Sexually Transmitted Diseases Treatment Guidelines Research Articles

Ulcerative nodules on the entire body

Ulcerative nodules on the entire body

Identifying variations in adherence to the CDC sexually transmitted disease treatment guidelines of Neisseria gonorrhoeae

ObjectiveNeisseria gonorrhoeae is identified as a national challenge due to emerging antimicrobial resistance. The Centers for Disease Control and Prevention (CDC) sexually transmitted diseases (STD) Treatment guidelines are updated to address emerging concerns. The aims of this study were 1) to determine the proportion of cases that were adherent to two aspects of the treatment guidelines: antimicrobial treatment and follow-up recommendations and 2) to evaluate differences in adherence based on clinical location. Study designA retrospective review of medical records was performed for the first positive N. gonorrhoeae tests identified in subjects between May 2011 and December 2013 at a large urban academic medical centre. We hypothesised that provider adherence to STD treatment and prevention guidelines was better at STD specialised clinics than non-specialised settings. MethodsAdherence to CDC STD treatment guidelines was determined for both treatment and prevention management. Demographic, testing differences, and appropriate treatment and follow-up between speciality and non-speciality clinics were evaluated using chi-squared, Fisher's exact, and Student's t-test, when appropriate. ResultsDuring the study period, 542/714 positive tests were analysed. Healthcare provider adherence to antimicrobial management guidelines was 82% during the study period. Adherence to the guidelines was 76% and 88% for the 2010 and 2012 time periods, respectively. Non-adherence to recommendations included lack of dual therapy for N. gonorrhoeae in speciality clinics and incorrect dose in non-speciality clinics. Appropriate preventive follow-up was identified in only 31% of cases. Both speciality clinics and non-speciality clinics had errors related to partner therapy. ConclusionsProviders in speciality clinics were more adherent to the guidelines compared with providers at other clinical sites. Significant lack of adherence was identified in the follow-up management of N. gonorrhoeae. Evaluation of treatment errors may help improve medical management of N. gonorrhoeae.

Diagnosis and Management of Uncomplicated Chlamydia trachomatis Infections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines.

In preparation for the 2015 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases (STD) Treatment Guidelines, the CDC convened an advisory group in 2013 to examine recent abstracts and published literature addressing the epidemiology, diagnosis, and management of STDs. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infection in adolescents and adults that were considered in development of the 2015 CDC STD Treatment Guidelines. The evidence reviewed primarily focused on CT infection risk factors in women, clinical significance of oropharyngeal CT detection, acceptability and performance of CT testing on self-collected specimens in men, performance of CT point-of-care tests, efficacy of recommended and investigational CT infection treatments, and timing of test of cure following CT infection treatment in pregnant women.

Epididymitis.

In April 2013, the Centers for Disease Control and Prevention (CDC) convened an advisory group to assist in development of the 2015 CDC sexually transmitted diseases (STDs) treatment guidelines. The advisory group examined recent abstracts and published literature addressing the diagnosis and management of sexually transmitted infections. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of epididymitis that were considered in preparation of the 2015 CDC STD treatment guidelines.

A Review of Evidence-Based Care of Symptomatic Trichomoniasis and Asymptomatic Trichomonas vaginalis Infections.

Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection, affecting an estimated 3.7 million women and men in the United States. Health disparities are prominent in the epidemiology of this infection, which affects 11% of women aged ≥40 years and a disproportionately high percentage of black women. Particularly high prevalences have been identified among sexually transmitted disease (STD) clinic patients and incarcerated individuals. This article reviews and updates scientific evidence in key topic areas used for the development of the 2015 STD Treatment Guidelines published by the Centers for Disease Control and Prevention. Current evidence is presented regarding conditions associated with Trichomonas vaginalis infection, including human immunodeficiency virus (HIV) and pregnancy complications such as preterm birth. Nucleic acid amplification tests and point-of-care tests are newly available diagnostic methods that can be conducted on a variety of specimens, potentially allowing highly sensitive testing and screening of both women and men at risk for infection. Usually, trichomoniasis can be cured with single-dose therapy of an appropriate nitroimidazole antibiotic, but women who are also infected with HIV should receive therapy for 7 days. Antimicrobial resistance is an emerging concern.

Management of Gonorrhea in Adolescents and Adults in the United States.

Gonorrhea is the second most commonly reported notifiable disease in the United States and is associated with serious health sequelae, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Treatment for gonorrhea has been complicated by antimicrobial resistance. Neisseria gonorrhoeae has developed resistance to each of the antimicrobials that were previously recommended as first-line treatment regimens, and current treatment options are severely limited. This article summarizes the key questions and data that were discussed at the Sexually Transmitted Diseases (STD) Treatment Guidelines Expert Consultation meeting in April 2013, and the rationale for the 2015 Centers for Disease Control and Prevention STD treatment guidelines for gonococcal infections in adolescents and adults. Key issues addressed include whether to change the dosage of ceftriaxone and azithromycin used in the recommended dual treatment regimen, whether to continue to list dual treatment with cefixime and azithromycin as an alternative treatment regimen, and management of gonococcal infections in persons with severe cephalosporin allergy or suspected treatment failure.

Diagnosis and Management of Uncomplicated Chlamydia trachomatis Infections in Adolescents and Adults: Summary of Evidence Reviewed for the 2010 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

In preparation for the 2010 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases (STD) Treatment Guidelines, the CDC convened an advisory group in April 2009 to examine recent abstracts and published literature addressing the diagnosis and management of STDs. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis infection in adolescents and adults that were considered in development of the 2010 CDC STD Treatment Guidelines. The evidence reviewed primarily focused on specimen types used for nucleic acid amplification testing for chlamydia diagnosis, considerations in screening men for chlamydia and repeat testing after infected men receive treatment, and the natural history of chlamydia.

Updates on Human Papillomavirus and Genital Warts and Counseling Messages From the 2010 Sexually Transmitted Diseases Treatment Guidelines

In April 2009, experts on sexually transmitted diseases (STDs) were convened to review updates on STD prevention and treatment in preparation for the revision of the Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines. At this meeting, there was a discussion of important updates on human papillomavirus (HPV), genital warts, and cervical cancer screening. Key questions were identified with assistance from an expert panel, and systematic reviews of the literature were conducted searching the English-language literature of the PubMed computerized database (US National Library of Medicine). The available evidence was reviewed, and new information was incorporated in the 2010 CDC STD Treatment Guidelines. Two HPV vaccines are now available, the quadrivalent HPV vaccine and the bivalent HPV vaccine; either vaccine is recommended routinely for girls aged 11 or 12 years. The quadrivalent HPV vaccine may be given to boys and men aged 9-26 years. A new patient-applied treatment option for genital warts, sinecatechins 15% ointment, is available and recommended for treatment of external genital warts. This product is a mixture of active ingredients (catechins) from green tea. Finally, updated counseling guidelines and messages about HPV, genital warts, and cervical cancer are included. This manuscript highlights updates to the 2010 CDC STD Treatment Guidelines for HPV and genital warts. Important additions to the 2010 STD Treatment Guidelines include information on prophylactic HPV vaccine recommendations, new patient-applied treatment options for genital warts, and counseling messages for patients on HPV, genital warts, cervical cancer screening, and HPV tests.

Cervical Cancer Screening Among Women Who Attend Sexually Transmitted Diseases (STD) Clinics: Background Paper for 2010 STD Treatment Guidelines

In April 2008, experts reviewed updates on sexually transmitted disease (STD) prevention and treatment in preparation for the revision of the Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines. This included a review of cervical cancer screening in the STD clinical setting. Key questions were identified with assistance from an expert panel. Reviews of the literature were conducted using the PubMed computerized database and shared with the panel. Updated information was incorporated in the 2010 CDC STD Treatment Guidelines. We recommend that STD clinics offering cervical screening services screen and treat women according to guidelines by the American College of Obstetrics and Gynecology, the American Cancer Society, the US Preventive Services Task Force, and the American Society for Colposcopists and Cervical Pathologists. New to the 2010 guidelines are higher age for initiating cervical screening (age ≥ 21 years) and less frequent intervals of screening (at least every 3 years). New recommendations include new technologies, such as liquid-based cytology and high-risk human papillomavirus (HPV) DNA tests. Liquid-based technologies are not recommended over conventional testing. HPV DNA tests are recommended as adjunct tests and with new indications for use in cervical screening and management. Stronger recommendations were issued for STD clinics offering cervical screening services to have protocols in place for follow-up of test results and referral (eg, colposcopy). Important additions to the 2010 STD Treatment Guidelines include information on updated algorithms for screening and management of women and recommendations for use of liquid-based cytology and high-risk HPV testing.

Interventions to prevent sexually transmitted infections, including HIV infection.

The Centers for Disease Control and Prevention (CDC) Sexually Transmitted Disease (STD) Treatment Guidelines were last updated in 2006. To update the "Clinical Guide to Prevention Services" section of the 2010 CDC STD Treatment Guidelines, we reviewed the recent science with reference to interventions designed to prevent acquisition of STDs, including human immunodeficiency virus (HIV) infection. Major interval developments include (1) licensure and uptake of immunization against genital human papillomavirus, (2) validation of male circumcision as a potent prevention tool against acquisition of HIV and some other sexually transmitted infections (STIs), (3) failure of a promising HIV vaccine candidate to afford protection against HIV acquisition, (4) encouragement about the use of antiretroviral agents as preexposure prophylaxis to reduce risk of HIV and herpes simplex virus acquisition, (5) enhanced emphasis on expedited partner management and rescreening for persons infected with Chlamydia trachomatis and Neisseria gonorrhoeae, (6) recognition that behavioral interventions will be needed to address a new trend of sexually transmitted hepatitis C among men who have sex with men, and (7) the availability of a modified female condom. A range of preventive interventions is needed to reduce the risks of acquiring STI, including HIV infection, among sexually active people, and a flexible approach targeted to specific populations should integrate combinations of biomedical, behavioral, and structural interventions. These would ideally involve an array of prevention contexts, including (1) communications and practices among sexual partners, (2) transactions between individual clients and their healthcare providers, and (3) comprehensive population-level strategies for prioritizing prevention research, ensuring accurate outcome assessment, and formulating health policy.

Neurosyphilis as a Cause of Cognitive Decline and Psychiatric Symptoms at Younger Age

Back to table of contents Previous article Next article LettersFull AccessNeurosyphilis as a Cause of Cognitive Decline and Psychiatric Symptoms at Younger AgeG. Keskin, M.D., G. Sunter, M.D., I. Midi, M.D., and N. Tuncer, M.D.G. KeskinSearch for more papers by this author, M.D., G. SunterSearch for more papers by this author, M.D., I. MidiSearch for more papers by this author, M.D., and N. TuncerSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe41AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A significant number of patients with neurosyphilis present with dementia with a progressive course and psychiatric symptoms such as depression, mania, and psychosis. The clinician should suspect neurosyphilis, which has initial symptoms related to psychiatric presentation, rather than medical or neurological symptoms in young patients, because delay in diagnosis causes permanent and irreversible symptoms.1 Here, we report a case of neurosyphilis and describe the clinical characteristics and laboratory findings with the differential diagnosis.Case ReportA 38-year-old man was admitted to the hospital with a 3-year history of memory impairment. He had attended the psychiatric clinic with manic behavior, aggression, and delusions, and had been treated with antipsychotics and antidepressants. One year earlier, he had had speech difficulty, sometimes using words in other languages. Six months later, he developed pallilalia and episodes of laughing and crying. He reported no previous disease, and the family history was unremarkable. The physical examination showed no abnormality. On neurological examination, he was alert, disoriented, and had slight dysarthria; he was slow in response to commands. Pupils did not respond to light but contracted normally to accommodation and convergence (Argyll-Robertson pupils). The deep tendon reflexes were symmetric and brisk. The plantar responses were bilaterally extensor. Results of liver function tests, thyroid hormones, vitamin B12, folic acid, and other biochemical tests were normal. In serum testing, treponema pallidum hemagglutination assay (TPHA) and venereal disease research laboratory test (VDRL) were positive, at 1/5120 and 1/8 titers, respectively. CSF showed normal WBC count, protein 25 mg/dl, glucose 56 mg/dl, and the TPHA test was positive, at 1/320 titer. He was serologically negative for HIV infection. His Mini-Mental State Exam (MMSE) score was 8/30 because of to deficits in orientation, memory, attention, calculation, recall, and language. Cranial MRI study showed cerebral atrophy, particularly in the frontal lobe Figure 1).FIGURE 1. Cerebral and Cerebellar Atrophy Seen in the Axial and Sagittal Sections on MRIThe patient was started on ceftriaxone (1.2g IM daily) for 14 days. He is currently being monitored by neurology and infectious disease departments, and syphilis serology will be performed regularly during that time.Discussion“General paresis” or dementia paralytica is a rapidly-progressive dementia characterized by personality changes and memory deficits. It usually develops 10 to 25 years after syphilis infection, but it can occur as soon as 2 years after the infection. In the early course of the illness, most of the patients had deficits in memory and judgment, leading to severe dementia. On the other hand, individuals may have severe psychiatric symptoms like psychosis, depression, or mania.2,3 Higher doses of intravenous Penicillin G have been recommended as first-line therapy for neurosyphilis over the years, and neurological examination and lumbar puncture should be performed at 3 to 6 months after the penicillin treatment.4,5As for our patient, dementia and cognitive decline persisted after antisyphilis treatment, and activities of daily livings were supported with help. We want to emphasize the necessity of early treatment in syphilis cases.Department of Neurology Marmara University Hospital Istanbul, Turkeye-mail: [email protected]com1. Marra CM : Update on neurosyphilis. Curr Infect Dis Rep 2009; 11:127–134Crossref, Medline, Google Scholar2. Sobhen T , Rowe HM , Ryan WG , et al.: Unusual case report: three cases of psychiatric manifestations of neurosyphilis. Psychiatr Serv 2004; 55:830–832Crossref, Medline, Google Scholar3. Kohler CG , Pickholtz J , Ballas C : Neurosyphilis presenting as schizophrenia-like psychosis. Neuropsychiatry Neuropsychol Behav Neurol 2000; 13:297–302Medline, Google Scholar4. Workowski KA , Berman SM : Sexually-Transmitted Disease Treatment Guidelines, 2006. MMWR Recomm Rep 2006; 55:1Medline, Google Scholar5. Marra CM , Maxwell CL , Smith SL , et al.: Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis 2004; 189:369Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByElevation of Cerebrospinal Fluid Light and Heavy Neurofilament Levels in Symptomatic Neurosyphilis10 July 2020 | Sexually Transmitted Diseases, Vol. 47, No. 9Klinicheskaya dermatologiya i venerologiya, Vol. 18, No. 1NeuroTransmitter, Vol. 28, No. 9General Hospital Psychiatry, Vol. 37, No. 1A Case of Neurosyphilis Presenting With Dementia and Psychiatric SymptomsZeynep Baran Tatar, M.D., Alparslan Cansiz, M.D., Ayhan Köksal, M.D., and Erhan Kurt, M.D.1 January 2014 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 26, No. 1Journal of Neuroinflammation, Vol. 10, No. 1 Volume 23Issue 4 Fall 2011Pages E41-E42 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011

Neurosyphilis as a Cause of Cognitive Decline and Psychiatric Symptoms at Younger Age

Back to table of contents Previous article Next article LettersFull AccessNeurosyphilis as a Cause of Cognitive Decline and Psychiatric Symptoms at Younger AgeG. Keskin, M.D., G. Sunter, M.D., I. Midi, M.D., and N. Tuncer, M.D.G. KeskinSearch for more papers by this author, M.D., G. SunterSearch for more papers by this author, M.D., I. MidiSearch for more papers by this author, M.D., and N. TuncerSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe41AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A significant number of patients with neurosyphilis present with dementia with a progressive course and psychiatric symptoms such as depression, mania, and psychosis. The clinician should suspect neurosyphilis, which has initial symptoms related to psychiatric presentation, rather than medical or neurological symptoms in young patients, because delay in diagnosis causes permanent and irreversible symptoms.1 Here, we report a case of neurosyphilis and describe the clinical characteristics and laboratory findings with the differential diagnosis.Case ReportA 38-year-old man was admitted to the hospital with a 3-year history of memory impairment. He had attended the psychiatric clinic with manic behavior, aggression, and delusions, and had been treated with antipsychotics and antidepressants. One year earlier, he had had speech difficulty, sometimes using words in other languages. Six months later, he developed pallilalia and episodes of laughing and crying. He reported no previous disease, and the family history was unremarkable. The physical examination showed no abnormality. On neurological examination, he was alert, disoriented, and had slight dysarthria; he was slow in response to commands. Pupils did not respond to light but contracted normally to accommodation and convergence (Argyll-Robertson pupils). The deep tendon reflexes were symmetric and brisk. The plantar responses were bilaterally extensor. Results of liver function tests, thyroid hormones, vitamin B12, folic acid, and other biochemical tests were normal. In serum testing, treponema pallidum hemagglutination assay (TPHA) and venereal disease research laboratory test (VDRL) were positive, at 1/5120 and 1/8 titers, respectively. CSF showed normal WBC count, protein 25 mg/dl, glucose 56 mg/dl, and the TPHA test was positive, at 1/320 titer. He was serologically negative for HIV infection. His Mini-Mental State Exam (MMSE) score was 8/30 because of to deficits in orientation, memory, attention, calculation, recall, and language. Cranial MRI study showed cerebral atrophy, particularly in the frontal lobe Figure 1).FIGURE 1. Cerebral and Cerebellar Atrophy Seen in the Axial and Sagittal Sections on MRIThe patient was started on ceftriaxone (1.2g IM daily) for 14 days. He is currently being monitored by neurology and infectious disease departments, and syphilis serology will be performed regularly during that time.Discussion“General paresis” or dementia paralytica is a rapidly-progressive dementia characterized by personality changes and memory deficits. It usually develops 10 to 25 years after syphilis infection, but it can occur as soon as 2 years after the infection. In the early course of the illness, most of the patients had deficits in memory and judgment, leading to severe dementia. On the other hand, individuals may have severe psychiatric symptoms like psychosis, depression, or mania.2,3 Higher doses of intravenous Penicillin G have been recommended as first-line therapy for neurosyphilis over the years, and neurological examination and lumbar puncture should be performed at 3 to 6 months after the penicillin treatment.4,5As for our patient, dementia and cognitive decline persisted after antisyphilis treatment, and activities of daily livings were supported with help. We want to emphasize the necessity of early treatment in syphilis cases.Department of Neurology Marmara University Hospital Istanbul, Turkeye-mail: [email protected]com1. Marra CM : Update on neurosyphilis. Curr Infect Dis Rep 2009; 11:127–134Crossref, Medline, Google Scholar2. Sobhen T , Rowe HM , Ryan WG , et al.: Unusual case report: three cases of psychiatric manifestations of neurosyphilis. Psychiatr Serv 2004; 55:830–832Crossref, Medline, Google Scholar3. Kohler CG , Pickholtz J , Ballas C : Neurosyphilis presenting as schizophrenia-like psychosis. Neuropsychiatry Neuropsychol Behav Neurol 2000; 13:297–302Medline, Google Scholar4. Workowski KA , Berman SM : Sexually-Transmitted Disease Treatment Guidelines, 2006. MMWR Recomm Rep 2006; 55:1Medline, Google Scholar5. Marra CM , Maxwell CL , Smith SL , et al.: Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis 2004; 189:369Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByElevation of Cerebrospinal Fluid Light and Heavy Neurofilament Levels in Symptomatic Neurosyphilis10 July 2020 | Sexually Transmitted Diseases, Vol. 47, No. 9Klinicheskaya dermatologiya i venerologiya, Vol. 18, No. 1NeuroTransmitter, Vol. 28, No. 9General Hospital Psychiatry, Vol. 37, No. 1A Case of Neurosyphilis Presenting With Dementia and Psychiatric SymptomsZeynep Baran Tatar, M.D., Alparslan Cansiz, M.D., Ayhan Köksal, M.D., and Erhan Kurt, M.D.1 January 2014 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 26, No. 1Journal of Neuroinflammation, Vol. 10, No. 1 Volume 23Issue 4 Fall 2011Pages E41-E42 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011

Can Experiential–Didactic Training Improve Clinical STD Practices?

High rates of sexually transmitted diseases (STDs) present an ongoing costly public health challenge. One approach to reduce STD transmission is to increase the number of clinicians adopting the Centers for Disease Control and Prevention's STD Treatment Guidelines. This evaluation assesses the effectiveness of a 3-day experiential and didactic training to translate recommendations into practice by increasing clinician knowledge and skills and helping participants anticipate and overcome barriers to implementation. Between 2001 and 2004, 110 direct care clinicians from 10 states participated in one of 27 standardized 3-day interactive trainings offered by the Denver STD/human immunodeficiency virus (HIV) Prevention Training Center. STD/HIV knowledge and clinical skills were measured before, immediately after, and 6 months after training. Practice patterns were assessed before training and after 6 months. Structural barriers to implementation were identified 6 months post-training. Trainees demonstrated significant post-training gains in mean knowledge scores immediately post-training (P < 0.001) and 6 months post-training (P = 0.002). After 6 months, self-reported mean skill levels remained significantly improved compared to precourse (P < 0.05) for each of 27 skills including STD risk assessment, clinical examination, diagnosis, and treatment. Self-reported improvement in practice patterns was significant for 23 of 35 practices (P < 0.05) 6 months post-training. Participants indicated that inadequate time (52.9%), facilities/equipment (51.5%), and staffing (47.1%) interfered with implementation of recommended practices. Experiential-didactic STD/HIV training can modestly improve knowledge, clinical skills, and implementation of STD recommended practices 6 months after training. Further research is needed to identify the impact of improved clinical practices on STD/HIV transmission.

Self-reported syphilis and gonorrhoea testing among men who have sex with men: national HIV behavioural surveillance system, 2003–5

Objectives:The Centers for Disease Control and Prevention provides guidance on sexually transmitted disease (STD) testing specifically for men who have sex with men (MSM) in STD treatment guidelines to address...

Estimating dissemination of Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines from a survey of physicians

Periodically, the Centers for Disease Control and Prevention (CDC) produce guidelines for the treatment of sexually transmitted diseases (STDs) in the USA. To date, few evaluations of the dissemination of these guidelines exist. A paper and pencil survey was distributed via priority mail to a sample of Atlanta-area physicians, 416 (34%) of whom responded with complete data. Physicians were drawn from private practice, managed-care settings and public settings. In all, 85% of respondents treated STD, with a further 10% referring cases. Of those treating STD, 56% owned a copy of the 2002 CDC Treatment Guidelines, and 26% knew how to access them. The corresponding figures for physicians not treating STD were 25% and 30%. Of the physicians who did have copies, half had accessed the internet for their copies. Acquisition of, or the knowledge of how to acquire, the CDC STD Treatment Guidelines was widespread. The internet may be an effective and cost-saving means of disseminating the guidelines, although the continued need for print distribution should not be discounted.

Knowledge About Sexually Transmitted Diseases in Women Among Primary Care Physicians

Little is known about sexually transmitted disease (STD) knowledge of primary care providers. The objectives of this study were to determine the knowledge about the management of STDs among primary care physicians and to identify physician characteristics associated with possession of STD knowledge. A self-administered questionnaire was mailed to a random sample of 1600 obstetrician/gynecologists, pediatricians, family physicians, and internists practicing in Pennsylvania. Information on physician and patient demographics was gathered, and we assessed knowledge and practice patterns concerning the management of STDs in young women. Physician knowledge regarding the evaluation and management of women with or at risk for STDs was associated with female gender (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.2), age < or =40 (OR: 2.3; 95% CI: 1.4-3.6), and metropolitan practice location (OR: 1.7; 95% CI: 1.1-2.6). Familiarity with the Center for Disease Control and Prevention's (CDC's) STD treatment guidelines was independently associated with STD knowledge (OR: 2.0; 95% CI: 1.2, 3.3). Physicians with good STD knowledge were more likely to report routinely screening at-risk women for Chlamydia trachomatis (OR: 3.9; 95% CI: 2.3-6.8). Inadequacies in physician knowledge may serve as a barrier to the appropriate diagnosis and treatment of STDs. Interventions to improve STD management practices should include continuing medical education and distribution of CDC's STD treatment guidelines to primary care providers.

Prevention of sexually transmitted diseases

Sexually transmitted diseases (STDs) represent a serious and ongoing public health concern in the developing and developed world. In the United States between 10 million to 20 million new STD cases occur every year [1]. In 2002 this included 834555 cases of chlamydia a 6.5% increase in prevalence from 2001 [2]. Forty-five million people in the United States are infected with genital herpes and one million new cases occur every year [3]. Five million people worldwide became infected with HIV in 2003 [4] and over 281000 people in the United States are living with HIV [5]. Because most STDs are initially asymptomatic and several are incurable the best hope for decreasing the personal and social costs of these infections is prevention. A National Institute of Medicine report in 1997 recognized that “although the barriers to STD prevention are formidable STDs can be prevented” but lamented the lack of an effective national system for STD prevention [6]. It is debatable as to how much progress has been made over the last 7 years. The current Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines state “The prevention and control of STDs is based on the following five major concepts: a) education and counseling of persons at risk on ways to adopt safer sexual behavior; b) identification of asymptomatically infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services; c) effective diagnosis and treatment of infected persons; d) evaluation treatment and counseling of sex partners of persons who are infected with an STD; and e) pre-exposure vaccination of persons at risk for vaccine-preventable STDs” [7]. With the exception of diagnosis and treatment this article reviews each of these and their underlying evidence of effectiveness. (authors)

Etiology of clinical proctitis among men who have sex with men.

In this retrospective review of cases of clinical proctitis, we identified the frequency of common sexually transmitted diseases (STDs) among men who have sex with men on the basis of reports from the municipal STD clinic in San Francisco. Of note, gonorrhea and chlamydia were the most common STDs, followed by herpes and syphilis. Current STD treatment guidelines recommend empiric treatment for gonorrhea and chlamydia, but treatment for herpes should also be considered. The implications for human immunodeficiency virus (HIV) transmission are also discussed.

Sexually transmitted diseases treatment guidelines

Sexually transmitted diseases (STDs) are a major health problem for adolescents. Health care providers for adolescents play a critical role in preventing and treating STDs. In May 2002, the Centers for Disease Control and Prevention published the Sexually Transmitted Diseases Treatment Guidelines 2002. These evidence-based guidelines are based on a systematic literature review focusing on information that had become available since the 1998 Guidelines for Treatment of STDs. This article reviews the new STD treatment guidelines for gonorrhea, chlamydia, bacterial vaginosis, trichomonas, vulvovaginal candidiasis, pelvic inflammatory disease, genital warts, herpes simplex virus infection, syphilis, and scabies. Although these guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed.

The CDC 2002 guidelines for the treatment of sexually transmitted diseases: implications for women’s health care

Persons rely on health care providers to make diagnostic and therapeutic decisions based on the most current information. With areas of practice changing rapidly, providers are challenged to keep abreast of new and changing treatment guidelines. The new Centers for Disease Control and Prevention (CDC) 2002 Sexually Transmitted Disease (STD) Treatment Guidelines provide clinical guidance in the appropriate assessment and management of STDs. This article reviews recent changes in the STD Treatment Guidelines for the most common disease entities and their sequelae encountered by women’s health practitioners. The changes noted in this article include new screening recommendations, use of new diagnostics, new treatment algorithms, and changes in therapeutic regimens.