The 2017/18 critical review of the Australasian STI Management Guidelines for primary care is now complete. Whilst the critical review is conducted annually, the Guidelines are a living document, for which we welcome your feedback on an ongoing basis.
What’s changed? This year the review focused on STI and syndrome management. The major changes proposed are to Mycoplasma genitalium, cervicitis, urethritis, PID and anorectal syndromes.
Please read the rationale for the changes here.
Please remember these guidelines are for a PRIMARY CARE audience. The list of changes are listed below.
Mycoplasma genitalium
• Several commercial assays are likely to become available in 2016/2017.• Azithromycin 1g PO is effective in up to 60% of infected individuals and only those with persisting symptoms should have further treatment. • MG is developing resistance to single dose macrolide treatments used for Chlamydia trachomatis, complicating the choice of first line treatment of urethritis for some men.
Ano-rectal syndromes
For rectal coinfection with gonorrhoea and chlamydia, treatment should be given for both infections i.e.: Ceftriaxone 500mg IMI, stat in 2mL 1% lignocaine PLUS Azithromycin 1g PO, stat PLUS Doxycycline 100mg PO, BD 21 days – 21 days Doxycycline also covers treatment of untested LGV.
PID – Pelvic Inflammatory Disease
• The majority of cases have no identified cause.• All women of reproductive age with new onset abdominal pain should have urine pregnancy test and, if positive, urgent pelvic ultrasound; testing for STIs as indicated in diagnosis; and, urinalysis for UTI.• Pelvic ultrasound is useful to detect alternative causes of pain, if the diagnosis is uncertain. • Clinician collected specimens is recommended although self-collection is acceptable if examination declined.• Begin treatment immediately, and consider admission in case of suspicion (or definitive diagnosis) of a pelvic abscess.
Urethritis – male
• Possible cause: Mycoplasma genitalium is developing resistance to single dose treatments used for Chlamydia trachomatis, complicating the choice of first line treatment of urethritis for some men. CT at non-genital sites may not be treated adequately with single dose treatments.
Chlamydia
Treatment with Doxycycline 100mg BD PO 7 days is equivalent to Azithromycin 1g PO and covers emerging evidence of undiagnosed rectal CT in women and MSM). Failure of Azithromycin to treat these sites is possibly contributing to persisting infection.• Contact tracing: consider the use of patient delivered partner therapy (PDPT), where appropriate. PDPT is currently legal in VIC and NT.
Trichomonas
• Testing is currently available through private pathology companies.
2016: Annual Critical Review Complete - what's changed?
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