nl_e17

The MMWR series of publications is published by the
Epidemiology Program Office, Centers for Disease
Control and Prevention (CDC), U.S. Department of
Health and Human Services, Atlanta, GA 30333.
SUGGESTED CITATION
Centers for Disease Control and Prevention. Sexually
transmitted diseases treatment guidelines 2002.
MMWR 2002;51(No. RR-6):[inclusive page
numbers].
Centers for Disease Control and Prevention
David W. Fleming, M.D.
Acting Director
Julie L. Gerberding, M.D.
Acting Deputy Director for Science and Public Health
Dixie E. Snider, Jr., M.D., M.P.H.
Associate Director for Science
Epidemiology Program Office
Stephen B. Thacker, M.D., M.Sc.
Director
Office of Scientific and Health Communications
John W. Ward, M.D.
Director
Editor, MMWR Series
Suzanne M. Hewitt, M.P.A.
Managing Editor
Rachel J. Wilson
Project Editor
Malbea A. Heilman
Beverly J. Holland
Visual Information Specialists
Michele D. Renshaw
Erica R. Shaver
Information Technology Specialists
MMWR
CONTENTS
Introduction ..................................................................................................... 1
Clinical Prevention Guidelines .......................................................................... 2
Prevention Messages .................................................................................... 2
Prevention Methods ...................................................................................... 3
STD/HIV Prevention Counseling .................................................................... 4
Partner Notification ...................................................................................... 4
Reporting and Confidentiality ....................................................................... 4
Special Populations .......................................................................................... 5
Pregnant Women ......................................................................................... 5
Adolescents .................................................................................................. 6
Children ....................................................................................................... 7
Men Who Have Sex with Men ....................................................................... 7
HIV Infection: Detection, Counseling, and Referral ........................................... 7
Detection of HIV Infection: Diagnostic Testing ............................................... 8
Counseling for Patients with HIV Infection and Referral to Support Services ... 9
Management of Sex Partners and Injection-Drug Partners ........................... 10
Special Considerations ............................................................................... 10
Diseases Characterized by Genital Ulcers ....................................................... 11
Management of Patients Who Have Genital Ulcers ..................................... 11
Chancroid .................................................................................................. 11
Genital Herpes Simplex Virus Infections ...................................................... 12
Granuloma Inguinale (Donovanosis) .......................................................... 17
Lymphogranuloma Venereum ..................................................................... 18
Syphilis ...................................................................................................... 18
Congenital Syphilis ........................................................................................ 26
Evaluation and Treatment of Infants in the First Month of Life ..................... 26
Evaluation and Treatment of Older Infants and Children ............................. 28
Follow-Up .................................................................................................. 28
Special Considerations ............................................................................... 28
Management of Patients Who Have a History of Penicillin Allergy ................... 28
Recommendations ...................................................................................... 29
Penicillin Allergy Skin Testing ...................................................................... 29
Diseases Characterized by Urethritis and Cervicitis ......................................... 30
Management of Male Patients Who Have Urethritis .................................... 30
Etiology ...................................................................................................... 30
Confirmed Urethritis ................................................................................... 30
Management of Patients Who Have Nongonococcal Urethritis .................... 31
Management of Patients Who Have Mucopurulent Cervicitis (MPC) ............. 32
Chlamydial Infections ................................................................................. 32
Gonococcal Infections ................................................................................ 36
Diseases Characterized by Vaginal Discharge ................................................. 42
Management of Patients Who Have Vaginal Infections ................................ 42
Bacterial Vaginosis ..................................................................................... 42
Trichomoniasis ........................................................................................... 44
Vulvovaginal Candidiasis ............................................................................ 45
Pelvic Inflammatory Disease ........................................................................... 48
Diagnostic Considerations .......................................................................... 48
Treatment .................................................................................................. 49
Follow-Up .................................................................................................. 51
Management of Sex Partners ...................................................................... 51
Prevention .................................................................................................. 51
Special Considerations ............................................................................... 51
Epididymitis ................................................................................................... 52
Diagnostic Considerations .......................................................................... 52
Treatment .................................................................................................. 52
Follow-Up .................................................................................................. 53
Management of Sex Partners ...................................................................... 53
Special Considerations ............................................................................... 53
Human Papillomavirus Infection ..................................................................... 53
Genital Warts ............................................................................................. 53
Subclinical Genital HPV Infection (Without Exophytic Warts) ........................ 57
Cervical Cancer Screening for Women Who Attend STD Clinics
or Have a History of STDs ............................................................................ 57
Recommendations ...................................................................................... 58
Special Considerations ............................................................................... 59
Vaccine Preventable STDs .............................................................................. 59
Hepatitis A ................................................................................................. 59
Hepatitis B ................................................................................................. 61
Hepatitis C .................................................................................................... 64
Sexual Activity ............................................................................................ 65
Diagnosis and Treatment ............................................................................ 65
Prevention .................................................................................................. 65
Postexposure Follow-Up ............................................................................. 66
Proctitis, Proctocolitis, and Enteritis ................................................................. 66
Treatment .................................................................................................. 67
Follow-Up .................................................................................................. 67
Management of Sex Partners ...................................................................... 67
Ectoparasitic Infections ................................................................................... 67
Pediculosis Pubis ........................................................................................ 67
Scabies ...................................................................................................... 68
Sexual Assault and STDs ................................................................................ 69
Adults and Adolescents .............................................................................. 69
Evaluation for Sexually Transmitted Infections ............................................. 69
Sexual Assault or Abuse of Children ........................................................... 71
References ..................................................................................................... 74
Abbreviations Used in This Publication ........................................................... 77