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STD Treatment 2010 RR5912

STD Treatment 2010 RR5912

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Recomendaciones del CDC,sobre ITS.2010
Recomendaciones del CDC,sobre ITS.2010

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department of health and human services
Centers for Disease Control and Prevention
Recommendations and Reports December 17, 2010 / Vol. 59 / No. RR-12
Morbidity and Mortality Weekly Report
Sexually Trasmitted DiseasesTreatmet Guidelies, 2010
 
MMWR
Te
 MMWR 
series o publications is published by the Oce o Surveillance, Epidemiology, and Laboratory Services, Centers orDisease Control and Prevention (CDC), U.S. Department o Healthand Human Services, Atlanta, GA 30333.
Suggested Citation:
Centers or Disease Control and Prevention.[itle]. MMWR 2010;59(No. RR-#):[inclusive page numbers].
Ceters r Disease Ctrl ad Preveti
Tomas R. Frieden, MD, MPH
Director 
Harold W. Jae, MD, MA 
 Associate Director or Science 
 James W. Stephens, PhD
Oce o the Associate Director or Science 
Stephen B. Tacker, MD, MSc
Deputy Director or Surveillance, Epidemiology, and Laboratory Services 
Stephanie Zaza, MD, MPH
Director, Epidemiology and Analysis Program Oce 
Editrial ad Prducti Sta
Ronald L. Moolenaar, MD, MPH
Editor,
MMWR 
Series 
Christine G. Casey, MD
Deputy Editor,
MMWR 
Series 
eresa F. Rutledge
 Managing Editor,
MMWR 
Series 
David C. Johnson
Lead echnical Writer-Editor 
Rachel J. Wilson
Project Editor 
Martha F. Boyd
Lead Visual Inormation Specialist 
Malbea A. LaPeteStephen R. Spriggserraye M. Starr
Visual Inormation Specialists 
Quang M. Doan, MBA Phyllis H. King
Inormation echnology Specialists 
Editrial Bard
 William L. Roper, MD, MPH, Chapel Hill, NC, ChairmanVirginia A. Caine, MD, Indianapolis, IN Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA David W. Fleming, MD, Seattle, WA  William E. Halperin, MD, DrPH, MPH, Newark, NJKing K. Holmes, MD, PhD, Seattle, WA Deborah Holtzman, PhD, Atlanta, GA  John K. Iglehart, Bethesda, MDDennis G. Maki, MD, Madison, WIPatricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WIBarbara K. Rimer, DrPH, Chapel Hill, NC John V. Rullan, MD, MPH, San Juan, PR  William Schaner, MD, Nashville, N Anne Schuchat, MD, Atlanta, GA Dixie E. Snider, MD, MPH, Atlanta, GA  John W. Ward, MD, Atlanta, GA 
ConTEnTS
Introduction .............................................................................. 1Methods ................................................................................... 1Clinical Prevention Guidance ..................................................... 2STD/HIV Prevention Counseling ............................................... 2Prevention Methods ................................................................ 4Partner Management .............................................................. 7Reporting and Condentiality .................................................. 8Special Populations ................................................................... 8Pregnant Women ................................................................... 8 Adolescents .......................................................................... 10Children .............................................................................. 11Persons in Correctional Facilities ............................................ 11Men Who Have Sex with Men ............................................... 12 Women Who Have Sex with Women .................................... 13HIV Inection: Detection, Counseling, and Reerral ..................... 14Diseases Characterized by Genital, Anal, or Perianal Ulcers ...... 18Chancroid............................................................................ 19Genital HSV Inections .......................................................... 20Granuloma Inguinale (Donovanosis) ...................................... 25Lymphogranuloma Venereum ................................................ 26Syphilis ................................................................................ 26Congenital Syphilis ............................................................ 36Management o Persons Who Have a History o Penicillin Allergy . 39Diseases Characterized by Urethritis and Cervicitis .................... 40Urethritis ............................................................................. 40Nongonococcal Urethritis ..................................................... 41Cervicitis .............................................................................. 43Chlamydial Inections.............................................................. 44Gonococcal Inections .............................................................. 49Diseases Characterized by Vaginal Discharge ........................... 56Bacterial Vaginosis ............................................................... 56Trichomoniasis ..................................................................... 58 Vulvovaginal Candidiasis ...................................................... 61Pelvic Infammatory Disease .................................................... 63Epididymitis ............................................................................ 67Human Papillomavirus (HPV) Inection ...................................... 69Genital Warts ......................................................................... 70Cervical Cancer Screening or Women Who Attend STD Clinicsor Have a History o STDs ....................................................... 74 Vaccine-Preventable STDs ........................................................ 78Hepatitis A ........................................................................... 78Hepatitis B ........................................................................... 80Hepatitis C .............................................................................. 85Proctitis, Proctocolitis, and Enteritis ........................................... 87Ectoparasitic Inections ............................................................. 88Pediculosis Pubis .................................................................. 88Scabies ................................................................................ 89Sexual Assault and STDs .......................................................... 90Reerences .............................................................................. 96Terms and Abbreviations Used in This Report .......................... 109
 
Vol. 59 / RR-12 Recommendations and Reports 1
Sexually Trasmitted Diseases Treatmet Guidelies, 2010
Prepared by Kimberly A. Workowski, MD
1,2
Stuart Berman, MD
1
1
Division o SD PreventionNational Center or HIV/AIDS, Viral Hepatitis, SD, and B Prevention
 2 
Emory University, Atlanta, Georgia
Summary 
Tese guidelines or the treatment o persons who have or are at risk or sexually transmitted diseases (SDs) were updated by CDC ater consultation with a group o proessionals knowledgeable in the eld o SDs who met in Atlanta on April 18–30, 2009. Te inormation in this report updates the 2006 Guidelines or reatment o Sexually ransmitted Diseases ( 
MMWR 
  2006;55[No. RR–11]). Included in these updated guidelines is new inormation regarding 1) the expanded diagnostic evaluation or cervicitis and trichomoniasis; 2) new treatment recommendations or bacterial vaginosis and genital warts; 3) the clinical ecacy o azithromycin or chlamydial inections in pregnancy; 4) the role o 
Mycoplasma genitalium
and trichomoniasis inurethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria or spinal fuid examination to evaluate or neurosyphilis; 7) the emergence o azithromycin-resistant 
reponema pallidum
; 8) the increasing prevalence o antimicrobial-resistant 
Neisseria gonorrhoeae
; 9) the sexual transmissiono hepatitis C; 10) diagnostic evaluation ater sexual assault; and 11) SD prevention approaches.
Itrducti
Te term sexually transmitted diseases (SDs) is used toreer to a variety o clinical syndromes caused by pathogensthat can be acquired and transmitted through sexual activity.Physicians and other health-care providers play a critical role inpreventing and treating SDs. Tese guidelines or the treat-ment o SDs are intended to assist with that eort. Althoughthese guidelines emphasize treatment, prevention strategies anddiagnostic recommendations also are discussed.Tese recommendations should be regarded as a source o clinical guidance and not prescriptive standards; health-careproviders should always consider the clinical circumstances o each person in the context o local disease prevalence. Tey areapplicable to various patient-care settings, including amily-planning clinics, private physicians’ oces, managed care orga-nizations, and other primary-care acilities. Tese guidelinesocus on the treatment and counseling o individual patientsand do not address other community services and interven-tions that are essential to SD/human immunodeciency virus(HIV) prevention eorts.
Methds
hese guidelines were developed using a multistageprocess. Beginning in 2008, CDC sta members and publicand private sector experts knowledgeable in the eld o SDssystematically reviewed literature using an evidence-basedapproach (e.g., published abstracts and peer-reviewed journalarticles), ocusing on the common SDs and inormation thathad become available since publication o the
 2006 Guidelines  or reatment o Sexually ransmitted Diseases 
(
1
)
.
CDC sta members and SD experts developed background papers andtables o evidence that summarized the type o study (e.g.,randomized controlled trial or case series), study populationand setting, treatments or other interventions, outcomemeasures assessed, reported ndings, and weaknesses and biasesin study design and analysis. CDC sta then developed a dratdocument on the basis o this evidence-based review. In April2009, this inormation was presented at a meeting o invitedconsultants (including public- and private-sector proessionalsknowledgeable in the treatment o patients with SDs), whereall evidence rom the literature reviews pertaining to SDmanagement was discussed.Specically, participants identied key questions regardingSD treatment that emerged rom the literature reviews anddiscussed the inormation available to answer those ques-tions. Discussion ocused on our principal outcomes o SDtherapy or each individual disease: 1) treatment o inectionbased on microbiologic eradication; 2) alleviation o signsand symptoms; 3) prevention o sequelae; and 4) prevention
Corresponding Author:
Kimberly Workowski, MD, Division o SD Prevention, National Center or HIV/AIDS, Viral Hepatitis,SD, and B Prevention, 10 Corporate Square, Corporate SquareBlvd, MS E02, Atlanta, GA 30333. elephone: 404-639-1898;Fax: 404-639-8610; kgw2@cdc.gov.

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