Population | Screening specifics | Guideline group, yr of recommendation | ||
---|---|---|---|---|
USPSTF, 2018 | ACOG, 2016 | ACS, 2020 | ||
Persons at average risk | Age to start screening | 21 yrs | 21 yrs | 25 yrs |
Age to end screening | 65 yrs | 65 yrs | 65 yrs | |
If three consecutive negative cytology tests or two negative cytology plus HPV tests or two negative HPV tests (ACS) with the most recent within the previous 5 yrs and no abnormal tests within the previous 10 yrs (ACS) and no CIN 2 or CIN 3 within the previous 25 yrs | ||||
Screening test options and intervals | Aged 21–65 yrs: Cytology alone every 3 yrs or Aged 21–29 yrs: Cytology alone every 3 yrs Aged 30–65 yrs: Cytology plus HPV testing every 5 yrs or Aged 21–29 yrs: Cytology alone every 3 yrs Aged 30–65: HPV testing alone every 5 yrs* |
HPV testing alone every 5 yrs or Cytology plus HPV testing every 5 yrs or Cytology alone every 3 yrs |
||
Preferred strategies | Cytology alone every 3 yrs and HPV testing alone every 5 yrs (equally preferred) | Cytology plus HPV testing every 5 yrs | HPV testing alone every 5 yrs | |
Previous hysterectomy with removal of cervix | Screening not recommended after hysterectomy for benign indications Surveillance testing recommended for previous diagnosis of high-grade precancer, AIS, or cancer |
|||
Persons with an immunocompromising medical condition† (e.g., HIV infection or solid organ transplantation) | Age to start screening | No specific recommendation | Within 1 yr of onset of sexual activity or, if already sexually active, within the first year after HIV or other immunocompromising medical condition diagnosis but no later than age 21 yrs | |
Age to end screening | None; lifelong screening recommended | |||
Screening test options and intervals | Aged 21–65 yrs: Cytology every year; after three consecutive annual normal cytology test results, screening can be every 3 yrs or Aged 21–29 yrs: Cytology every year Aged 30–65 yrs: Cytology plus HPV testing every 3 yrs |
|||
Previous hysterectomy with removal of cervix | Not specified | |||
Persons with in utero exposure to diethylstilbestrol§ | Age to start screening | No specific recommendation | Not specified | No specific recommendation |
Age to end screening | Not specified | |||
Screening test options and intervals | Cytology alone annually | |||
Previous hysterectomy with removal of cervix | Not specified | |||
Persons who have received HPV vaccination | No changes to the screening approaches above | |||
Population | Screening specifics | ASCCP, 2019, and ACOG, 2020 | ||
Persons with a diagnosis of CIN 2 or CIN 3 (histologic HSIL¶) within the previous 25 yrs | Age to start screening | Not applicable | ||
Age to end screening | May end at age 65 yrs if CIN diagnosis ≥25 yrs ago and criteria for ending screening met, otherwise continue screening past age 65 yrs Continued screening for ≥25 yrs after diagnosis is acceptable if patient is in good health |
|||
Screening test options and intervals |
Initial surveillance:
HPV testing alone or cytology plus HPV testing at 6, 18, and 30 mos or Cytology at 6, 12, 18, 24, and 30 mos Long-term surveillance: HPV testing alone or cytology plus HPV testing every 3 yrs or Cytology alone annually Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs Routine screening can resume after the posttreatment surveillance period |
|||
Previous hysterectomy with removal of cervix | HPV testing alone or cytology plus HPV testing every 3 yrs or Cytology alone annually Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs |
TABLE 1. Cervical cancer screening and surveillance recommendations
Source: Perkins R, Guido R, Saraiya M, et al. Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016–2020. J Womens Health (Larchmt) 2021;30:5–13.
Abbreviations: ACS = American Cancer Society; ACOG = American College of Obstetricians and Gynecologists; AIS = adenocarcinoma in situ; ASCCP = American Society for Colposcopy and Cervical Pathology; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; USPSTF = U.S. Preventive Services Task Force.
*Considered an alternative screening strategy by ACOG.
†Panel for Opportunistic Infections, ACOG, 2016.
§ACOG, 2016.
¶Either by cytology or by histology; includes a persistent cytologic diagnosis of atypical squamous cells, cannot rule out HSIL.
Current HPV result | Current Pap test result | Previous result | Management by 2012 guidelines | Management by 2019 guidelines |
---|---|---|---|---|
Negative | ASC-US | Unknown or HPV negative* | Repeat Pap plus HPV testing in 3 yrs | Repeat HPV test with or without concurrent Pap test in 3 yrs |
Negative | LSIL | Unknown or HPV negative* | Repeat Pap plus HPV testing in 1 yr preferred, colposcopy acceptable | Repeat HPV test with or without concurrent Pap test in 1 yr |
Negative | ASC-H | Noncontributory | Colposcopy | Colposcopy |
Noncontributory | AGC | Noncontributory | Colposcopy | Colposcopy |
Positive | NILM | Unknown or HPV negative* | Repeat Pap plus HPV testing in 1 yr | Repeat HPV test with or without concurrent Pap test in 1 yr |
Positive | NILM | HPV positive† | Colposcopy | Colposcopy |
Positive for genotype HPV 16, HPV 18, or both | NILM | Noncontributory | Colposcopy | Colposcopy |
Positive for genotype HPV 16, HPV 18, or both | ASC-US or LSIL | Noncontributory | Not applicable, genotyping not recommended for ASC-US or LSIL in 2012 | Colposcopy |
Positive | ASC-US or LSIL | Unknown or HPV positive | Colposcopy | Colposcopy |
Positive | ASC-US or LSIL | Negative screening results with HPV testing or HPV plus Pap testing within the previous 5 yrs | Colposcopy | Repeat HPV test with or without concurrent Pap test in 1 yr§ |
Positive | ASC-US or LSIL | Colposcopy confirming the absence of high-grade lesion within the past yr | Colposcopy | Repeat HPV test with or without concurrent Pap test in 1 yr§ |
Positive | ASC-H | Noncontributory | Colposcopy | Colposcopy or expedited treatment |
Positive untyped, positive for genotype other than HPV 16, or negative | HSIL | Noncontributory | Colposcopy or expedited treatment | Colposcopy or expedited treatment |
Positive for genotype HPV 16 | HSIL | Noncontributory | Colposcopy or expedited treatment | Expedited treatment¶ |
TABLE 2. Comparison of 2012 and 2019 consensus recommendations for management of common abnormalities — American Society for Colposcopy and Cervical Pathology
Sources: Massad LS, Einstein MH, Huh WK, et al.; 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013;121:829–46; Perkins RB, Guido RS, Castle PE, et al; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020;24:102–31; Perkins R, Guido R, Saraiya M, et al. Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016–2020. J Womens Health (Larchmt) 2021;30:5–13.
Abbreviations: AGC = atypical glandular cells; AIS = adenocarcinoma in situ; ASC-H = atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion; ASC-US = atypical squamous cells of undetermined significance; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; LSIL = low-grade squamous intraepithelial lesion; NILM = negative for intraepithelial lesion or malignancy; Pap = Papanicolaou.
*Colposcopy may be warranted for patients with a history of high-grade lesions (CIN 2 or CIN 3, histologic or cytologic HSIL, ASC-H, AGC, or AIS).
†Previous Pap test results do not modify the recommendation; colposcopy is always recommended for two consecutive HPV-positive tests
§Negative HPV test or cotest (HPV plus Pap test) results only reduce risk sufficiently to defer colposcopy if performed for screening purposes within the last 5 years. Colposcopy is still warranted if negative HPV test or cotest results occurred in the context of surveillance for a previous abnormal result.
¶Expedited treatment is preferred for nonpregnant patients aged ≥25 years. Colposcopy with biopsy is an acceptable option if desired by patient after shared decision-making.
Vaccine | Trade name (manufacturer) | Age group (yrs) | Dose | Route | Schedule | Booster |
---|---|---|---|---|---|---|
Hep A inactivated (2 doses) | Havrix (GlaxoSmithKline) | 1–18 | 0.5 mL (720 ELISA units inactivated HAV) | IM | 0, 6–12 mos | None |
≥19 | 1 mL (1,440 ELISA units inactivated HAV | IM | 0, 6–12 mos | None | ||
Hep A inactivated (2 doses) | Vaqta (Merck) | 1–18 | 0.5 mL (25 units HAV antigen) | IM | 0, 6–18 mos | None |
≥19 | 1 mL (50 units HAV antigen) | IM | 0, 6–18 mos | None | ||
Combined Hep A and Hep B* (3 doses) | Twinrix (GlaxoSmithKline) | ≥18 (primary) | 1 mL (720 ELISA units inactivated plus 20 μg HBsAg | IM | 0, 1, 6 mos | None |
≥18 (accelerated) | 1 mL (720 ELISA units inactivated plus 20 μg HBsAg | IM | 0, 7, 21–30 days | 12 mos |
TABLE 3. Vaccines for preventing hepatitis A infection
Source: Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5).
Abbreviations: ELISA = enzyme-linked immunosorbent assay; HAV = hepatitis A virus; HBsAg = hepatitis B surface antigen; Hep A = hepatitis A; Hep B = hepatitis B; IM= intramuscular.
*Combined Hep A and Hep B vaccine (Twinrix) should not be used as postexposure prophylaxis.
Indication and age group | Risk category and health status | Hepatitis A vaccine | IG* |
---|---|---|---|
Postexposure prophylaxis | |||
0–11 mos | Healthy | No | 0.1 mL/kg body weight |
12 mos to 40 yrs | Healthy | 1 dose† | None |
>40 yrs | Healthy | 1 dose† | 0.1 mL/kg body weight§ |
≥12 mos | Immunocompromised or chronic liver disease | 1 dose† | 0.1 mL/kg body weight¶ |
≥12 mos | Vaccine contraindicated** | No | 0.1 mL/kg body weight |
Pre-exposure protection (e.g., travel)†† | |||
<6 mos | Healthy | No | 0.1–0.2 mL/kg body weight§§ |
6–11 mos | Healthy | 1 dose¶¶ | None |
12 mos to 40 yrs | Healthy | 1 dose*** | None |
>40 yrs | Healthy | 1 dose*** | 0.1–0.2 mL/kg body weight§§,††† |
>6 mos | Immunocompromised or chronic liver disease | 1 dose*** | 0.1–0.2 mL/kg body weight§§,††† |
>6 mos | Persons who elect not to receive vaccine or for whom vaccine is contraindicated** | No | 0.1–0.2 mL/kg body weight§§ |
TABLE 4. Recommendations for hepatitis A postexposure prophylaxis and pre-exposure protection, by age group and risk category — Advisory Committee on Immunization Practices, 2020
Source: Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5).
Abbreviations: HAV = hepatitis A virus; IG = immune globulin.
*Measles, mumps, and rubella vaccine should not be administered for ≥2 weeks before and 6 months after administration of IG.
†A second dose of hepatitis A vaccine is not required for postexposure prophylaxis; however, for long-term immunity, the vaccination series should be completed with a second dose ≥6 months after the first dose.
§The provider's risk assessment should determine the need for IG administration. If the provider's risk assessment determines that both vaccine and IG are warranted, hepatitis A vaccine and IG should be administered simultaneously at different anatomic sites (e.g., separate limbs).
¶Vaccine and IG should be administered simultaneously at different anatomic sites (e.g., separate limbs).
**Life-threatening allergic reaction to a previous dose of hepatitis A vaccine or allergy to any vaccine component.
††IG should be considered before travel for persons with special risk factors for either HAV infection or severe disease from HAV infection.
§§0.1 mL/kg body weight for travel ≤1 month; 0.2 mL/kg body weight for travel ≤2 months; 0.2 mL/kg every 2 months for travel of ≥2 months' duration.
¶¶This dose should not be counted toward the routine 2-dose series, which should be initiated at age 12 months.
***For persons not previously vaccinated with hepatitis A vaccine, administer dose as soon as travel is considered and complete the series according to routine schedule if the next dose is needed before travel.
†††Can be administered on the basis of the provider's risk assessment.
Serologic marker | Interpretation | |||
---|---|---|---|---|
HBsAg | Total anti-HBc | IgM anti-HBc | Anti-HBs | |
- | - | - | - | Never infected |
+† | - | - | - | Early acute infection; transient (≤18 days) after vaccination |
+ | + | + | - | Acute infection |
- | + | + | - | Acute resolving infection |
- | + | - | + | Recovered from past infection and immune |
+ | + | - | - | Chronic infection |
- | + | - | - | Past infection; low-level chronic infection§; passive transfer to infant born to HBsAg-positive mother; false positive (no infection) |
- | - | - | + | Immune if concentration is >10 mIU/mL after vaccination, passive transfer after HBIG administration |
TABLE 5. Interpretation of serologic test results* for hepatitis B virus infection
Source: Adapted from Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1).
Abbreviations: anti-HBc = antibody to hepatitis B core antigen; anti-HBs = antibody to hepatitis B surface antigen; HBIG = hepatitis B immune globulin; HBsAg = hepatitis B surface antigen; IgM = immunoglobulin M.
*- = negative test result; + = positive test result.
†To ensure that an HBsAg-positive test result is not false positive, samples with repeatedly reactive HBsAg results should be tested with a neutralizing confirmatory test cleared by the Food and Drug Administration.
§Persons positive for only anti-HBc are unlikely to be infectious, except under unusual circumstances involving direct percutaneous exposure to large quantities of blood (e.g., blood transfusion or organ transplantation) or mutant HBsAg-related infection.
Age group (yrs) | Single-antigen vaccine | Combination vaccine | ||||||
---|---|---|---|---|---|---|---|---|
Recombivax HB | Engerix-B | Heplisav-B* | Twinrix† | |||||
Dose (μg)§ | Volume (mL) | Dose (μg)§ | Volume (mL) | Dose (μg)§ | Volume (mL) | Dose (μg)§ | Volume (mL) | |
Infants (<1) | 5 | 0.5 | 10 | 0.5 | —¶ | —¶ | NA | NA |
Children (1–10) | 5 | 0.5 | 10 | 0.5 | —¶ | —¶ | NA | NA |
Adolescents (11–15) | 10** | 1.0 | NA | NA | —¶ | —¶ | NA | NA |
Adolescents (11–19) | 5 | 0.5 | 10 | 0.5 | —¶ | —¶ | NA | NA |
Adults (≥18) | —†† | —†† | —†† | —†† | 20* | 0.5 | 20† | 1 |
Adults (≥20) | 10 | 1 | 20 | 1 | 20† | 0.5 | 20† | 1 |
Hemodialysis patients and other immunocompromised persons (<20§§) | 5 | 0.5 | 10 | 0.5 | 20 | 0.5 | NA | NA |
Hemodialysis patients and other immunocompromised persons (≥20) | 40¶¶ | 1 | 40*** | 2.0 | 20 | 0.5 | NA | NA |
TABLE 6. Recommended doses of licensed formulations of hepatitis B vaccines
Source: Adapted from Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1).
Abbreviation: NA = not applicable.
*Administered on a 2-dose schedule.
†Combined hepatitis A and B vaccines. This vaccine is recommended for persons aged ≥18 years who are at increased risk for both hepatitis B and hepatitis A virus infections.
§Recombinant hepatitis B surface antigen protein dose.
¶Heplisav-B should not be used for vaccination of infants, children, or adolescents because the safety and effectiveness of Heplisav-B has not been established in persons aged <8 years and is not approved for use in these populations.
**Adult formulation administered on a 2-dose schedule.
††Engerix-B and Recombivax HB are approved for use in persons of all ages.
§§Higher doses might be more immunogenic; however, no specific recommendations have been made.
¶¶Dialysis formulation administered on a 3-dose schedule at 0, 1, and 6 months.
***Two 1.0-mL doses administered at one site, on a 4-dose schedule at 0, 1, 2, and 6 months.
Source of exposure | Unvaccinated person§ | Previously vaccinated person¶ |
---|---|---|
HBsAg-positive source
Percutaneous (e.g., bite or needlestick) or mucosal exposure to HBsAg-positive blood or body fluids or Sex or needle-sharing contact with an HBsAg-positive person or Victim of sexual assault or abuse by an assailant who is HBsAg positive |
Administer hepatitis B vaccine series and HBIG | Complete hepatitis B vaccine series and HBIG, if vaccine series not completed or Administer hepatitis B vaccine booster dose, if previous vaccination without testing** |
Source with unknown HBsAg status Percutaneous (e.g., bite or needlestick) or mucosal exposure to potentially infectious blood or body fluids from a source with unknown HBsAg status or Sex or needle-sharing contact with person with unknown HBsAg status or Victim of sexual assault or abuse by a perpetrator with unknown HBsAg status |
Administer hepatitis B vaccine series | Complete hepatitis B vaccine series |
TABLE 7. Guidelines for postexposure prophylaxis* of persons with nonoccupational exposure† to blood or body fluids that contain blood, by exposure type and hepatitis B vaccination status
Sources: CDC. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep 2013;62(No. RR-10); CDC. Postexposure prophylaxis to prevent hepatitis B virus infection. MMWR Recomm Rep 2006;55(No. RR-16).
Abbreviations: HBIG = hepatitis B immune globulin; HBsAg = hepatitis B surface antigen.
*When indicated, immunoprophylaxis should be initiated as soon as possible, preferably within 24 hours. Studies are limited regarding the maximum interval after exposure during which postexposure prophylaxis is effective, but the interval is unlikely to exceed 7 days for percutaneous exposures or 14 days for sexual exposures. The hepatitis B vaccine series should be completed. These guidelines apply to nonoccupational exposures.
†These guidelines apply to nonoccupational exposures.
§A person who is in the process of being vaccinated but who has not completed the vaccine series should complete the series and receive treatment for hepatitis B as indicated.
¶A person who has written documentation of a complete hepatitis B vaccine series and who did not receive postvaccination testing.
**No booster dose is needed for persons who have written documentation of hepatitis B vaccine series with serologic response.
Infection | Evidence for sexual abuse | Recommended action |
---|---|---|
Gonorrhea* | Diagnostic | Report† |
Syphilis* | Diagnostic | Report† |
HIV§ | Diagnostic | Report† |
Chlamydia trachomatis* | Diagnostic | Report† |
Trichomonas vaginalis* | Diagnostic | Report† |
Anogenital herpes | Suspicious | Consider report†,¶ |
Condylomata acuminata (anogenital warts)* | Suspicious | Consider report†,¶,** |
Anogenital molluscum contagiosum | Inconclusive | Medical follow-up |
Bacterial vaginosis | Inconclusive | Medical follow-up |
TABLE 8. Implications of commonly encountered sexually transmitted or sexually associated infections for diagnosis and reporting of sexual abuse among infants and prepubertal children
Sources: Adapted from Kellogg N; American Academy of Pediatrics Committee on Child Abuse and Neglect. The evaluation of child abuse in children. Pediatrics 2005;16:506–12; Adams JA, Farst KJ, Kellogg ND. Interpretation of medical findings in suspected child abuse: an update for 2018. J Pediatr Adolesc Gynecol 2018;31:225–31.
*If unlikely to have been perinatally acquired and vertical transmission, which is rare, is excluded.
†Reports should be made to the local or state agency mandated to receive reports of suspected child abuse or neglect.
§If unlikely to have been acquired perinatally or through transfusion.
¶Unless a clear history of autoinoculation exists.
**Report if evidence exists to suspect abuse, including history, physical examination, or other identified infections. Lesions appearing for the first time in a child aged >5 years are more likely to have been caused by sexual transmission.
1. Partners
|
BOX 1. The Five P’s approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention
Gastrointestinal symptoms
Headache Pruritis without rash Localized rash Delayed onset rash (>24 hours) Symptoms unknown Family history of penicillin or another drug allergy Patient denies allergy but it is on the medical record |
BOX 2. Low-risk history in patients who report penicillin allergy
Major determinant
Positive control
|
BOX 3. Skin test reagents for identifying persons at risk for adverse reactions to penicillin
Source: Adapted from Saxon A, Beall GN, Rohr AS, Adelman DC. Immediate hypersensitivity reactions to beta-lactam antibiotics. Ann Intern Med 1987;107:204–15.
Uncomplicated vulvovaginal candidiasis (VVC)
|
BOX 4. Classification of vulvovaginal candidiasis
Source: Sobel JD, Faro S, Force RW, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol 1998;178:203–11.
Children
Persons at increased risk for hepatitis A virus (HAV) infection
Persons at increased risk for severe disease from HAV infection
Other persons recommended for vaccination
Vaccination during outbreaks
Implementation strategies for settings providing services to adults
Hepatitis A vaccination is no longer recommended by the Advisory Committee on Immunization Practices
|
BOX 5. Populations recommended for hepatitis A vaccination — Advisory Committee on Immunization Practices, 2020
Source: Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5).
This activity is intended for family medicine clinicians, internists, adolescent medicine clinicians, obstetricians/gynecologists, emergency medicine clinicians, infectious disease clinicians, and other clinicians caring for patients with or at risk for sexually transmitted infections (STIs).
The goal of this activity is to describe on-site STI treatment and partner services, operational determinants of quality services in various clinical settings, and indications for consultation with or referral to a specialist for patients with STI-related conditions, according to updated Centers for Disease Control and Prevention (CDC) guidelines.
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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11–14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.
The term "sexually transmitted infection" (STI) refers to a pathogen that causes infection through sexual contact, whereas the term "sexually transmitted disease" (STD) refers to a recognizable disease state that has developed from an infection. Physicians and other health care providers have a crucial role in preventing and treating STIs. These guidelines are intended to assist with that effort. Although the guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed.
This report updates Sexually Transmitted Diseases Treatment Guidelines, 2015[1] and should be regarded as a source of clinical guidance rather than prescriptive standards. Health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. These guidelines are applicable to any patient care setting that serves persons at risk for STIs, including family planning clinics, HIV care clinics, correctional health care settings, private physicians' offices, Federally Qualified Health Centers, clinics for adolescent care, and other primary care facilities. These guidelines are focused on treatment and counseling and do not address other community services and interventions that are essential to STI and HIV prevention efforts.
These STI treatment guidelines complement Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020[2] regarding quality clinical services for STIs in primary care and STD specialty care settings. This guidance specifies operational determinants of quality services in various clinical settings, describes on-site treatment and partner services, and indicates when STI-related conditions should be managed through consultation with or referral to a specialist.