Public Health

The Centers for Disease Control and Prevention (CDC) released the Sexually Transmitted Infections (STI) Treatment Guidelines, 2021, which provide current evidence-based diagnostic, management, and treatment recommendations.

The updated STI Tx Guide app is now available for free on Apple and Android mobile devices. Use it, as well as CDC’s other provider resources, to navigate the guidelines quickly.

STIs are common and costly to the nation’s health and economy.[1,2] Each year, 26 million new STIs occur,[1] totaling nearly $16 billion in medical costs.[2] Following evidence-based recommendations is one important way to prevent infections and protect people.

Here are five changes to know about the 2021 STI Treatment Guidelines:

1. Treatment recommendations changed for chlamydia, trichomoniasis, and pelvic inflammatory disease (PID)

Chlamydia and trichomoniasis account for 11 million new infections each year (about 4 million and 7 million, respectively).[1] PID, an infection of the upper genital tract, may be less common, but 2 million reproductive-aged women self-reported this syndrome over 10 years.[3]

All three infections disproportionately affect women.[1] Chlamydia can lead to PID, which can result in chronic pelvic pain, tubal factor infertility, and potentially fatal ectopic pregnancy. Pregnant women with trichomoniasis are at an increased risk for preterm delivery and low birthweight. Chlamydia and trichomoniasis are both associated with increased risk for HIV acquisition and transmission.

Prompt and appropriate treatment with the following regimens is critical to avoid severe health complications:

  • Chlamydia: Doxycycline is now the first-line recommended treatment; 100 mg orally twice a day for 7 days.
  • Trichomoniasis: Metronidazole is recommended for treating all women; 500 mg orally twice a day for 7 days.
  • PID: The recommended outpatient regimen is ceftriaxone 500 mg intramuscularly in a single dose + doxycycline 100 mg orally twice a day for 14 days + metronidazole 500 mg orally twice a day for 14 days.

Because of high reinfection rates, CDC recommends retesting patients 3 months after receiving chlamydia and/or trichomoniasis treatment.

2. Updated and expanded gonorrhea treatment recommendations to minimize the threat of drug resistance

CDC estimates that more than a million new gonorrhea infections occur each year, and about half of all infections are resistant to at least one antibiotic.[4] In late 2020, CDC updated gonorrhea treatment guidelines for adolescents and adults to ensure effective treatment and minimize the threat of drug resistance.[5] The full STI Treatment guidelines expand on recommendations for neonates, children, and other specific clinical situations (ie, disseminated gonococcal infection, proctitis, epididymitis, PID, and sexual assault).

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