Updated CDC STI Treatment Guidelines Now Available

On July 22nd the Centers for Disease Control and Prevention (CDC) released the Sexually Transmitted Infections (STI) Treatment Guidelines, 2021. These updated guidelines provide evidence-based recommendations on the prevention, diagnosis, and treatment of STIs. Provider resources include a downloadable wall chart and pocket guide.  A new mobile app is coming soon. Key treatment updates include:

  1. Chlamydia: Doxycycline 100 mg PO BID x 7 days recommended for uncomplicated infection at all sites.
    • Azithromycin 1 g PO x 1 is an alternative, 2nd line treatment, though remains 1st line if pregnancy cannot be ruled out.
  2. Gonorrhea: 1st line treatment is now ceftriaxone 500 mg IM x1 MONOTHERAPY
    • Doxycycline 100 mg PO BID x 7 days should be added in cases where chlamydial co-infection has not been ruled out.
  3. Mycoplasma genitalium (M. gen): Recommended treatment: Doxycycline 100 mg PO BID x 7 days FOLLOWED BY moxifloxacin 400 mg PO daily x 7 days.
    • NAAT testing for M. gen is indicated in patients with recurrent/persistent urethritis.
  4. Pelvic Inflammatory Disease (PID): 1st line treatment for PID now includes anaerobic coverage for all patients, regardless of whether BV infection is detected.
    • For outpatient therapy: Ceftriaxone IM x 1 (dosed per weight-based GC guidance) PLUS Doxycycline 100 mg PO BID AND Metronidazole 500 mg PO BID (both x 14 days).
  5. Nongonococcal Urethritis (NGU): Doxycycline 100 mg PO BID x 7 days has replaced azithromycin 1 g PO once as the preferred initial therapy for NGU.
  6. Trichomonas: Treatment no longer varies by HIV status.
    • Vaginal infection: Metronidazole 500 mg PO BID x 7 days.
    • Penile/urethral infection: Metronidazole or tinidazole, both dosed at 2 gm PO x 1.