On July 22^nd 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, 2^nd line treatment, though remains 1^st line if pregnancy cannot be ruled out.
2. Gonorrhea: 1^st 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): 1^st 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.

KAJ