Updated 2021 Sexually Transmitted Infections (STI) Treatment Guidelines

On October 20, 2021, NH DHHS issued a health alert on updated 2021 sexually transmitted infections guidelines.

NH DPHS Health AlertsKey Points and Recommendations:

  • Refer to CDC’s new 2021 STI Treatment Guidelines for information on prevention, screening, diagnosis, and treatment of STIs. The following are some key updates: 
    • ​Treatment of Chlamydia trachomatis: The preferred treatment for adolescents and adults is doxycycline. Azithromycin is now an “alternative regimen” (except during pregnancy) because doxycycline has shown higher treatment efficacy for urogenital, rectal, and oropharyngeal infection. 
    • Treatment of Neisseria gonorrhoeae: The preferred treatment for uncomplicated urogenital, rectal, and pharyngeal infection in adolescents and adults is monotherapy with ceftriaxone 500 mg IM x1 (for persons weighing ≥150 kg use 1 gram IM x1). If suspected or documented treatment failure occurs, clinicians should perform a simultaneous nucleic acid amplification test (NAAT) and culture for antimicrobial susceptibility testing. Dual therapy with azithromycin and a cephalosporin is no longer recommended because N. gonorrhoeae resistance to azithromycin is increasing. 
    • Syphilis screening during pregnancy: Providers should continue to screen all pregnant women for syphilis at their first prenatal visit. Pregnant women who are at risk for syphilis during pregnancy (e.g., due to a substance use disorder, diagnosis of another STI, multiple sex partners or a new sex partner, etc.) should be re-tested for syphilis at 28 weeks’ gestation and again at delivery. 
    • Management of Mycoplasma genitalium: Men with recurrent non-gonococcal urethritis and women with recurrent cervicitis should be tested for M. genitalium; testing should be considered in women with pelvic inflammatory disease (PID). Diagnostic testing for M. genitalium is with a NAAT. Treatment involves two-stage therapy, and recommendations are based on whether resistance testing is available (see STI treatment guidelines for Mycoplasma genitalium). 
    • Recommendations for treatment of Trichomonas vaginalis, bacterial vaginosis, and empiric treatment of PID have been updated. 
    • There are new recommendations for two-step serologic diagnosis of genital herpes simplex virus (HSV) infection.
  • Review CDC’s screening recommendations summary table for STI screening recommendations by both disease and patient population. Testing should be based on reported sexual behaviors and sites of exposure (e.g., urogenital, pharyngeal, rectal). 
  • The National Network of STD Clinical Prevention Training Centers (NNPTC) provides online clinical consultation that can be accessed at www.stdccn.org
    • Providers can also reach out to the NH Division of Public Health Services (DPHS) with questions about STI screening and treatment by calling 603-271-4496 (after hours call 603-271-5300 and ask for the public health nurse on call).

Full DHHS Alert