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Review

STI update: Testing, treatment, and emerging threats

Matifadza Hlatshwayo, MD, MPH, Hilary E. L. Reno, MD, PhD and Melanie L. Yarbrough, PhD
Cleveland Clinic Journal of Medicine November 2019, 86 (11) 733-740; DOI: https://doi.org/10.3949/ccjm.86a.18098
Matifadza Hlatshwayo
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine in St. Louis, Saint Louis, MO
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Hilary E. L. Reno
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine in St. Louis, Saint Louis, MO
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Melanie L. Yarbrough
Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, Saint Louis, MO
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  • For correspondence: myarbro@wustl.edu
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    TABLE 1

    Screening recommendations and laboratory testing for common sexually transmitted infections

    OrganismDiseaseScreening recommendationsOptimal testing methodSpecimen types
    Neisseria gonorrhoeae and Chlamydia trachomatisFemales: cervicitis
    Males: urethritis
    Females ≤ 25 years old, annually
    Men who have sex with men; consider in young males in high-prevalence areas, annually
    Nucleic acid amplification test (NAAT)Females: vaginal or endocervical swab, first-void urine
    Males: urethral, rectal, or throat swab; first-void urine
    Mycoplasma genitaliumFemales: cervicitis
    Males: urethritis
    Routine screening not recommendedNAATFemales: vaginal or endocervical swab, first-void urine
    Males: first-void urine
    Trichomonas vaginalisFemales: vaginitis
    Males: urethritis, epididymitis, prostatitis
    Routine screening not recommended; but women with human immunodeficiency virus infection should be screened annuallyNAATFemales: vaginal or urine swab, first-void urine
    Males: first-void urine
    • Adapted from the US Centers for Disease Control and Prevention, reference 12.

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    TABLE 2

    Treatment recommendations for common sexually transmitted infections

    OrganismTreatmentAlternatives
    Chlamydia trachomatisAzithromycin 1 g by mouth, 1 dose
    or
    Doxycycline 100 mg by mouth twice daily for 7 days
    Erythromycin base 500 mg by mouth every 6 hours for 7 days
    or
    Erythromycin ethylsuccinate 800 mg by mouth every 6 hours for 7 days
    or
    Ofloxacin 300 mg by mouth twice daily for 7 days
    or
    Levofloxacin 500 mg by mouth daily for 7 days
    Neisseria gonorrhoeae (uncomplicated infection)Ceftriaxone 250 mg intramuscularly, 1 dose and
    Azithromycin 1 g by mouth
    Gonococcal conjunctivitis: ceftriaxone 1 g intramuscularly, 1 dose
    History of severe cephalosporin allergy:
    Gentamicin 240 mg intramuscularly plus
    Azithromycin 2 g by mouth, 1 dose
    N gonorrhoeae (disseminated infection)Ceftriaxone 1 g intravenously
    or intramuscularly every 24 hours
    or
    Cefotaxime 1 g intravenously every 8 hours
    or
    Ceftizoxime 1 g intravenously every 8 hours plus
    concurrent treatment for chlamydia
    Can switch to an oral antibiotic based on
    susceptibilities 24–48 hours after clinical
    improvement for 7 days of treatment
    Mycoplasma genitaliumAzithromycin 1 g by mouth, 1 dose
    or
    Azithromycin 500 mg by mouth, 1 dose and then 250 mg by mouth for 4 more days (limited by resistance)
    Moxifloxacin 400 mg by mouth for 7–14 days
    Trichomonas vaginalisMetronidazole 500 mg by mouth twice a day for 7 days
    or
    Metronidazole 2 g by mouth, 1 dose
    Tinidazole 2 g by mouth, 1 dose;
    or 1 g by mouth every day for 5 days
    • Adapted from US Centers for Disease Control and Prevention, reference 7

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Cleveland Clinic Journal of Medicine: 86 (11)
Cleveland Clinic Journal of Medicine
Vol. 86, Issue 11
1 Nov 2019
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STI update: Testing, treatment, and emerging threats
Matifadza Hlatshwayo, Hilary E. L. Reno, Melanie L. Yarbrough
Cleveland Clinic Journal of Medicine Nov 2019, 86 (11) 733-740; DOI: 10.3949/ccjm.86a.18098

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STI update: Testing, treatment, and emerging threats
Matifadza Hlatshwayo, Hilary E. L. Reno, Melanie L. Yarbrough
Cleveland Clinic Journal of Medicine Nov 2019, 86 (11) 733-740; DOI: 10.3949/ccjm.86a.18098
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  • Article
    • ABSTRACT
    • STI RATES ARE HIGH AND RISING
    • BARRIERS AND CHALLENGES TO DIAGNOSIS
    • STI EVALUATION
    • GONORRHEA AND CHLAMYDIA
    • M GENITALIUM IS EMERGING
    • TRICHOMONIASIS
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