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Sexually Transmitted Disease Prevention Program


CDC Releases Update: 2020 Treatment Guidelines for Gonococcal Infections

In December 2020, the CDC updated recommendations for the treatment of uncomplicated gonorrhea in adolescents and adults: two-drug approach no longer recommended; treat with just one 500 mg injection of ceftriaxone. Further details are outlined below:

Regimen for uncomplicated gonococcal infections of the cervix, urethra, or rectum:

Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (300 lb)

  • For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.
  • If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, or rectum if ceftriaxone is not available:

Gentamicin 240 mg IM as a single dose plus azithromycin 2 g orally as a single dose OR

Cefixime 800 mg orally as a single dose. If treating with cefixime, and chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

Recommended regimen for uncomplicated gonococcal infections of the pharynx:

Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (300 lb)

  • For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.
  • If chlamydia coinfection is identified when pharyngeal gonorrhea testing is performed, providers should treat for chlamydia with doxycycline 100 mg orally twice a day for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.
  • No reliable alternative treatments are available for pharyngeal gonorrhea. For persons with a history of a beta-lactam allergy, a thorough assessment of the reaction is recommended.*
  • For persons with an anaphylactic or other severe reaction (e.g., Stevens Johnson syndrome) to ceftriaxone, consult an infectious disease specialist for an alternative treatment recommendation.

Follow-Up

A test-of-cure is not needed for persons who receive a diagnosis of uncomplicated urogenital or rectal gonorrhea who are treated with any of the recommended or alternative regimens; however, any person with pharyngeal gonorrhea who is treated with any regimen should return 14 days after treatment for a test-of cure using either culture or NAAT. All positive cultures for test-of-cure should undergo antimicrobial susceptibility testing.

Symptoms that persist after treatment should be evaluated by culture for N. gonorrhoeae (with or without simultaneous NAAT), and any gonococci isolated should be tested for antimicrobial susceptibility. Persistent urethritis, cervicitis, or proctitis also might be caused by other organisms (see Urethritis, Cervicitis, and Proctitis sections).

A high prevalence of N. gonorrhoeae infection has been observed among men and women previously treated for gonorrhea (86,480,481,577). Rather than signaling treatment failure, most of these infections result from reinfection caused by failure of sex partners to receive treatment or the initiation of sexual activity with a new infected partner, indicating a need for improved patient education and treatment of sex partners. Men or women who have been treated for gonorrhea should be retested 3 months after treatment regardless of whether they believe their sex partners were treated. If retesting at 3 months is not possible, clinicians should retest whenever persons next present for medical care within 12 months following initial treatment.

More information on treatment failures can be found at the bottom of this page, under "Treatment Failures". 

Abbreviation: IM = intramuscular.

* CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2015;64(No. RR-3). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm.

Further information can be found on the CDC's website, by clicking here.


 

Mission Statement

The mission of the STD Prevention Program is to intervene in the spread of sexually transmitted diseases (STDs) and reduce the complications of these diseases.  The program provides technical and financial assistance to local STD programs for surveillance, case detection through screening, ensuring treatment of known cases, case follow-up, and education.  Efforts are coordinated among health care providers screening for syphilis, gonorrhea, and chlamydia.  Other important aspects of this program include education and prevention counseling for persons impacted by STDs.

Get Tested

Fast Facts

  • Many STDs are asymptomatic, meaning you can't tell you have one without being tested. It's important to get tested regularly if you're sexually active.
  • Latex condoms used the right way every time will greatly reduce your risk of getting an STD.
  • If diagnosed with an STD, it's important to take all medication exactly as prescribed. You and any partners should wait 7 days after treatment before having sex again to avoid reinfection.
  • Some STDs, like chlamydia and gonorrhea, can cause irreversible damage to the reproductive system if not treated.

Looking for a clinic near you? Check out our STD Clinics Map of agencies that partner with the ISDH STD Prevention Program. Enter your zip code to find a testing facility close to you. A list of those clinics can be found here.

For more information about what STDs are, how they're spread, and who's at risk, please visit the CDC STD webpage.

Information for Health Care Providers

STD Morbidity Reporting in Indiana

Positive cases of chlamydia, gonorrhea, and syphilis are to be reported using the Indiana Confidential Sexually Transmitted Disease (STD) Report, State Form 56459. Health care providers should not report cases of herpes or trichomoniasis.

*ATTENTION* As of 5/3/2018, we have updated our disease reporting map to reflect two new agencies housing Disease Intervention Specialists. Those counties impacted are listed below. Per Dr. Box's recommendations, STD Communicable Disease Reports should be faxed to:

  • Meridian Health Services at 888-389-9810 for Decatur, Delaware, Fayette, Franklin, Henry, Randolph, Rush, Wayne, and Union counties.
  • Madison County Health Department at 765-646-9208 for Adams, Blackford, Grant, Huntington, Jay, Madison, Miami, Wabash, and Wells counties.
     

Please refer to the DIS Contact Map for more information on how to contact your local DIS.

In Indiana, case reports of reportable STDs should go to the Disease Intervention Specialist (DIS) in your area within 72 hours of diagnosis. Use the resources below to determine where your case reports should be faxed.

Looking to report a case of HIV? Click here.

STD Treatment Guidelines

The CDC provides guidelines for recommended courses of treatment for STDs.

Providers can email STD@isdh.in.gov for printed copies of the STD treatment guidelines.

Expedited Partner Therapy for Health Care Professionals in Indiana

Expedited Partner Therapy, or EPT, is the practice of treating sexual partners of patients diagnosed with an STD (specifically chlamydia and/or gonorrhea) without an intervening medical evaluation. This practice helps prevent re-infection of patients and is considered an effective partner management strategy. Prescribing treatment to partners is a protected activity under the Indiana Administrative Code. See the resources below for more information.

National and Statewide Increase in Syphilis Cases

Once on a trajectory for elimination in the United States, the rate of syphilis infection has been increasing every year since 2001. The syphilis rate increased 17.6% to 8.7 cases per 100,000 population between 2015 and 2016, the highest rate reported since 1993. In Indiana, the number of primary and secondary syphilis cases has increased from 285 to 326 during that time period. Congenital syphilis cases have also increased at the state and national level, which is a major public health concern.

Please use the documents at the links provided below for guidance on managing syphilis diagnosed in your patients.

NEDSS Base System (NBS)

The NEDSS Base System (NBS) is an electronic disease reporting and case management platform supported by the Centers for Disease Control and Prevention. In 2018, the Infectious Disease Epidemiology, Sexually Transmitted Disease Prevention, and Tuberculosis programs at the Indiana State Department of Health (ISDH) plan to transition their individual electronic disease surveillance and monitoring systems to the centralized NBS system.

NEDSS Base System (NBS) Transition Information