[procaare] New CDC Treatment Guidelines Critical to Preventing Health Consequences of Sexually Transmitted Diseases

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New CDC Treatment Guidelines Critical to Preventing Health Consequences of Sexually
Transmitted Diseases
- Morbidity and Mortality Weekly Report (MMWR) (05.10.02)
*******************

The CDC has issued national guidelines to help health care providers protect their
patients from the health consequences of sexually transmitted diseases (STDs). CDC revises
the guidelines periodically (approximately every four years). This is the fifth CDC
edition of the guidelines. Major recommendations include: *Chlamydia screening is advised
annually for sexually active adolescent (19 years old and under) and young adult (20- to
24 years-old) women. Even without symptoms, screening is recommended, as well as screening
older women with a risk factor for chlamydia (a new partner or multiple sexual partners).
It is also now recommended that all women with chlamydial infections be rescreened three
to four months after treatment is completed.

This is the first time CDC has recommended rescreening in the management of chlamydia.
Chlamydia is concentrated among female adolescents. In the United States, millions of
cases go unrecognized. Reinfection with chlamydial infection is a key risk factor for
pelvic inflammatory disease (PID). PID can damage the fallopian tubes, uterus and ovaries,
and cause chronic pelvic pain. One in five women with PID also become infertile. Moreover,
women infected with chlamydia are up to five times more likely to become infected with
HIV, if exposed. Chlamydia is the most commonly reported infectious disease in the United
States; 702,093 cases were reported in 2000. *Alternative gonorrhea treatments in the wake
of increasing drug resistance in California. Gonorrhea is the second most common
infectious disease reported to CDC, with nearly 360,000 cases in 2000. Drug-resistant
strains are becoming increasingly common in the United States. Ciprofloxacin-resistant
gonorrhea was found to be endemic to Hawaii in 2000, when CDC recommended that the state
cease its use of fluoroquinolone antibiotics - ciprofloxacin, ofloxacin, and
levofloxacin - for treating gonorrhea.

Ciprofloxacin-resistant strains have become so common on the west coast that the use of
fluoroquinolone antibiotics to treat gonorrhea is inadvisable in California. Previously,
CDC recommended that fluoroquinolones not be prescribed for treating gonorrhea in Hawaii
and in those patients who visited the island state, other Pacific Islands, or Asia,
because a substantial proportion of the gonorrhea cases in those areas are resistant to
ciprofloxacin. The antibiotics cefixime and ceftriaxone are now recommended as first-line
drugs to treat gonorrhea in Hawaii and California.

CDC made these new recommendations after examining data from the Gonococcal Isolate
Surveillance Project (GISP), a CDC- sponsored surveillance system, which monitors drug
resistance of gonorrhea. The GISP project is limited to several areas in the United
States. It is critical therefore that local data are available to guide prescribing
recommendations. Most importantly, data from local drug susceptibility testing are
necessary to guide local treatment recommendations. CDC requests that local and state
public health professionals and health care providers report cases of gonorrhea that are
resistant to any recommended antibiotics. If not treated successfully, gonorrhea can cause
PID and can facilitate HIV transmission. *Expanded risk assessment and screening among gay
and bisexual men. Recent data have shown a higher frequency of unprotected sex and
increased rates of syphilis and gonorrhea in many US cities among men who have sex with
men (MSM), many of whom are HIV infected. To highlight the critical need for health care
providers to expand screening and treatment of STDs among MSM, the new guidelines include
detailed recommendations for this high-risk population.

The new guidelines urge health care providers to assess the sexual risk for all male
patients, including the gender of partners. For MSM patients who are sexually active, the
guidelines recommend annual screening for STDs - HIV, chlamydia (anal, urethral), syphilis
and gonorrhea (anal, pharyngeal, urethral) - and vaccination against hepatitis A and B.
More frequent STD screening may be indicated for those who indicate having multiple
anonymous partners or having sex in conjunction with illicit drug use. *New serological
tests available to help diagnose genital herpes. An estimated one million people are newly
infected with the Herpes Simplex Virus (HSV) each year. While most people have mild or
unrecognized symptoms and remain undiagnosed, many individuals seek medical attention when
they begin to suffer from the painful ulcers characteristic of this viral disease. Now,
new testing procedures may help providers with diagnosing and managing genital herpes type
one (HSV-1) or type two (HSV-2).

Since antiviral therapy may benefit individuals with herpes symptoms, providers can tailor
counseling and treatment plans to best fit their needs. Patients infected with HSV-2 (the
most common) can choose from suppressive or episodic antiviral treatments. Genital HSV-1,
which is often caused by oral- genital sexual contact with a person with an oral HSV-1
infection (fever blister), is much less likely to recur, and treatment may only be needed
in patients with initial symptoms.

HSV may play a major role in the spread of HIV. HSV stays in the body indefinitely and is
incurable. In the United States, an estimated 50 million people are infected. *Prevention
of STDs. The guidelines encourage health care providers to focus on risk assessment and
counseling in addition to the clinical aspects of STD control - screening and treatment.
Providers are encouraged to use client-centered counseling approaches tailored for each of
their patients. To avoid the spread of STDs, the guidelines suggest patients should
abstain from oral, vaginal or anal sex. Patients who are sexually active should be
counseled to be in a mutually monogamous relationship with an uninfected partner or use a
condom during each sexual act. *The use of Nonoxynol-9 (N-9). Recent studies have found
that frequent use of N-9, a spermicide contraceptive, can cause genital lesions (in the
vagina) and, therefore, may increase the risk of HIV transmission. It has also been found
to cause damage to the lining of the rectum, providing an entry point for HIV and other
STDs.

Spermicides - especially those that contain N-9 - should not be used for STD prevention.
Furthermore, N-9 lubricants should not be used during anal intercourse. While the level of
N- 9 used as a lubricant in condoms is much lower than the level found to be harmful,
condoms lubricated with N-9 spermicide also are not recommended because they have a
shorter shelf life, cost more and have been associated with urinary tract infections in
women. However, previously purchased condoms with N-9 can be used, provided they have not
passed their expiration date, since the protection provided by the condom against HIV
outweighs the potential risk of N-9.

The 2002 Guidelines for the Treatment of Sexually Transmitted Diseases can be ordered at
http://www.cdc.gov/std.

Source: CDC HIV/STD/TB Prevention News Update,  May 10, 2002

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