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The Hawai‘i STD Treatment Guideline reflects the 2002 CDC STD Treatment Guidelines and the Region IX Infertility Clinical Guidelines to focus primarily on STDs encountered in an office practice and to address the differences in the epidemiology of STDs in Hawai‘i as compared to mainland US. These Guidelines are intended as a source of clinical guidance and are not a comprehensive list of all effective regimens.
Special note on the treatment of gonococcal infections
Ciprofloxacin-resistant N. gonorrhoeae is endemic in Hawai‘i. Patients diagnosed with gonorrhea in Hawai‘i should not be treated with fluroquinolones. Clinicians who suspects or identifies treatment failure should submit a gonococcal culture specimen for antibiotic susceptibility testing. When a patient is diagnosed with an antibiotic-resistant gonorrhea, it is strongly recommended to identify sex partners so that they may be examined and appropriately treated. Contact the STD Prevention Program at (808)733-9281 for assistance in case management of patients diagnosed with antibiotic-resistant gonococcal infections or their sex partners.
Special note on the Treatment of Syphilis
Long-acting benzathine penicillin is the drug of choice for treating most stages of syphilis. The alternative regimens listed in the treatment guideline may be used; however, close follow-up is essential because data on non-penicillin regimens for the treatment of syphilis are limited – particularly for treating patients who are also infected with HIV. There may be a higher risk of treatment failure when using alternative regimens among these patients.
Laboratory Test Results
It is imperative to obtain a sexual history for both assessing STD risk and interpreting STD test results. The possibility that positive test results may be false should be considered when patients have unanticipated positive test results.
- “False-Positive Gonorrhea Test Results with a Nucleic Acid Amplification Test: The Impact of Low Prevalence on Positive Predictive Value.”
Alan R Katz, Paul V Effler, Roy G Ohye, Barbara Brouillet, Maria Veneranda Lee, Peter M Whiticar. CID 2004:38 (15 March) 814-819.
- “Azithromycin Treatment Failures in Syphilis Infections- San Francisco, California, 2002-2003.”
MMWR 53(9) 197-198. March 12, 2004.
- “Increases in Fluoroquinolone-Resistant Neisseria gonorrhoeae Among Men Who Have Sex with Men --- United States, 2003, and Revised Recommendations for Gonorrhea Treatment, 2004.”
MMWR 53(16):335-338. April 30, 2004.
- “Oral Alternatives to Cefixime for the Treatment of Uncomplicated Neiserria Gonorrhoeae Urogenital Infections.”
MMWR 51(46):1052. November 22, 2002.