Updated guidelines target treatment of STDs

In an effort to improve the care of patients with sexually transmitted diseases (STDs), the Centers for Disease Control & Prevention recently updated its STD guidelines. The update is an evidence-based document, the result of experts' evaluation of the medical literature since the previous publication of Sexually Transmitted Diseases Treatment Guidelines in 2002.

The guidelines emphasize treatment but also discuss expanded prevention approaches and diagnostic evaluations. "There are new antimicrobial recommendations for trichomoniasis and added data on the clinical efficacy of azithromycin for chlamydial infections in pregnancy. The panel also highlighted the increasing prevalence of quinolone-resistant N. gonorrhoeae," said Sandhya Nalmas, M.D., division of infectious diseases at Newark (N.J.) Beth Israel Medical Center. Pharmacists can play a critical role in preventing and treating STDs, and "knowledge about the recommendations in the guidelines is the first step."

Treatment recommendations for certain STDs, such as syphilis, have not changed. "Parenteral penicillin G still remains the drug of choice for treating all stages of syphilis," noted Parales. The preparations of penicillin used-benzathine, aqueous procaine, or aqueous crystalline-the dosage and length of therapy depend on the clinical manifestations of the disease. The panel emphasized that neither combinations of benzathine and procaine penicillin nor oral penicillin are appropriate treatment for syphilis. Reports have shown that inappropriate use of combination benzathine-procaine penicillin (Bicillin C-R, King Pharmaceuticals) instead of the standard benzathine penicillin (Bicillin L-A, King) has occurred. "Pharmacists and other healthcare providers should be aware of the differences between the two drugs and ensure that inappropriate use of the combination penicillin product for treating syphilis is avoided," said Parales.

The updated Sexually Transmitted Diseases Treatment Guidelines are available on the CDC Web site at http://www.cdc.gov/.

THE AUTHOR is a writer and hospital pharmacist in New Jersey.