, et al.: Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med 1997, 337:1105–1111.

    Article  PubMed  CAS  Google Scholar 

  9. Wald A: New therapies and prevention strategies for genital herpes. Clin Infect Dis 1999, 28(suppl 1):S4-S13. This paper updates new therapeutic options for treatment and suppression of genital herpes and provides extensive instruction for counseling patients with this condition.

    PubMed  Google Scholar 

  10. Fife KH, Barbarash RA, Rudolph T, et al.: Valacyclovir versus acyclovir in the treatment of first episode genital herpes infection: results of an international multicenter double blind randomized clinical trial. Sex Transm Dis 1997, 24:481–486.

    Article  PubMed  CAS  Google Scholar 

  11. Loveless M, Harris W, Sacks S: Treatment of first episode genital herpes with famciclovir [abstract]. In Programs and Abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Francisco: American Society of Microbiology; 1995:12.

    Google Scholar 

  12. Spruance S, Trying S, Degregorio B, et al.: A large-scale placebo controlled, dose-ranging trial of peroral valacyclovir for episodic treatment of recurrent herpes genitalis. Arch Intern Med 1996, 156:1729–1735.

    Article  PubMed  CAS  Google Scholar 

  13. Bodsworth NJ, Crooks RJ, Borelli S, et al.: Valaciclovir versus acyclovir in patient-initiated treatment of recurrent genital herpes: a randomized double-blind clinical trial. Genitourin Med 1997, 73:110–116.

    PubMed  CAS  Google Scholar 

  14. Sachs S, Aoki FY, Diaz-Mitoma F, et al.: Patient-initiated twice-daily oral famciclovir for early recurrent genital herpes: a randomized double-blind multicenter trial. JAMA 1996, 276:44–49.

    Article  Google Scholar 

  15. Patel R, Bodsworth NJ, Wooley P, et al.: Valacyclovir for the suppression of recurrent genital HSV infection: a placebo controlled study of once-daily therapy. Genitourin Med 1997, 73:105–109.

    PubMed  CAS  Google Scholar 

  16. Diaz-Mitoma F, Sibbald G, Shafran SD, et al.: Oral famciclovir for the suppression of recurrent genital herpes: a randomized controlled trial. JAMA 1998, 280:887–892.

    Article  PubMed  CAS  Google Scholar 

  17. Fife KH, Crumpacker CS, Mertz GJ, et al.: Recurrence and resistance patterns of herpes simplex virus following cessation of >6 years of chronic suppression with acyclovir. J Infect Dis 1994, 169:1338–1341.

    PubMed  CAS  Google Scholar 

  18. Wald A, Corey L, Cone R, et al.: Frequent genital HSV shedding in immunocompetent women. J Clin Invest 1997, 99:1092–1097.

    Article  PubMed  CAS  Google Scholar 

  19. Wald A, Zeh J, Barnum G, et al.: Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Ann Intern Med 1996, 124:8–15.

    PubMed  CAS  Google Scholar 

  20. Augenbraun MH, Rolfs R: Treatment of syphilis 1998: nonpregnant adults. Clin Infect Dis 1999, 28(suppl 1):S21-S28. These authors examine current controversies in the treatment of syphilis, especially in patients with HIV infection.

    PubMed  Google Scholar 

  21. Rolfs RT, Joesoef MR, Hendershot EF, et al.: A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. N Engl J Med 1997, 337:307–314.

    Article  PubMed  CAS  Google Scholar 

  22. Hook E, Roddy R, Handsfield H: Ceftriaxone for incubating and early syphilis. J Infect Dis 1988, 158:881–884.

    PubMed  Google Scholar 

  23. Stamm L, Parrish E: In-vitro activity of azithromycin and CP-63,956 against Treponema pallidum. J Antimicrob Chemother 1990, 25:11–14.

    PubMed  CAS  Google Scholar 

  24. Lukehart S, Fohn M, Baker-Zander S: Efficacy of azithromycin for therapy of active syphilis in the rabbit model. J Antimicrob Chemother 1990, suppl 25A:91–99.

    Google Scholar 

  25. Verdon M, Handsfield H, Johnson R: Pilot study of azithromycin for the treatment of primary and secondary syphilis. Clin Infect Dis 1994, 19:486–488.

    PubMed  CAS  Google Scholar 

  26. Mertz K, Weiss JB, Webb RM, et al.: An investigation of genital ulcers in Jackson, Mississippi with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection. J Infect Dis 1998, 178:1060–1066.

    Article  PubMed  CAS  Google Scholar 

  27. Schmid GP: Treatment of chancroid 1997. Clin Infect Dis 1999, 28(suppl 1):S14-S20. This paper reviews the current literature on therapeutic options for chancroid.

    PubMed  Google Scholar 

  28. Burstein GR, Zenilman JM: Nongonococcal urethritis—a new paradigm. Clin Infect Dis 1999, 28(suppl 1):S66-S73. These authors provide recommendations on appropriate evaluation and management of men with nongonococcal urethritis.

    PubMed  Google Scholar 

  29. Viscidi RP, Bobo L, Hook EW, et al.: Transmission of Chlamydia trachomatis among sexual partners assessed by polymerase chain reaction. J Infect Dis 1993, 168:488–492.

    PubMed  CAS  Google Scholar 

  30. Jaschek G, Gaydos CA, Welsh L, et al.: Direct detection of Chlamydia trachomatis in urine specimens from symptomatic and asymptomatic men by using a rapid polymerase chain reaction assay. J Clin Microbiol 1993, 31:1209–1212.

    PubMed  CAS  Google Scholar 

  31. Vogels WH, Van Voorst-Vader PC, Schroeder FP: Chlamydia trachomatis infection in a high risk population: comparison of polymerase chain reaction and cell culture for diagnosis and follow up. J Clin Microbiol 1993, 31:1103–1107.

    PubMed  CAS  Google Scholar 

  32. Marrazzo JM, White CL, Krekeler B, et al.: Community-based urine screening for Chlamydia trachomatis with a ligase chain reaction assay. Ann Intern Med 1997, 127:796–803.

    PubMed  CAS  Google Scholar 

  33. Krieger JN, Jenny C, Verdon M, et al.: Clinical manifestations of trichomoniasis in men. Ann Intern Med 1993, 118:844–849.

    PubMed  CAS  Google Scholar 

  34. Scholes D, Stergachis A, Heidrich FE, et al.: Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996, 334:1362–1366.

    Article  PubMed  CAS  Google Scholar 

  35. Magid D, Douglas JM, Schwartz JS: Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental costeffectiveness analysis. Ann Intern Med 1996, 124:389–399.

    PubMed  CAS  Google Scholar 

  36. Magat AH, Alger LS, Nagey DA, et al.: Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstet Gynecol 1993, 81:745–749.

    PubMed  CAS  Google Scholar 

  37. Knapp JS, Fox KK, Trees D, et al.: Fluoroquinolone resistance in Neisseria gonorrhoeae. Emerg Infect Dis 1997, 3:33–39.

    Article  PubMed  CAS  Google Scholar 

  38. Fox KK, Knapp JS: Antimicrobial resistance in Neisseria gonorrhoeae. Curr Opin Urology 1999, 9:65–70.

    Article  CAS  Google Scholar 

  39. Walker CK, Workowski KA, Washington AE, et al.: Anaerobes in pelvic inflammatory disease: implications for the Centers for Disease Control and Prevention’s guidelines for treatment of sexually transmitted diseases. Clin Infect Dis 1999, 28(suppl 1):S29-S36.

    PubMed  Google Scholar 

  40. Arredondo JL, Diaz V, Gaitan H, et al.: Oral clindamycin and ciprofloxacin versus intramuscular ceftriaxone and oral doxycycline in the treatment of mild-to-moderate pelvic inflammatory disease in outpatients. Clin Infect Dis 1997, 24:170–178.

    PubMed  CAS  Google Scholar 

  41. Wendel GD, Cox SM, Bawdon RE, et al.: A randomized trail of ofloxacin versus cefoxitin and doxycycline in the outpatient treatment of acute salpingitis. Am J Obstet Gynecol 1991, 164:1390–1396.

    PubMed  Google Scholar 

  42. Crombleholme W, Landers D, Ohm-Smith M, et al.: Sulbactam/ ampicillin versus metronidazole/gentamicin in the treatment of severe pelvic infections. Drugs 1986, 31:11–13.

    PubMed  Google Scholar 

  43. Heinonen PK, Teisala K, Aine R, Miettinen A: Intravenous and oral ciprofloxacin in the treatment of proven pelvic inflammatory disease: a comparison with doxycycline and metronidazole. Am J Med 1989, 87:152S-156S.

    Article  PubMed  CAS  Google Scholar 

  44. Crombleholme WR, Schachter J, Ohm-Smith M, et al.: Efficacy of single agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin. Am J Med 1989, 87:142S-147S.

    Article  PubMed  CAS  Google Scholar 

  45. Chow AW, Malkasian KL, Marshall J, et al.: The bacteriology of acute pelvic inflammatory disease. Am J Obstet Gynecol 1975, 122:876–879.

    PubMed  CAS  Google Scholar 

  46. Sobel JD. Vaginitis. N Engl J Med 1997, 337:1896–1903. This is an excellent comprehensive evaluation of the management of vaginitis.

    Article  PubMed  CAS  Google Scholar 

  47. Joesoef MR, Schmid GP, Hillier SL: Bacterial vaginosis: review of treatment options and potential clinical indications for therapy. Clin Infect Dis 1999, 28(suppl 1):S57-S65.

    Article  PubMed  Google Scholar 

  48. Larsson PG, Platz-Christensen JJ, Theils H, et al.: Incidence of pelvic inflammatory disease after first trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind randomized study. Am J Obstet Gynecol 1992, 166:100–103.

    PubMed  CAS  Google Scholar 

  49. Hillier SL, Nugent RP, Eschenbach DA, et al.: Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. N Engl J Med 1995, 333:1737–1742.

    Article  PubMed  CAS  Google Scholar 

  50. Hauth JC, Goldenberg RL, Andrews WW, et al.: Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995, 333:1732–1736.

    Article  PubMed  CAS  Google Scholar 

  51. Morales WJ, Schorr S, Albritton J: Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study. Am J Obstet Gynecol 1994, 171:345–349.

    PubMed  CAS  Google Scholar 

  52. Burtin P, Taddio A, Ariburnu O, et al.: Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol 1995, 172:525–529.

    Article  PubMed  CAS  Google Scholar 

  53. Schwebke JR: Metronidazole: utilization in the obstetric and gynecologic patient. Sex Transm Dis 1995, 22:370–376.

    Article  PubMed  CAS  Google Scholar 

  54. Struthers BJ: Metronidazole appears not to be a human teratogen: review of literature. Infect Dis Obstet Gynecol 1997, 5:326–335.

    Article  PubMed  CAS  Google Scholar 

  55. Narcisi EM, Secor WE: In vitro effect of tinidazole and furazolidone on metronidazole-resistant Trichomonas vaginalis. Antimicrob Agents Chemother 1996, 40:1121–1125.

    PubMed  CAS  Google Scholar 

  56. Beutner KR, Wiley DJ, Douglas JM, et al.: Genital warts and their treatment. Clin Infect Dis 1999, 28(suppl_1):S37-S56.

    PubMed  Google Scholar 

  57. Trying S, Edwards L, Cherry LK, et al.: Safety and efficacy of 0.5% podofilox gel in the treatment of anogenital warts. Arch Dermatol 1998, 134:33–38.

    Article  Google Scholar 

  58. Beutner KR, Spruance SL, Hougham AJ, et al.: Treatment of genital warts with an immune-response modifier (imiquimod). J Am Acad Dermatol 1998, 38:230–239.

    Article  PubMed  CAS  Google Scholar 

  59. Edwards L, Ferenczy A, Eron L, et al.: Self-administered topical 5% imiquimod cream for external anogenital warts. Arch Dermatol 1998, 134:25–30.

    Article  PubMed  CAS  Google Scholar 

  60. Centers for Disease Control and Prevention: Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination-recommendations of the Immunization Practices Advisory Committee. MMWR Morb Mortal Wkly Rep 199140(RR-13):1–20.

    Google Scholar 

  61. Centers for Disease Control and Prevention: Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 1996, 45(RR-15):1–30.

    Google Scholar 

  62. Grosskurth H, Mosha F, Todd J, et al.: Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995, 346:530–536.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Guidelines Unit, Epidemiology and Surveillance Branch, Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E02, 30333, Atlanta, GA, USA

    Kimberly A. Workowski MD

Authors
  1. Kimberly A. Workowski MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Workowski, K.A. The 1998 CDC sexually transmitted diseases treatment guidelines. Curr Infect Dis Rep 2, 44–50 (2000). https://doi.org/10.1007/s11908-000-0086-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-000-0086-9

Keywords

Search

Navigation