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One of the challenges that continually face public health officials is to stay on top of the rampant sexually transmitted infections (STIs), also knows as STDs, in the face of the ever-evolving resistance to drugs which lose their ability to successfully treat the infections in question.

Medscape reported at the end of December 2010 on the latest update on STD treatment guidelines from the division of STD Prevention at the Centers for Disease Control (CDC) and Prevention.

These guidelines are intended to assist the clinician with the management of persons who have, or are at risk for, sexually transmitted diseases. Although these guidelines emphasize treatment, prevention strategies and diagnostic evaluation are also discussed.

Some of the key changes include the prevention and treatment of HPV, gonorrhea, and lymphogranuloma venereum proctocolitis.

These guidelines highlight expanded prevention recommendations for sexually transmitted infections, including pre-exposure vaccination for human papillomavirus virus (HPV).Pre-exposure vaccination is one of the most effective methods to prevent transmission of HPV. There are 2 HPV vaccines licensed for females aged 9 through 26 years to prevent cervical pre-cancer and cancer: the quadrivalent HPV vaccine Gardasil® and the bivalent HPV vaccine Cervarix®. Gardasil will also prevent genital warts. Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is the catch-up vaccination for females aged 13 through 26 years. Gardasil may also be given to males aged 9 through 26 years to prevent genital warts.

Treating Gonorrhoea

Neisseria gonorrhoeae, or GC, has developed resistance to many classes of antimicrobials recommended for treatment. Quinolone-resistant Neisseria gonorrhoeae strains are now widely disseminated throughout the United States and the world, and as a result, quinolones are not recommended for the treatment of gonorrhea. Although currently recommended regimens are effective for gonorrhea within the United States, the susceptibility of gonococcal isolates to cephalosporins has been decreasing and treatment failures with oral cephalosporins have been documented in Southeast Asia. Based on prior experience with quinolone-resistant N gonorrhoeae, it is probable that such isolates may spread to the Unites States. Due to these reports, Ceftriaxone 250 mg intramuscularly or Cefixime 400 mg orally are recommended for urogenital gonorrhoea infection. Since many with gonorrhea are co-infected with Chlamydia, therapy with Azithromycin or Doxycycline is recommended.


Lymphogranuloma venereum proctocolitis (LGV) is being increasingly recognized especially among HIV-positive men who have sex with men. In persons with painful perianal ulcers or those detected on anoscopy, presumptive therapy should include treatment for LGV, which is Doxycycline 100 mg twice daily for 21 days.

Genital warts

A new patient-applied treatment for genital warts is available. The treatment of 15%genital warts sinecatechins ointment should be applied by the patient 3 times daily until complete clearance of the warts.

Bacterial vaginosis

Bacterial vaginosis is not a sexually transmitted disease. It is included here on the basis of the part of the body it affects (the vagina). There is also a new alternative treatment for bacterial vaginosis: 2 g of Tinidazole taken daily for 3 days or 1 g taken daily for 5 days. There is a full topic on bacterial vaginosis here:

Genital herpes

For episodic outbreaks of herpes simplex virus, an additional treatment option Famciclovir recommended for genital herpesis 500 mg of Famciclovir followed by 2 days of 250 mg taken twice daily. There are also some data that Moxifloxacin, at 400 mg daily for 7 days, is effective in non-gonococcal urethritis treatment failures due to Mycoplasma genitalium.

A more comprehensive article on pelvic inflammatory diseases (PID) and their recommended forms of treatment can be reached by clicking here:

Treatment modalities for sexually transmitted diseases (STDs)

sinecatechins ointment

Veregen® is the brand name for Sinecatechins 15% ointment now recommended for genital warts

By Dr Joe Kabyemela, MD