Sexually transmitted infections
Also known as: chlamydia · gonorrhea · STD · STI · syphilis
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Sexually Transmitted Infections Treatment Guidelines, 2021
Centers for Disease Control and Prevention (CDC) · 2021
CDC's reference guideline on preventing, diagnosing and treating sexually transmitted infections in the United States, replacing the 2015 edition. It is accompanied by regimen tables, a wall chart and a pocket guide.
Guidelines for the management of symptomatic sexually transmitted infections
World Health Organization (WHO) · 2021
WHO guidance to help countries update national STI case-management policy, addressing both aetiological diagnosis and syndromic management for people presenting with STI symptoms.
- Recommendations are organised by clinical syndrome, including urethral discharge, vaginal discharge, lower abdominal pain, genital ulcer and anorectal discharge. source
- WHO developed the update in response to shifts in STI epidemiology and advances in diagnosis and treatment since its earlier syndromic-management guidance. source
US vs EU key differences
- Diagnostic strategy differs: WHO explicitly retains syndromic treatment for urethral discharge in settings without same-day molecular testing, covering gonorrhoea and chlamydia empirically, while the CDC guidelines are built around etiologic diagnosis with nucleic acid amplification testing. source
- WHO recommends performing same-day NAAT for N. gonorrhoeae and C. trachomatis and treating by result where quality-assured molecular testing is available, reserving syndromic cover for lower-resource settings. source
- The 2021 CDC guidelines moved uncomplicated gonorrhoea to single-agent ceftriaxone 500 mg intramuscularly, dropping routine azithromycin co-treatment and adding doxycycline only when chlamydial coinfection has not been excluded. source
What changed recently
- US2015 → 20212021-07-23
The 2021 CDC guidelines replaced dual therapy for uncomplicated gonorrhoea (ceftriaxone 250 mg plus azithromycin) with a single 500 mg intramuscular dose of ceftriaxone, reflecting declining cephalosporin susceptibility and stewardship concerns about azithromycin. Doxycycline for seven days became the preferred chlamydia regimen and is added only when chlamydial co-infection has not been excluded.
source ↗curation confidence 90% - GLOBAL2003 → 20212021-01-01
The 2021 WHO guidelines moved away from purely syndromic care: where quality-assured molecular assays are available, treatment should be directed by laboratory diagnosis, while resource-limited settings use a modified syndromic algorithm. Treatment recommendations across the five common STI syndromes were also rewritten to account for rising antimicrobial resistance, especially in Neisseria gonorrhoeae.
source ↗curation confidence 90%
See the full update feed for changes across every system.