Protecting, maintaining and improving the health of all Minnesotans
September 16, 2015
Dear Colleague:
On June 5, 2015, CDC published the Sexually Transmitted Diseases Treatment Guidelines, 2015. With
more than 20 million cases of STDs occurring in the United States each year, it is critical for healthcare
providers to have access to scientifically-sound, evidence-based diagnostic, treatment, and prevention
recommendations to help reduce the burden of these infections.
The 2015 Guidelines update the previous 2010 guidelines with new guidance, including:
•
Annual screening recommended for gonorrhea for all sexually active women aged <25 and for
older women at increased risk for infection. [Routine screening of all sexually active women < 25
is not recommended in all areas of Minnesota. Consult MDH.]
•
Treatment for gonorrhea: Ceftriaxone 250 mg IM, single dose PLUS Azithromycin 1 g orally,
single dose. Use both to improve treatment efficacy and help slow antibiotic resistance.
Alternative treatment if ceftriaxone is not available: Cefixime 400 mg orally, single dose PLUS
Azithromycin 1 g orally, single dose. Alternative treatment for patients with cephalosporin
allergies: Gemifloxacin 320 mg orally PLUS Azithromycin 2 gm; also Gentamycin 240 mg IM PLUS
Azithromycin 2 gm.
•
Test-of-cure for pharyngeal gonorrhea: 14 days only for persons with pharyngeal and rectal GC
receiving alternative treatment.
•
Treatment for chlamydia: Delayed release doxycycline (Doryx) 200 mg daily x 7 days can be
alternative to doxycycline 100 mg twice daily x 7 days to treat urogenital chlamydia.
•
Test-of-cure for chlamydia: (Repeat testing 3-4 weeks after treatment is completed) is not
recommended for patients treated with recommended or alternative regimens, unless
therapeutic adherence is in question, symptoms persist, or reinfection is suspected. Note: most
treatment failures shown to be from reinfection rather than actual treatment failures.
•
Treatment for latent syphilis – For pregnant females the time between doses cannot be more
than 7 days as stated in the CDC Treatment Guidelines Webinar. Otherwise the series starts
over. Nine days between doses for all other cases of latent syphilis.
•
A person having neurological signs and symptoms of syphilis (e.g., cognitive dysfunction, motor
or sensory deficits, ophthalmic or auditory symptoms, cranial nerve palsies, or signs of
meningitis or stoke, cranial nerve dysfunction, meningitis, stroke, and hearing loss) or
STD/HIV/TB Section • Infectious Disease Epidemiology, Prevention and Control Division •
625 Robert Street North • P.O. Box 64975 • St. Paul, Minnesota 55164-0975 • 651-201-5414
http://www.health.state.mn.us
An equal opportunity employer
ophthalmic disease (e.g., uveitis, neuroretinitis, and optic neuritis) should be evaluated for
neurosyphilis.
•
Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV is now included in the Clinical
Prevention Guidance section. The full CDC PrEP Guidelines also include recommendations for
frequent testing for other STDs for those on PrEP.
Reminders:
•
•
•
•
•
•
•
•
All providers are required to report all laboratory confirmed cases of chlamydia and gonorrhea
on a MDH Confidential Provider Case Report form. The form may be downloaded from the MDH
website at http://www.health.state.mn.us/stdreporting. Laboratory reports do not substitute for
the provider case report form.
A MDH Confidential Provider Case Report form is also required to be submitted to MDH on all
persons requiring treatment for a syphilis infection.
Congenital syphilis and chancroid require immediate reporting to 651-201-5414.
Clinicians should talk to their patients about their sexual partners being tested and treated for
potential exposure to STDs.
MDH provides partner notification services for persons diagnosed with STDs and HIV. More
information: http://www.health.state.mn.us/divs/idepc/dtopics/stds/partnerservices.html.
In Minnesota, clinicians can provide Expedited Partner Therapy (EPT) for sex partners. More
information: http://www.health.state.mn.us/divs/idepc/dtopics/stds/ept/index.html.
Persons testing positive for HIV should also be screened for STDs.
MDH STD website containing latest data and resources: http://www.health.state.mn.us/std.
For more information about the new STD Treatment Guidelines, visit the CDC website at:
http://www.cdc.gov/std/default.htm.
Krissie L. Guerard, M.S.
STD/HIV/TB Section Manager
Infectious Disease Epidemiology, Prevention
and Control Division
PO Box 64975
St. Paul, Minnesota 55164-0975
KLG:CLJ:rad-k