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2015 STD Treatment Guidelines
These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The 2015 Guidelines update the previous 2010 Guidelines with new diagnostic, treatment, and prevention recommendations for STDs.
These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.
CDC Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014
This report updates CDC’s 2002 recommendations regarding screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections and provides new recommendations regarding optimal specimen types, the use of tests to detect rectal and oropharyngeal C. trachomatis and N. gonorrhoeae infections, and circumstances when supplemental testing is indicated. The recommendations in this report are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available tests, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients.
Incidence, Prevalence, and Cost of Sexually Transmitted Infection in the United States
In February 2013, CDC published two analyses that provide an in-depth look at the severe human and economic burden of sexually transmitted infections (STIs) in the United States. CDC's new estimates show that there are about 20 million new infections in the United States each year, costing the American healthcare system nearly $16 billion in direct medical costs alone.
America's youth shoulder a substantial burden of these infections. CDC estimates that half of all new STIs in the country occur among young men and women. CDC's new data suggest that there are more than 110 million total STIs among men and women across the nation.
CDC's analyses included eith common STIs: chlamydia, gonorrhea, heapatitis B virus (HBV), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), human papillomavirus (HPV), syphilis, and trichomoniasis.
STD Trends in the United States (2011 National Data for Chlamydia, Gonorrhea, and Syphilis)
This fact sheet summarizes 2011 data on chlamydia, gonorrhea, and syphilis published in CDC's annual report, Sexually Transmitted Diseases Surveillance, 2011 (available at www.cdc.gov/std/stats). The data are based on state and local STD case reports from a variety of private and public sources which indicate that the majority of cases are seen in non-STD clinic settings, such as private physician offices and health maintenance organizations.
Many cases of chlamydia, gonorrhea, and syphilis continue to go undiagnosed and unreported, and data on several addtional STDs (such as human papillomavirus, herpes simplex virus, and trichomoniasis) are not routinely reported to CDC. As a result, the annual surveillance report captures only a fraction of the true burden of STDs in America. However, it provides important insights into the scope and trends of this hidden edpidemic.
Bringing the Lab to the Patient: Developing Point-of-Care Diagnostics for Resource Limited Settings
Easy-to-use, inexpensive point-of-care tests (POCTs) to diagnose infectious diseases are urgently needed in resource-limited settings where laboratory capacity is limited. Development and implementation of new POCTs requires coordinated efforts among the scientists and engineers designing the tests and the health care workers deploying them. Recognizing the need to connect theses groups, the American Academy of Microbiology convened a colloquium in September 2011 to discuss how to develop POCTs that can be effectively integrated into resource limited settings.
Based on that colloquium, this report identifies the POCTs that would make the biggest impact on health and the qualities they need to be effective in resource limited settings. The report also discusses systemic barriers to POCT deployment and recommends addressing these barriers in order to foster a more conducive environment for POCT development. The report is an example of the benefit of improved communication among the many groups that must work together to bring POCTs to the people that need them most.
The National Chlamydia Coalition
The National Chlamydia Coalition (NCC) Research Committee has released a series of Research Briefs:
Developments in STD Screening: Chlamydia Testing discusses current methods of diagnostic and testing methods; preferred specimens; new specimen types, such as urine and vaginal swabs; rectal and pharyngeal specimens; and alternative venues for screening. The Research Brief may be viewed as a pdf.
Laboratory Considerations for Male Chlamydia Screening describes and reviews the methods for laboratory diagnosis of Chlamydia trachomatis in men. There are no formal recommendations by professional organizations for screening men for chlamydia, however, guidance has been provided by the Centers for Disease Control and Prevention for clinical sites wishing to screen men. The Research Brief may be viewed as a pdf.
Getting More Young Women Screened for Chlamydia: Findings from Qualitative Research provides valuable insights into why women do or do not seek chlamydia screening and helps us understand the key factors influencing a woman's decision to get tested, including attitudes, knowledge, beliefs, perceived social norms, and skills. The Research Brief may be viewed as a pdf.
Developing Effective Strategies for Increasing Patient Retesting Rates (April 2012) discusses how low retesting rates are often a result of low patient return rates as well as missed opportunities for retesting patients who return to the medical office for other reasons. The Expert Commentary may be viewed as a pdf.
The NCC introduced a new feature in June of 2012 - Hot Topic - an updated version of the Research Translation Committee's Research Brief:
Cost Effectiveness of Chlamydia Screening (June 2012) discusses how increasing chlamydia screening coverage of women could be a cost-effective way to improve women's health and reduce the burden of chlamydia in the population. The Research Brief may be viewed as a pdf.
Extra-Genital Chlamydia and Gonorrhea Infections (August 2012) discusses the testing of extra-genital sites for chlamydia and gonorrhea, especially within the high risk men-who-have-sex-with men (MSM) community. The Research Brief may be viewed as a pdf.
Comparative Effectiveness of POC Tests for Chlamydia in a Clinic Setting (September 2012) shows that promising new chlamydia point-of-care tests are likely to be cost-effective compared with traditional nucleic acid amplification tests in a clinic when specified characteristics are met. The Expert Commentary (by Charlotte Gaydos, MS, MPH, DrPH) may be viewed as a pdf.
Practical Strategies for Improving Chlamydia and Gonorrhea Retesting (October 2012) discusses how prevention and management of chlamydial and gonococcal infections are priorities for women's health. The Centers for Disease Control and Prevention (CDC) highlights the prevention and early detection of repeat infections in females as a key strategy to avert STD-related infertility. The Expert Commentary may be viewed as a pdf.
Many with Chlamydia Fail to Receive Recommended Retest (February 2013) discusses how interventions, both for providers and for patients, need to be developed, piloted, and implemented to increase adherence to CDC recommendations for chlamydia testing, retesting, and partner treatment. The Expert Commentary may be viewed as a pdf.
New Estimates on Health and Economic Burden of STIs (March 2013) discusses the ongoing severe health and economic toll of sexually transmitted infections in the United States, and demonstrates an urgent need for prevention especially among young men and women. The Expert Commentary may be viewed as a pdf.
New Rapid Real-Time Assay for Chlamydia & Gonorrhea Screening (April 2013) discusses the Cepheid® GeneXpert CT/NG assay, FDA cleared in December 2012, that demonstrates excellent sensitivity and specificity, and could guide treatment decisions which may significantly improve chlamydia and gonorrhea control efforts. The Expert Commentary (by Charlotte Gaydos, MS, MPH, DrPH) may be viewed as a pdf.
Research Suggests Family Planning Clinics Should Screen Males for Chlamydia (July 2013) discusses the need for cost-effectiveness studies assessing the potential benefits of screening men for chlamydia in Family Planning settings, where prevalence is much higher that 5%, may be viewed as a pdf.
STD Surveillance 2012: Focus on Chlamydia (March 2014) discusses the statistics and trends for Chlamydia trachomatis as presented in the annual report by the Division of STD Prevention at CDC. The Expert Commentary (by Charlotte Gaydos, MS, MPH, DrPH) may be viewed as a pdf.
Hot Topics from the 2014 National STD Prevention Conference (July 2014) discusses several important topics that may be of interest to public health officials, chlamydia researchers, and primary care clincians who are interested in chlamydia, and summarizes new findings and why they are important to emphasize. The Expert Commentary (by Charlotte Gaydos, MS, MPH, DrPH, et al) may viewed as a pdf.
Chlamydia Screening for Sexually Active Young Women Under the Affordable Care Act: New Opportunities and Lingering Barriers (December 2014) discusses how the ACA offers multiple pathways to improve rate of chlamydia screening through expansions to insurance coverage and elimination of patient cost-sharing, and how they will impact a substantial number of sexually active young women, and can be viewed as a PDF.