CDC screening and treatment guidelines for STIs

Healthcare clinicians need a clear understanding of current CDC sexually transmitted infection (STI) screening and treatment recommendations for chlamydia, gonorrhea, trichomoniasis and Mycoplasma genitalium to ensure compliant clinical practice. The CDC guidelines mandate comprehensive STI testing for all women diagnosed with bacterial vaginosis, recommend opt-out screening protocols for young women, and include M. genitalium testing and treatment protocols with resistance testing when available. This comprehensive summary provides healthcare clinicians with the essential CDC guideline details needed for immediate practice implementation and standard-of-care compliance.

Chlamydia, gonorrhea and trichomoniasis screening guidelines

For sexually active women under 25 years of age, annual screening for both chlamydia and gonorrhea is recommended. Sexually active women aged 25 years and older require screening if they are at increased risk. This includes women who have: new and/or multiple partners; a partner with concurrent partners or an STI; a history of STIs; or a history of exchanging sex for payment.

Clinicians might consider opt-out chlamydia and gonorrhea screening for adolescent and young adult women during clinical encounters. This involves notifying the patient that testing will be performed unless the patient declines, regardless of reported sexual activity. 

For trichomoniasis, diagnostic testing should be performed for women seeking care for vaginal discharge. Screening should be offered as opt-out at intake for women in high-prevalence settings and for asymptomatic women at high risk for infection.

All persons who receive a diagnosis of chlamydia, gonorrhea or trichomoniasis should be retested three months after treatment.

Mycoplasma genitalium testing protocols

Women with recurrent cervicitis should be tested for M. genitalium, and testing should be considered among women with PID. Testing should be accompanied by resistance testing, if available. Screening for asymptomatic M. genitalium infection among women is not recommended, and extragenital testing for M. genitalium is not recommended. 

High-risk populations

Sexually active men who have sex with men require at least annual screening for chlamydia and gonorrhea at sites of contact (urethra, rectum and pharynx) regardless of condom use, with screening every 3 to 6 months if at increased risk.

HIV-infected individuals should be screened for chlamydia and gonorrhea at first HIV evaluation and at least annually thereafter, with more frequent screening based on individual risk behaviors and local epidemiology. Sexually active HIV-infected women should be screened for trichomoniasis at entry to care and at least annually thereafter. Annual trichomoniasis screening is recommended for asymptomatic women with HIV due to the risks linked to both trichomoniasis and HIV infection.  

Treatment and follow-up protocols 

Doxycycline 100 mg orally 2 times/day for 7 days is the recommended regimen for chlamydia. Gonorrhea treatment requires ceftriaxone 500 mg IM in a single dose for persons weighing less than 150 kg.

M. genitalium requires a two-stage therapy approach. If resistance testing is available, macrolide-sensitive infections should be treated with doxycycline followed by azithromycin; macrolide-resistant cases require doxycycline followed by moxifloxacin. Without resistance testing, clinicians should use doxycycline followed by moxifloxacin