STD: What's New?
Things are changing in the world of sexually transmitted infections (STIs) all the time.
New events, conferences, resources, and even new diagnostic, treatment, and prevention recommendations occur regularly.
Below is an example of what is going on in Wisconsin and elsewhere.
CDC releases clinical guidelines for use of doxycycline to protect against STIs
The CDC (Centers for Disease Control and Prevention) recently released guidelines for the use of doxycycline post-exposure prophylaxis (Doxy PEP). Doxy PEP is a preventive antibiotic regimen that, when taken within 72 hours of unprotected anal, oral, or vaginal sex, can prevent the spread of gonorrhea, chlamydia, and syphilis in people who are at high risk for these infections.
According to the CDC, Doxy PEP represents the first new bacterial STI prevention tool in decades. Having tools like Doxy PEP available is critical at a time when bacterial STIs, especially syphilis, are increasing in Wisconsin and nationwide.
The guidelines released by CDC outline the recommendations for the use of Doxy PEP in select populations to prevent chlamydia, gonorrhea and syphilis. Based on the high efficacy observed in randomized clinical trials and a review of the populations that would benefit the most, the agency recommends that providers discuss the risks and benefits of Doxy PEP with gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW) patients who have a history of at least one bacterial STI (specifically syphilis, chlamydia, or gonorrhea) during the past 12 months. If Doxy PEP is prescribed, the provider should write the prescription for self-administration to be taken as soon as possible within 72 hours after having oral, vaginal, or anal sex. The recommended dose for Doxy PEP is 200 mg (milligrams) of doxycycline with a maximum dose of 200 mg every 24 hours.
Doxy PEP should be offered as part of a comprehensive sexual health approach that includes other risk reduction techniques, such as STI screening and treatment, recommended vaccination, and linkage to HIV pre-exposure prophylaxis (PrEP) and care.
The full guidelines for the use of Doxy PEP can be found on the CDC webpage.
Update on erythromycin ophthalmic ointment shortage
The CDC (Centers for Disease Control and Prevention) posted update regarding the ongoing erythromycin ophthalmic ointment (0.5%) shortage in the United States (US) and interim clinical considerations for the prevention of ophthalmia neonatorum.
According to the US Food and Drug Administration (FDA), the shortage of this medication is a result of several changes in the market. Since 2022, multiple pharmaceutical companies have discontinued or decreased manufacturing and distribution of erythromycin ointment (0.5%) in the US. To help mitigate these shortages, the FDA has approved a temporary importation of limited quantities of erythromycin ophthalmic ointment (0.5%) from Canada’s Steri-Med Pharma.
Erythromycin ophthalmic ointment (0.5%) is the only CDC recommended regimen for the prevention of ophthalmia neonatorum. To assist during this shortage, CDC has updated the clinical considerations for ophthalmia neonatorum prophylaxis options for those who do not have access to erythromycin ophthalmic ointment. Prenatal screening continues to be the most important strategy in preventing gonorrhea and chlamydia infections in newborns.
See the CDC webpage on the availability of STI Testing and Treatment Products for additional information.
DHS calling on medical providers to increase syphilis screening and testing during pregnancy
In October 2023, The Department of Health Services (DHS) issued a memo to health care providers in the state calling for increased awareness and testing for the sexually transmitted infection (STI) syphilis. Surveillance data from 2022 and preliminary data for 2023 show a continued rise in cases in the state. The most recent data available shows that cases of syphilis increased 19% (1,608 to 1,916) from 2021 to 2022. Among those cases, congenital syphilis increased 81% (16 to 29) during this same time period. By comparison, Wisconsin had an average 0-2 congenital syphilis cases per year in the 2010s.
HIV and STI at-home test kit pilot ended successfully
DHS partnered with Simple HealthKit for a pilot program that provided free at-home test kits for HIV, syphilis, chlamydia, gonorrhea, and trichomoniasis. In seven weeks, from the end of August to the end of October 2023, we delivered 361 test kits to Wisconsin residents across the state.
DHS distributed 316 Clinical and laboratory guidance for suspected treatment failure among patients treated for gonorrhea
In August 2023, DHS issued a memo on monitoring for suspected gonorrhea treatment failure. (PDF) This guidance is especially for those providing treatment and case management for individuals diagnosed with gonorrhea infection.
New 2021 STD treatment guidelines from the CDC (Centers for Disease Control and Prevention)
CDC has recently published new 2021 treatment guidelines that replace the 2015 guidance.
CDC recommends new treatment for gonorrhea
New CDC treatment recommendations for uncomplicated gonorrhea infections were published on Dec. 18, 2020, and now recommend treatment for uncomplicated gonorrhea infection with a single dose of 500mg of ceftriaxone IM. The preferred treatment for coinfection with chlamydia if not ruled out is 100mg of doxycycline two times per day for seven days. A test of cure (TOC) is recommended for all gonococcal infections of the pharynx. Changes in Wisconsin Electronic Disease Surveillance System (WEDSS) and on the report form to accommodate documentation for the new recommendations are in process.
Visit the CDC website for more information and rationale for these new recommendations.
New podcast episode – Exploring the new CDC guidelines for gonorrhea treatment
In a new episode of The Family Planning Files podcast, the National Clinical Training Center for Family Planning (NCTCFP) sat down with Dr. Hilary Reno to discuss the treatment guidelines for gonorrhea released by the CDC in December 2020.
Laboratory director's letter
The Chief Medical Office for the Bureau of Communicable Diseases, Dr. Westergaard and the STI unit have created a letter to help laboratory directors with syphilis testing and reporting. View a copy of the letter Reporting of Treponemal and Non-Treponemal Syphilis Testing and the Correct Syphilis Testing Algorithm for CDC Defined Reverse Sequence Syphilis Testing.