Sexually Transmitted Diseases Treatment Guidelines 2015

The term sexually transmitted diseases (STDs) refers to a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity. Physicians and other health-care providers play a critical role in preventing and treating STDs. These guidelines for the treatment of STDs are intended to assist with that effort.

Although these guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed.

These recommendations should be regarded as a source of clinical guidance rather than prescriptive standards; std test center 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 STDs, including family-planning clinics, HIV-care clinics, correctional health-care settings, private physicians’ offices

Clinical Prevention Guidance:

The prevention and control of STDs are based on the following five major strategies (5): 

• accurate risk assessment and education and counseling of persons at risk on ways to avoid STDs through changes in sexual behaviors and use of recommended prevention services; 

• pre-exposure vaccination of persons at risk for vaccine-preventable STDs; 

• identification of asymptomatically infected persons and persons with symptoms associated with STDs centers; 

• effective diagnosis, treatment, counseling, and follow up of infected persons; and 

• evaluation, treatment, and counseling of sex partners of persons who are infected with an STD.

STD/HIV Risk Assessment:

Primary prevention of STDs includes performing an assessment of behavioral risk (i.e., assessing the sexual behaviors that may place persons at risk for infection) as well as biologic risk (i.e., testing for risk markers for HIV acquisition or transmission). As part of the clinical encounter, health-care providers should routinely obtain sexual histories from their patients and address risk reduction as indicated in this report.

Guidance for obtaining a sexual history is available on the CDC Division of STD Prevention resource page (http://www.cdc.gov/std/treatment/resources.htm) and in the curriculum provided by CDC’s STD/HIV PreventionTraining Centers

The Five P’s: Partners, Practices, Prevention of Pregnancy, Protection from STDs, and Past History of STDs

1. Partners 

• “Do you have sex with men, women, or both?” 

• “In the past 2 months, how many partners have you had sex with?”

• “In the past 12 months, how many partners have you had sex with?”

• “Is it possible that any of your sex partners in the past 12 months had sex with someone else while they were still in a sexual relationship with you?”

2. Practices 

• “To understand your risks for STDs, I need to understand the kind of sex you have had recently.” 

• “Have you had vaginal sex, meaning ‘penis in vagina sex’?” If yes, “Do you use condoms: never, sometimes, or always?” 

• “Have you had anal sex, meaning ‘penis in rectum/ anus sex’?” If yes, “Do you use condoms: never, sometimes, or always?” 

• “Have you had oral sex, meaning ‘mouth on penis/ vagina’?” 

• For condom answers: 

• If “never”: “Why don’t you use condoms?” 

• If “sometimes”: “In what situations (or with whom) do you use condoms?”

3. Prevention of pregnancy 

• “What are you doing to prevent pregnancy?” 

4. Protection from STDs 

• “What do you do to protect yourself from STDs and HIV?” 

5. Past history of STDs 

• “Have you ever had an STD?” 

• “Have any of your partners had an STD?” Additional questions to identify HIV and viral hepatitis risk include: 

• “Have you or any of your partners ever injected drugs?” 

• “Have your or any of your partners exchanged money or drugs for sex?” 

• “Is there anything else about your sexual practices that I need to know about?”

In addition to obtaining a behavioral risk assessment, a comprehensive STD/HIV risk assessment should include STD screening, because STDs are biologic markers of risk, particularly for HIV acquisition and transmission among some MSM. STD screening is an essential and underutilized component of an STD/HIV risk assessment in most clinical settings. Persons seeking treatment or evaluation for a particular STD should be screened for HIV and other STDs as indicated by community prevalence and individual risk factors (see prevention section and sections on chlamydia, gonorrhea, and syphilis). 

Persons should be informed about all the STDs for which they are being tested and notified about tests for common STDs (e.g., genital herpes and human papillomavirus [HPV]) that are available but not being performed. Efforts should be made to ensure that all persons receive care regardless of individual circumstances (e.g., ability to pay, citizenship or immigration status, language spoken, or specific sex practices). 

STD/HIV Prevention Counseling:

After obtaining a sexual history from their patients, all providers should encourage risk reduction by providing prevention counseling. Prevention counseling is most effective if provided in a nonjudgmental and empathetic manner appropriate to the patient’s culture, language, gender, sexual orientation, age, and developmental level. Prevention counseling for STD/HIV should be offered to all sexually active adolescents and to all adults who have received an STD diagnosis, have had an STD in the past year, or have multiple sexual partners.

USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STDs and HIV. Such interactive counseling, which can be resource intensive, is directed at a person’s risk, the situations in which risk occurs, and the use of personalized goal-setting strategies.

One such approach, known as clientcentered STD/HIV prevention counseling, involves tailoring a discussion of risk reduction to the individual situation. While one large study in STD clinics (Project RESPECT) demonstrated that this approach was associated with lower acquisition of curable STDs (e.g., trichomoniasis, chlamydia, gonorrhea, and syphilis), another study conducted 10 years later in the same settings but different contexts (Project AWARE) did not replicate this result. Briefer provider delivered prevention messages have been shown to be feasible and to decrease subsequent STDs in HIV primary-care settings. Other approaches use motivational interviewing to move clients toward achievable risk-reduction goals. Client-centered counseling and motivational interviewing can be used effectively by clinicians and staff trained in these approaches.

CDC provides additional information on these and other effective behavioral interventions. Training in client-centered counseling is available through the CDC STD/HIV National Network of Prevention Training Centers