Sexually Transmitted Diseases in Review: The 2002 CDC STD Treatment Guidelines

S exually transmitted diseases (STDs) are among the most common infectious diseases in the United States today. More than 20 STDs have now been identified, and they affect more than 13 million men and women in this country each year. Equally startling is the price tag associated with their prevention and treatment in the clinical setting: the National Institute of Allergy and Infectious Diseases of the National Institutes of Health reckons that the annual comprehensive cost of STDs in the U.S. alone is in excess of $10 billion. Because of the vital role clinicians play in the identification and management of STDs, the U.S. Centers for Disease Control and Prevention (cdc) has long been aware of the need to identify options that will best translate into effective prevention and treatment. One particularly useful resource has been the development of STD Treatment Guidelines, which were updated and published by the cdc in May 2002 (U.S. Centers for Disease Control and Prevention, 2002). The most recent incarnation of the Guidelines is the product of evidencebased deliberations by the cdc, in consultation with publicand private-sector professionals knowledgeable in the treatment of patients with STDs. They are applicable to various patient-care settings, including family planning clinics, private physicians’ offices, managed care organizations, and other primary-care facilities. Although the Guidelines are largely concerned with the clinical manifestations and treatment of STDs, they also stress the importance of the role of the health-care provider in controlling the spread of disease in given communities. This article reviews six common STDs— genital herpes, syphilis, gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis—that can be considered in broad groups according to whether their major initial manifestations are 1) genital sores; 2) urethritis or cervicitis; or 3) vaginal discharge. The diagnostic and treatment recommendations, unless otherwise noted, reflect those specified by the cdc in the 2002 update.