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The bibliography lists all references used in the online course. The View by Topic selection organizes the references sequentially by Module, Lesson, and subsections in the lessons. The View by Author lists the authors in alphabetical order.

Bibliography

The bibliography lists all references used in the online course. The View by Topic selection organizes the references sequentially by Module, Lesson, and subsections in the lessons. The View by Author lists the authors in alphabetical order.

Module 1. Question Bank Topics

Lesson 1. Anogenital Warts

Additional References

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 2. Bacterial Vaginosis

Additional References

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PubMed Abstract»
Allsworth JE, Peipert JF. Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data. Obstet Gynecol. 2007;109:114-20.
PubMed Abstract»
Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74:14-22.
PubMed Abstract»
Antonio MA, Meyn LA, Murray PJ, Busse B, Hillier SL. Vaginal colonization by probiotic Lactobacillus crispatus CTV-05 is decreased by sexual activity and endogenous Lactobacilli. J Infect Dis. 2009;199:1506-13.
PubMed Abstract»
Balkus JE, Manhart LE, Lee J, et al. Periodic Presumptive Treatment for Vaginal Infections May Reduce the Incidence of Sexually Transmitted Bacterial Infections. J Infect Dis. 2016;213:1932-7.
PubMed Abstract»
Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 2016;3:4.
PubMed Abstract»
Beigi RH, Austin MN, Meyn LA, Krohn MA, Hillier SL. Antimicrobial resistance associated with the treatment of bacterial vaginosis. Am J Obstet Gynecol. 2004;191:1124-9.
PubMed Abstract»
Berger BJ, Kolton S, Zenilman JM, Cummings MC, Feldman J, McCormack WM. Bacterial vaginosis in lesbians: a sexually transmitted disease. Clin Infect Dis. 1995;21:1402-5.
PubMed Abstract»
Bilardi JE, Walker S, Temple-Smith M, et al. The burden of bacterial vaginosis: women's experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis. PLoS One. 2013;8:e74378.
PubMed Abstract»
Bradshaw CS, Brotman RM. Making inroads into improving treatment of bacterial vaginosis - striving for long-term cure. BMC Infect Dis. 2015;15:292.
PubMed Abstract»
Bradshaw CS, Morton AN, Garland SM, Horvath LB, Kuzevska I, Fairley CK. Evaluation of a point-of-care test, BVBlue, and clinical and laboratory criteria for diagnosis of bacterial vaginosis. J Clin Microbiol. 2005;43:1304-8.
PubMed Abstract»
Bradshaw CS, Sobel JD. Current Treatment of bacterial vaginosis-limitations and need for innovation. J Infect Dis. 2016;214 Suppl 1:S14-20.
PubMed Abstract»
Bradshaw CS, Tabrizi SN, Fairley CK, Morton AN, Rudland E, Garland SM. The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. J Infect Dis. 2006;194:828-36.
PubMed Abstract»
Bradshaw CS, Vodstrcil LA, Hocking JS, et al. Recurrence of bacterial vaginosis is significantly associated with posttreatment sexual activities and hormonal contraceptive use. Clin Infect Dis. 2013;56:777-86.
PubMed Abstract»
Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. 2013:CD000262.
PubMed Abstract»
Brotman RM, Klebanoff MA, Nansel TR, et al. Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection. J Infect Dis. 2010;202:1907-15.
PubMed Abstract»
Bunge KE, Beigi RH, Meyn LA, Hillier SL. The efficacy of retreatment with the same medication for early treatment failure of bacterial vaginosis. Sex Transm Dis. 2009;36:711-3.
PubMed Abstract»
Burtin P, Taddio A, Ariburnu O, Einarson TR, Koren G. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol. 1995;172:525-9.
PubMed Abstract»
Carey JC, Klebanoff MA, Hauth JC, et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 2000;342:534-40.
PubMed Abstract»
Cartwright CP, Lembke BD, Ramachandran K, et al. Development and validation of a semiquantitative, multitarget PCR assay for diagnosis of bacterial vaginosis. J Clin Microbiol. 2012;50:2321-9.
PubMed Abstract»
Cherpes TL, Meyn LA, Krohn MA, Lurie JG, Hillier SL. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis. 2003;37:319-25.
PubMed Abstract»
Cherpes TL, Wiesenfeld HC, Melan MA, et al. The associations between pelvic inflammatory disease, Trichomonas vaginalis infection, and positive herpes simplex virus type 2 serology. Sex Transm Dis. 2006;33:747-52.
PubMed Abstract»
Cohen CR, Lingappa JR, Baeten JM, et al. Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples. PLoS Med. 2012;9:e1001251.
PubMed Abstract»
Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician. 2000;62:1095-104.
PubMed Abstract»
Erickson SH, Oppenheim GL, Smith GH. Metronidazole in breast milk. Obstet Gynecol. 1981;57:48-50.
PubMed Abstract»
Esber A, Vicetti Miguel RD, Cherpes TL, Klebanoff MA, Gallo MF, Turner AN. Risk of Bacterial Vaginosis Among Women With Herpes Simplex Virus Type 2 Infection: A Systematic Review and Meta-analysis. J Infect Dis. 2015;212:8-17.
PubMed Abstract»
Ferris MJ, Masztal A, Aldridge KE, Fortenberry JD, Fidel PL Jr, Martin DH. Association of Atopobium vaginae, a recently described metronidazole resistant anaerobe, with bacterial vaginosis. BMC Infect Dis. 2004;4:5.
PubMed Abstract»
Fethers KA, Fairley CK, Hocking JS, Gurrin LC, Bradshaw CS. Sexual risk factors and bacterial vaginosis: a systematic review and meta-analysis. Clin Infect Dis. 2008;47:1426-35.
PubMed Abstract»
Fethers KA, Fairley CK, Morton A, et al. Early sexual experiences and risk factors for bacterial vaginosis. J Infect Dis. 2009;200:1662-70.
PubMed Abstract»
Fredricks DN, Fiedler TL, Thomas KK, Oakley BB, Marrazzo JM. Targeted PCR for detection of vaginal bacteria associated with bacterial vaginosis. J Clin Microbiol. 2007;45:3270-6.
PubMed Abstract»
Hauth JC, Goldenberg RL, Andrews WW, DuBard MB, Copper RL. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med. 1995;333:1732-6.
PubMed Abstract»
Hemmerling A, Harrison W, Schroeder A, et al. Phase 2a study assessing colonization efficiency, safety, and acceptability of Lactobacillus crispatus CTV-05 in women with bacterial vaginosis. Sex Transm Dis. 2010;37:745-50.
PubMed Abstract»
Hillier SL, Nugent RP, Eschenbach DA, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med. 1995;333:1737-42.
PubMed Abstract»
Jamieson DJ, Duerr A, Klein RS, et al. Longitudinal analysis of bacterial vaginosis: findings from the HIV epidemiology research study. Obstet Gynecol. 2001;98:656-63.
PubMed Abstract»
Joesoef MR, Hillier SL, Wiknjosastro G, et al. Intravaginal clindamycin treatment for bacterial vaginosis: effects on preterm delivery and low birth weight. Am J Obstet Gynecol. 1995;173:1527-31.
PubMed Abstract»
Karani A, De Vuyst H, Luchters S, et al. The Pap smear for detection of bacterial vaginosis. Int J Gynaecol Obstet. 2007;98:20-3.
PubMed Abstract»
Klebanoff MA, Nansel TR, Brotman RM, et al. Personal hygienic behaviors and bacterial vaginosis. Sex Transm Dis. 2010;37:94-9.
PubMed Abstract»
Koss CA, Baras DC, Lane SD, et al. Investigation of metronidazole use during pregnancy and adverse birth outcomes. Antimicrob Agents Chemother. 2012;56:4800-5.
PubMed Abstract»
Koumans EH, Markowitz LE, Hogan V. Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data. Clin Infect Dis. 2002;35:S152-72.
PubMed Abstract»
Koumans EH, Sternberg M, Bruce C, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007;34:864-9.
PubMed Abstract»
Lamont RF, Duncan SL, Mandal D, Bassett P. Intravaginal clindamycin to reduce preterm birth in women with abnormal genital tract flora. Obstet Gynecol. 2003;101:516-22.
PubMed Abstract»
Lamont RF, Nhan-Chang CL, Sobel JD, Workowski K, Conde-Agudelo A, Romero R. Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011;205:177-90.
PubMed Abstract»
Larsson PG, Carlsson B. Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Infect Dis Obstet Gynecol. 2002;10:133-40.
PubMed Abstract»
Larsson PG, Platz-Christensen JJ, Thejls H, Forsum U, Påhlson C. Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study. Am J Obstet Gynecol. 1992;166:100-3.
PubMed Abstract»
Laxmi U, Agrawal S, Raghunandan C, Randhawa VS, Saili A. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med. 2012;25:64-7.
PubMed Abstract»
Liu CM, Hungate BA, Tobian AA, et al. Penile microbiota and female partner bacterial vaginosis in Rakai, Uganda. MBio. 2015;6:e00589.
PubMed Abstract»
Livengood CH 3rd, Ferris DG, Wiesenfeld HC, et al. Effectiveness of two tinidazole regimens in treatment of bacterial vaginosis: a randomized controlled trial. Obstet Gynecol. 2007;110:302-9.
PubMed Abstract»
Marrazzo JM, Thomas KK, Fiedler TL, Ringwood K, Fredricks DN. Relationship of specific vaginal bacteria and bacterial vaginosis treatment failure in women who have sex with women. Ann Intern Med. 2008;149:20-8.
PubMed Abstract»
Martin DH, Marrazzo JM. The vaginal microbiome: current understanding and future directions. J Infect Dis. 2016;214 Suppl 1:S36-41.
PubMed Abstract»
Mastromarino P, Macchia S, Meggiorini L, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clin Microbiol Infect. 2009;15:67-74.
PubMed Abstract»
McClelland RS, Richardson BA, Hassan WM, et al. Improvement of vaginal health for Kenyan women at risk for acquisition of human immunodeficiency virus type 1: results of a randomized trial. J Infect Dis. 2008;197:1361-8.
PubMed Abstract»
McDonald HM, O'Loughlin JA, Vigneswaran R, et al. Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a randomised, placebo controlled trial. Br J Obstet Gynaecol. 1997;104:1391-7.
PubMed Abstract»
McElligott KA, Havrilesky LJ, Myers ER. Preoperative screening strategies for bacterial vaginosis prior to elective hysterectomy: a cost comparison study. Am J Obstet Gynecol. 2011;205:500.e1-7.
PubMed Abstract»
McGregor JA, French JI, Jones W, et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol. 1994;170:1048-59.
PubMed Abstract»
Mehta SD. Systematic review of randomized trials of treatment of male sexual partners for improved bacteria vaginosis outcomes in women. Sex Transm Dis. 2012;39:822-30.
PubMed Abstract»
Meltzer MC, Desmond RA, Schwebke JR. Association of Mobiluncus curtisii with recurrence of bacterial vaginosis. Sex Transm Dis. 2008;35:611-3.
PubMed Abstract»
Mitchell C, Marrazzo J. Bacterial vaginosis and the cervicovaginal immune response. Am J Reprod Immunol. 2014;71:555-63.
PubMed Abstract»
Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study. Am J Obstet Gynecol. 1994;171:345-7.
PubMed Abstract»
Myer L, Kuhn L, Stein ZA, Wright TC Jr, Denny L. Intravaginal practices, bacterial vaginosis, and women's susceptibility to HIV infection: epidemiological evidence and biological mechanisms. Lancet Infect Dis. 2005;5:786-94.
PubMed Abstract»
Nelson DB, Hanlon A, Hassan S, et al. Preterm labor and bacterial vaginosis-associated bacteria among urban women. J Perinat Med. 2009;37:130-4.
PubMed Abstract»
Ness RB, Hillier SL, Kip KE, et al. Bacterial vaginosis and risk of pelvic inflammatory disease. Obstet Gynecol. 2004;104:761-9.
PubMed Abstract»
Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29:297-301.
PubMed Abstract»
Nyirjesy P, McIntosh MJ, Steinmetz JI, Schumacher RJ, Joffrion JL. The effects of intravaginal clindamycin and metronidazole therapy on vaginal mobiluncus morphotypes in patients with bacterial vaginosis. Sex Transm Dis. 2007;34:197-202.
PubMed Abstract»
Oakeshott P, Kerry S, Hay S, Hay P. Bacterial vaginosis and preterm birth: a prospective community-based cohort study. Br J Gen Pract. 2004;54:119-22.
PubMed Abstract»
Odendaal HJ, Popov I, Schoeman J, Smith M, Grové D. Preterm labour--is bacterial vaginosis involved? S Afr Med J. 2002;92:231-4.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Passmore CM, McElnay JC, Rainey EA, D'Arcy PF. Metronidazole excretion in human milk and its effect on the suckling neonate. Br J Clin Pharmacol. 1988;26:45-51.
PubMed Abstract»
Patterson JL, Stull-Lane A, Girerd PH, Jefferson KK. Analysis of adherence, biofilm formation and cytotoxicity suggests a greater virulence potential of Gardnerella vaginalis relative to other bacterial-vaginosis-associated anaerobes. Microbiology. 2010;156:392-9.
PubMed Abstract»
Peterman TA, Tian LH, Metcalf CA, et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med. 2006;145:564-72.
PubMed Abstract»
Piper JM, Mitchel EF, Ray WA. Prenatal use of metronidazole and birth defects: no association. Obstet Gynecol. 1993;82:348-52.
PubMed Abstract»
Reichman O, Akins R, Sobel JD. Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. Sex Transm Dis. 2009;36:732-4.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Schwebke JR, Desmond R. A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases. Am J Obstet Gynecol. 2007;196:517.e1-6.
PubMed Abstract»
Schwebke JR, Desmond R. Risk factors for bacterial vaginosis in women at high risk for sexually transmitted diseases. Sex Transm Dis. 2005;32:654-8.
PubMed Abstract»
Schwebke JR, Hillier SL, Sobel JD, McGregor JA, Sweet RL. Validity of the vaginal gram stain for the diagnosis of bacterial vaginosis. Obstet Gynecol. 1996;88:573-6.
PubMed Abstract»
Schwebke JR, Muzny CA, Josey WE. Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model. J Infect Dis. 2014;210:338-43.
PubMed Abstract»
Screening for bacterial vaginosis in pregnancy to prevent preterm delivery: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148:214-9.
PubMed Abstract»
Senok AC, Verstraelen H, Temmerman M, Botta GA. Probiotics for the treatment of bacterial vaginosis. Cochrane Database Syst Rev. 2009 Oct 7:CD006289.
PubMed Abstract»
Sewankambo N, Gray RH, Wawer MJ, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet. 1997;350:546-50.
PubMed Abstract»
Skinner CJ, Stokes J, Kirlew Y, Kavanagh J, Forster GE. A case-controlled study of the sexual health needs of lesbians. Genitourin Med. 1996;72:277-80.
PubMed Abstract»
Sobel J, Peipert JF, McGregor JA, et al. Efficacy of clindamycin vaginal ovule (3-day treatment) vs. clindamycin vaginal cream (7-day treatment) in bacterial vaginosis. Infect Dis Obstet Gynecol. 2001;9:9-15.
PubMed Abstract»
Sobel JD, Ferris D, Schwebke J, et al. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2006;194:1283-9.
PubMed Abstract»
Soper DE. Bacterial vaginosis and postoperative infections. Am J Obstet Gynecol. 1993;169:467-9.
PubMed Abstract»
Tokyol C, Aktepe OC, Cevrioğlu AS, Altindiş M, Dilek FH. Bacterial vaginosis: comparison of Pap smear and microbiological test results. Mod Pathol. 2004;17:857-60.
PubMed Abstract»
Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. Lancet. 2003;361:983-8.
PubMed Abstract»
Ugwumadu A, Reid F, Hay P, Manyonda I. Natural history of bacterial vaginosis and intermediate flora in pregnancy and effect of oral clindamycin. Obstet Gynecol. 2004;104:114-9.
PubMed Abstract»
Vermeulen GM, Bruinse HW. Prophylactic administration of clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: a randomised placebo-controlled double-blind trial. Br J Obstet Gynaecol. 1999;106:652-7.
PubMed Abstract»
Vodstrcil LA, Walker SM, Hocking JS, et al. Incident bacterial vaginosis (BV) in women who have sex with women is associated with behaviors that suggest sexual transmission of BV. Clin Infect Dis. 2015;60:1042-53.
PubMed Abstract»
Wasserheit JN. Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis. 1992;19:61-77.
PubMed Abstract»
Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6-10.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by vaginal itching, burning, irritation, odor or discharge: vulvovaginal candidiasis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases characterized by vaginal discharge: Bacterial vaginosis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Yudin MH, Landers DV, Meyn L, Hillier SL. Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy: a randomized trial. Obstet Gynecol. 2003;102:527-34.
PubMed Abstract»
Zozaya M, Ferris MJ, Siren JD, et al. Bacterial communities in penile skin, male urethra, and vaginas of heterosexual couples with and without bacterial vaginosis. Microbiome. 2016;4:16.
PubMed Abstract»

Lesson 3. Candidiasis - Vulvovaginal

Additional References

Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004;291:1368-79.
PubMed Abstract»
Apalata T, Carr WH, Sturm WA, Longo-Mbenza B, Moodley P. Determinants of symptomatic vulvovaginal candidiasis among human immunodeficiency virus type 1 infected women in rural KwaZulu-Natal, South Africa. Infect Dis Obstet Gynecol. 2014;2014:387070.
PubMed Abstract»
Duerr A, Heilig CM, Meikle SF, et al. Incident and persistent vulvovaginal candidiasis among human immunodeficiency virus-infected women: Risk factors and severity. Obstet Gynecol. 2003;101:548-56.
PubMed Abstract»
Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol. 1998;92:757-65.
PubMed Abstract»
Eckert LO. Clinical practice. Acute vulvovaginitis. N Engl J Med. 2006;355:1244-52.
PubMed Abstract»
Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016;42:905-27.
PubMed Abstract»
Kennedy MA, Sobel JD. Vulvovaginal candidiasis caused by non-albicans Candida species: new insights. Curr Infect Dis Rep. 2010;12:465-70.
PubMed Abstract»
Mølgaard-Nielsen D, Pasternak B, Hviid A. Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med. 2013;369:830-9.
PubMed Abstract»
Mølgaard-Nielsen D, Svanström H, Melbye M, Hviid A, Pasternak B. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA. 2016;315:58-67.
PubMed Abstract»
Powell AM, Nyirjesy P. Recurrent vulvovaginitis. Best Pract Res Clin Obstet Gynaecol. 2014;28:967-76.
PubMed Abstract»
Schuman P, Capps L, Peng G, et al. Weekly fluconazole for the prevention of mucosal candidiasis in women with HIV infection. A randomized, double-blind, placebo-controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS. Ann Intern Med. 1997;126:689-96.
PubMed Abstract»
Shahid Z, Sobel JD. Reduced fluconazole susceptibility of Candida albicans isolates in women with recurrent vulvovaginal candidiasis: effects of long-term fluconazole therapy. Diagn Microbiol Infect Dis. 2009;64:354-6.
PubMed Abstract»
Sobel JD, Brooker D, Stein GE, et al. Single oral dose fluconazole compared with conventional clotrimazole topical therapy of Candida vaginitis. Fluconazole Vaginitis Study Group. Am J Obstet Gynecol. 1995;172:1263-8.
PubMed Abstract»
Sobel JD, Faro S, Force RW, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol. 1998;178:203-11.
PubMed Abstract»
Sobel JD, Wiesenfeld HC, Martens M, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004;351:876-83.
PubMed Abstract»
Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 2016;214:15-21.
PubMed Abstract»
Sobel JD. Vulvovaginal candidiasis: a comparison of HIV-positive and -negative women. Int J STD AIDS. 2002;13:358-62.
PubMed Abstract»
Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369:1961-71.
PubMed Abstract»
U.S. Food and Drug Administration. Fluconazole (Diflucan): Drug Safety Communication - FDA Evaluating Study Examining Use of Oral Fluconazole (Diflucan) in Pregnancy April 26, 2016.
US Food and Drug Administration»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases characterized by vaginal discharge: Vulvovaginal candidiasis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»

Lesson 5. Chancroid

Additional References

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Other sexually transmitted diseases. Atlanta: U.S. Department of Health and Human Services; 2016.
CDC»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Gonococcal infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»

Lesson 10. Hepatitis A

Additional References

Advisory Committee on Immunization Practices (ACIP), Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55:1-23.
PubMed Abstract»
Advisory Committee on Immunization Practices. Supplementary text 1. Provider Guidance on Risk Assessment and Clinical Decision-making for Hepatitis A Postexposure Prophylaxis. Supplements: Update: Recommendations of the Advisory Committee on Immunization Practices for use of Hepatitis A vaccine for post-exposure prophylaxis and for international travel. November 2, 2018
CDC»
Bell BP, Shapiro CN, Alter MJ, et al. The diverse patterns of hepatitis A epidemiology in the United States-implications for vaccination strategies. J Infect Dis. 1998;178:1579-84.
PubMed Abstract»
Bialek SR, Barry V, Bell BP, et al. Seroprevalence and correlates of hepatitis a among HIV-negative American men who have sex with men. Sex Health. 2011;8:343-8.
PubMed Abstract»
Bohm SR, Berger KW, Hackert PB, et al. Hepatitis A outbreak among adults with developmental disabilities in group homes--Michigan, 2013. MMWR Morb Mortal Wkly Rep. 2015;64:148-52.
PubMed Abstract»
Bower WA, Nainan OV, Han X, Margolis HS. Duration of viremia in hepatitis A virus infection. J Infect Dis. 2000;182:12-7.
PubMed Abstract»
Brennan J, Moore K, Sizemore L, et al. Notes from the Field: Acute Hepatitis A Virus Infection Among Previously Vaccinated Persons with HIV Infection - Tennessee, 2018. MMWR Morb Mortal Wkly Rep. 2019;68:328-329.
PubMed Abstract»
Brundage SC, Fitzpatrick AN. Hepatitis A. Am Fam Physician. 2006;73:2162-8.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). 2019 Viral Hepatitis Surveillance Report—Hepatitis A. Published May 2021.
CDC»
Cuthbert JA. Hepatitis A: old and new. Clin Microbiol Rev. 2001;14:38-58.
PubMed Abstract»
Doshani M, Weng M, Moore KL, Romero JR, Nelson NP. Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. MMWR Morb Mortal Wkly Rep. 2019;68:153-156.
PubMed Abstract»
Foster M, Ramachandran S, Myatt K, et al. Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness - California, Kentucky, Michigan, and Utah, 2017. MMWR Morb Mortal Wkly Rep. 2018;67:1208-1210.
PubMed Abstract»
Foster MA, Hofmeister MG, Kupronis BA, et al. Increase in Hepatitis A Virus Infections - United States, 2013-2018. MMWR Morb Mortal Wkly Rep. 2019;68:413-5.
PubMed Abstract»
Girardi E, Scognamiglio P, Sciarrone MR, et al. High HIV prevalence in male patients with acute hepatitis A in the Rome metropolitan area, Italy 2002-2008. J Hepatol. 2011;54:1102-6.
PubMed Abstract»
Klevens RM, Kruszon-Moran D, Wasley A, et al. Seroprevalence of hepatitis A virus antibodies in the U.S.: results from the National Health and Nutrition Examination Survey. Public Health Rep. 2011;126:522-32.
PubMed Abstract»
Latash J, Dorsinville M, Del Rosso P, et al. Notes from the Field: Increase in Reported Hepatitis A Infections Among Men Who Have Sex with Men - New York City, January-August 2017. MMWR Morb Mortal Wkly Rep. 2017;66:999-1000.
PubMed Abstract»
Link-Gelles R, Hofmeister MG, Nelson NP. Use of hepatitis A vaccine for post-exposure prophylaxis in individuals over 40 years of age: A systematic review of published studies and recommendations for vaccine use. Vaccine. 2018;36:2745-50.
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Litt IF, Cohen MI. Perihepatitis associated with salpingitis in adolescents. JAMA. 1978;240:1253-4.
PubMed Abstract»
Lu PJ, Byrd KK, Murphy TV. Hepatitis A vaccination coverage among adults 18-49 years traveling to a country of high or intermediate endemicity, United States. Vaccine. 2013;31:2348-57.
PubMed Abstract»
Ly KN, Klevens RM. Trends in disease and complications of hepatitis A virus infection in the United States, 1999-2011: a new concern for adults. J Infect Dis. 2015;212:176-82.
PubMed Abstract»
McKnight KL, Lemon SM. Hepatitis A Virus Genome Organization and Replication Strategy. Cold Spring Harb Perspect Med. 2018;8(12). pii: a033480.
PubMed Abstract»
Nainan OV, Xia G, Vaughan G, Margolis HS. Diagnosis of hepatitis a virus infection: a molecular approach. Clin Microbiol Rev. 2006;19:63-79.
PubMed Abstract»
Nelson NP, Link-Gelles R, Hofmeister MG, et al. Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel. MMWR Morb Mortal Wkly Rep. 2018;67:1216-1220.
PubMed Abstract»
Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020;69:1-38.
PubMed Abstract»
Nelson NP. Updated Dosing Instructions for Immune Globulin (Human) GamaSTAN S/D for Hepatitis A Virus Prophylaxis. MMWR Morb Mortal Wkly Rep. 2017;66:959-960.
PubMed Abstract»
Ott JJ, Irving G, Wiersma ST. Long-term protective effects of hepatitis A vaccines. A systematic review. Vaccine. 2012;31:3-11.
PubMed Abstract»
Raczniak GA, Bulkow LR, Bruce MG, et al. Long-term immunogenicity of hepatitis A virus vaccine in Alaska 17 years after initial childhood series. J Infect Dis. 2013;207:493-6.
PubMed Abstract»
Raczniak GA, Thomas TK, Bulkow LR, et al. Duration of protection against hepatitis A for the current two-dose vaccine compared to a three-dose vaccine schedule in children. Vaccine. 2013;31:2152-5.
PubMed Abstract»
Regan DG, Wood JG, Benevent C, et al. Estimating the critical immunity threshold for preventing hepatitis A outbreaks in men who have sex with men. Epidemiol Infect. 2016;144:1528-37.
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Sharapov UM, Bulkow LR, Negus SE, et al. Persistence of hepatitis A vaccine induced seropositivity in infants and young children by maternal antibody status: 10-year follow-up. Hepatology. 2012;56:516-22.
PubMed Abstract»
Storch GA, Bodicky C, Parker M, Blecka LJ, Aach RD. Use of conventional and IgM-specific radioimmunoassays for anti-hepatitis A antibody in an outbreak of hepatitis A. Am J Med. 1982;73:663-8.
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Tong MJ, el-Farra NS, Grew MI. Clinical manifestations of hepatitis A: recent experience in a community teaching hospital. J Infect Dis. 1995;171 Suppl 1:S15-8.
PubMed Abstract»
Van Herck K, Jacquet JM, Van Damme P. Antibody persistence and immune memory in healthy adults following vaccination with a two-dose inactivated hepatitis A vaccine: long-term follow-up at 15 years. J Med Virol. 2011;83:1885-91.
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Victor JC, Monto AS, Surdina TY, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007;357:1685-94.
PubMed Abstract»
Wallace MR, Brandt CJ, Earhart KC, et al. Safety and immunogenicity of an inactivated hepatitis A vaccine among HIV-infected subjects. Clin Infect Dis. 2004;39:1207-13.
PubMed Abstract»
Winokur PL, Stapleton JT. Immunoglobulin prophylaxis for hepatitis A. Clin Infect Dis. 1992;14:580-6.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Viral hepatitis infections: hepatitis A virus (HAV) infection. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 11. Hepatitis B

Additional References

Abara WE, Qaseem A, Schillie S, McMahon BJ, Harris AM. Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2017;167:794-804.
PubMed Abstract»
Alter HJ, Purcell RH, Gerin JL, et al. Transmission of hepatitis B to chimpanzees by hepatitis B surface antigen-positive saliva and semen. Infect Immun. 1977;16:928-33.
PubMed Abstract»
Busch K, Thimme R. Natural history of chronic hepatitis B virus infection. Med Microbiol Immunol. 2015;204:5-10.
PubMed Abstract»
Colin JF, Cazals-Hatem D, Loriot MA, et al. Influence of human immunodeficiency virus infection on chronic hepatitis B in homosexual men. Hepatology. 1999;29:1306-10.
PubMed Abstract»
Davis LG, Weber DJ, Lemon SM. Horizontal transmission of hepatitis B virus. Lancet. 1989;1:889-93.
PubMed Abstract»
Dionne-Odom J, Tita AT, Silverman NS. #38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol. 2016;214:6-14.
PubMed Abstract»
Ganem D, Prince AM. Hepatitis B virus infection--natural history and clinical consequences. N Engl J Med. 2004;350:1118-29.
PubMed Abstract»
Gupta I, Ratho RK. Immunogenicity and safety of two schedules of Hepatitis B vaccination during pregnancy. J Obstet Gynaecol Res. 2003;29:84-6.
PubMed Abstract»
Halperin SA, Dobson S, McNeil S, et al. Comparison of the safety and immunogenicity of hepatitis B virus surface antigen co-administered with an immunostimulatory phosphorothioate oligonucleotide and a licensed hepatitis B vaccine in healthy young adults. Vaccine. 2006;24:20-6.
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Halperin SA, Ward B, Cooper C, et al. Comparison of safety and immunogenicity of two doses of investigational hepatitis B virus surface antigen co-administered with an immunostimulatory phosphorothioate oligodeoxyribonucleotide and three doses of a licensed hepatitis B vaccine in healthy adults 18-55 years of age. Vaccine. 2012;30:2556-63.
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Halperin SA, Ward BJ, Dionne M, et al. Immunogenicity of an investigational hepatitis B vaccine (hepatitis B surface antigen co-administered with an immunostimulatory phosphorothioate oligodeoxyribonucleotide) in nonresponders to licensed hepatitis B vaccine. Hum Vaccin Immunother. 2013;9:1438-44.
PubMed Abstract»
Heyward WL, Kyle M, Blumenau J, et al. Immunogenicity and safety of an investigational hepatitis B vaccine with a Toll-like receptor 9 agonist adjuvant (HBsAg-1018) compared to a licensed hepatitis B vaccine in healthy adults 40-70 years of age. Vaccine. 2013;31:5300-5.
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Hyams KC. Risks of chronicity following acute hepatitis B virus infection: a review. Clin Infect Dis. 1995;20:992-1000.
PubMed Abstract»
Jackson S, Lentino J, Kopp J, et al. Immunogenicity of a two-dose investigational hepatitis B vaccine, HBsAg-1018, using a toll-like receptor 9 agonist adjuvant compared with a licensed hepatitis B vaccine in adults. Vaccine. 2018;36:668-674.
PubMed Abstract»
Jourdain G, Ngo-Giang-Huong N, Harrison L, et al. Tenofovir versus Placebo to Prevent Perinatal Transmission of Hepatitis B. N Engl J Med. 2018;378:911-23.
PubMed Abstract»
Launay O, van der Vliet D, Rosenberg AR, et al. Safety and immunogenicity of 4 intramuscular double doses and 4 intradermal low doses vs standard hepatitis B vaccine regimen in adults with HIV-1: a randomized controlled trial. JAMA. 2011;305:1432-40.
PubMed Abstract»
Lin K, Vickery J. Screening for hepatitis B virus infection in pregnant women: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:874-6.
PubMed Abstract»
Lu PJ, Byrd KK, Murphy TV, Weinbaum C. Hepatitis B vaccination coverage among high-risk adults 18-49 years, U.S., 2009. Vaccine. 2011;29:7049-57.
PubMed Abstract»
Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep. 2006;55:1-33; quiz CE1-4.
PubMed Abstract»
Owens DK, Davidson KW, Krist AH, et al. Screening for Hepatitis B Virus Infection in Pregnant Women: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2019;322:349-54.
PubMed Abstract»
Pan CQ, Duan Z, Dai E, et al. Tenofovir to Prevent Hepatitis B Transmission in Mothers with High Viral Load. N Engl J Med. 2016;374:2324-34.
PubMed Abstract»
Poovorawan Y, Chongsrisawat V, Theamboonlers A, Crasta PD, Messier M, Hardt K. Long-term anti-HBs antibody persistence following infant vaccination against hepatitis B and evaluation of anamnestic response: a 20-year follow-up study in Thailand. Hum Vaccin Immunother. 2013;9:1679-84.
PubMed Abstract»
Poovorawan Y, Chongsrisawat V, Theamboonlers A, Leroux-Roels G, Crasta PD, Hardt K. Persistence and immune memory to hepatitis B vaccine 20 years after primary vaccination of Thai infants, born to HBsAg and HBeAg positive mothers. Hum Vaccin Immunother. 2012;8:896-904.
PubMed Abstract»
Schillie S, Harris A, Link-Gelles R, Romero J, Ward J, Nelson N. Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant. MMWR Morb Mortal Wkly Rep. 2018;67:455-458.
PubMed Abstract»
Schillie S, Murphy TV, Sawyer M, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep. 2013;62:1-19.
PubMed Abstract»
Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67:1-31.
PubMed Abstract»
Spradling PR, Xing J, Williams R, et al. Immunity to hepatitis B virus (HBV) infection two decades after implementation of universal infant HBV vaccination: association of detectable residual antibodies and response to a single HBV challenge dose. Clin Vaccine Immunol. 2013;20:559-61.
PubMed Abstract»
Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560-1599.
PubMed Abstract»
Trépo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet. 2014;384:2053-63.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Viral hepatitis infections: hepatitis B virus (HBV) infection. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Wu T, Kwok RM, Tran TT. Isolated anti-HBc: The Relevance of Hepatitis B Core Antibody-A Review of New Issues. Am J Gastroenterol. 2017;112:1780-8.
PubMed Abstract»
Zanetti AR, Van Damme P, Shouval D. The global impact of vaccination against hepatitis B: a historical overview. Vaccine. 2008;26:6266-73.
PubMed Abstract»

Lesson 14. HIV Infection

Additional References

Barbee LA, Tat S, Dhanireddy S, Marrazzo JM. Implementation and Operational Research: Effectiveness and Patient Acceptability of a Sexually Transmitted Infection Self-Testing Program in an HIV Care Setting. J Acquir Immune Defic Syndr. 2016;72:e26-31.
PubMed Abstract»
Bentsen C, McLaughlin L, Mitchell E, et al. Performance evaluation of the Bio-Rad Laboratories GS HIV Combo Ag/Ab EIA, a 4th generation HIV assay for the simultaneous detection of HIV p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2 in human serum or plasma. J Clin Virol. 2011;52 Suppl 1:S57-61.
PubMed Abstract»
Bissessor M, Bradshaw CS, Fairley CK, Chen MY, Chow EP. Provision of HIV test results by telephone is both safe and efficient for men who have sex with men. Int J STD AIDS. 2017;28:39-44.
PubMed Abstract»
Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55:1-17.
PubMed Abstract»
Branson BM, Mermin J. Establishing the diagnosis of HIV infection: new tests and a new algorithm for the United States. J Clin Virol. 2011;52 Suppl 1:S3-4.
PubMed Abstract»
Branson BM. Home sample collection tests for HIV infection. JAMA. 1998;280:1699-701.
PubMed Abstract»
Branson BM. State of the art for diagnosis of HIV infection. Clin Infect Dis. 2007;45 Suppl 4:S221-5.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). HIV Testing Technologies: CLIA-Waived Rapid HIV Tests.
CDC»
Centers for Disease Control and Prevention (CDC). Technical Update on HIV-1/2 Differentiation Assays. August 12, 2016.
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Centers for Disease Control and Prevention and Association of Public Health Laboratories. 2018 Quick reference guide: Recommended laboratory HIV testing algorithm for serum or plasma specimens. Published January 27, 2018.
CDC»
Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. Published June 27, 2014.
CDC»
Centers for Disease Control and Prevention. Estimated HIV Incidence and Prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report. 2019;24(No. 1):1-89. Published February 2019.
CDC»
Centers for Disease Control and Prevention. HIV-2 Infection Surveillance--United States, 1987-2009. MMWR Morb Mortal Wkly Rep. 2011;60:985-8.
PubMed Abstract»
Chou R, Huffman LH, Fu R, Smits AK, Korthuis PT. Screening for HIV: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2005;143:55-73.
PubMed Abstract»
Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493-505.
PubMed Abstract»
Cohen MS, Gay CL, Busch MP, Hecht FM. The detection of acute HIV infection. J Infect Dis. 2010;202 Suppl 2:S270-7.
PubMed Abstract»
Cornett JK, Kirn TJ. Laboratory diagnosis of HIV in adults: a review of current methods. Clin Infect Dis. 2013;57:712-8.
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Eshleman SH, Khaki L, Laeyendecker O, et al. Detection of individuals with acute HIV-1 infection using the ARCHITECT HIV Ag/Ab Combo assay. J Acquir Immune Defic Syndr. 2009;52:121-4.
PubMed Abstract»
Fiebig EW, Wright DJ, Rawal BD, et al. Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection. AIDS. 2003;17:1871-9.
PubMed Abstract»
Flagg EW, Weinstock HS, Frazier EL, Valverde EE, Heffelfinger JD, Skarbinski J. Bacterial sexually transmitted infections among HIV-infected patients in the United States: estimates from the Medical Monitoring Project. Sex Transm Dis. 2015;42:171-9.
PubMed Abstract»
Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999;75:3-17.
PubMed Abstract»
Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS. 2012;26:893-6.
PubMed Abstract»
Jones J, Weiss K, Mermin J, et al. Proportion of Incident Human Immunodeficiency Virus Cases Among Men Who Have Sex With Men Attributable to Gonorrhea and Chlamydia: A Modeling Analysis. Sex Transm Dis. 2019;46:357-63.
PubMed Abstract»
Keating SM, Kassanjee R, Lebedeva M, et al. Performance of the Bio-Rad Geenius HIV1/2 Supplemental Assay in Detecting "Recent" HIV Infection and Calculating Population Incidence. J Acquir Immune Defic Syndr. 2016;73:581-588.
PubMed Abstract»
Keaveney S, Sadlier C, O'Dea S, Delamere S, Bergin C. High prevalence of asymptomatic sexually transmitted infections in HIV-infected men who have sex with men: a stimulus to improve screening. Int J STD AIDS. 2014;25:758-61.
PubMed Abstract»
Malloch L, Kadivar K, Putz J, et al. Comparative evaluation of the Bio-Rad Geenius HIV-1/2 Confirmatory Assay and the Bio-Rad Multispot HIV-1/2 Rapid Test as an alternative differentiation assay for CLSI M53 algorithm-I. J Clin Virol. 2013;58 Suppl 1:e85-91.
PubMed Abstract»
Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39:446-53.
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Masciotra S, McDougal JS, Feldman J, Sprinkle P, Wesolowski L, Owen SM. Evaluation of an alternative HIV diagnostic algorithm using specimens from seroconversion panels and persons with established HIV infections. J Clin Virol. 2011;52 Suppl 1:S17-22.
PubMed Abstract»
Miller WC, Rosenberg NE, Rutstein SE, Powers KA. Role of acute and early HIV infection in the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5:277-82.
PubMed Abstract»
Mitchell EO, Stewart G, Bajzik O, Ferret M, Bentsen C, Shriver MK. Performance comparison of the 4th generation Bio-Rad Laboratories GS HIV Combo Ag/Ab EIA on the EVOLIS™ automated system versus Abbott ARCHITECT HIV Ag/Ab Combo, Ortho Anti-HIV 1+2 EIA on Vitros ECi and Siemens HIV-1/O/2 enhanced on Advia Centaur. J Clin Virol. 2013;58 Suppl 1:e79-84.
PubMed Abstract»
Montesinos I, Eykmans J, Delforge ML. Evaluation of the Bio-Rad Geenius HIV-1/2 test as a confirmatory assay. J Clin Virol. 2014;60:399-401.
PubMed Abstract»
Morin SF, Myers JJ, Shade SB, Koester K, Maiorana A, Rose CD. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav. 2007;11:S6-16.
PubMed Abstract»
Myers JJ, Kang Dufour MS, Koester KA, et al. Helping clinicians deliver consistent HIV prevention counseling to their HIV-infected patients. AIDS Care. 2013;25:640-5.
PubMed Abstract»
Nasrullah M, Wesolowski LG, Meyer WA 3rd, et al. Performance of a fourth-generation HIV screening assay and an alternative HIV diagnostic testing algorithm. AIDS. 2013;27:731-7.
PubMed Abstract»
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Considerations for antiretroviral use in special patient populations: acute and recent (early) HIV infection. December 18, 2019.
HIV.gov»
Patel MR, Brooks JT, Tie Y, Garg S, Bradley H. Prevalence of Gonorrhea and Chlamydia Testing by Anatomical Site Among Men Who Have Sex With Men in HIV Medical Care, United States, 2013-2014. Sex Transm Dis. 2018;45:25-27.
PubMed Abstract»
Pilcher CD, Tien HC, Eron JJ Jr, et al. Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis. 2004;189:1785-92.
PubMed Abstract»
Pinkerton SD. How many sexually-acquired HIV infections in the USA are due to acute-phase HIV transmission? AIDS. 2007;21:1625-9.
PubMed Abstract»
Richardson JL, Milam J, Stoyanoff S, et al. Using patient risk indicators to plan prevention strategies in the clinical care setting. J Acquir Immune Defic Syndr. 2004;37 Suppl 2:S88-94.
PubMed Abstract»
Rieg G, Lewis RJ, Miller LG, Witt MD, Guerrero M, Daar ES. Asymptomatic sexually transmitted infections in HIV-infected men who have sex with men: prevalence, incidence, predictors, and screening strategies. AIDS Patient Care STDS. 2008;22:947-54.
PubMed Abstract»
Rodger AJ, Cambiano V, Bruun T, et al. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016;316:171-81.
PubMed Abstract»
Rosenberg NE, Pilcher CD, Busch MP, Cohen MS. How can we better identify early HIV infections? Curr Opin HIV AIDS. 2015;10:61-8.
PubMed Abstract»
Schacker T, Collier AC, Hughes J, Shea T, Corey L. Clinical and epidemiologic features of primary HIV infection. Ann Intern Med. 1996;125:257-64.
PubMed Abstract»
Smith MK, Rutstein SE, Powers KA, et al. The detection and management of early HIV infection: a clinical and public health emergency. J Acquir Immune Defic Syndr. 2013 Jul;63 Suppl 2:S187-99.
PubMed Abstract»
Soni S, White JA. Self-screening for Neisseria gonorrhoeae and Chlamydia trachomatis in the human immunodeficiency virus clinic--high yields and high acceptability. Sex Transm Dis. 2011;38:1107-9.
PubMed Abstract»
US Preventive Services Task Force.. Screening for HIV: recommendation statement. Ann Intern Med. 2005;143:32-7.
PubMed Abstract»
Weintrob AC, Giner J, Menezes P, et al. Infrequent diagnosis of primary human immunodeficiency virus infection: missed opportunities in acute care settings. Arch Intern Med. 2003;163:2097-100.
PubMed Abstract»
Wingood GM, DiClemente RJ, Mikhail I, et al. A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: The WiLLOW Program. J Acquir Immune Defic Syndr. 2004;37 Suppl 2:S58-67.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. HIV infection: detection, counseling, and referral. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 15. HPV Infection: Prevention

Additional References

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by vaginal itching, burning, irritation, odor or discharge: trichomoniasis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 19. Mycoplasma genitalium

Additional References

Bjartling C, Osser S, Persson K. Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. Am J Obstet Gynecol. 2012;206:476.e1-8.
PubMed Abstract»
Cohen CR, Mugo NR, Astete SG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. 2005;81:463-6.
PubMed Abstract»
Couldwell DL, Tagg KA, Jeoffreys NJ, Gilbert GL. Failure of moxifloxacin treatment in Mycoplasma genitalium infections due to macrolide and fluoroquinolone resistance. Int J STD AIDS. 2013;24:822-8.
PubMed Abstract»
Daley GM, Russell DB, Tabrizi SN, McBride J. Mycoplasma genitalium: a review. Int J STD AIDS. 2014;25:475-87.
PubMed Abstract»
Dehon PM, Hagensee ME, Sutton KJ, Oddo HE, Nelson N, McGowin CL. Histological Evidence of Chronic Mycoplasma genitalium-Induced Cervicitis in HIV-Infected Women: A Retrospective Cohort Study. J Infect Dis. 2016;213:1828-35.
PubMed Abstract»
Dehon PM, McGowin CL. The immunopathogenesis of Mycoplasma genitalium infections in women: A Narrative Review. Sex Transm Dis. 2017;44:428-432.
PubMed Abstract»
Dize L, Barnes P Jr, Barnes M, et al. Performance of self-collected penile-meatal swabs compared to clinician-collected urethral swabs for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium by nucleic acid amplification assays. Diagn Microbiol Infect Dis. 2016;86:131-5.
PubMed Abstract»
Falk L, Fredlund H, Jensen JS. Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection. Sex Transm Infect. 2005;81:73-8.
PubMed Abstract»
Falk L, Jensen JS. Successful outcome of macrolide-resistant Mycoplasma genitalium urethritis after spectinomycin treatment: a case report. J Antimicrob Chemother. 2017;72:624-625.
PubMed Abstract»
Francis SC, Kent CK, Klausner JD, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008;35:797-800.
PubMed Abstract»
Gaydos CA. Mycoplasma genitalium: Accurate diagnosis Is necessary for adequate treatment. J Infect Dis. 2017;216:S406-S411.
PubMed Abstract»
Getman D, Jiang A, O'Donnell M, Cohen S. Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States. J Clin Microbiol. 2016;54:2278-83.
PubMed Abstract»
Golden MR, Workowski KA, Bolan G. Developing a Public Health Response to Mycoplasma genitalium. J Infect Dis. 2017;216:S420-S426.
PubMed Abstract»
Gottesman T, Yossepowitch O, Samra Z, Rosenberg S, Dan M. Prevalence of Mycoplasma genitalium in men with urethritis and in high risk asymptomatic males in Tel Aviv: a prospective study. Int J STD AIDS. 2017;28:127-32.
PubMed Abstract»
Haggerty CL, Taylor BD. Mycoplasma genitalium: an emerging cause of pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2011;2011:959816.
PubMed Abstract»
Haggerty CL, Totten PA, Astete SG, Ness RB. Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2006;2006:30184.
PubMed Abstract»
Horner PJ, Martin DH. Mycoplasma genitalium Infection in Men. J Infect Dis. 2017;216:S396-S405.
PubMed Abstract»
Jensen JS, Cusini M, Gomberg M, Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016;30:1650-6.
PubMed Abstract»
Jensen JS, Cusini M, Gomberg M, Moi H. Background review for the 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2016;30:1686-93.
PubMed Abstract»
Jernberg E, Moghaddam A, Moi H. Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: an open study. Int J STD AIDS. 2008;19:676-9.
PubMed Abstract»
Jurstrand M, Jensen JS, Magnuson A, Kamwendo F, Fredlund H. A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy. Sex Transm Infect. 2007;83:319-23.
PubMed Abstract»
Lau A, Bradshaw CS, Lewis D, et al. The efficacy of azithromycin for the treatment of genital Mycoplasma genitalium: a systematic review and meta-analysis. Clin Infect Dis. 2015;61:1389-99.
PubMed Abstract»
Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:418-26.
PubMed Abstract»
Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis. 2011;53 Suppl 3:S129-42.
PubMed Abstract»
Manhart LE, Critchlow CW, Holmes KK, et al. Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis. 2003;187:650-7.
PubMed Abstract»
Manhart LE, Jensen JS, Bradshaw CS, Golden MR, Martin DH. Efficacy of antimicrobial therapy for Mycoplasma genitalium infections. Clin Infect Dis. 2015;61 Suppl 8:S802-17.
PubMed Abstract»
Manhart LE. Has the time come to systematically test for Mycoplasma genitalium? Sex Transm Dis. 2009;36:607-8.
PubMed Abstract»
McGowin CL, Totten PA. The Unique microbiology and molecular pathogenesis of Mycoplasma genitalium. J Infect Dis. 2017 Jul 15;216:S382-S388.
PubMed Abstract»
Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium in women with lower genital tract inflammation. Sex Transm Infect. 2009;85:10-4.
PubMed Abstract»
Munson E, Bykowski H, Munson KL, et al. Clinical Laboratory Assessment of Mycoplasma genitalium Transcription-mediated amplification using primary female urogenital specimens. J Clin Microbiol. 2016;54:432-8.
PubMed Abstract»
Oakeshott P, Aghaizu A, Hay P, et al. Is Mycoplasma genitalium in women the "New Chlamydia?" A community-based prospective cohort study. Clin Infect Dis. 2010;51:1160-6.
PubMed Abstract»
Read TRH, Fairley CK, Murray GL, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68:554-60.
PubMed Abstract»
Seña AC, Lensing S, Rompalo A, et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis. 2012;206:357-65.
PubMed Abstract»
Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL. Clinical presentation of Mycoplasma genitalium infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis. 2009;48:41-7.
PubMed Abstract»
Simms I, Eastick K, Mallinson H, et al. Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease. Sex Transm Infect. 2003;79:154-6.
PubMed Abstract»
Stamm WE, Running K, Hale J, Holmes KK. Etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in women with the acute urethral syndrome. Sex Transm Dis. 1983;10:318-22.
PubMed Abstract»
Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G. Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study. Fertil Steril. 2008;90:513-20.
PubMed Abstract»
Taylor-Robinson D, Jensen JS. Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev. 2011;24:498-514.
PubMed Abstract»
U.S. Food and Drug Administration. FDA permits marketing of first test to aid in the diagnosis of a sexually-transmitted infection known as Mycoplasma genitalium. January 23, 2019
FDA News Release»
Unemo M, Salado-Rasmussen K, Hansen M, et al. Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016. Clin Microbiol Infect. 2018;24:533-9.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 21. Pelvic Inflammatory Disease (PID)

Additional References

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by vaginal itching, burning, irritation, odor or discharge: bacterial vaginosis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 22. Penicillin Allergy

Additional References

Gonzalez-Estrada A, Radojicic C. Penicillin allergy: A practical guide for clinicians. Cleve Clin J Med. 2015;82:295-300.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 23. Proctitis, Proctocolitis, and Enteritis

Additional References

Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M. The etiology of infectious proctitis in men who have sex with men differs according to HIV status. Sex Transm Dis. 2013;40:768-70.
PubMed Abstract»
Diepersloot RJ, Kroes AC, Visser W, Jiwa NM, Rothbarth PH. Acute ulcerative proctocolitis associated with primary cytomegalovirus infection. Arch Intern Med. 1990;150:1749-51.
PubMed Abstract»
Dukers-Muijrers NH, Morré SA, Speksnijder A, van der Sande MA, Hoebe CJ. Chlamydia trachomatis test-of-cure cannot be based on a single highly sensitive laboratory test taken at least 3 weeks after treatment. PLoS One. 2012;7:e34108.
PubMed Abstract»
Escobedo AA, Almirall P, Alfonso M, Cimerman S, Chacín-Bonilla L. Sexual transmission of giardiasis: a neglected route of spread? Acta Trop. 2014;132:106-11.
PubMed Abstract»
Hoentjen F, Rubin DT. Infectious proctitis: when to suspect it is not inflammatory bowel disease. Dig Dis Sci. 2012;57:269-73.
PubMed Abstract»
Hung CC, Chang SY, Ji DD. Entamoeba histolytica infection in men who have sex with men. Lancet Infect Dis. 2012;12:729-36.
PubMed Abstract»
Kong FY, Tabrizi SN, Fairley CK, et al. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother. 2015;70:1290-7.
PubMed Abstract»
Rompalo AM. Diagnosis and treatment of sexually acquired proctitis and proctocolitis: an update. Clin Infect Dis. 1999;28 Suppl 1:S84-90.
PubMed Abstract»
Wu XR, Liu XL, Katz S, Shen B. Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis. Inflamm Bowel Dis. 2015;21:703-15.
PubMed Abstract»

Lesson 24. Scabies

Additional References

Anderson AL, Chaney E. Pubic lice (Pthirus pubis): history, biology and treatment vs. knowledge and beliefs of US college students. Int J Environ Res Public Health. 2009;6:592-600.
PubMed Abstract»
Belvisi V, Orsi GB, Del Borgo C, et al. Large Nosocomial Outbreak Associated with a Norwegian Scabies Index Case Undergoing TNF-α Inhibitor Treatment: Management and Control. Infect Control Hosp Epidemiol. 2015;36:1358-60.
PubMed Abstract»
Burkhart CG, Burkhart CN. Oral ivermectin for Phthirus pubis. J Am Acad Dermatol. 2004;51:1037-8.
PubMed Abstract»
Chosidow O. Clinical practices. Scabies. N Engl J Med. 2006;354:1718-27.
PubMed Abstract»
Cook AM, Romanelli F. Ivermectin for the treatment of resistant scabies. Ann Pharmacother. 2003;37:279-81.
PubMed Abstract»
Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med. 2010;362:717-25.
PubMed Abstract»
Elosua-González M, García-Zamora E. Crusted Scabies. N Engl J Med. 2017;377:476.
PubMed Abstract»
Flinders DC, De Schweinitz P. Pediculosis and scabies. Am Fam Physician. 2004;69:341-8.
PubMed Abstract»
Fuentes-Suárez A, González-Márquez TN. "Acrobatic" Lice. N Engl J Med. 2017;377:e19.
PubMed Abstract»
Huffam SE, Currie BJ. Ivermectin for Sarcoptes scabiei hyperinfestation. Int J Infect Dis. 1998;2:152-4.
PubMed Abstract»
Koch E, Clark JM, Cohen B, et al. Management of head louse infestations in the United States—a literature review. Pediatr Dermatol. 2016;33:466-72.
PubMed Abstract»
Leone PA. Scabies and pediculosis pubis: an update of treatment regimens and general review. Clin Infect Dis. 2007;44 Suppl 3:S153-9.
PubMed Abstract»
Ortega-Loayza AG, McCall CO, Nunley JR. Crusted scabies and multiple dosages of ivermectin. J Drugs Dermatol. 2013;12:584-5.
PubMed Abstract»
Roberts LJ, Huffam SE, Walton SF, Currie BJ. Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect. 2005;50:375-81.
PubMed Abstract»
Wendel K, Rompalo A. Scabies and pediculosis pubis: an update of treatment regimens and general review. Clin Infect Dis. 2002;35:S146-51.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 25. Sexual Assault and Abuse and STIs

Additional References

A National Protocol for Sexual Assault Medical Forensic Examinations Adults/Adolescents. Second Edition. U.S. Department of Justice. Office on Violence Against Women. April 2013
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PubMed Abstract»
Centers for Disease Control and Prevention (CDC). HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men - United States. MMWR Morb Mortal Wkly Rep. 2013;62:958-62.
PubMed Abstract»
Centers for Disease Control and Prevention, U.S. Department of Health and Human Service. Update: Interim Statement Regarding Potential Fetal Harm from Exposure to Dolutegravir—Implications for HIV Post-exposure Prophylaxis (PEP).
CDC»
Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, and Other Nonoccupational Exposure to HIV – United States, 2016.
CDC»
Crawford-Jakubiak JE, Alderman EM, Leventhal JM, AAP Committee on child abuse and neglect,, AAP Committee on ON adolescence. Care of the Adolescent After an Acute Sexual Assault. Pediatrics. 2017;139:e20164243.
PubMed Abstract»
de Voux A, Kidd S, Grey JA, et al. State-Specific Rates of Primary and Secondary Syphilis Among Men Who Have Sex with Men - United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66:349-354.
PubMed Abstract»
Deutsch SA, Benyo S, Xie S, et al. Addressing Human Papillomavirus Prevention During Pediatric Acute Sexual Assault Care. J Forensic Nurs. 2018;14:154-161.
PubMed Abstract»
Du Mont J, Myhr TL, Husson H, Macdonald S, Rachlis A, Loutfy MR. HIV postexposure prophylaxis use among Ontario female adolescent sexual assault victims: a prospective analysis. Sex Transm Dis. 2008;35:973-8.
PubMed Abstract»
Fanfair RN, Wallingford M, Long LL, et al. Acquired macrolide-resistant Treponema pallidum after a human bite. Sex Transm Dis. 2014;41:493-5.
PubMed Abstract»
Houmes BV, Fagan MM, Quintana NM. Establishing a sexual assault nurse examiner (SANE) program in the emergency department. J Emerg Med. 2003;25:111-21.
PubMed Abstract»
Iversen OE, Miranda MJ, Ulied A, et al. Immunogenicity of the 9-Valent HPV Vaccine Using 2-Dose Regimens in Girls and Boys vs a 3-Dose Regimen in Women. JAMA. 2016;316:2411-2421.
PubMed Abstract»
Kellogg N. The evaluation of sexual abuse in children. Pediatrics. 2005;116:506-12.
PubMed Abstract»
Krause KH, Lewis-O'Connor A, Berger A, et al. Current practice of HIV postexposure prophylaxis treatment for sexual assault patients in an emergency department. Womens Health Issues. 2014;24:e407-12.
PubMed Abstract»
Linden JA. Clinical practice. Care of the adult patient after sexual assault. N Engl J Med. 2011;365:834-41.
PubMed Abstract»
Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination - Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016;65:1405-8.
PubMed Abstract»
Ohnishi M, Saika T, Hoshina S, et al. Ceftriaxone-resistant Neisseria gonorrhoeae, Japan. Emerg Infect Dis. 2011;17:148-9.
PubMed Abstract»
Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States. January 17, 2020.
HIV.gov»
Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk: a systematic review. AIDS. 2014;28:1509-19.
PubMed Abstract»
Schillie S, Murphy TV, Sawyer M, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep. 2013;62:1-19.
PubMed Abstract»
Seña AC, Hsu KK, Kellogg N, et al. Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children. Clin Infect Dis. 2015;61 Suppl 8:S856-64.
PubMed Abstract»
Sonawane K, Suk R, Chiao EY, et al. Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014. Ann Intern Med. 2017;167:714-724.
PubMed Abstract»
Stoltey JE, Cohen SE. Syphilis transmission: a review of the current evidence. Sex Health. 2015;12:103-9.
PubMed Abstract»
U.S. Department of Justice Office on Violence Against Women. A National Protocol for Sexual Abuse Medical Forensic Examinations, Pediatric. April 2016.
U.S. Department of Justice»
U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. National Best Practices for Sexual Assault Kits: A Multidisciplinary Approach. August 8, 2017.
U.S. Department of Justice»
Ucciferri C, Tamburro M, Falasca K, Sammarco ML, Ripabelli G, Vecchiet J. Prevalence of anal, oral, penile and urethral Human Papillomavirus in HIV infected and HIV uninfected men who have sex with men. J Med Virol. 2018;90:358-366.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs: adolescents and adults. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Wu T, Kwok RM, Tran TT. Isolated anti-HBc: The Relevance of Hepatitis B Core Antibody-A Review of New Issues. Am J Gastroenterol. 2017;112:1780-8.
PubMed Abstract»
Yakely AE, Avni-Singer L, Oliveira CR, Niccolai LM. Human Papillomavirus Vaccination and Anogenital Warts: A Systematic Review of Impact and Effectiveness in the United States. Sex Transm Dis. 2019;46:213-20.
PubMed Abstract»
Yasuda M, Ito S, Hatazaki K, Deguchi T. Remarkable increase of Neisseria gonorrhoeae with decreased susceptibility of azithromycin and increase in the failure of azithromycin therapy in male gonococcal urethritis in Sendai in 2015. J Infect Chemother. 2016;22:841-843.
PubMed Abstract»

Lesson 27. Trichomoniasis

Additional References

Aggarwal A, Shier RM. Recalcitrant Trichomonas vaginalis infections successfully treated with vaginal acidification. J Obstet Gynaecol Can. 2008;30:55-8.
PubMed Abstract»
Alcaide ML, Feaster DJ, Duan R, et al. The incidence of Trichomonas vaginalis infection in women attending nine sexually transmitted diseases clinics in the USA. Sex Transm Infect. 2016;92:58-62.
PubMed Abstract»
Andrea SB, Chapin KC. Comparison of Aptima Trichomonas vaginalis transcription-mediated amplification assay and BD affirm VPIII for detection of T. vaginalis in symptomatic women: performance parameters and epidemiological implications. J Clin Microbiol. 2011;49:866-9.
PubMed Abstract»
Bachmann LH, Hobbs MM, Seña AC, et al. Trichomonas vaginalis genital infections: progress and challenges. Clin Infect Dis. 2011;53 Suppl 3:S160-72.
PubMed Abstract»
Balkus JE, Richardson BA, Mochache V, et al. A prospective cohort study comparing the effect of single-dose 2 g metronidazole on Trichomonas vaginalis infection in HIV-seropositive versus HIV-seronegative women. Sex Transm Dis. 2013;40:499-505.
PubMed Abstract»
Bosserman EA, Helms DJ, Mosure DJ, Secor WE, Workowski KA. Utility of antimicrobial susceptibility testing in Trichomonas vaginalis-infected women with clinical treatment failure. Sex Transm Dis. 2011;38:983-7.
PubMed Abstract»
Brown HL, Fuller DD, Jasper LT, Davis TE, Wright JD. Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis. Infect Dis Obstet Gynecol. 2004;12:17-21.
PubMed Abstract»
Campbell L, Woods V, Lloyd T, Elsayed S, Church DL. Evaluation of the OSOM Trichomonas rapid test versus wet preparation examination for detection of Trichomonas vaginalis vaginitis in specimens from women with a low prevalence of infection. J Clin Microbiol. 2008;46:3467-9.
PubMed Abstract»
Carter JE, Whithaus KC. Neonatal respiratory tract involvement by Trichomonas vaginalis: a case report and review of the literature. Am J Trop Med Hyg. 2008;78:17-9.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Other sexually transmitted diseases. Atlanta: U.S. Department of Health and Human Services; 2016.
CDC»
Cherpes TL, Wiesenfeld HC, Melan MA, et al. The associations between pelvic inflammatory disease, Trichomonas vaginalis infection, and positive herpes simplex virus type 2 serology. Sex Transm Dis. 2006;33:747-52.
PubMed Abstract»
Cotch MF, Pastorek JG 2nd, Nugent RP, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study Group. Sex Transm Dis. 1997;24:353-60.
PubMed Abstract»
Crowell AL, Sanders-Lewis KA, Secor WE. In vitro metronidazole and tinidazole activities against metronidazole-resistant strains of Trichomonas vaginalis. Antimicrob Agents Chemother. 2003;47:1407-9.
PubMed Abstract»
Dize L, Barnes P Jr, Barnes M, et al. Performance of self-collected penile-meatal swabs compared to clinician-collected urethral swabs for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium by nucleic acid amplification assays. Diagn Microbiol Infect Dis. 2016;86:131-5.
PubMed Abstract»
Fouts AC, Kraus SJ. Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis. J Infect Dis. 1980;141:137-143.
PubMed Abstract»
Francis SC, Kent CK, Klausner JD, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008;35:797-800.
PubMed Abstract»
Freeman AH, Katz KA, Pandori MW, et al. Prevalence and correlates of Trichomonas vaginalis among incarcerated persons assessed using a highly sensitive molecular assay. Sex Transm Dis. 2010;37:165-8.
PubMed Abstract»
Gatski M, Kissinger P. Observation of probable persistent, undetected Trichomonas vaginalis infection among HIV-positive women. Clin Infect Dis. 2010;51:114-5.
PubMed Abstract»
Ginocchio CC, Chapin K, Smith JS, et al. Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as determined by the Aptima Trichomonas vaginalis nucleic acid amplification assay. J Clin Microbiol. 2012;50:2601-8.
PubMed Abstract»
Helms DJ, Mosure DJ, Metcalf CA, et al. Risk factors for prevalent and incident Trichomonas vaginalis among women attending three sexually transmitted disease clinics. Sex Transm Dis. 2008;35:484-8.
PubMed Abstract»
Helms DJ, Mosure DJ, Secor WE, Workowski KA. Management of Trichomonas vaginalis in women with suspected metronidazole hypersensitivity. Am J Obstet Gynecol. 2008;198:370.e1-7.
PubMed Abstract»
Hollman D, Coupey SM, Fox AS, Herold BC. Screening for Trichomonas vaginalis in high-risk adolescent females with a new transcription-mediated nucleic acid amplification test (NAAT): associations with ethnicity, symptoms, and prior and current STIs. J Pediatr Adolesc Gynecol. 2010;23:312-6.
PubMed Abstract»
Hoots BE, Peterman TA, Torrone EA, Weinstock H, Meites E, Bolan GA. A Trich-y question: should Trichomonas vaginalis infection be reportable? Sex Transm Dis. 2013;40:113-6.
PubMed Abstract»
Howe K, Kissinger PJ. Single-dose compared with multidose metronidazole for the treatment of trichomoniasis in women: a meta-analysis. Sex Transm Dis. 2017;44:29-34.
PubMed Abstract»
Huppert JS, Mortensen JE, Reed JL, et al. Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women. Clin Infect Dis. 2007;45:194-8.
PubMed Abstract»
Kelley CF, Rosenberg ES, OʼHara BM, Sanchez T, del Rio C, Sullivan PS. Prevalence of urethral Trichomonas vaginalis in black and white men who have sex with men. Sex Transm Dis. 2012;39:739.
PubMed Abstract»
Kigozi GG, Brahmbhatt H, Wabwire-Mangen F, et al. Treatment of Trichomonas in pregnancy and adverse outcomes of pregnancy: a subanalysis of a randomized trial in Rakai, Uganda. Am J Obstet Gynecol. 2003;189:1398-400.
PubMed Abstract»
Kingston MA, Bansal D, Carlin EM. 'Shelf life' of Trichomonas vaginalis. Int J STD AIDS. 2003;14:28-9.
PubMed Abstract»
Kirkcaldy RD, Augostini P, Asbel LE, et al. Trichomonas vaginalis antimicrobial drug resistance in 6 US cities, STD Surveillance Network, 2009-2010. Emerg Infect Dis. 2012;18:939-43.
PubMed Abstract»
Kissinger P, Adamski A, Clark RA, Mena L, Levison J, Martin DH. Does antiretroviral therapy interfere with the treatment of Trichomonas vaginalis among HIV+ women? Sex Transm Dis. 2013;40:506-7.
PubMed Abstract»
Kissinger P, Amedee A, Clark RA, et al. Trichomonas vaginalis treatment reduces vaginal HIV-1 shedding. Sex Transm Dis. 2009;36:11-6.
PubMed Abstract»
Kissinger P, Mena L, Levison J, et al. A randomized treatment trial: single versus 7-day dose of metronidazole for the treatment of Trichomonas vaginalis among HIV-infected women. J Acquir Immune Defic Syndr. 2010;55:565-71.
PubMed Abstract»
Klebanoff MA, Carey JC, Hauth JC, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med. 2001;345:487-93.
PubMed Abstract»
Lord E, Newnham T, Dorrell L, et al. Detecting asymptomatic Trichomonas vaginalis in females using the BD ProbeTec™ Trichomonas vaginalis Qx nucleic acid amplification test. Int J STD AIDS. 2016.
PubMed Abstract»
McClelland RS, Sangare L, Hassan WM, et al. Infection with Trichomonas vaginalis increases the risk of HIV-1 acquisition. J Infect Dis. 2007;195:698-702.
PubMed Abstract»
Meites E, Gaydos CA, Hobbs MM, et al. A Review of evidence-based care of symptomatic Trichomoniasis and asymptomatic Trichomonas vaginalis infections. Clin Infect Dis. 2015;61 Suppl 8:S837-48.
PubMed Abstract»
Meites E, Gaydos CA, Hobbs MM, et al. A review of evidence-based care of symptomatic Trichomoniasis and asymptomatic Trichomonas vaginalis infections. Clin Infect Dis. 2015;61 Suppl 8:S837-48.
PubMed Abstract»
Meites E, Llata E, Braxton J, et al. Trichomonas vaginalis in selected U.S. sexually transmitted disease clinics: testing, screening, and prevalence. Sex Transm Dis. 2013;40:865-9.
PubMed Abstract»
Mohamed OA, Cohen CR, Kungu D, et al. Urine proves a poor specimen for culture of Trichomonas vaginalis in women. Sex Transm Infect. 2001;77:78-9.
PubMed Abstract»
Moodley P, Wilkinson D, Connolly C, Moodley J, Sturm AW. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis. 2002;34:519-22.
PubMed Abstract»
Muzny C, Barnes A, Mena L. Symptomatic Trichomonas vaginalis infection in the setting of severe nitroimidazole allergy: successful treatment with boric acid. Sex Health. 2012;9:389-91.
PubMed Abstract»
Muzny CA, Rivers CA, Mena LA, Schwebke JR. Genotypic characterization of Trichomonas vaginalis isolates among women who have sex with women in sexual partnerships. Sex Transm Dis. 2012;39:556-8.
PubMed Abstract»
Nijhawan AE, DeLong AK, Celentano DD, et al. The association between Trichomonas infection and incarceration in HIV-seropositive and at-risk HIV-seronegative women. Sex Transm Dis. 2011;38:1094-100.
PubMed Abstract»
Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2009;200:188.e1-7.
PubMed Abstract»
Peterman TA, Tian LH, Metcalf CA, Malotte CK, Paul SM, Douglas JM Jr. Persistent, undetected Trichomonas vaginalis infections? Clin Infect Dis. 2009;48:259-60.
PubMed Abstract»
Petrin D, Delgaty K, Bhatt R, Garber G. Clinical and microbiological aspects of Trichomonas vaginalis. Clin Microbiol Rev. 1998;11:300-17.
PubMed Abstract»
Roth AM, Williams JA, Ly R, et al. Changing sexually transmitted infection screening protocol will result in improved case finding for Trichomonas vaginalis among high-risk female populations. Sex Transm Dis. 2011;38:398-400.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Schwebke JR, Barrientes FJ. Prevalence of Trichomonas vaginalis isolates with resistance to metronidazole and tinidazole. Antimicrob Agents Chemother. 2006;50:4209-10.
PubMed Abstract»
Schwebke JR, Hobbs MM, Taylor SN, et al. Molecular testing for Trichomonas vaginalis in women: results from a prospective U.S. clinical trial. J Clin Microbiol. 2011;49:4106-11.
PubMed Abstract»
Seña AC, Bachmann LH, Hobbs MM. Persistent and recurrent Trichomonas vaginalis infections: epidemiology, treatment and management considerations. Expert Rev Anti Infect Ther. 2014;12:673-85.
PubMed Abstract»
Seña AC, Miller WC, Hobbs MM, et al. Trichomonas vaginalis infection in male sexual partners: implications for diagnosis, treatment, and prevention. Clin Infect Dis. 2007;44:13-22.
PubMed Abstract»
Stoner KA, Rabe LK, Meyn LA, Hillier SL. Survival of Trichomonas vaginalis in wet preparation and on wet mount. Sex Transm Infect. 2013;89:485-8.
PubMed Abstract»
Sutcliffe S, Newman SB, Hardick A, Gaydos CA. Prevalence and correlates of Trichomonas vaginalis infection among female US federal prison inmates. Sex Transm Dis. 2010;37:585-90.
PubMed Abstract»
Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, Markowitz L. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004. Clin Infect Dis. 2007;45:1319-26.
PubMed Abstract»
Swartzendruber A, Sales JM, Brown JL, Diclemente RJ, Rose ES. Correlates of incident Trichomonas vaginalis infections among African American female adolescents. Sex Transm Dis. 2014;41:240-5.
PubMed Abstract»
Tayal SC, Ochogwu SA, Bunce H. Paromomycin treatment of recalcitrant Trichomonas vaginalis. Int J STD AIDS. 2010;21:217-8.
PubMed Abstract»
Trintis J, Epie N, Boss R, Riedel S. Neonatal Trichomonas vaginalis infection: a case report and review of literature. Int J STD AIDS. 2010;21:606-7.
PubMed Abstract»
Van Der Pol B, Kraft CS, Williams JA. Use of an adaptation of a commercially available PCR assay aimed at diagnosis of chlamydia and gonorrhea to detect Trichomonas vaginalis in urogenital specimens. J Clin Microbiol. 2006;44:366-73.
PubMed Abstract»
Van Der Pol B, Kwok C, Pierre-Louis B, et al. Trichomonas vaginalis infection and human immunodeficiency virus acquisition in African women. J Infect Dis. 2008;197:548-54.
PubMed Abstract»
Van Der Pol B, Williams JA, Orr DP, Batteiger BE, Fortenberry JD. Prevalence, incidence, natural history, and response to treatment of Trichomonas vaginalis infection among adolescent women. J Infect Dis. 2005;192:2039-44.
PubMed Abstract»

Lesson 28. Urethritis

Additional References

Bachmann LH, Manhart LE, Martin DH, et al. Advances in the understanding and treatment of male urethritis. Clin Infect Dis. 2015;61 Suppl 8:S763-9.
PubMed Abstract»
Barbee LA, Khosropour CM, Dombrowski JC, Manhart LE, Golden MR. An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sex Transm Infect. 2016;92:155-60.
PubMed Abstract»
Bjartling C, Osser S, Persson K. Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. Am J Obstet Gynecol. 2012;206:476.e1-8.
PubMed Abstract»
Bowie WR, Alexander ER, Stimson JB, Floyd JF, Holmes KK. Therapy for nongonococcal urethritis: double-blind randomized comparison of two doses and two durations of minocycline. Ann Intern Med. 1981;95:306-11.
PubMed Abstract»
Bradshaw CS, Tabrizi SN, Read TR, et al. Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure. J Infect Dis. 2006;193:336-45.
PubMed Abstract»
Burnett AM, Anderson CP, Zwank MD. Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. Am J Emerg Med. 2012;30:1114-7.
PubMed Abstract»
Charoenwatanachokchai A, Chitwarakorn A, Palanuvej T, Pakdeewong S, Khumhaeng M, Kreaurat M. Azithromycin in non-gonococcal urethritis. J Med Assoc Thai. 1997;80:440-5.
PubMed Abstract»
Charoenwatanachokchai A, Chitwarakorn A, Siriwongrangsun P, Pariyasak W, Yenyasun N, Sukwit S. Azithromycin in the treatment of chlamydial cervicitis and eradication of Ureaplasma urealyticum in female lower genital tract. J Med Assoc Thai. 1997;80:343-7.
PubMed Abstract»
Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997;349:1868-73.
PubMed Abstract»
Deguchi T, Yasuda M, Yokoi S, et al. Treatment of uncomplicated gonococcal urethritis by double-dosing of 200 mg cefixime at a 6-h interval. J Infect Chemother. 2003;9:35-9.
PubMed Abstract»
Dehon PM, Hagensee ME, Sutton KJ, Oddo HE, Nelson N, McGowin CL. Histological Evidence of Chronic Mycoplasma genitalium-Induced Cervicitis in HIV-Infected Women: A Retrospective Cohort Study. J Infect Dis. 2016;213:1828-35.
PubMed Abstract»
Dehon PM, McGowin CL. The immunopathogenesis of Mycoplasma genitalium infections in women: A Narrative Review. Sex Transm Dis. 2017;44:428-432.
PubMed Abstract»
Falk L, Fredlund H, Jensen JS. Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection. Sex Transm Infect. 2005;81:73-8.
PubMed Abstract»
Geisler WM, Yu S, Venglarik M, Schwebke JR. Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections. Sex Transm Infect. 2004;80:401-5.
PubMed Abstract»
Geisler WM. Diagnosis and Management of Uncomplicated Chlamydia trachomatis Infections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2015;61 Suppl 8:S774-84.
PubMed Abstract»
Gitau RW, Graham SM, Masese LN, et al. Effect of acquisition and treatment of cervical infections on HIV-1 shedding in women on antiretroviral therapy. AIDS. 2010;24:2733-7.
PubMed Abstract»
Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-85.
PubMed Abstract»
Golden MR, Workowski KA, Bolan G. Developing a Public Health Response to Mycoplasma genitalium. J Infect Dis. 2017;216:S420-S426.
PubMed Abstract»
Holmes KK, Handsfield HH, Wang SP, et al. Etiology of nongonococcal urethritis. N Engl J Med. 1975;292:1199-205.
PubMed Abstract»
Jernberg E, Moghaddam A, Moi H. Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: an open study. Int J STD AIDS. 2008;19:676-9.
PubMed Abstract»
Jordan SJ, Aaron KJ, Schwebke JR, Van Der Pol BJ, Hook EW 3rd. Defining the Urethritis Syndrome in Men Using Patient Reported Symptoms. Sex Transm Dis. 2018;45:e40-e42.
PubMed Abstract»
Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis. 2005;41:623-9.
PubMed Abstract»
Kletzel HH, Rotem R, Barg M, Michaeli J, Reichman O. Ureaplasma urealyticum: the Role as a Pathogen in Women's Health, a Systematic Review. Curr Infect Dis Rep. 2018;20:33.
PubMed Abstract»
Krieger JN, Verdon M, Siegel N, Holmes KK. Natural history of urogenital trichomoniasis in men. J Urol. 1993;149:1455-8.
PubMed Abstract»
LeFevre ML; U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:902-10.
PubMed Abstract»
Lusk MJ, Konecny P. Cervicitis: a review. Curr Opin Infect Dis. 2008;21:49-55.
PubMed Abstract»
Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis. 2011;53 Suppl 3:S129-42.
PubMed Abstract»
Manhart LE, Critchlow CW, Holmes KK, et al. Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis. 2003;187:650-7.
PubMed Abstract»
Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013;56:934-42.
PubMed Abstract»
Manhart LE. Has the time come to systematically test for Mycoplasma genitalium? Sex Transm Dis. 2009;36:607-8.
PubMed Abstract»
Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. 2007;44 Suppl 3:S102-10.
PubMed Abstract»
Marrazzo JM, Whittington WL, Celum CL, et al. Urine-based screening for Chlamydia trachomatis in men attending sexually transmitted disease clinics. Sex Transm Dis. 2001;28:219-25.
PubMed Abstract»
Marrazzo JM, Wiesenfeld HC, Murray PJ, et al. Risk factors for cervicitis among women with bacterial vaginosis. J Infect Dis. 2006;193:617-24.
PubMed Abstract»
Martin DH, Pollock S, Kuo CC, Wang SP, Brunham RC, Holmes KK. Chlamydia trachomatis infections in men with Reiter's syndrome. Ann Intern Med. 1984;100:207-13.
PubMed Abstract»
Mcclelland RS, Wang CC, Mandaliya K, et al. Treatment of cervicitis is associated with decreased cervical shedding of HIV-1. AIDS. 2001;15:105-10.
PubMed Abstract»
McCormack WM, Dalu ZA, Martin DH, et al. Double-blind comparison of trovafloxacin and doxycycline in the treatment of uncomplicated Chlamydial urethritis and cervicitis. Trovafloxacin Chlamydial Urethritis/Cervicitis Study Group. Sex Transm Dis. 1999;26:531-6.
PubMed Abstract»
Mikamo H, Sato Y, Hayasaki Y, Hua YX, Tamaya T. Adequate levofloxacin treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 2000;46:150-2.
PubMed Abstract»
Mikamo H, Sato Y, Hayasaki Y, Tamaya T. Adequate macrolide treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 1999;45:396-8.
PubMed Abstract»
Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294.
PubMed Abstract»
Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium in women with lower genital tract inflammation. Sex Transm Infect. 2009;85:10-4.
PubMed Abstract»
Moodley P, Sturm AW. Sexually transmitted infections, adverse pregnancy outcome and neonatal infection. Semin Neonatol. 2000;5:255-69.
PubMed Abstract»
Ong JJ, Morton AN, Henzell HR, et al. Clinical Characteristics of Herpes Simplex Virus Urethritis Compared With Chlamydial Urethritis Among Men. Sex Transm Dis. 2017;44:121-125.
PubMed Abstract»
Phillips I, Dimian C, Barlow D, et al. A comparative study of two different regimens of sparfloxacin versus doxycycline in the treatment of non-gonococcal urethritis in men. J Antimicrob Chemother. 1996;37 Suppl A:123-34.
PubMed Abstract»
Pitt RA, Alexander S, Horner PJ, Ison CA. Presentation of clinically suspected persistent chlamydial infection: a case series. Int J STD AIDS. 2013;24:469-75.
PubMed Abstract»
Pond MJ, Nori AV, Patel S, et al. Performance evaluation of automated urine microscopy as a rapid, non-invasive approach for the diagnosis of non-gonococcal urethritis. Sex Transm Infect. 2015;91:165-70.
PubMed Abstract»
Read TRH, Fairley CK, Murray GL, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68:554-60.
PubMed Abstract»
Rietmeijer CA, Mettenbrink CJ. Recalibrating the Gram stain diagnosis of male urethritis in the era of nucleic acid amplification testing. Sex Transm Dis. 2012;39:18-20.
PubMed Abstract»
Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67:1-31.
PubMed Abstract»
Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. 2003;30:49-56.
PubMed Abstract»
Schwartz MA, Hooton TM. Etiology of nongonococcal nonchlamydial urethritis. Dermatol Clin. 1998;16:727-33, xi.
PubMed Abstract»
Schwebke JR, Hook EW 3rd. High rates of Trichomonas vaginalis among men attending a sexually transmitted diseases clinic: implications for screening and urethritis management. J Infect Dis. 2003;188:465-8.
PubMed Abstract»
Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis. 2011;52:163-70.
PubMed Abstract»
Seña AC, Lensing S, Rompalo A, et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis. 2012;206:357-65.
PubMed Abstract»
Stamm WE, Batteiger BE, McCormack WM, Totten PA, Sternlicht A, Kivel NM. A randomized, double-blind study comparing single-dose rifalazil with single-dose azithromycin for the empirical treatment of nongonococcal urethritis in men. Sex Transm Dis. 2007;34:545-52.
PubMed Abstract»
Stamm WE, Hicks CB, Martin DH, et al. Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men. A randomized double-blind study. JAMA. 1995;274:545-9.
PubMed Abstract»
Stamm WE, Running K, Hale J, Holmes KK. Etiologic role of Mycoplasma hominis and Ureaplasma urealyticum in women with the acute urethral syndrome. Sex Transm Dis. 1983;10:318-22.
PubMed Abstract»
Steinhandler L, Peipert JF, Heber W, Montagno A, Cruickshank C. Combination of bacterial vaginosis and leukorrhea as a predictor of cervical chlamydial or gonococcal infection. Obstet Gynecol. 2002;99:603-7.
PubMed Abstract»
Stimson JB, Hale J, Bowie WR, Holmes KK. Tetracycline-resistant Ureaplasma urealyticum: a cause of persistent nongonococcal urethritis. Ann Intern Med. 1981;94:192-4.
PubMed Abstract»
Takahashi S, Ichihara K, Hashimoto J, et al. Clinical efficacy of levofloxacin 500 mg once daily for 7 days for patients with non-gonococcal urethritis. J Infect Chemother. 2011;17:392-6.
PubMed Abstract»
Takahashi S, Matsukawa M, Kurimura Y, et al. Clinical efficacy of azithromycin for male nongonococcal urethritis. J Infect Chemother. 2008;14:409-12.
PubMed Abstract»
Tan HH, Chan RK. An open label comparative study of azithromycin and doxycycline in the treatment of non-gonococcal urethritis in males and Chlamydia trachomatis cervicitis in female sex workers in an STD clinic in Singapore. Singapore Med J. 1999;40:519-23.
PubMed Abstract»
Taylor SN, DiCarlo RP, Martin DH. Comparison of methylene blue/gentian violet stain to Gram's stain for the rapid diagnosis of gonococcal urethritis in men. Sex Transm Dis. 2011;38:995-6.
PubMed Abstract»
Taylor SN, Lensing S, Schwebke J, et al. Prevalence and treatment outcome of cervicitis of unknown etiology. Sex Transm Dis. 2013;40:379-85.
PubMed Abstract»
Taylor SN. Cervicitis of unknown etiology. Curr Infect Dis Rep. 2014;16:409.
PubMed Abstract»
Taylor SN. Epididymitis. Clin Infect Dis. 2015;61 Suppl 8:S770-3.
PubMed Abstract»
Thorpe EM Jr, Stamm WE, Hook EW 3rd, et al. Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises. Genitourin Med. 1996;72:93-7.
PubMed Abstract»
U.S. Food and Drug Administration. FDA permits marketing of first test to aid in the diagnosis of a sexually-transmitted infection known as Mycoplasma genitalium. January 23, 2019
FDA News Release»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases characterized by urethritis and cervicitis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Emerging Issues. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Special populations. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»

Module 2. Self-Study Lessons 2nd Edition

Lesson 1. Chlamydial Infections

Module 2 » Lesson 1. Chlamydial Infections

Extra demo screening

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Chlamydial infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: men who have sex with men (MSM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: persons in correctional facilities. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: pregnant women. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: transgender and gender diverse persons. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: women who have sex with women (WSW) and women who have sex with women and men (WSWM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. HIV infection: detection, counseling, and referral. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 1. Chlamydial Infections

Epidemiology in the United States

Bernstein KT, Marcus JL, Nieri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. J Acquir Immune Defic Syndr. 2010;53:537-43.
PubMed Abstract»
CDC Fact Sheet. Incidence, prevalence, and cost of sexually transmitted infections in the United States. February 2013.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2020. Chlamydia. Atlanta: U.S. Department of Health and Human Services; April 2022.
CDC STD Surveillance»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2022. Atlanta: U.S. Department of Health and Human Services; April 2024.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Chlamydia. Atlanta: U.S. Department of Health and Human Services; September 2018.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Atlanta: U.S. Department of Health and Human Services; October 2019.
CDC»
Chesson HW, Bernstein KT, Gift TL, Marcus JL, Pipkin S, Kent CK. The cost-effectiveness of screening men who have sex with men for rectal chlamydial and gonococcal infection to prevent HIV Infection. Sex Transm Dis. 2013;40:366-71.
PubMed Abstract»
Chesson HW, Song R, Bingham A, Farnham PG. The Estimated Number and Lifetime Medical Cost of HIV Infections Attributable to Sexually Transmitted Infections Acquired in the United States in 2018: A Compilation of Published Modeling Results. Sex Transm Dis. 2021;48:292-298.
PubMed Abstract»
Chesson HW, Spicknall IH, Bingham A, et al. The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018. Sex Transm Dis. 2021;48:215-21.
PubMed Abstract»
Datta SD, Torrone E, Kruszon-Moran D, et al. Chlamydia trachomatis trends in the United States among persons 14 to 39 years of age, 1999-2008. Sex Transm Dis. 2012;39:92-6.
PubMed Abstract»
Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis. 2010;201 Suppl 2:S134-55.
PubMed Abstract»
Kreisel KM, Spicknall IH, Gargano JW, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2018. Sex Transm Dis. 2021;48:208-14.
PubMed Abstract»
Lee V, Tobin JM, Foley E. Relationship of cervical ectopy to chlamydia infection in young women. J Fam Plann Reprod Health Care. 2006;32:104-6.
PubMed Abstract»
LeFevre ML; U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:902-10.
PubMed Abstract»
Machado Junior LC, Dalmaso AS, Carvalho HB. Evidence for benefits from treating cervical ectopy: literature review. Sao Paulo Med J. 2008;126:132-9.
PubMed Abstract»
Miller WC, Ford CA, Morris M, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. 2004;291:2229-36.
PubMed Abstract»
Niccolai LM, Hochberg AL, Ethier KA, Lewis JB, Ickovics JR. Burden of recurrent Chlamydia trachomatis infections in young women: further uncovering the "hidden epidemic". Arch Pediatr Adolesc Med. 2007;161:246-51.
PubMed Abstract»
Ota KV, Fisman DN, Tamari IE, et al. Incidence and treatment outcomes of pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections in men who have sex with men: a 13-year retrospective cohort study. Clin Infect Dis. 2009;48:1237-43.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Peterman TA, Tian LH, Metcalf CA, et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med. 2006;145:564-72.
PubMed Abstract»
Ross JD. Pelvic inflammatory disease. BMJ Clin Evid. 2013;2013.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334:1362-6.
PubMed Abstract»
Scott Lamontagne D, Baster K, Emmett L, et al. Incidence and reinfection rates of genital chlamydial infection among women aged 16-24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group. Sex Transm Infect. 2007;83:292-303.
PubMed Abstract»
Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years--United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014;63:834-8.
PubMed Abstract»
US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326:949-56.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Chlamydial infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Chlamydial infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Xu F, Schillinger JA, Markowitz LE, Sternberg MR, Aubin MR, St Louis ME. Repeat Chlamydia trachomatis infection in women: analysis through a surveillance case registry in Washington State, 1993-1998. Am J Epidemiol. 2000;152:1164-70.
PubMed Abstract»
Module 2 » Lesson 1. Chlamydial Infections

Microbiology, Pathogenesis, and Transmission

Althaus CL, Heijne JC, Low N. Towards more robust estimates of the transmissibility of Chlamydia trachomatis. Sex Transm Dis. 2012;39:402-4.
PubMed Abstract»
Althaus CL, Turner KM, Mercer CH, et al. Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling. Health Technol Assess. 2014;18:1-100, vii-viii.
PubMed Abstract»
Batteiger BE, Xu F, Johnson RE, Rekart ML. Protective immunity to Chlamydia trachomatis genital infection: evidence from human studies. J Infect Dis. 2010;201 Suppl 2:S178-89.
PubMed Abstract»
Brunham RC. Immunity to Chlamydia trachomatis. J Infect Dis. 2013;207:1796-7.
PubMed Abstract»
Cossé MM, Hayward RD, Subtil A. One Face of Chlamydia trachomatis: The Infectious Elementary Body. Curr Top Microbiol Immunol. 2018;412:35-58.
PubMed Abstract»
Darville T, Hiltke TJ. Pathogenesis of genital tract disease due to Chlamydia trachomatis. J Infect Dis. 2010;201 Suppl 2:S114-25.
PubMed Abstract»
Elwell C, Mirrashidi K, Engel J. Chlamydia cell biology and pathogenesis. Nat Rev Microbiol. 2016;14:385-400.
PubMed Abstract»
Hafner LM. Pathogenesis of fallopian tube damage caused by Chlamydia trachomatis infections. Contraception. 2015;92:108-15.
PubMed Abstract»
Moulder JW. Interaction of chlamydiae and host cells in vitro. Microbiol Rev. 1991;55:143-90.
PubMed Abstract»
Schachter J, Grossman M, Sweet RL, Holt J, Jordan C, Bishop E. Prospective study of perinatal transmission of Chlamydia trachomatis. JAMA. 1986;255:3374-7.
PubMed Abstract»
Stephens RS. The cellular paradigm of chlamydial pathogenesis. Trends Microbiol. 2003;11:44-51.
PubMed Abstract»
Module 2 » Lesson 1. Chlamydial Infections

Clinical Manifestations

Bradley MG, Hobson D, Lee N, Tait IA, Rees E. Chlamydial infections of the urethra in women. Genitourin Med. 1985;61:371-5.
PubMed Abstract»
Brunham RC, Binns B, McDowell J, Paraskevas M. Chlamydia trachomatis infection in women with ectopic pregnancy. Obstet Gynecol. 1986;67:722-6.
PubMed Abstract»
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039-48.
PubMed Abstract»
Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014;63:1-19.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Chlamydia. Atlanta: U.S. Department of Health and Human Services; September 2018.
CDC»
Cook JA. Eliminating blinding trachoma. N Engl J Med. 2008;358:1777-9.
PubMed Abstract»
Dukers-Muijrers NH, Schachter J, van Liere GA, Wolffs PF, Hoebe CJ. What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion. BMC Infect Dis. 2015;15:533.
PubMed Abstract»
Elwell C, Mirrashidi K, Engel J. Chlamydia cell biology and pathogenesis. Nat Rev Microbiol. 2016;14:385-400.
PubMed Abstract»
Gérard HC, Carter JD, Hudson AP. Chlamydia trachomatis is present and metabolically active during the remitting phase in synovial tissues from patients with chronic Chlamydia-induced reactive arthritis. Am J Med Sci. 2013;346:22-5.
PubMed Abstract»
Garland SM, Malatt A, Tabrizi S, et al. Chlamydia trachomatis conjunctivitis. Prevalence and association with genital tract infection. Med J Aust. 1995;162:363-6.
PubMed Abstract»
Geisler WM, Black CM, Bandea CI, Morrison SG. Chlamydia trachomatis OmpA genotyping as a tool for studying the natural history of genital chlamydial infection. Sex Transm Infect. 2008;84:541-4.
PubMed Abstract»
Geisler WM, Suchland RJ, Whittington WL, Stamm WE. The relationship of serovar to clinical manifestations of urogenital Chlamydia trachomatis infection. Sex Transm Dis. 2003;30:160-5.
PubMed Abstract»
Geisler WM. Duration of untreated, uncomplicated Chlamydia trachomatis genital infection and factors associated with chlamydia resolution: a review of human studies. J Infect Dis. 2010;201 Suppl 2:S104-13.
PubMed Abstract»
Gratrix J, Singh AE, Bergman J, et al. Evidence for increased Chlamydia case finding after the introduction of rectal screening among women attending 2 Canadian sexually transmitted infection clinics. Clin Infect Dis. 2015;60:398-404.
PubMed Abstract»
Handsfield HH. Lymphogranuloma venereum treatment and terminology. Sex Transm Dis. 2018;45:409-411.
PubMed Abstract»
Hillis SD, Wasserheit JN. Screening for chlamydia--a key to the prevention of pelvic inflammatory disease. N Engl J Med. 1996;334:1399-401.
PubMed Abstract»
Hoentjen F, Rubin DT. Infectious proctitis: when to suspect it is not inflammatory bowel disease. Dig Dis Sci. 2012;57:269-73.
PubMed Abstract»
Hook EW 3rd, Spitters C, Reichart CA, Neumann TM, Quinn TC. Use of cell culture and a rapid diagnostic assay for Chlamydia trachomatis screening. JAMA. 1994;272:867-70.
PubMed Abstract»
Karlsson A, Österlund A, Forssén A. Pharyngeal Chlamydia trachomatis is not uncommon any more. Scand J Infect Dis. 2011;43:344-8.
PubMed Abstract»
LeFevre ML; U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:902-10.
PubMed Abstract»
Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. 2007;44 Suppl 3:S102-10.
PubMed Abstract»
Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294.
PubMed Abstract»
Money DM, Hawes SE, Eschenbach DA, et al. Antibodies to the chlamydial 60 kd heat-shock protein are associated with laparoscopically confirmed perihepatitis. Am J Obstet Gynecol. 1997;176:870-7.
PubMed Abstract»
Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186:929-37.
PubMed Abstract»
Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ. 2010;340:c1642.
PubMed Abstract»
Oztürk O, Seven H. Chlamydia trachomatis tonsillopharyngitis. Case Rep Otolaryngol. 2012;2012:736107.
PubMed Abstract»
Ris HW. Perihepatitis (Fitz-Hugh--Curtis syndrome). A review and case presentation. J Adolesc Health Care. 1984;5:272-6.
PubMed Abstract»
Ross JD. Pelvic inflammatory disease. BMJ Clin Evid. 2013;2013.
PubMed Abstract»
Schachter J, Moncada J. Lymphogranuloma venereum: how to turn an endemic disease into an outbreak of a new disease? Start looking. Sex Transm Dis. 2005;32:331-2.
PubMed Abstract»
Stoner BP, Cohen SE. Lymphogranuloma venereum 2015: Clinical presentation, diagnosis, and treatment. Clin Infect Dis. 2015;61 Suppl 8:S865-73.
PubMed Abstract»
Taylor HR, Burton MJ, Haddad D, West S, Wright H. Trachoma. Lancet. 2014;384:2142-52.
PubMed Abstract»
Taylor SN. Cervicitis of unknown etiology. Curr Infect Dis Rep. 2014;16:409.
PubMed Abstract»
Taylor SN. Epididymitis. Clin Infect Dis. 2015;61 Suppl 8:S770-3.
PubMed Abstract»
Wang SP, Eschenbach DA, Holmes KK, Wager G, Grayston JT. Chlamydia trachomatis infection in Fitz-Hugh-Curtis syndrome. Am J Obstet Gynecol. 1980;138:1034-8.
PubMed Abstract»
Wiesenfeld HC. Screening for Chlamydia trachomatis infections in women. N Engl J Med. 2017;376:765-73.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Chlamydial infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers: lymphogranuloma venereum (LGV). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Chlamydial infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 1. Chlamydial Infections

Laboratory Diagnosis

Black CM, Marrazzo J, Johnson RE, et al. Head-to-head multicenter comparison of DNA probe and nucleic acid amplification tests for Chlamydia trachomatis infection in women performed with an improved reference standard. J Clin Microbiol. 2002;40:3757-63.
PubMed Abstract»
Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014;63:1-19.
PubMed Abstract»
Chernesky MA, Hook EW 3rd, Martin DH, et al. Women find it easy and prefer to collect their own vaginal swabs to diagnose Chlamydia trachomatis or Neisseria gonorrhoeae infections. Sex Transm Dis. 2005;32:729-33.
PubMed Abstract»
Cook RL, Hutchison SL, Østergaard L, Braithwaite RS, Ness RB. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. 2005;142:914-25.
PubMed Abstract»
Gaydos CA, Quinn TC, Willis D, et al. Performance of the APTIMA Combo 2 assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in female urine and endocervical swab specimens. J Clin Microbiol. 2003;41:304-9.
PubMed Abstract»
Genç M, Mårdh A. A cost-effectiveness analysis of screening and treatment for Chlamydia trachomatis infection in asymptomatic women. Ann Intern Med. 1996;124:1-7.
PubMed Abstract»
Hadgu A, Dendukuri N, Hilden J. Evaluation of nucleic acid amplification tests in the absence of a perfect gold-standard test: a review of the statistical and epidemiologic issues. Epidemiology. 2005;16:604-12.
PubMed Abstract»
Jensen IP, Fogh H, Prag J. Diagnosis of Chlamydia trachomatis infections in a sexually transmitted disease clinic: evaluation of a urine sample tested by enzyme immunoassay and polymerase chain reaction in comparison with a cervical and/or a urethral swab tested by culture and polymerase chain reaction. Clin Microbiol Infect. 2003;9:194-201.
PubMed Abstract»
Knox J, Tabrizi SN, Miller P, et al. Evaluation of self-collected samples in contrast to practitioner-collected samples for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by polymerase chain reaction among women living in remote areas. Sex Transm Dis. 2002;29:647-54.
PubMed Abstract»
Lunny C, Taylor D, Hoang L, et al. Self-collected versus clinician-collected sampling for Chlamydia and Gonorrhea screening: a systemic review and meta-analysis. PLoS One. 2015;10:e0132776.
PubMed Abstract»
Mabey D, Peeling RW. Lymphogranuloma venereum. Sex Transm Infect. 2002;78:90-2.
PubMed Abstract»
Masek BJ, Arora N, Quinn N, et al. Performance of three nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by use of self-collected vaginal swabs obtained via an Internet-based screening program. J Clin Microbiol. 2009;47:1663-7.
PubMed Abstract»
Schachter J, Chernesky MA, Willis DE, et al. Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections. Sex Transm Dis. 2005;32:725-8.
PubMed Abstract»
U.S. Food and Drug Administration: FDA News Release. FDA allows for first point-of-care Chlamydia and Gonorrhea test to be used in more near-patient care settings. FDA news release. March 30, 2021.
U.S. FDA»
U.S. Food and Drug Administration. FDA clears first diagnostic tests for extragenital testing for chlamydia and gonorrhea. FDA news release. May 23, 2019.
U.S. FDA»
Van der Helm JJ, Hoebe CJ, van Rooijen MS, et al. High performance and acceptability of self-collected rectal swabs for diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men and women. Sex Transm Dis. 2009;36:493-7.
PubMed Abstract»
Van Der Pol B, Taylor SN, Mena L, et al. Evaluation of the Performance of a Point-of-Care Test for Chlamydia and Gonorrhea. JAMA Netw Open. 2020;3:e204819.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Chlamydial infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers: lymphogranuloma venereum (LGV). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Chlamydial infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 1. Chlamydial Infections

Screening for Chlamydial Infection

Burstein GR, Snyder MH, Conley D, Boekeloo BO, Quinn TC, Zenilman JM. Adolescent chlamydia testing practices and diagnosed infections in a large managed care organization. Sex Transm Dis. 2001;28:477-83.
PubMed Abstract»
Cook RL, Hutchison SL, Østergaard L, Braithwaite RS, Ness RB. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. 2005;142:914-25.
PubMed Abstract»
Gaydos CA, Quinn TC, Willis D, et al. Performance of the APTIMA Combo 2 assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in female urine and endocervical swab specimens. J Clin Microbiol. 2003;41:304-9.
PubMed Abstract»
Genç M, Mårdh A. A cost-effectiveness analysis of screening and treatment for Chlamydia trachomatis infection in asymptomatic women. Ann Intern Med. 1996;124:1-7.
PubMed Abstract»
Hillis SD, Wasserheit JN. Screening for chlamydia--a key to the prevention of pelvic inflammatory disease. N Engl J Med. 1996;334:1399-401.
PubMed Abstract»
Hu D, Hook EW 3rd, Goldie SJ. Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis. Ann Intern Med. 2004;141:501-13.
PubMed Abstract»
Karlsson A, Österlund A, Forssén A. Pharyngeal Chlamydia trachomatis is not uncommon any more. Scand J Infect Dis. 2011;43:344-8.
PubMed Abstract»
Lee VF, Tobin JM, Harindra V. Re-infection of Chlamydia trachomatis in patients presenting to the genitourinary medicine clinic in Portsmouth: the chlamydia screening pilot study - three years on. Int J STD AIDS. 2004;15:744-6.
PubMed Abstract»
LeFevre ML; U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:902-10.
PubMed Abstract»
Meyers D, Wolff T, Gregory K, et al. USPSTF recommendations for STI screening. Am Fam Physician. 2008;77:819-24.
PubMed Abstract»
Niccolai LM, Hochberg AL, Ethier KA, Lewis JB, Ickovics JR. Burden of recurrent Chlamydia trachomatis infections in young women: further uncovering the "hidden epidemic". Arch Pediatr Adolesc Med. 2007;161:246-51.
PubMed Abstract»
Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ. 2010;340:c1642.
PubMed Abstract»
Peters RP, Nijsten N, Mutsaers J, Jansen CL, Morré SA, van Leeuwen AP. Screening of oropharynx and anorectum increases prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection in female STD clinic visitors. Sex Transm Dis. 2011;38:783-7.
PubMed Abstract»
Peters RP, Verweij SP, Nijsten N, et al. Evaluation of sexual history-based screening of anatomic sites for Chlamydia trachomatis and Neisseria gonorrhoeae infection in men having sex with men in routine practice. BMC Infect Dis. 2011;11:203.
PubMed Abstract»
Postma MJ, Welte R, van den Hoek JA, van Doornum GJ, Jager HC, Coutinho RA. Cost-effectiveness of partner pharmacotherapy in screening women for asymptomatic infection with Chlamydia trachomatis. Value Health. 2001;4:266-75.
PubMed Abstract»
Romoren M, Rahman M, Sundby J, Hjortdahl P. Chlamydia and gonorrhoea in pregnancy: effectiveness of diagnosis and treatment in Botswana. Sex Transm Infect. 2004;80:395-400.
PubMed Abstract»
Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334:1362-6.
PubMed Abstract»
Scott Lamontagne D, Baster K, Emmett L, et al. Incidence and reinfection rates of genital chlamydial infection among women aged 16-24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group. Sex Transm Infect. 2007;83:292-303.
PubMed Abstract»
Sexton ME, Baker JJ, Nakagawa K, et al. How reliable is self-testing for gonorrhea and chlamydia among men who have sex with men? J Fam Pract. 2013;62:70-8.
PubMed Abstract»
Tipple C, Hill SC, Smith A. Is screening for pharyngeal Chlamydia trachomatis warranted in high-risk groups? Int J STD AIDS. 2010;21:770-1.
PubMed Abstract»
U.S. Food and Drug Administration. FDA clears first diagnostic tests for extragenital testing for chlamydia and gonorrhea. FDA news release. May 23, 2019.
U.S. FDA»
US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326:949-56.
PubMed Abstract»
Van der Helm JJ, Hoebe CJ, van Rooijen MS, et al. High performance and acceptability of self-collected rectal swabs for diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men and women. Sex Transm Dis. 2009;36:493-7.
PubMed Abstract»
Watson EJ, Templeton A, Russell I, et al. The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review. J Med Microbiol. 2002;51:1021-31.
PubMed Abstract»
Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol. 2002;100:456-63.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Chlamydial infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: pregnant women. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: women who have sex with women (WSW) and women who have sex with women and men (WSWM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Chlamydial infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. HIV infection: detection, counseling, and referral. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Special populations. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 1. Chlamydial Infections

Treatment of Adolescents and Adults

Adair CD, Gunter M, Stovall TG, McElroy G, Veille JC, Ernest JM. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol. 1998;91:165-8.
PubMed Abstract»
Augenbraun M, Bachmann L, Wallace T, Dubouchet L, McCormack W, Hook EW 3rd. Compliance with doxycycline therapy in sexually transmitted diseases clinics. Sex Transm Dis. 1998;25:1-4.
PubMed Abstract»
Bachmann LH, Stephens J, Richey CM, Hook EW 3rd. Measured versus self-reported compliance with doxycycline therapy for chlamydia-associated syndromes: high therapeutic success rates despite poor compliance. Sex Transm Dis. 1999;26:272-8.
PubMed Abstract»
Bernstein KT, Stephens SC, Barry PM, et al. Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the oropharynx to the urethra among men who have sex with men. Clin Infect Dis. 2009;49:1793-7.
PubMed Abstract»
Brihmer C, Mårdh PA, Kallings I, et al. Efficacy and safety of azithromycin versus lymecyline in the treatment of genital chlamydial infections in women. Scand J Infect Dis. 1996;28:451-4.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Hypertrophic pyloric stenosis in infants following pertussis prophylaxis with erythromycin--Knoxville, Tennessee, 1999. MMWR Morb Mortal Wkly Rep. 1999;48:1117-20.
PubMed Abstract»
Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014;63:1-19.
PubMed Abstract»
Charoenwatanachokchai A, Chitwarakorn A, Palanuvej T, Pakdeewong S, Khumhaeng M, Kreaurat M. Azithromycin in non-gonococcal urethritis. J Med Assoc Thai. 1997;80:440-5.
PubMed Abstract»
Dombrowski JC, Wierzbicki MR, Newman LM, et al. Doxycycline versus azithromycin for the treatment of rectal chlamydia in men who have sex with men: a randomized controlled trial. Clin Infect Dis. 2021;73:824-31.
PubMed Abstract»
Drummond F, Ryder N, Wand H, et al. Is azithromycin adequate treatment for asymptomatic rectal chlamydia? Int J STD AIDS. 2011;22:478-80.
PubMed Abstract»
Dukers-Muijrers NH, Schachter J, van Liere GA, Wolffs PF, Hoebe CJ. What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion. BMC Infect Dis. 2015;15:533.
PubMed Abstract»
Dukers-Muijrers NHTM, Wolffs PFG, De Vries H, et al. Treatment effectiveness of azithromycin and doxycycline in uncomplicated rectal and vaginal Chlamydia trachomatis infections in women: a multicenter observational study (FemCure). Clin Infect Dis. 2019;69:1946-54.
PubMed Abstract»
Eberly MD, Eide MB, Thompson JL, Nylund CM. Azithromycin in early infancy and pyloric stenosis. Pediatrics. 2015;135:483-8.
PubMed Abstract»
Elgalib A, Alexander S, Tong CY, White JA. Seven days of doxycycline is an effective treatment for asymptomatic rectal Chlamydia trachomatis infection. Int J STD AIDS. 2011;22:474-7.
PubMed Abstract»
Fung M, Scott KC, Kent CK, Klausner JD. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex Transm Infect. 2007;83:304-9.
PubMed Abstract»
Geisler WM, Koltun WD, Abdelsayed N, et al. Safety and efficacy of WC2031 versus vibramycin for the treatment of uncomplicated urogenital Chlamydia trachomatis infection: a randomized, double-blind, double-dummy, active-controlled, multicenter trial. Clin Infect Dis. 2012;55:82-8.
PubMed Abstract»
Geisler WM, Uniyal A, Lee JY, et al. Azithromycin versus doxycycline for urogenital Chlamydia trachomatis infection. N Engl J Med. 2015;373:2512-21.
PubMed Abstract»
Geisler WM. Diagnosis and Management of Uncomplicated Chlamydia trachomatis Infections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2015;61 Suppl 8:S774-84.
PubMed Abstract»
Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-85.
PubMed Abstract»
Hathorn E, Opie C, Goold P. What is the appropriate treatment for the management of rectal Chlamydia trachomatis in men and women? Sex Transm Infect. 2012;88:352-4.
PubMed Abstract»
Honein MA, Paulozzi LJ, Himelright IM, et al. Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. Lancet. 1999;354:2101-5.
PubMed Abstract»
Hosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis. 2009;36:478-89.
PubMed Abstract»
Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infect Dis Obstet Gynecol. 2001;9:197-202.
PubMed Abstract»
Katusic D, Petricek I, Mandic Z, et al. Azithromycin vs doxycycline in the treatment of inclusion conjunctivitis. Am J Ophthalmol. 2003;135:447-51.
PubMed Abstract»
Khosropour CM, Dombrowski JC, Barbee LA, Manhart LE, Golden MR. Comparing azithromycin and doxycycline for the treatment of rectal chlamydial infection: a retrospective cohort study. Sex Transm Dis. 2014;41:79-85.
PubMed Abstract»
Klausner JD, Chaw JK. Patient-delivered therapy for chlamydia: putting research into practice. Sex Transm Dis. 2003;30:509-11.
PubMed Abstract»
Kong FY, Tabrizi SN, Fairley CK, et al. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother. 2015;70:1290-7.
PubMed Abstract»
Kong FY, Tabrizi SN, Law M, et al. Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials. Clin Infect Dis. 2014;59:193-205.
PubMed Abstract»
Larsen B, Glover DD. Serum erythromycin levels in pregnancy. Clin Ther. 1998;20:971-7.
PubMed Abstract»
Lau A, Kong F, Fairley CK, et al. Treatment efficacy of azithromycin 1 g single dose versus doxycycline 100 mg twice daily for 7 days for the treatment of rectal chlamydia among men who have sex with men - a double-blind randomised controlled trial protocol. BMC Infect Dis. 2017;17:35.
PubMed Abstract»
Lau A, Kong FYS, Fairley CK, et al. Azithromycin or doxycycline for asymptomatic rectal Chlamydia trachomatis. N Engl J Med. 2021;384:2418-27.
PubMed Abstract»
Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis. 2002;29:497-502.
PubMed Abstract»
Lazenby GB, Korte JE, Tillman S, Brown FK, Soper DE. A recommendation for timing of repeat Chlamydia trachomatis test following infection and treatment in pregnant and nonpregnant women. Int J STD AIDS. 2017;28:902-909.
PubMed Abstract»
Louik C, Werler MM, Mitchell AA. Erythromycin use during pregnancy in relation to pyloric stenosis. Am J Obstet Gynecol. 2002;186:288-90.
PubMed Abstract»
Magid D, Douglas JM Jr, Schwartz JS. Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental cost-effectiveness analysis. Ann Intern Med. 1996;124:389-99.
PubMed Abstract»
Manavi K, Hettiarachchi N, Hodson J. Comparison of doxycycline with azithromycin in treatment of pharyngeal chlamydia infection. Int J STD AIDS. 2016;27:1303-8.
PubMed Abstract»
Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013;56:934-42.
PubMed Abstract»
Marcus JL, Kohn RP, Barry PM, Philip SS, Bernstein KT. Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the female oropharynx to the male urethra. Sex Transm Dis. 2011;38:372-3.
PubMed Abstract»
Martin DH, Jones RB, Johnson RB. A phase-II study of trovafloxacin for the treatment of Chlamydia trachomatis infections. Sex Transm Dis. 1999;26:369-73.
PubMed Abstract»
McCormack WM, Dalu ZA, Martin DH, et al. Double-blind comparison of trovafloxacin and doxycycline in the treatment of uncomplicated Chlamydial urethritis and cervicitis. Trovafloxacin Chlamydial Urethritis/Cervicitis Study Group. Sex Transm Dis. 1999;26:531-6.
PubMed Abstract»
McCormack WM, Martin DH, Hook EW 3rd, Jones RB. Daily oral grepafloxacin vs. twice daily oral doxycycline in the treatment of Chlamydia trachomatis endocervical infection. Infect Dis Obstet Gynecol. 1998;6:109-15.
PubMed Abstract»
Mikamo H, Ninomiya M, Tamaya T. Clinical efficacy of clarithromycin against uterine cervical and pharyngeal Chlamydia trachomatis and the sensitivity of polymerase chain reaction to detect C. trachomatis at various time points after treatment. J Infect Chemother. 2003;9:282-3.
PubMed Abstract»
Mikamo H, Sato Y, Hayasaki Y, Hua YX, Tamaya T. Adequate levofloxacin treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 2000;46:150-2.
PubMed Abstract»
Mikamo H, Sato Y, Hayasaki Y, Tamaya T. Adequate macrolide treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 1999;45:396-8.
PubMed Abstract»
Peipert JF, Sweet RL, Walker CK, Kahn J, Rielly-Gauvin K. Evaluation of ofloxacin in the treatment of laparoscopically documented acute pelvic inflammatory disease (salpingitis). Infect Dis Obstet Gynecol. 1999;7:138-44.
PubMed Abstract»
Phillips I, Dimian C, Barlow D, et al. A comparative study of two different regimens of sparfloxacin versus doxycycline in the treatment of non-gonococcal urethritis in men. J Antimicrob Chemother. 1996;37 Suppl A:123-34.
PubMed Abstract»
Pitsouni E, Iavazzo C, Athanasiou S, Falagas ME. Single-dose azithromycin versus erythromycin or amoxicillin for Chlamydia trachomatis infection during pregnancy: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents. 2007;30:213-21.
PubMed Abstract»
Rahangdale L, Guerry S, Bauer HM, et al. An observational cohort study of Chlamydia trachomatis treatment in pregnancy. Sex Transm Dis. 2006;33:106-10.
PubMed Abstract»
Rastogi S, Das B, Salhan S, Mittal A. Effect of treatment for Chlamydia trachomatis during pregnancy. Int J Gynaecol Obstet. 2003;80:129-37.
PubMed Abstract»
Renault CA, Israelski DM, Levy V, Fujikawa BK, Kellogg TA, Klausner JD. Time to clearance of Chlamydia trachomatis ribosomal RNA in women treated for chlamydial infection. Sex Health. 2011;8:69-73.
PubMed Abstract»
Ross JD, Crean A, McMillan A. Efficacy of anti-chlamydial therapy with oxytetracycline and erythromycin. Int J STD AIDS. 1996;7:373-4.
PubMed Abstract»
Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. 2003;30:49-56.
PubMed Abstract»
Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis. 2011;52:163-70.
PubMed Abstract»
Smith C, Egunsola O, Choonara I, Kotecha S, Jacqz-Aigrain E, Sammons H. Use and safety of azithromycin in neonates: a systematic review. BMJ Open. 2015;5:e008194.
PubMed Abstract»
Somani J, Bhullar VB, Workowski KA, Farshy CE, Black CM. Multiple drug-resistant Chlamydia trachomatis associated with clinical treatment failure. J Infect Dis. 2000;181:1421-7.
PubMed Abstract»
Stamm WE, Batteiger BE, McCormack WM, Totten PA, Sternlicht A, Kivel NM. A randomized, double-blind study comparing single-dose rifalazil with single-dose azithromycin for the empirical treatment of nongonococcal urethritis in men. Sex Transm Dis. 2007;34:545-52.
PubMed Abstract»
Stamm WE, Hicks CB, Martin DH, et al. Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men. A randomized double-blind study. JAMA. 1995;274:545-9.
PubMed Abstract»
Steedman NM, McMillan A. Treatment of asymptomatic rectal Chlamydia trachomatis: is single-dose azithromycin effective? Int J STD AIDS. 2009;20:16-8.
PubMed Abstract»
Takahashi S, Ichihara K, Hashimoto J, et al. Clinical efficacy of levofloxacin 500 mg once daily for 7 days for patients with non-gonococcal urethritis. J Infect Chemother. 2011;17:392-6.
PubMed Abstract»
Takahashi S, Matsukawa M, Kurimura Y, et al. Clinical efficacy of azithromycin for male nongonococcal urethritis. J Infect Chemother. 2008;14:409-12.
PubMed Abstract»
Tan HH, Chan RK. An open label comparative study of azithromycin and doxycycline in the treatment of non-gonococcal urethritis in males and Chlamydia trachomatis cervicitis in female sex workers in an STD clinic in Singapore. Singapore Med J. 1999;40:519-23.
PubMed Abstract»
Thorpe EM Jr, Stamm WE, Hook EW 3rd, et al. Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises. Genitourin Med. 1996;72:93-7.
PubMed Abstract»
Wang SA, Papp JR, Stamm WE, Peeling RW, Martin DH, Holmes KK. Evaluation of antimicrobial resistance and treatment failures for Chlamydia trachomatis: a meeting report. J Infect Dis. 2005;191:917-23.
PubMed Abstract»
Wehbeh HA, Ruggeirio RM, Shahem S, Lopez G, Ali Y. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med. 1998;43:509-14.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Chlamydial infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers: lymphogranuloma venereum (LGV). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Chlamydial infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 1. Chlamydial Infections

Management of Sex Partners

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Chlamydial infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 1. Chlamydial Infections

Treatment of Neonates and Children

Centers for Disease Control and Prevention (CDC). Hypertrophic pyloric stenosis in infants following pertussis prophylaxis with erythromycin--Knoxville, Tennessee, 1999. MMWR Morb Mortal Wkly Rep. 1999;48:1117-20.
PubMed Abstract»
Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014;63:1-19.
PubMed Abstract»
Eberly MD, Eide MB, Thompson JL, Nylund CM. Azithromycin in early infancy and pyloric stenosis. Pediatrics. 2015;135:483-8.
PubMed Abstract»
Honein MA, Paulozzi LJ, Himelright IM, et al. Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. Lancet. 1999;354:2101-5.
PubMed Abstract»
Smith C, Egunsola O, Choonara I, Kotecha S, Jacqz-Aigrain E, Sammons H. Use and safety of azithromycin in neonates: a systematic review. BMJ Open. 2015;5:e008194.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Chlamydial infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N. Treatment of neonatal chlamydial conjunctivitis: a systematic review and meta-analysis. J Pediatric Infect Dis Soc. 2018;7:e107-e115.
PubMed Abstract»
Module 2 » Lesson 1. Chlamydial Infections

Counseling and Education

Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years--United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014;63:834-8.
PubMed Abstract»

Additional References

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Adams DA, Jajosky RA, Ajani U, et al. Summary of notifiable diseases--United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;61:1-121.
PubMed Abstract»
Apewokin SK, Geisler WM, Bachmann LH. Spontaneous resolution of extragenital chlamydial and gonococcal infections prior to therapy. Sex Transm Dis. 2010;37:343-4.
PubMed Abstract»
Barbee LA, Khosropour CM, Dombrowski JC, Manhart LE, Golden MR. An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sex Transm Infect. 2016;92:155-60.
PubMed Abstract»
Bernstein KT, Stephens SC, Barry PM, et al. Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the oropharynx to the urethra among men who have sex with men. Clin Infect Dis. 2009;49:1793-7.
PubMed Abstract»
Brunham RC. Immunology. A Chlamydia vaccine on the horizon. Science. 2015;348:1322-3.
PubMed Abstract»
Cantor A, Dana T, Griffin JC, et al. Screening for Chlamydial and Gonococcal Infections: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;326:957-66.
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Charoenwatanachokchai A, Chitwarakorn A, Palanuvej T, Pakdeewong S, Khumhaeng M, Kreaurat M. Azithromycin in non-gonococcal urethritis. J Med Assoc Thai. 1997;80:440-5.
PubMed Abstract»
Charoenwatanachokchai A, Chitwarakorn A, Siriwongrangsun P, Pariyasak W, Yenyasun N, Sukwit S. Azithromycin in the treatment of chlamydial cervicitis and eradication of Ureaplasma urealyticum in female lower genital tract. J Med Assoc Thai. 1997;80:343-7.
PubMed Abstract»
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PubMed Abstract»
Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-85.
PubMed Abstract»
Hoentjen F, Rubin DT. Infectious proctitis: when to suspect it is not inflammatory bowel disease. Dig Dis Sci. 2012;57:269-73.
PubMed Abstract»
Hueston WJ, Lenhart JG. A decision analysis to guide antibiotic selection for Chlamydia infection during pregnancy. Arch Fam Med. 1997;6:551-5.
PubMed Abstract»
Ito S, Yasuda M, Seike K, et al. Clinical and microbiological outcomes in treatment of men with non-gonococcal urethritis with a 100-mg twice-daily dose regimen of sitafloxacin. J Infect Chemother. 2012;18:414-8.
PubMed Abstract»
Joesoef MR, Weinstock HS, Johnson RE. Factors associated with recurrent chlamydial infection and failure to return for retesting in young women entering national job training program, 1998--2005. Sex Transm Dis. 2008;35:368-71.
PubMed Abstract»
Kjaer HO, Dimcevski G, Hoff G, Olesen F, Ostergaard L. Recurrence of urogenital Chlamydia trachomatis infection evaluated by mailed samples obtained at home: 24 weeks' prospective follow up study. Sex Transm Infect. 2000;76:169-72.
PubMed Abstract»
Kong FY, Tabrizi SN, Fairley CK, et al. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother. 2015;70:1290-7.
PubMed Abstract»
LeFevre ML; U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:902-10.
PubMed Abstract»
Li B, Hocking JS, Bi P, Bell C, Fairley CK. The efficacy of azithromycin and doxycycline treatment for rectal chlamydial infection: a retrospective cohort study in South Australia. Intern Med J. 2018;48:259-64.
PubMed Abstract»
Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013;56:934-42.
PubMed Abstract»
Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. 2007;44 Suppl 3:S102-10.
PubMed Abstract»
Mikamo H, Sato Y, Hayasaki Y, Hua YX, Tamaya T. Adequate levofloxacin treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 2000;46:150-2.
PubMed Abstract»
Mikamo H, Sato Y, Hayasaki Y, Tamaya T. Adequate macrolide treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 1999;45:396-8.
PubMed Abstract»
Moi H, Blee K, Horner PJ. Management of non-gonococcal urethritis. BMC Infect Dis. 2015;15:294.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Peterman TA, Tian LH, Metcalf CA, et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med. 2006;145:564-72.
PubMed Abstract»
Petitta A, Hart SM, Bailey EM. Economic evaluation of three methods of treating urogenital chlamydial infections in the emergency department. Pharmacotherapy. 1999;19:648-54.
PubMed Abstract»
Phillips I, Dimian C, Barlow D, et al. A comparative study of two different regimens of sparfloxacin versus doxycycline in the treatment of non-gonococcal urethritis in men. J Antimicrob Chemother. 1996;37 Suppl A:123-34.
PubMed Abstract»
Sanders CJ, Mulder MM. Periurethral gland abscess: aetiology and treatment. Sex Transm Infect. 1998;74:276-8.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. 2003;30:49-56.
PubMed Abstract»
Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis. 2011;52:163-70.
PubMed Abstract»
Stamm WE, Batteiger BE, McCormack WM, Totten PA, Sternlicht A, Kivel NM. A randomized, double-blind study comparing single-dose rifalazil with single-dose azithromycin for the empirical treatment of nongonococcal urethritis in men. Sex Transm Dis. 2007;34:545-52.
PubMed Abstract»
Stamm WE, Hicks CB, Martin DH, et al. Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men. A randomized double-blind study. JAMA. 1995;274:545-9.
PubMed Abstract»
Takahashi S, Ichihara K, Hashimoto J, et al. Clinical efficacy of levofloxacin 500 mg once daily for 7 days for patients with non-gonococcal urethritis. J Infect Chemother. 2011;17:392-6.
PubMed Abstract»
Takahashi S, Matsukawa M, Kurimura Y, et al. Clinical efficacy of azithromycin for male nongonococcal urethritis. J Infect Chemother. 2008;14:409-12.
PubMed Abstract»
Tamarelle J, Thiébaut ACM, Sabin B, et al. Early screening for Chlamydia trachomatis in young women for primary prevention of pelvic inflammatory disease (i-Predict): study protocol for a randomised controlled trial. Trials. 2017;18:534.
PubMed Abstract»
Tan HH, Chan RK. An open label comparative study of azithromycin and doxycycline in the treatment of non-gonococcal urethritis in males and Chlamydia trachomatis cervicitis in female sex workers in an STD clinic in Singapore. Singapore Med J. 1999;40:519-23.
PubMed Abstract»
Taylor SN. Cervicitis of unknown etiology. Curr Infect Dis Rep. 2014;16:409.
PubMed Abstract»
Taylor SN. Epididymitis. Clin Infect Dis. 2015;61 Suppl 8:S770-3.
PubMed Abstract»
Thorpe EM Jr, Stamm WE, Hook EW 3rd, et al. Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises. Genitourin Med. 1996;72:93-7.
PubMed Abstract»
Vaughan AS, Kelley CF, Luisi N, del Rio C, Sullivan PS, Rosenberg ES. An application of propensity score weighting to quantify the causal effect of rectal sexually transmitted infections on incident HIV among men who have sex with men. BMC Med Res Methodol. 2015;15:25.
PubMed Abstract»
Viravan C, Dance DA, Ariyarit C, et al. A prospective clinical and bacteriologic study of inguinal buboes in Thai men. Clin Infect Dis. 1996;22:233-9.
PubMed Abstract»
Wada K, Uehara S, Mitsuhata R, et al. Prevalence of pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae among heterosexual men in Japan. J Infect Chemother. 2012;18:729-33.
PubMed Abstract»
Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6-10.
PubMed Abstract»
Whittington WL, Kent C, Kissinger P, et al. Determinants of persistent and recurrent Chlamydia trachomatis infection in young women: results of a multicenter cohort study. Sex Transm Dis. 2001;28:117-23.
PubMed Abstract»
Wikström A, Rotzén-Ostlund M, Marions L. Occurrence of pharyngeal Chlamydia trachomatis is uncommon in patients with a suspected or confirmed genital infection. Acta Obstet Gynecol Scand. 2010;89:78-81.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: adolescents. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: children. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. HIV infection: detection, counseling, and referral. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Stevens CE, Suchland RJ, et al. Clinical manifestations of genital infection due to Chlamydia trachomatis in women: differences related to serovar. Clin Infect Dis. 1994;19:756-60.
PubMed Abstract»

Lesson 2. Gonococcal Infections

Module 2 » Lesson 2. Gonococcal Infections

Epidemiology in the United States

Bissessor M, Whiley DM, Fairley CK, et al. Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection. Clin Infect Dis. 2015;60:557-63.
PubMed Abstract»
Bolan GA, Sparling PF, Wasserheit JN. The emerging threat of untreatable gonococcal infection. N Engl J Med. 2012;366:485-7.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Cephalosporin susceptibility among Neisseria gonorrhoeae isolates--United States, 2000-2010. MMWR Morb Mortal Wkly Rep. 2011;60:873-7.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007;56:332-6.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2020. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; April 2022.
CDC STD Surveillance»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2022. Atlanta: U.S. Department of Health and Human Services; April 2024.
CDC»
Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with men--United States, 2003, and revised recommendations for gonorrhea treatment, 2004. MMWR Morb Mortal Wkly Rep. 2004;53:335-8.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; September 2018.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; October 2019.
CDC»
Centers for Disease Control and Prevention. Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep. 2012;61:590-4.
PubMed Abstract»
Chesson HW, Kent CK, Owusu-Edusei K Jr, Leichliter JS, Aral SO. Disparities in sexually transmitted disease rates across the "eight Americas". Sex Transm Dis. 2012;39:458-64.
PubMed Abstract»
Chesson HW, Spicknall IH, Bingham A, et al. The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018. Sex Transm Dis. 2021;48:215-21.
PubMed Abstract»
Kirkcaldy RD, Harvey A, Papp JR, et al. Neisseria gonorrhoeae Antimicrobial Susceptibility Surveillance - The Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014. MMWR Surveill Summ. 2016;65:1-19.
PubMed Abstract»
Newman LM, Berman SM. Epidemiology of STD disparities in African American communities. Sex Transm Dis. 2008;35:S4-12.
PubMed Abstract»
Stenger MR, Pathela P, Anschuetz G, et al. Increases in the Rate of Neisseria gonorrhoeae Among Gay, Bisexual and Other Men Who Have Sex With Men-Findings From the Sexually Transmitted Disease Surveillance Network 2010-2015. Sex Transm Dis. 2017;44:393-397.
PubMed Abstract»
Module 2 » Lesson 2. Gonococcal Infections

Gonococcal Antimicrobial Susceptibility

Bissessor M, Whiley DM, Fairley CK, et al. Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection. Clin Infect Dis. 2015;60:557-63.
PubMed Abstract»
Bolan GA, Sparling PF, Wasserheit JN. The emerging threat of untreatable gonococcal infection. N Engl J Med. 2012;366:485-7.
PubMed Abstract»
Brown LB, Krysiak R, Kamanga G, et al. Neisseria gonorrhoeae antimicrobial susceptibility in Lilongwe, Malawi, 2007. Sex Transm Dis. 2010;37:169-72.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2020. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; April 2022.
CDC STD Surveillance»
Centers for Disease Control and Prevention. Gonococcal Isolate Surveillance Project (GISP) Profiles, 2022.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; September 2018.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; October 2019.
CDC»
Kirkcaldy RD, Harvey A, Papp JR, et al. Neisseria gonorrhoeae Antimicrobial Susceptibility Surveillance - The Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014. MMWR Surveill Summ. 2016;65:1-19.
PubMed Abstract»
Picker MA, Knoblock RJ, Hansen H, et al. Notes from the Field: First Case in the United States of Neisseria gonorrhoeae Harboring Emerging Mosaic penA60 Allele, Conferring Reduced Susceptibility to Cefixime and Ceftriaxone. MMWR Morb Mortal Wkly Rep. 2020;69:1876-77.
PubMed Abstract»
Ross JDC, Brittain C, Cole M, et al. Gentamicin compared with ceftriaxone for the treatment of gonorrhoea (G-ToG): a randomised non-inferiority trial. Lancet. 2019;393:2511-20.
PubMed Abstract»
St Cyr S, Barbee L, Workowski KA, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1911-6.
PubMed Abstract»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Gonococcal infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 2. Gonococcal Infections

Microbiology, Pathogenesis, and Transmission

Barbee LA, Khosropour CM, Dombrowksi JC, Golden MR. New human immunodeficiency virus diagnosis independently associated with rectal gonorrhea and chlamydia in men who have sex with men. Sex Transm Dis. 2017;44:385-9.
PubMed Abstract»
Barbee LA, Khosropour CM, Dombrowski JC, Manhart LE, Golden MR. An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sex Transm Infect. 2016;92:155-60.
PubMed Abstract»
Barbee LA, Soge OO, Khosropour CM, et al. The Duration of Pharyngeal Gonorrhea: A Natural History Study. Clin Infect Dis. 2021;73:575-82.
PubMed Abstract»
Bernstein KT, Stephens SC, Barry PM, et al. Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the oropharynx to the urethra among men who have sex with men. Clin Infect Dis. 2009;49:1793-7.
PubMed Abstract»
Bro-Jorgensen A, Jensen T. Gonococcal pharyngeal infections. Report of 110 cases. Br J Vener Dis. 1973;49:491-9.
PubMed Abstract»
Cohen MS, Cannon JG. Human experimentation with Neisseria gonorrhoeae: progress and goals. J Infect Dis. 1999;179 Suppl 2:S375-9.
PubMed Abstract»
Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997;349:1868-73.
PubMed Abstract»
Cornelisse VJ, Bradshaw CS, Chow EPF, Williamson DA, Fairley CK. Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018. Emerg Infect Dis. 2019;25:1373-6.
PubMed Abstract»
Criss AK, Seifert HS. A bacterial siren song: intimate interactions between Neisseria and neutrophils. Nat Rev Microbiol. 2012;10:178-90.
PubMed Abstract»
Hill SA, Masters TL, Wachter J. Gonorrhea - an evolving disease of the new millennium. Microb Cell. 2016;3:371-89.
PubMed Abstract»
Hooper RR, Reynolds GH, Jones OG, et al. Cohort study of venereal disease. I: the risk of gonorrhea transmission from infected women to men. Am J Epidemiol. 1978;108:136-44.
PubMed Abstract»
Lin JS, Donegan SP, Heeren TC, et al. Transmission of Chlamydia trachomatis and Neisseria gonorrhoeae among men with urethritis and their female sex partners. J Infect Dis. 1998;178:1707-12.
PubMed Abstract»
Marcus JL, Kohn RP, Barry PM, Philip SS, Bernstein KT. Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the female oropharynx to the male urethra. Sex Transm Dis. 2011;38:372-3.
PubMed Abstract»
Quillin SJ, Seifert HS. Neisseria gonorrhoeae host adaptation and pathogenesis. Nat Rev Microbiol. 2018;16:226-40.
PubMed Abstract»
Sackel SG, Alpert S, Fiumara NJ, Donner A, Laughlin CA, McCormack WM. Orogenital contact and the isolation of Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum from the pharynx. Sex Transm Dis. 1979;6:64-8.
PubMed Abstract»
Templeton DJ, Jin F, McNally LP, et al. Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia. Sex Transm Infect. 2010;86:90-6.
PubMed Abstract»
Module 2 » Lesson 2. Gonococcal Infections

Clinical Manifestations

Balmelli C, Günthard HF. Gonococcal tonsillar infection--a case report and literature review. Infection. 2003;31:362-5.
PubMed Abstract»
Barbee LA, Soge OO, Khosropour CM, et al. The Duration of Pharyngeal Gonorrhea: A Natural History Study. Clin Infect Dis. 2021;73:575-82.
PubMed Abstract»
Bleich AT, Sheffield JS, Wendel GD Jr, Sigman A, Cunningham FG. Disseminated gonococcal infection in women. Obstet Gynecol. 2012;119:597-602.
PubMed Abstract»
Bro-Jorgensen A, Jensen T. Gonococcal pharyngeal infections. Report of 110 cases. Br J Vener Dis. 1973;49:491-9.
PubMed Abstract»
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039-48.
PubMed Abstract»
Chan PA, Robinette A, Montgomery M, et al. Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature. Infect Dis Obstet Gynecol. 2016;2016:5758387.
PubMed Abstract»
Chow EPF, Chen MY, Williamson DA, et al. Oropharyngeal and genital gonorrhea infections among women and heterosexual men reporting sexual contact with partners With gonorrhea: implication for oropharyngeal testing of heterosexual gonorrhea contacts. Sex Transm Dis. 2019;46:743-7.
PubMed Abstract»
Crew PE, Abara WE, McCulley L, et al. Disseminated Gonococcal Infections in Patients Receiving Eculizumab: A Case Series. Clin Infect Dis. 2019;69:596-600.
PubMed Abstract»
Handsfield HH, Lipman TO, Harnisch JP, Tronca E, Holmes KK. Asymptomatic gonorrhea in men. Diagnosis, natural course, prevalence and significance. N Engl J Med. 1974;290:117-23.
PubMed Abstract»
Harrison WO, Hooper RR, Wiesner PJ, et al. A trial of minocycline given after exposure to prevent gonorrhea. N Engl J Med. 1979;300:1074-8.
PubMed Abstract»
Kerle KK, Mascola JR, Miller TA. Disseminated gonococcal infection. Am Fam Physician. 1992;45:209-14.
PubMed Abstract»
Klausner JD, Kohn R, Kent C. Etiology of clinical proctitis among men who have sex with men. Clin Infect Dis. 2004;38:300-2.
PubMed Abstract»
McCormack WM, Stumacher RJ, Johnson K, Donner A. Clinical spectrum of gonococcal infection in women. Lancet. 1977;1:1182-5.
PubMed Abstract»
Morris SR, Klausner JD, Buchbinder SP, et al. Prevalence and incidence of pharyngeal gonorrhea in a longitudinal sample of men who have sex with men: the EXPLORE study. Clin Infect Dis. 2006;43:1284-9.
PubMed Abstract»
O'Brien JP, Goldenberg DL, Rice PA. Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine (Baltimore). 1983;62:395-406.
PubMed Abstract»
Quillin SJ, Seifert HS. Neisseria gonorrhoeae host adaptation and pathogenesis. Nat Rev Microbiol. 2018;16:226-40.
PubMed Abstract»
Templeton DJ, Jin F, McNally LP, et al. Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia. Sex Transm Infect. 2010;86:90-6.
PubMed Abstract»
Tice AW Jr, Rodriguez VL. Pharyngeal gonorrhea. JAMA. 1981;246:2717-9.
PubMed Abstract»
Wan WL, Farkas GC, May WN, Robin JB. The clinical characteristics and course of adult gonococcal conjunctivitis. Am J Ophthalmol. 1986;102:575-83.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by urethritis and cervicitis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Gonococcal infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 2. Gonococcal Infections

Laboratory Diagnosis

Bachmann LH, Johnson RE, Cheng H, et al. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis rectal infections. J Clin Microbiol. 2010;48:1827-32.
PubMed Abstract»
Bachmann LH, Johnson RE, Cheng H, Markowitz LE, Papp JR, Hook EW 3rd. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae oropharyngeal infections. J Clin Microbiol. 2009;47:902-7.
PubMed Abstract»
Brownell AD, Shapiro RA, Hammerschlag MR. Caution Is Required When Using Non-Food and Drug Administration-Cleared Assays to Diagnose Sexually Transmitted Infections in Children. J Pediatr. 2019;206:280-2.
PubMed Abstract»
Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014;63:1-19.
PubMed Abstract»
Schachter J, Moncada J, Liska S, Shayevich C, Klausner JD. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sex Transm Dis. 2008;35:637-42.
PubMed Abstract»
U.S. Food and Drug Administration: FDA News Release. FDA allows for first point-of-care Chlamydia and Gonorrhea test to be used in more near-patient care settings. FDA news release. March 30, 2021.
U.S. FDA»
U.S. Food and Drug Administration. FDA clears first diagnostic tests for extragenital testing for chlamydia and gonorrhea. FDA news release. May 23, 2019.
U.S. FDA»
Van Der Pol B, Taylor SN, Mena L, et al. Evaluation of the Performance of a Point-of-Care Test for Chlamydia and Gonorrhea. JAMA Netw Open. 2020;3:e204819.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Gonococcal infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs: adolescents and adults. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs: sexual assault or abuse of children. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Gonococcal infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 2. Gonococcal Infections

Screening for Gonococcal Infection

LeFevre ML; U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:902-10.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: men who have sex with men (MSM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: persons in correctional facilities. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: pregnant women. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: transgender and gender diverse persons. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: women who have sex with women (WSW) and women who have sex with women and men (WSWM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Gonococcal infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Gonococcal infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. HIV infection: detection, counseling, and referral. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Special populations. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 2. Gonococcal Infections

Treatment

Cámara J, Serra J, Ayats J, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67:1858-60.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Cephalosporin susceptibility among Neisseria gonorrhoeae isolates--United States, 2000-2010. MMWR Morb Mortal Wkly Rep. 2011;60:873-7.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Fluoroquinolone-resistance in Neisseria gonorrhoeae, Hawaii, 1999, and decreased susceptibility to azithromycin in N. gonorrhoeae, Missouri, 1999. MMWR Morb Mortal Wkly Rep. 2000;49:833-7.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007;56:332-6.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2020. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; April 2022.
CDC STD Surveillance»
Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with men--United States, 2003, and revised recommendations for gonorrhea treatment, 2004. MMWR Morb Mortal Wkly Rep. 2004;53:335-8.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Gonorrhea. Atlanta: U.S. Department of Health and Human Services; October 2019.
CDC»
Chen MY, McNulty A, Avery A, et al. Solithromycin versus ceftriaxone plus azithromycin for the treatment of uncomplicated genital gonorrhoea (SOLITAIRE-U): a randomised phase 3 non-inferiority trial. Lancet Infect Dis. 2019 Aug;19:833-42.
PubMed Abstract»
Chisholm SA, Mouton JW, Lewis DA, Nichols T, Ison CA, Livermore DM. Cephalosporin MIC creep among gonococci: time for a pharmacodynamic rethink? J Antimicrob Chemother. 2010;65:2141-8.
PubMed Abstract»
Connolly KL, Eakin AE, Gomez C, Osborn BL, Unemo M, Jerse AE. Pharmacokinetic Data Are Predictive of In Vivo Efficacy for Cefixime and Ceftriaxone against Susceptible and Resistant Neisseria gonorrhoeae Strains in the Gonorrhea Mouse Model. Antimicrob Agents Chemother. 2019;63(3):e01644-18.
PubMed Abstract»
Deguchi T, Yasuda M, Hatazaki K, et al. New Clinical Strain of Neisseria gonorrhoeae with Decreased Susceptibility to Ceftriaxone, Japan. Emerg Infect Dis. 2016;22:142-4.
PubMed Abstract»
Fung M, Scott KC, Kent CK, Klausner JD. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex Transm Infect. 2007;83:304-9.
PubMed Abstract»
Gadde J, Spence M, Wheeler B, Adkinson NF Jr. Clinical experience with penicillin skin testing in a large inner-city STD clinic. JAMA. 1993;270:2456-63.
PubMed Abstract»
Gernert KM, Seby S, Schmerer MW, et al. Azithromycin susceptibility of Neisseria gonorrhoeae in the USA in 2017: a genomic analysis of surveillance data. Lancet Microbe. 2020;1:e154-e164.
PubMed Abstract»
Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-85.
PubMed Abstract»
Haimovici R, Roussel TJ. Treatment of gonococcal conjunctivitis with single-dose intramuscular ceftriaxone. Am J Ophthalmol. 1989;107:511-4.
PubMed Abstract»
Hook EW 3rd, Golden M, Jamieson BD, et al. A Phase 2 Trial of Oral Solithromycin 1200 mg or 1000 mg as Single-Dose Oral Therapy for Uncomplicated Gonorrhea. Clin Infect Dis. 2015;61:1043-8.
PubMed Abstract»
Hook EW 3rd, Golden MR, Taylor SN, et al. Efficacy and Safety of Single-Dose Oral Delafloxacin Compared With Intramuscular Ceftriaxone for Uncomplicated Gonorrhea Treatment: An Open-Label, Noninferiority, Phase 3, Multicenter, Randomized Study. Sex Transm Dis. 2019;46:279-86.
PubMed Abstract»
Hosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis. 2009;36:478-89.
PubMed Abstract»
Khosropour CM, Dombrowski JC, Barbee LA, Manhart LE, Golden MR. Comparing azithromycin and doxycycline for the treatment of rectal chlamydial infection: a retrospective cohort study. Sex Transm Dis. 2014;41:79-85.
PubMed Abstract»
Kidd S, Workowski KA. Management of Gonorrhea in Adolescents and Adults in the United States. Clin Infect Dis. 2015;61 Suppl 8:S785-801.
PubMed Abstract»
Kirkcaldy RD, Weinstock HS, Moore PC, et al. The efficacy and safety of gentamicin plus azithromycin and gemifloxacin plus azithromycin as treatment of uncomplicated gonorrhea. Clin Infect Dis. 2014;59:1083-91.
PubMed Abstract»
Kong FY, Tabrizi SN, Fairley CK, et al. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother. 2015;70:1290-7.
PubMed Abstract»
Kong FY, Tabrizi SN, Law M, et al. Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials. Clin Infect Dis. 2014;59:193-205.
PubMed Abstract»
Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. 2007;44 Suppl 3:S102-10.
PubMed Abstract»
Novalbos A, Sastre J, Cuesta J, et al. Lack of allergic cross-reactivity to cephalosporins among patients allergic to penicillins. Clin Exp Allergy. 2001;31:438-43.
PubMed Abstract»
Ohnishi M, Golparian D, Shimuta K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55:3538-45.
PubMed Abstract»
Peterman TA, Tian LH, Metcalf CA, et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med. 2006;145:564-72.
PubMed Abstract»
Picker MA, Knoblock RJ, Hansen H, et al. Notes from the Field: First Case in the United States of Neisseria gonorrhoeae Harboring Emerging Mosaic penA60 Allele, Conferring Reduced Susceptibility to Cefixime and Ceftriaxone. MMWR Morb Mortal Wkly Rep. 2020;69:1876-77.
PubMed Abstract»
Ross JDC, Brittain C, Cole M, et al. Gentamicin compared with ceftriaxone for the treatment of gonorrhoea (G-ToG): a randomised non-inferiority trial. Lancet. 2019;393:2511-20.
PubMed Abstract»
Soge OO, Salipante SJ, No D, Duffy E, Roberts MC. In Vitro Activity of Delafloxacin against Clinical Neisseria gonorrhoeae Isolates and Selection of Gonococcal Delafloxacin Resistance. Antimicrob Agents Chemother. 2016;60:3106-11.
PubMed Abstract»
St Cyr S, Barbee L, Workowski KA, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1911-6.
PubMed Abstract»
Taylor SN, Marrazzo J, Batteiger BE, et al. Single-Dose Zoliflodacin (ETX0914) for Treatment of Urogenital Gonorrhea. N Engl J Med. 2018;379:1835-45.
PubMed Abstract»
Taylor SN, Morris DH, Avery AK, et al. Gepotidacin for the Treatment of Uncomplicated Urogenital Gonorrhea: A Phase 2, Randomized, Dose-Ranging, Single-Oral Dose Evaluation. Clin Infect Dis. 2018;67:504-512.
PubMed Abstract»
Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56:1273-80.
PubMed Abstract»
Wind CM, de Vries E, Schim van der Loeff MF, et al. Decreased Azithromycin Susceptibility of Neisseria gonorrhoeae Isolates in Patients Recently Treated with Azithromycin. Clin Infect Dis. 2017;65:37-45.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Gonococcal infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Gonococcal infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»

Additional References

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PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
Fung M, Scott KC, Kent CK, Klausner JD. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex Transm Infect. 2007;83:304-9.
PubMed Abstract»
Galarza PG, Alcalá B, Salcedo C, et al. Emergence of high level azithromycin-resistant Neisseria gonorrhoeae strain isolated in Argentina. Sex Transm Dis. 2009;36:787-8.
PubMed Abstract»
Goire N, Lahra MM, Chen M, et al. Molecular approaches to enhance surveillance of gonococcal antimicrobial resistance. Nat Rev Microbiol. 2014;12:223-9.
PubMed Abstract»
Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-85.
PubMed Abstract»
Golparian D, Fernandes P, Ohnishi M, Jensen JS, Unemo M. In vitro activity of the new fluoroketolide solithromycin (CEM-101) against a large collection of clinical Neisseria gonorrhoeae isolates and international reference strains, including those with high-level antimicrobial resistance: potential treatment option for gonorrhea? Antimicrob Agents Chemother. 2012;56:2739-42.
PubMed Abstract»
Gratrix J, Bergman J, Egan C, Drews SJ, Read R, Singh AE. Retrospective review of pharyngeal gonorrhea treatment failures in Alberta, Canada. Sex Transm Dis. 2013;40:877-9.
PubMed Abstract»
Handsfield HH, Dalu ZA, Martin DH, Douglas JM Jr, McCarty JM, Schlossberg D. Multicenter trial of single-dose azithromycin vs. ceftriaxone in the treatment of uncomplicated gonorrhea. Azithromycin Gonorrhea Study Group. Sex Transm Dis. 1994;21:107-11.
PubMed Abstract»
Hjelmevoll SO, Olsen ME, Sollid JU, et al. Appropriate time for test-of-cure when diagnosing gonorrhoea with a nucleic acid amplification test. Acta Derm Venereol. 2012;92:316-9.
PubMed Abstract»
Hook EW 3rd, Behets F, Van Damme K, et al. A phase III equivalence trial of azithromycin versus benzathine penicillin for treatment of early syphilis. J Infect Dis. 2010;201:1729-35.
PubMed Abstract»
Hosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis. 2009;36:478-89.
PubMed Abstract»
Johnson RE, Newhall WJ, Papp JR, et al. Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections--2002. MMWR Recomm Rep. 2002;51:1-38.
PubMed Abstract»
Jones RN, Biedenbach DJ, Ambrose PG, Wikler MA. Zabofloxacin (DW-224a) activity against Neisseria gonorrhoeae including quinolone-resistant strains. Diagn Microbiol Infect Dis. 2008;62:110-2.
PubMed Abstract»
Jones RN, Fritsche TR, Sader HS. Antimicrobial activity of DC-159a, a new fluoroquinolone, against 1,149 recently collected clinical isolates. Antimicrob Agents Chemother. 2008;52:3763-75.
PubMed Abstract»
Katz AR, Komeya AY, Soge OO, et al. Neisseria gonorrhoeae with high-level resistance to azithromycin: case report of the first isolate identified in the United States. Clin Infect Dis. 2012;54:841-3.
PubMed Abstract»
Khosropour CM, Dombrowski JC, Barbee LA, Manhart LE, Golden MR. Comparing azithromycin and doxycycline for the treatment of rectal chlamydial infection: a retrospective cohort study. Sex Transm Dis. 2014;41:79-85.
PubMed Abstract»
Kidd S, Kirkaldy R, Ye T, Papp J, Trees D, Shapiro SJ. Cephalosporin-resistant Neisseria gonorrhoeae public health response plan.
CDC»
Kirkcaldy RD, Bolan GA, Wasserheit JN. Cephalosporin-resistant gonorrhea in North America. JAMA. 2013;309:185-7.
PubMed Abstract»
Kirkcaldy RD, Hook EW 3rd, Soge OO, et al. Trends in Neisseria gonorrhoeae Susceptibility to Cephalosporins in the United States, 2006-2014. JAMA. 2015;314:1869-71.
PubMed Abstract»
Kirkcaldy RD, Kidd S, Weinstock HS, Papp JR, Bolan GA. Trends in antimicrobial resistance in Neisseria gonorrhoeae in the USA: the Gonococcal Isolate Surveillance Project (GISP), January 2006-June 2012. Sex Transm Infect. 2013;89 Suppl 4:iv5-10.
PubMed Abstract»
Kissinger PJ, Reilly K, Taylor SN, Leichliter JS, Rosenthal S, Martin DH. Early repeat Chlamydia trachomatis and Neisseria gonorrhoeae infections among heterosexual men. Sex Transm Dis. 2009;36:498-500.
PubMed Abstract»
Kong FY, Tabrizi SN, Fairley CK, et al. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother. 2015;70:1290-7.
PubMed Abstract»
Kong FY, Tabrizi SN, Law M, et al. Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials. Clin Infect Dis. 2014;59:193-205.
PubMed Abstract»
Lafferty WE, Hughes JP, Handsfield HH. Sexually transmitted diseases in men who have sex with men. Acquisition of gonorrhea and nongonococcal urethritis by fellatio and implications for STD/HIV prevention. Sex Transm Dis. 1997;24:272-8.
PubMed Abstract»
Laga M, Meheus A, Piot P. Epidemiology and control of gonococcal ophthalmia neonatorum. Bull World Health Organ. 1989;67:471-7.
PubMed Abstract»
Lauderdale TL, Shiau YR, Lai JF, Chen HC, King CH. Comparative in vitro activities of nemonoxacin (TG-873870), a novel nonfluorinated quinolone, and other quinolones against clinical isolates. Antimicrob Agents Chemother. 2010;54:1338-42.
PubMed Abstract»
LeFevre ML; U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:902-10.
PubMed Abstract»
Lewis DA. New treatment options for Neisseria gonorrhoeae in the era of emerging antimicrobial resistance. Sex Health. 2019;16:449-56.
PubMed Abstract»
Linhart Y, Shohat T, Amitai Z, et al. Sexually transmitted infections among brothel-based sex workers in Tel-Aviv area, Israel: high prevalence of pharyngeal gonorrhoea. Int J STD AIDS. 2008;19:656-9.
PubMed Abstract»
Lo JY, Ho KM, Leung AO, et al. Ceftibuten resistance and treatment failure of Neisseria gonorrhoeae infection. Antimicrob Agents Chemother. 2008;52:3564-7.
PubMed Abstract»
Lo JY, Ho KM, Lo AC. Surveillance of gonococcal antimicrobial susceptibility resulting in early detection of emerging resistance. J Antimicrob Chemother. 2012;67:1422-6.
PubMed Abstract»
Lyss SB, Kamb ML, Peterman TA, et al. Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States. Ann Intern Med. 2003;139:178-85.
PubMed Abstract»
MacDonald N, Mailman T, Desai S. Gonococcal infections in newborns and in adolescents. Adv Exp Med Biol. 2008;609:108-30.
PubMed Abstract»
Manavi K, Zafar F, Shahid H. Oropharyngeal gonorrhoea: rate of co-infection with sexually transmitted infection, antibiotic susceptibility and treatment outcome. Int J STD AIDS. 2010;21:138-40.
PubMed Abstract»
Marcus JL, Kohn RP, Barry PM, Philip SS, Bernstein KT. Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the female oropharynx to the male urethra. Sex Transm Dis. 2011;38:372-3.
PubMed Abstract»
Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. 2007;44 Suppl 3:S102-10.
PubMed Abstract»
Mayer KH, Klausner JD, Handsfield HH. Intersecting epidemics and educable moments: sexually transmitted disease risk assessment and screening in men who have sex with men. Sex Transm Dis. 2001;28:464-7.
PubMed Abstract»
McLean CA, Wang SA, Hoff GL, et al. The emergence of Neisseria gonorrhoeae with decreased susceptibility to Azithromycin in Kansas City, Missouri, 1999 to 2000. Sex Transm Dis. 2004;31:73-8.
PubMed Abstract»
McMillan A, Young H. The treatment of pharyngeal gonorrhoea with a single oral dose of cefixime. Int J STD AIDS. 2007;18:253-4.
PubMed Abstract»
Miller WC, Ford CA, Morris M, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. 2004;291:2229-36.
PubMed Abstract»
Mimiaga MJ, Mayer KH, Reisner SL, et al. Asymptomatic gonorrhea and chlamydial infections detected by nucleic acid amplification tests among Boston area men who have sex with men. Sex Transm Dis. 2008;35:495-8.
PubMed Abstract»
Moncada J, Schachter J, Liska S, Shayevich C, Klausner JD. Evaluation of self-collected glans and rectal swabs from men who have sex with men for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by use of nucleic acid amplification tests. J Clin Microbiol. 2009;47:1657-62.
PubMed Abstract»
Moran JS, Levine WC. Drugs of choice for the treatment of uncomplicated gonococcal infections. Clin Infect Dis. 1995;20 Suppl 1:S47-65.
PubMed Abstract»
Muratani T, Akasaka S, Kobayashi T, et al. Outbreak of cefozopran (penicillin, oral cephems, and aztreonam)-resistant Neisseria gonorrhoeae in Japan. Antimicrob Agents Chemother. 2001;45:3603-6.
PubMed Abstract»
Nathawad R, Mendez H, Ahmad A, et al. Severe ocular reactions after neonatal ocular prophylaxis with gentamicin ophthalmic ointment. Pediatr Infect Dis J. 2011;30:175-6.
PubMed Abstract»
Nettleton WD, Kent JB, Macomber K, et al. Notes from the field: ongoing cluster of highly related disseminated gonococcal infections - Southwest Michigan, 2019. MMWR Morb Mortal Wkly Rep. 2020;69:353-4.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Palmer HM, Young H, Winter A, Dave J. Emergence and spread of azithromycin-resistant Neisseria gonorrhoeae in Scotland. J Antimicrob Chemother. 2008;62:490-4.
PubMed Abstract»
Park MA, Koch CA, Klemawesch P, Joshi A, Li JT. Increased adverse drug reactions to cephalosporins in penicillin allergy patients with positive penicillin skin test. Int Arch Allergy Immunol. 2010;153:268-73.
PubMed Abstract»
Peterman TA, Tian LH, Metcalf CA, et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med. 2006;145:564-72.
PubMed Abstract»
Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol Head Neck Surg. 2007;136:340-7.
PubMed Abstract»
Putnam SD, Castanheira M, Moet GJ, Farrell DJ, Jones RN. CEM-101, a novel fluoroketolide: antimicrobial activity against a diverse collection of Gram-positive and Gram-negative bacteria. Diagn Microbiol Infect Dis. 2010;66:393-401.
PubMed Abstract»
Riedner G, Rusizoka M, Todd J, et al. Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med. 2005;353:1236-44.
PubMed Abstract»
Sathia L, Ellis B, Phillip S, Winston A, Smith A. Pharyngeal gonorrhoea - is dual therapy the way forward? Int J STD AIDS. 2007;18:647-8.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Scangarella-Oman NE, Hossain M, Dixon PB, et al. Microbiological Analysis from a Phase 2 Randomized Study in Adults Evaluating Single Oral Doses of Gepotidacin in the Treatment of Uncomplicated Urogenital Gonorrhea Caused by Neisseria gonorrhoeae. Antimicrob Agents Chemother. 2018:62(12).pii: e01221-18.
PubMed Abstract»
Schwarcz SK, Zenilman JM, Schnell D, et al. National surveillance of antimicrobial resistance in Neisseria gonorrhoeae. The Gonococcal Isolate Surveillance Project. JAMA. 1990;264:1413-7.
PubMed Abstract»
Scott WJ, Eck CD. Povidone-iodine and ophthalmia neonatorum. Ophthalmology. 2012;119:653-4; author reply 654.
PubMed Abstract»
Shafer WM, Folster JP. Towards an understanding of chromosomally mediated penicillin resistance in Neisseria gonorrhoeae: evidence for a porin-efflux pump collaboration. J Bacteriol. 2006;188:2297-9.
PubMed Abstract»
Soge OO, Harger D, Schafer S, et al. Emergence of increased azithromycin resistance during unsuccessful treatment of Neisseria gonorrhoeae infection with azithromycin (Portland, OR, 2011). Sex Transm Dis. 2012;39:877-9.
PubMed Abstract»
Starnino S, Stefanelli P. Azithromycin-resistant Neisseria gonorrhoeae strains recently isolated in Italy. J Antimicrob Chemother. 2009;63:1200-4.
PubMed Abstract»
Steingrimsson O, Olafsson JH, Thorarinsson H, Ryan RW, Johnson RB, Tilton RC. Azithromycin in the treatment of sexually transmitted disease. J Antimicrob Chemother. 1990;25 Suppl A:109-14.
PubMed Abstract»
Swanston WH, Prabhakar P, Barrow L, Mahabir BS, Furlonge C. Single dose (direct observed) azithromycin therapy for Neisseria gonorrhoeae and Chlamydia trachomatis in STD clinic attenders with genital discharge in Trinidad and Tobago. West Indian Med J. 2001;50:198-202.
PubMed Abstract»
Tapsall JW, Shultz TR, Limnios EA, Donovan B, Lum G, Mulhall BP. Failure of azithromycin therapy in gonorrhea and discorrelation with laboratory test parameters. Sex Transm Dis. 1998;25:505-8.
PubMed Abstract»
Tapsall JW. Neisseria gonorrhoeae and emerging resistance to extended spectrum cephalosporins. Curr Opin Infect Dis. 2009;22:87-91.
PubMed Abstract»
Trelle S, Shang A, Nartey L, Cassell JA, Low N. Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review. BMJ. 2007;334:354.
PubMed Abstract»
U.S. Food and Drug Administration: FDA News Release. FDA allows for first point-of-care Chlamydia and Gonorrhea test to be used in more near-patient care settings. FDA news release. March 30, 2021.
U.S. FDA»
U.S. Food and Drug Administration. FDA clears first diagnostic tests for extragenital testing for chlamydia and gonorrhea. FDA news release. May 23, 2019.
U.S. FDA»
Unemo M, Golparian D, Limnios A, et al. In vitro activity of ertapenem versus ceftriaxone against Neisseria gonorrhoeae isolates with highly diverse ceftriaxone MIC values and effects of ceftriaxone resistance determinants: ertapenem for treatment of gonorrhea? Antimicrob Agents Chemother. 2012;56:3603-9.
PubMed Abstract»
Unemo M, Nicholas RA. Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea. Future Microbiol. 2012;7:1401-22.
PubMed Abstract»
Unemo M, Seifert HS, Hook EW 3rd, Hawkes S, Ndowa F, Dillon JR. Gonorrhoea. Nat Rev Dis Primers. 2019;5:79.
PubMed Abstract»
Unemo M, Shafer WM. Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future. Ann N Y Acad Sci. 2011;1230:E19-28.
PubMed Abstract»
Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27:587-613.
PubMed Abstract»
Van Der Pol B, Taylor SN, Mena L, et al. Evaluation of the Performance of a Point-of-Care Test for Chlamydia and Gonorrhea. JAMA Netw Open. 2020;3:e204819.
PubMed Abstract»
Wade JJ, Graver MA. Survival of six auxotypes of Neisseria gonorrhoeae in transport media. J Clin Microbiol. 2003;41:1720-1.
PubMed Abstract»
Wang SA, Harvey AB, Conner SM, et al. Antimicrobial resistance for Neisseria gonorrhoeae in the United States, 1988 to 2003: the spread of fluoroquinolone resistance. Ann Intern Med. 2007;147:81-8.
PubMed Abstract»
Waters LJ, Boag FC, Betournay R. Efficacy of azithromycin 1 g single dose in the management of uncomplicated gonorrhoea. Int J STD AIDS. 2005;16:84.
PubMed Abstract»
Waugh MA. Open study of the safety and efficacy of a single oral dose of azithromycin for the treatment of uncomplicated gonorrhoea in men and women. J Antimicrob Chemother. 1993;31 Suppl E:193-8.
PubMed Abstract»
Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6-10.
PubMed Abstract»
Weinstock H, Workowski KA. Pharyngeal gonorrhea: an important reservoir of infection? Clin Infect Dis. 2009;49:1798-800.
PubMed Abstract»
Wiesner PJ, Tronca E, Bonin P, Pedersen AH, Holmes KK. Clinical spectrum of pharyngeal gonococcal infection. N Engl J Med. 1973;288:181-5.
PubMed Abstract»
Wind CM, Schim van der Loeff MF, Unemo M, Schuurman R, van Dam AP, de Vries HJ. Test of Cure for Anogenital Gonorrhoea Using Modern RNA-Based and DNA-Based Nucleic Acid Amplification Tests: A Prospective Cohort Study. Clin Infect Dis. 2016;62:1348-55.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: adolescents. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: children. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: men who have sex with men (MSM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: persons in correctional facilities. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: pregnant women. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: transgender and gender diverse persons. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: women who have sex with women (WSW) and women who have sex with women and men (WSWM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Gonococcal infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs: adolescents and adults. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Berman SM, Douglas JM Jr. Emerging antimicrobial resistance in Neisseria gonorrhoeae: urgent need to strengthen prevention strategies. Ann Intern Med. 2008;148:606-13.
PubMed Abstract»
Young H, Moyes A, McMillan A. Azithromycin and erythromycin resistant Neisseria gonorrhoeae following treatment with azithromycin. Int J STD AIDS. 1997;8:299-302.
PubMed Abstract»
Yu RX, Yin Y, Wang GQ, et al. Worldwide susceptibility rates of Neisseria gonorrhoeae isolates to cefixime and cefpodoxime: a systematic review and meta-analysis. PLoS One. 2014;9:e87849.
PubMed Abstract»

Lesson 3. Syphilis

Module 2 » Lesson 3. Syphilis

Introduction

Ghanem KG, Ram S, Rice PA. The Modern Epidemic of Syphilis. N Engl J Med. 2020;382:845-54.
PubMed Abstract»
Ho EL, Lukehart SA. Syphilis: using modern approaches to understand an old disease. J Clin Invest. 2011;121:4584-92.
PubMed Abstract»
Hook EW 3rd, Marra CM. Acquired syphilis in adults. N Engl J Med. 1992;326:1060-9.
PubMed Abstract»
Hook EW Rd. Syphilis. Lancet. 2017;389:1550-7.
PubMed Abstract»
Medoro AK, Sánchez PJ. Syphilis in Neonates and Infants. Clin Perinatol. 2021;48:293-309.
PubMed Abstract»
Peeling RW, Mabey D, Kamb ML, Chen XS, Radolf JD, Benzaken AS. Syphilis. Nat Rev Dis Primers. 2017;3:17073.
PubMed Abstract»
Peeling RW, Ye H. Diagnostic tools for preventing and managing maternal and congenital syphilis: an overview. Bull World Health Organ. 2004;82:439-46.
PubMed Abstract»
Rac MW, Revell PA, Eppes CS. Syphilis during pregnancy: a preventable threat to maternal-fetal health. Am J Obstet Gynecol. 2017;216:352-363.
PubMed Abstract»
Rac MW, Revell PA, Eppes CS. Syphilis during pregnancy: a preventable threat to maternal-fetal health. Am J Obstet Gynecol. 2017;216:352-63.
PubMed Abstract»
Module 2 » Lesson 3. Syphilis

Epidemiology in the United States

Cantor AG, Pappas M, Daeges M, Nelson HD. Screening for Syphilis: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;315:2328-37.
PubMed Abstract»
CDC, National Center for HIV, STD and TB Prevention, Division of STD Prevention. The national plan to eliminate syphilis from the United States. Atlanta (GA): CDC, 1999.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2020. Syphilis. Atlanta: U.S. Department of Health and Human Services; April 2022.
CDC STD Surveillance»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2022. Atlanta: U.S. Department of Health and Human Services; April 2024.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Syphilis. Atlanta: U.S. Department of Health and Human Services; September 2018.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Syphilis. Atlanta: U.S. Department of Health and Human Services; October 2019.
CDC»
Chesson HW, Spicknall IH, Bingham A, et al. The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018. Sex Transm Dis. 2021;48:215-21.
PubMed Abstract»
Katz DA, Dombrowski JC, Bell TR, Kerani RP, Golden MR. HIV incidence among men who have sex with men After diagnosis with sexually transmitted infections. Sex Transm Dis. 2016;43:249-54.
PubMed Abstract»
Kidd SE, Grey JA, Torrone EA, Weinstock HS. Increased Methamphetamine, Injection Drug, and Heroin Use Among Women and Heterosexual Men with Primary and Secondary Syphilis - United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019;68:144-8.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Pathela P, Braunstein SL, Blank S, Shepard C, Schillinger JA. The high risk of an HIV diagnosis following a diagnosis of syphilis: a population-level analysis of New York City men. Clin Infect Dis. 2015;61:281-7.
PubMed Abstract»
Peterman TA, Su J, Bernstein KT, Weinstock H. Syphilis in the United States: on the rise? Expert Rev Anti Infect Ther. 2015;13:161-8.
PubMed Abstract»
Spicknall IH, Kreisel KM, Weinstock HS. Estimates of the Prevalence and Incidence of Syphilis in the United States, 2018. Sex Transm Dis. 2021;48:247-52.
PubMed Abstract»
Taylor MM, Aynalem G, Smith LV, Montoya J, Kerndt P. Methamphetamine use and sexual risk behaviours among men who have sex with men diagnosed with early syphilis in Los Angeles County. Int J STD AIDS. 2007;18:93-7.
PubMed Abstract»
US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, et al. Screening for Syphilis Infection in Nonpregnant Adults and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315:2321-7.
PubMed Abstract»
Module 2 » Lesson 3. Syphilis

Microbiology, Pathogenesis, and Transmission

Adegoke AO, Akanni O, Dirisu J. Risk of transfusion-transmitted syphilis in a tertiary hospital in Nigeria. N Am J Med Sci. 2011;3:78-81.
PubMed Abstract»
Edmondson DG, Hu B, Norris SJ. Long-Term In Vitro Culture of the Syphilis Spirochete Treponema pallidum subsp. pallidum. mBio. 2018;9:e01153-18.
PubMed Abstract»
Edmondson DG, Norris SJ. In Vitro Cultivation of the Syphilis Spirochete Treponema pallidum. Curr Protoc. 2021;1:e44.
PubMed Abstract»
Fraser CM, Norris SJ, Weinstock GM, et al. Complete genome sequence of Treponema pallidum, the syphilis spirochete. Science. 1998;281:375-88.
PubMed Abstract»
Hook EW Rd. Syphilis. Lancet. 2017;389:1550-7.
PubMed Abstract»
Izard J, Renken C, Hsieh CE, et al. Cryo-electron tomography elucidates the molecular architecture of Treponema pallidum, the syphilis spirochete. J Bacteriol. 2009;191:7566-80.
PubMed Abstract»
Lafond RE, Lukehart SA. Biological basis for syphilis. Clin Microbiol Rev. 2006;19:29-49.
PubMed Abstract»
Medoro AK, Sánchez PJ. Syphilis in Neonates and Infants. Clin Perinatol. 2021;48:293-309.
PubMed Abstract»
Peeling RW, Mabey D, Kamb ML, Chen XS, Radolf JD, Benzaken AS. Syphilis. Nat Rev Dis Primers. 2017;3:17073.
PubMed Abstract»
Phan A, Romeis E, Tantalo L, Giacani L. In vitro Transformation and Selection of Treponema pallidum subsp. pallidum. Curr Protoc. 2022;2:e507.
PubMed Abstract»
Module 2 » Lesson 3. Syphilis

Clinical Manifestations

Baughn RE, Musher DM. Secondary syphilitic lesions. Clin Microbiol Rev. 2005;18:205-16.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2020. Syphilis. Atlanta: U.S. Department of Health and Human Services; April 2022.
CDC STD Surveillance»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Syphilis. Atlanta: U.S. Department of Health and Human Services; October 2019.
CDC»
Chahine LM, Khoriaty RN, Tomford WJ, Hussain MS. The changing face of neurosyphilis. Int J Stroke. 2011;6:136-43.
PubMed Abstract»
Chapel TA. The variability of syphilitic chancres. Sex Transm Dis. 1978;5:68-70.
PubMed Abstract»
Cremin BJ, Fisher RM. The lesions of congenital syphilis. Br J Radiol. 1970;43:333-41.
PubMed Abstract»
Crissey JT, Denenholz DA. Syphilis. Clin Dermatol. 1984;2:1-166.
PubMed Abstract»
Fiumara NJ, Lessell S. Manifestations of late congenital syphilis. An analysis of 271 patients. Arch Dermatol. 1970;102:78-83.
PubMed Abstract»
French P. Syphilis. BMJ. 2007;334:143-7.
PubMed Abstract»
Ghanem KG, Ram S, Rice PA. The Modern Epidemic of Syphilis. N Engl J Med. 2020;382:845-54.
PubMed Abstract»
Ghanem KG. Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2015;61 Suppl 8:S818-36.
PubMed Abstract»
Ho EL, Lukehart SA. Syphilis: using modern approaches to understand an old disease. J Clin Invest. 2011;121:4584-92.
PubMed Abstract»
Hook EW 3rd, Marra CM. Acquired syphilis in adults. N Engl J Med. 1992;326:1060-9.
PubMed Abstract»
Hook EW 3rd, Roddy RE, Handsfield HH. Ceftriaxone therapy for incubating and early syphilis. J Infect Dis. 1988;158:881-4.
PubMed Abstract»
Hook EW Rd. Syphilis. Lancet. 2017;389:1550-7.
PubMed Abstract»
Lafond RE, Lukehart SA. Biological basis for syphilis. Clin Microbiol Rev. 2006;19:29-49.
PubMed Abstract»
Lautenschlager S. Cutaneous manifestations of syphilis: recognition and management. Am J Clin Dermatol. 2006;7:291-304.
PubMed Abstract»
Lukehart SA, Hook EW 3rd, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med. 1988;109:855-62.
PubMed Abstract»
Marra CM. Neurosyphilis. Continuum (Minneap Minn). 2015;21:1714-28.
PubMed Abstract»
Marra CM. Update on neurosyphilis. Curr Infect Dis Rep. 2009;11:127-34.
PubMed Abstract»
Marx GE, Dhanireddy S, Marrazzo JM, et al. Variations in clinical presentation of ocular syphilis: case series reported from a growing epidemic in the United States. Sex Transm Dis. 2016;43:519-23.
PubMed Abstract»
Medoro AK, Sánchez PJ. Syphilis in Neonates and Infants. Clin Perinatol. 2021;48:293-309.
PubMed Abstract»
Moradi A, Salek S, Daniel E, et al. Clinical features and incidence rates of ocular complications in patients with ocular syphilis. Am J Ophthalmol. 2015;159:334-43.e1.
PubMed Abstract»
Oliver S, Sahi SK, Tantalo LC, et al. Molecular typing of Treponema pallidum in ocular syphilis. Sex Transm Dis. 2016;43:524-7.
PubMed Abstract»
Peeling RW, Mabey D, Kamb ML, Chen XS, Radolf JD, Benzaken AS. Syphilis. Nat Rev Dis Primers. 2017;3:17073.
PubMed Abstract»
Rac MW, Revell PA, Eppes CS. Syphilis during pregnancy: a preventable threat to maternal-fetal health. Am J Obstet Gynecol. 2017;216:352-363.
PubMed Abstract»
Rac MW, Revell PA, Eppes CS. Syphilis during pregnancy: a preventable threat to maternal-fetal health. Am J Obstet Gynecol. 2017;216:352-63.
PubMed Abstract»
Ramchandani MS, Litvack JR, Marra CM. Otosyphilis: A Review of the Literature. Sex Transm Dis. 2020;47:296-300.
PubMed Abstract»
Rathbun KC. Congenital syphilis. Sex Transm Dis. 1983;10:93-9.
PubMed Abstract»
Rolfs RT, Joesoef MR, Hendershot EF, et al. A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group. N Engl J Med. 1997;337:307-14.
PubMed Abstract»
Singh AE, Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev. 1999;12:187-209.
PubMed Abstract»
Spoor TC, Wynn P, Hartel WC, Bryan CS. Ocular syphilis. Acute and chronic. J Clin Neuroophthalmol. 1983;3:197-203.
PubMed Abstract»
Theeuwen H, Whipple M, Litvack JR. Otosyphilis: Resurgence of an Old Disease. Laryngoscope. 2019;129:1680-4.
PubMed Abstract»
Towns JM, Leslie DE, Denham I, Azzato F, Fairley CK, Chen M. Painful and multiple anogenital lesions are common in men with Treponema pallidum PCR-positive primary syphilis without herpes simplex virus coinfection: a cross-sectional clinic-based study. Sex Transm Infect. 2016;92:110-5.
PubMed Abstract»
Watts PJ, Greenberg HL, Khachemoune A. Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations. Int J Dermatol. 2016;55:714-28.
PubMed Abstract»
Woolston S, Cohen SE, Fanfair RN, Lewis SC, Marra CM, Golden MR. A cluster of ocular syphilis cases - Seattle, Washington, and San Francisco, California, 2014-2015. MMWR Morb Mortal Wkly Rep. 2015;64:1150-1.
PubMed Abstract»
Woolston SL, Dhanireddy S, Marrazzo J. Ocular syphilis: a clinical review. Curr Infect Dis Rep. 2016;18:36.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Syphilis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 3. Syphilis

Laboratory Diagnosis

Association of Public Health Laboratories (APHL) and Centers for Disease Control and Prevention (CDC). Laboratory diagnostic testing for Treponema pallidum, Expert Consultation Meeting Summary Report, January 13-15, 2009, Atlanta, GA.
CDC and APHL»
Centers for Disease Control and Prevention (CDC). Discordant results from reverse sequence syphilis screening--five laboratories, United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011;60:133-7.
PubMed Abstract»
el-Zaatari MM, Martens MG, Anderson GD. Incidence of the prozone phenomenon in syphilis serology. Obstet Gynecol. 1994;84:609-12.
PubMed Abstract»
Geisler WM. The prozone phenomenon in syphilis testing. South Med J. 2004;97:327-8.
PubMed Abstract»
Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA. 2003;290:1510-4.
PubMed Abstract»
Jurado RL, Campbell J, Martin PD. Prozone phenomenon in secondary syphilis. Has its time arrived? Arch Intern Med. 1993;153:2496-8.
PubMed Abstract»
Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev. 1995;8:1-21.
PubMed Abstract»
Marra CM, Maxwell CL, Smith SL, et al. Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis. 2004;189:369-76.
PubMed Abstract»
Marra CM, Tantalo LC, Maxwell CL, Ho EL, Sahi SK, Jones T. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis. Sex Transm Dis. 2012;39:453-7.
PubMed Abstract»
Marra CM. Neurosyphilis. Continuum (Minneap Minn). 2015;21:1714-28.
PubMed Abstract»
Marra CM. Update on neurosyphilis. Curr Infect Dis Rep. 2009;11:127-34.
PubMed Abstract»
Nandwani R, Evans DT. Are you sure it's syphilis? A review of false positive serology. Int J STD AIDS. 1995;6:241-8.
PubMed Abstract»
Peeling RW, Mabey D, Kamb ML, Chen XS, Radolf JD, Benzaken AS. Syphilis. Nat Rev Dis Primers. 2017;3:17073.
PubMed Abstract»
Peeling RW, Ye H. Diagnostic tools for preventing and managing maternal and congenital syphilis: an overview. Bull World Health Organ. 2004;82:439-46.
PubMed Abstract»
Ratnam S. The laboratory diagnosis of syphilis. Can J Infect Dis Med Microbiol. 2005;16:45-51.
PubMed Abstract»
Romanowski B, Sutherland R, Fick GH, Mooney D, Love EJ. Serologic response to treatment of infectious syphilis. Ann Intern Med. 1991;114:1005-9.
PubMed Abstract»
Satyaputra F, Hendry S, Braddick M, Sivabalan P, Norton R. The laboratory diagnosis of Syphilis. J Clin Microbiol. 2021 May 12. Online ahead of print.
PubMed Abstract»
Seña AC, White BL, Sparling PF. Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century. Clin Infect Dis. 2010;51:700-8.
PubMed Abstract»
Seña AC, Wolff M, Behets F, et al. Rate of Decline in Nontreponemal Antibody Titers and Seroreversion After Treatment of Early Syphilis. Sex Transm Dis. 2017;44:6-10.
PubMed Abstract»
Tuddenham S, Katz SS, Ghanem KG. Syphilis Laboratory Guidelines: Performance Characteristics of Nontreponemal Antibody Tests. Clin Infect Dis. 2020;71:S21-S42.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Syphilis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 3. Syphilis

Screening for Syphilis

Cantor AG, Pappas M, Daeges M, Nelson HD. Screening for Syphilis: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;315:2328-37.
PubMed Abstract»
Hollier LM, Hill J, Sheffield JS, Wendel GD Jr. State laws regarding prenatal syphilis screening in the United States. Am J Obstet Gynecol. 2003;189:1178-83.
PubMed Abstract»
U.S. Preventive Services Task Force. Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:705-9.
PubMed Abstract»
US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, et al. Screening for Syphilis Infection in Nonpregnant Adults and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315:2321-7.
PubMed Abstract»
Wolff T, Shelton E, Sessions C, Miller T. Screening for syphilis infection in pregnant women: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:710-6.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: men who have sex with men (MSM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: persons in correctional facilities. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: pregnant women. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: transgender and gender diverse persons. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Special populations. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Syphilis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 3. Syphilis

Treatment

Brown ST. Adverse reactions in syphilis therapy. J Am Vener Dis Assoc. 1976;3:172-6.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Inadvertent use of Bicillin C-R to treat syphilis infection--Los Angeles, California, 1999-2004. MMWR Morb Mortal Wkly Rep. 2005;54:217-9.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Symptomatic early neurosyphilis among HIV-positive men who have sex with men--four cities, United States, January 2002-June 2004. MMWR Morb Mortal Wkly Rep. 2007;56:625-8.
PubMed Abstract»
Cousins DE, Taylor M, Lee V. The outcome of treatment of early syphilis with different benzathine penicillin regimens in HIV-infected and -uninfected patients. Int J STD AIDS. 2012;23:632-4.
PubMed Abstract»
Gadde J, Spence M, Wheeler B, Adkinson NF Jr. Clinical experience with penicillin skin testing in a large inner-city STD clinic. JAMA. 1993;270:2456-63.
PubMed Abstract»
Ghanem KG, Erbelding EJ, Cheng WW, Rompalo AM. Doxycycline compared with benzathine penicillin for the treatment of early syphilis. Clin Infect Dis. 2006;42:e45-9.
PubMed Abstract»
Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Neurosyphilis in a clinical cohort of HIV-1-infected patients. AIDS. 2008;22:1145-51.
PubMed Abstract»
Ghanem KG. Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2015;61 Suppl 8:S818-36.
PubMed Abstract»
Hook EW 3rd, Roddy RE, Handsfield HH. Ceftriaxone therapy for incubating and early syphilis. J Infect Dis. 1988;158:881-4.
PubMed Abstract»
Hook EW Rd. Syphilis. Lancet. 2017;389:1550-7.
PubMed Abstract»
Lukehart SA, Godornes C, Molini BJ, et al. Macrolide resistance in Treponema pallidum in the United States and Ireland. N Engl J Med. 2004;351:154-8.
PubMed Abstract»
Marra CM, Maxwell CL, Tantalo LC, Sahi SK, Lukehart SA. Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis. Clin Infect Dis. 2008;47:893-9.
PubMed Abstract»
Marra CM. Update on neurosyphilis. Curr Infect Dis Rep. 2009;11:127-34.
PubMed Abstract»
Mitchell SJ, Engelman J, Kent CK, Lukehart SA, Godornes C, Klausner JD. Azithromycin-resistant syphilis infection: San Francisco, California, 2000-2004. Clin Infect Dis. 2006;42:337-45.
PubMed Abstract»
Nathan L, Bawdon RE, Sidawi JE, Stettler RW, McIntire DM, Wendel GD Jr. Penicillin levels following the administration of benzathine penicillin G in pregnancy. Obstet Gynecol. 1993;82:338-42.
PubMed Abstract»
Novalbos A, Sastre J, Cuesta J, et al. Lack of allergic cross-reactivity to cephalosporins among patients allergic to penicillins. Clin Exp Allergy. 2001;31:438-43.
PubMed Abstract»
Rolfs RT, Joesoef MR, Hendershot EF, et al. A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group. N Engl J Med. 1997;337:307-14.
PubMed Abstract»
Shann S, Wilson J. Treatment of neurosyphilis with ceftriaxone. Sex Transm Infect. 2003;79:415-6.
PubMed Abstract»
Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019;321:188-99.
PubMed Abstract»
Wong T, Singh AE, De P. Primary syphilis: serological treatment response to doxycycline/tetracycline versus benzathine penicillin. Am J Med. 2008;121:903-8.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Syphilis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Xiao Y, Tong ML, Lin LR, et al. Serological response predicts normalization of cerebrospinal fluid abnormalities at six months after treatment in HIV-negative neurosyphilis patients. Sci Rep. 2017;7:9911.
PubMed Abstract»
Module 2 » Lesson 3. Syphilis

Post-Treatment Follow Up

Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA. 2014;312:1905-17.
PubMed Abstract»
Ghanem KG, Hook EW 3rd. The terms "serofast" and "serological nonresponse" in the modern syphilis era. Sex Transm Dis. 2021;48:451-2.
PubMed Abstract»
Seña AC, Wolff M, Behets F, et al. Response to therapy following retreatment of serofast early syphilis patients with benzathine penicillin. Clin Infect Dis. 2013;56:420-2.
PubMed Abstract»
Seña AC, Wolff M, Martin DH, et al. Predictors of serological cure and Serofast State after treatment in HIV-negative persons with early syphilis. Clin Infect Dis. 2011;53:1092-9.
PubMed Abstract»
Seña AC, Zhang XH, Li T, et al. A systematic review of syphilis serological treatment outcomes in HIV-infected and HIV-uninfected persons: rethinking the significance of serological non-responsiveness and the serofast state after therapy. BMC Infect Dis. 2015;15:479.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Zhang X, Shahum A, Yang LG, et al. Outcomes From Re-Treatment and Cerebrospinal Fluid Analyses in Patients With Syphilis Who Had Serological Nonresponse or Lack of Seroreversion After Initial Therapy. Sex Transm Dis. 2021;48:443-50.
PubMed Abstract»

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Ghanem KG, Erbelding EJ, Wiener ZS, Rompalo AM. Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics. Sex Transm Infect. 2007;83:97-101.
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Kidd S, Bowen VB, Torrone EA, Bolan G. Use of National Syphilis Surveillance Data to Develop a Congenital Syphilis Prevention Cascade and Estimate the Number of Potential Congenital Syphilis Cases Averted. Sex Transm Dis. 2018;45:S23-S28.
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Llata E, Braxton J, Asbel L, et al. New Human Immunodeficiency Virus Diagnoses Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics, STD Surveillance Network, January 2010 to June 2013. Sex Transm Dis. 2018;45:577-82.
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Macy E, Ngor EW. Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin, and oral amoxicillin. J Allergy Clin Immunol Pract. 2013;1:258-63.
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Macy E, Poon K-Y T. Self-reported antibiotic allergy incidence and prevalence: age and sex effects. Am J Med. 2009;122:778.e1-7.
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Marra CM, Boutin P, McArthur JC, et al. A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Clin Infect Dis. 2000;30:540-4.
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Marra CM, Maxwell CL, Tantalo L, et al. Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter? Clin Infect Dis. 2004;38:1001-6.
PubMed Abstract»
Matthias J, Dwiggins P, Totten Y, Blackmore C, Wilson C, Peterman TA. Notes from the Field: Evaluation of the Sensitivity and Specificity of a Commercially Available Rapid Syphilis Test - Escambia County, Florida, 2016. MMWR Morb Mortal Wkly Rep. 2016;65:1174-1175.
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Moorthy TT, Lee CT, Lim KB, Tan T. Ceftriaxone for treatment of primary syphilis in men: a preliminary study. Sex Transm Dis. 1987;14:116-8.
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Novalbos A, Sastre J, Cuesta J, et al. Lack of allergic cross-reactivity to cephalosporins among patients allergic to penicillins. Clin Exp Allergy. 2001;31:438-43.
PubMed Abstract»
Oliver SE, Aubin M, Atwell L, et al. Ocular syphilis - eight jurisdictions, United States, 2014-2015. MMWR Morb Mortal Wkly Rep. 2016;65:1185-1188.
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Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
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Park IU, Chow JM, Bolan G, Stanley M, Shieh J, Schapiro JM. Screening for syphilis with the treponemal immunoassay: analysis of discordant serology results and implications for clinical management. J Infect Dis. 2011;204:1297-304.
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Park M, Markus P, Matesic D, Li JT. Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy. Ann Allergy Asthma Immunol. 2006;97:681-7.
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Peterman TA, Heffelfinger JD, Swint EB, Groseclose SL. The changing epidemiology of syphilis. Sex Transm Dis. 2005;32:S4-10.
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Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol Head Neck Surg. 2007;136:340-7.
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Psomas KC, Brun M, Causse A, Atoui N, Reynes J, Le Moing V. Efficacy of ceftriaxone and doxycycline in the treatment of early syphilis. Med Mal Infect. 2012;42:15-9.
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Raja AS, Lindsell CJ, Bernstein JA, Codispoti CD, Moellman JJ. The use of penicillin skin testing to assess the prevalence of penicillin allergy in an emergency department setting. Ann Emerg Med. 2009;54:72-7.
PubMed Abstract»
Rescigno RJ, Glatman M, Patel SN. A complicated case of sarcoidosis. Neurosyphilis. JAMA Ophthalmol. 2014;132:649-50.
PubMed Abstract»
Riedner G, Rusizoka M, Todd J, et al. Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med. 2005;353:1236-44.
PubMed Abstract»
Romano A, Gaeta F, Valluzzi RL, Caruso C, Rumi G, Bousquet PJ. IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of penicillins, monobactams, and carbapenems. J Allergy Clin Immunol. 2010;126:994-9.
PubMed Abstract»
Rompalo AM, Joesoef MR, O'Donnell JA, et al. Clinical manifestations of early syphilis by HIV status and gender: results of the syphilis and HIV study. Sex Transm Dis. 2001;28:158-65.
PubMed Abstract»
Slutsker JS, Hennessy RR, Schillinger JA. Factors Contributing to Congenital Syphilis Cases - New York City, 2010-2016. MMWR Morb Mortal Wkly Rep. 2018;67:1088-1093.
PubMed Abstract»
Smith NH, Musher DM, Huang DB, et al. Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin. Int J STD AIDS. 2004;15:328-32.
PubMed Abstract»
Sogn DD, Evans R 3rd, Shepherd GM, et al. Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults. Arch Intern Med. 1992;152:1025-32.
PubMed Abstract»
Stamm LV. Global challenge of antibiotic-resistant Treponema pallidum. Antimicrob Agents Chemother. 2010;54:583-9.
PubMed Abstract»
Stoner BP. Current controversies in the management of adult syphilis. Clin Infect Dis. 2007;44 Suppl 3:S130-46.
PubMed Abstract»
Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and secondary syphilis among black and Hispanic men who have sex with men: case report data from 27 States. Ann Intern Med. 2011;155:145-51.
PubMed Abstract»
Trivedi S, Williams C, Torrone E, Kidd S. National Trends and Reported Risk Factors Among Pregnant Women With Syphilis in the United States, 2012-2016. Obstet Gynecol. 2019;133:27-32.
PubMed Abstract»
Tsai JC, Lin YH, Lu PL, et al. Comparison of serological response to doxycycline versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients: a multi-center observational study. PLoS One. 2014;9:e109813.
PubMed Abstract»
Vanhaecke C, Grange P, Benhaddou N, et al. Clinical and biological characteristics of 40 patients with neurosyphilis and evaluation of Treponema pallidum nested polymerase chain reaction in cerebrospinal fluid samples. Clin Infect Dis. 2016;63:1180-6.
PubMed Abstract»
Vega JM, Blanca M, García JJ, et al. Immediate allergic reactions to amoxicillin. Allergy. 1994;49:317-22.
PubMed Abstract»
Walker GJ. Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database Syst Rev. 2001;CD001143.
PubMed Abstract»
Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6-10.
PubMed Abstract»
Wendel GD Jr, Sheffield JS, Hollier LM, Hill JB, Ramsey PS, Sánchez PJ. Treatment of syphilis in pregnancy and prevention of congenital syphilis. Clin Infect Dis. 2002;35:S200-9.
PubMed Abstract»
Wendel GD Jr, Stark BJ, Jamison RB, Molina RD, Sullivan TJ. Penicillin allergy and desensitization in serious infections during pregnancy. N Engl J Med. 1985;312:1229-32.
PubMed Abstract»
Wong BB, Keith PK, Waserman S. Clinical history as a predictor of penicillin skin test outcome. Ann Allergy Asthma Immunol. 2006;97:169-74.
PubMed Abstract»
Wong EH, Klausner JD, Caguin-Grygiel G, et al. Evaluation of an IgM/IgG sensitive enzyme immunoassay and the utility of index values for the screening of syphilis infection in a high-risk population. Sex Transm Dis. 2011;38:528-32.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: men who have sex with men (MSM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: persons in correctional facilities. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: pregnant women. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: transgender and gender diverse persons. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: women who have sex with women (WSW) and women who have sex with women and men (WSWM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Syphilis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Yang CJ, Lee NY, Chen TC, et al. One dose versus three weekly doses of benzathine penicillin G for patients co-infected with HIV and early syphilis: a multicenter, prospective observational study. PLoS One. 2014;9:e109667.
PubMed Abstract»
Yang CJ, Tang HJ, Chang SY, et al. Comparison of serological responses to single-dose azithromycin (2 g) versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients in an area of low prevalence of macrolide-resistant Treponema pallidum infection. J Antimicrob Chemother. 2016;71:775-82.
PubMed Abstract»
Zetola NM, Klausner JD. Syphilis and HIV infection: an update. Clin Infect Dis. 2007;44:1222-8.
PubMed Abstract»
Zhu L, Qin M, Du L, Xie RH, Wong T, Wen SW. Maternal and congenital syphilis in Shanghai, China, 2002 to 2006. Int J Infect Dis. 2010;14 Suppl 3:e45-8.
PubMed Abstract»

Lesson 4. Genital Herpes

Module 2 » Lesson 4. Genital Herpes

Epidemiology in the United States

Bernstein DI, Bellamy AR, Hook EW 3rd, et al. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clin Infect Dis. 2013;56:344-51.
PubMed Abstract»
Bradley H, Markowitz LE, Gibson T, McQuillan GM. Seroprevalence of herpes simplex virus types 1 and 2--United States, 1999-2010. J Infect Dis. 2014;209:325-33.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Other sexually transmitted diseases. Atlanta: U.S. Department of Health and Human Services; 2016.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Other STDs: Herpes simplex virus. Atlanta: U.S. Department of Health and Human Services; October 2019.
CDC»
Cherpes TL, Meyn LA, Hillier SL. Cunnilingus and vaginal intercourse are risk factors for herpes simplex virus type 1 acquisition in women. Sex Transm Dis. 2005;32:84-9.
PubMed Abstract»
Chesson HW, Spicknall IH, Bingham A, et al. The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018. Sex Transm Dis. 2021;48:215-21.
PubMed Abstract»
Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years--United States, 1988 to 2010. Sex Transm Dis. 2013;40:860-4.
PubMed Abstract»
Gnann JW Jr, Whitley RJ. CLINICAL PRACTICE. Genital Herpes. N Engl J Med. 2016;375:666-74.
PubMed Abstract»
Groves MJ. Genital Herpes: A Review. Am Fam Physician. 2016;93:928-34.
PubMed Abstract»
Lafferty WE, Downey L, Celum C, Wald A. Herpes simplex virus type 1 as a cause of genital herpes: impact on surveillance and prevention. J Infect Dis. 2000;181:1454-7.
PubMed Abstract»
McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015-2016. NCHS Data Brief. 2018;304:1-8.
PubMed Abstract»
Okafor N, Rosenberg ES, Luisi N, et al. Disparities in herpes simplex virus type 2 infection between black and white men who have sex with men in Atlanta, GA. Int J STD AIDS. 2015;26:740-5.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis. 2003;30:797-800.
PubMed Abstract»
Ryder N, Jin F, McNulty AM, Grulich AE, Donovan B. Increasing role of herpes simplex virus type 1 in first-episode anogenital herpes in heterosexual women and younger men who have sex with men, 1992-2006. Sex Transm Infect. 2009;85:416-9.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Sizemore JM Jr, Lakeman F, Whitley R, Hughes A, Hook EW 3rd. The spectrum of genital herpes simplex virus infection in men attending a sexually transmitted disease clinic. J Infect Dis. 2006;193:905-11.
PubMed Abstract»
Spicknall IH, Flagg EW, Torrone EA. Estimates of the Prevalence and Incidence of Genital Herpes, United States, 2018. Sex Transm Dis. 2021;48:260-5.
PubMed Abstract»
Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA. 2006;296:964-73.
PubMed Abstract»
Module 2 » Lesson 4. Genital Herpes

Microbiology, Pathogenesis, and Transmission

Ashley RL, Militoni J, Lee F, Nahmias A, Corey L. Comparison of Western blot (immunoblot) and glycoprotein G-specific immunodot enzyme assay for detecting antibodies to herpes simplex virus types 1 and 2 in human sera. J Clin Microbiol. 1988;26:662-7.
PubMed Abstract»
Ashley RL. Sorting out the new HSV type specific antibody tests. Sex Transm Infect. 2001;77:232-7.
PubMed Abstract»
Barnabas RV, Celum C. Infectious co-factors in HIV-1 transmission herpes simplex virus type-2 and HIV-1: new insights and interventions. Curr HIV Res. 2012;10:228-37.
PubMed Abstract»
Cliffe AR, Wilson AC. Restarting Lytic Gene Transcription at the Onset of Herpes Simplex Virus Reactivation. J Virol. 2017;91(2). pii: e01419
PubMed Abstract»
Corey L. Herpes simplex virus type 2 and HIV-1: the dialogue between the 2 organisms continues. J Infect Dis. 2007;195:1242-4.
PubMed Abstract»
Cunningham AL, Diefenbach RJ, Miranda-Saksena M, et al. The cycle of human herpes simplex virus infection: virus transport and immune control. J Infect Dis. 2006;194 Suppl 1:S11-8.
PubMed Abstract»
Engelberg R, Carrell D, Krantz E, Corey L, Wald A. Natural history of genital herpes simplex virus type 1 infection. Sex Transm Dis. 2003;30:174-7.
PubMed Abstract»
Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years--United States, 1988 to 2010. Sex Transm Dis. 2013;40:860-4.
PubMed Abstract»
Franzen-Röhl E, Schepis D, Atterfelt F, et al. Herpes simplex virus specific T cell response in a cohort with primary genital infection correlates inversely with frequency of subsequent recurrences. Sex Transm Infect. 2017;93:169-174.
PubMed Abstract»
Johnston C, Corey L. Current Concepts for Genital Herpes Simplex Virus Infection: Diagnostics and Pathogenesis of Genital Tract Shedding. Clin Microbiol Rev. 2016;29:149-61.
PubMed Abstract»
Johnston C, Koelle DM, Wald A. Current status and prospects for development of an HSV vaccine. Vaccine. 2014;32:1553-60.
PubMed Abstract»
Johnston C, Zhu J, Jing L, et al. Virologic and immunologic evidence of multifocal genital herpes simplex virus 2 infection. J Virol. 2014;88:4921-31.
PubMed Abstract»
Koelle DM, Benedetti J, Langenberg A, Corey L. Asymptomatic reactivation of herpes simplex virus in women after the first episode of genital herpes. Ann Intern Med. 1992;116:433-7.
PubMed Abstract»
Kukhanova MK, Korovina AN, Kochetkov SN. Human herpes simplex virus: life cycle and development of inhibitors. Biochemistry (Mosc). 2014;79:1635-52.
PubMed Abstract»
Mark KE, Wald A, Magaret AS, et al. Rapidly cleared episodes of herpes simplex virus reactivation in immunocompetent adults. J Infect Dis. 2008;198:1141-9.
PubMed Abstract»
Mertz GJ, Benedetti J, Ashley R, Selke SA, Corey L. Risk factors for the sexual transmission of genital herpes. Ann Intern Med. 1992;116:197-202.
PubMed Abstract»
Mertz GJ, Schmidt O, Jourden JL, et al. Frequency of acquisition of first-episode genital infection with herpes simplex virus from symptomatic and asymptomatic source contacts. Sex Transm Dis. 1985;12:33-9.
PubMed Abstract»
Mertz GJ. Asymptomatic shedding of herpes simplex virus 1 and 2: implications for prevention of transmission. J Infect Dis. 2008;198:1098-100.
PubMed Abstract»
Perng GC, Jones C, Ciacci-Zanella J, et al. Virus-induced neuronal apoptosis blocked by the herpes simplex virus latency-associated transcript. Science. 2000;287:1500-3.
PubMed Abstract»
Perng GC, Jones C. Towards an understanding of the herpes simplex virus type 1 latency-reactivation cycle. Interdiscip Perspect Infect Dis. 2010;2010:262415.
PubMed Abstract»
Phipps W, Saracino M, Magaret A, et al. Persistent genital herpes simplex virus-2 shedding years following the first clinical episode. J Infect Dis. 2011;203:180-7.
PubMed Abstract»
Ribes JA, Steele AD, Seabolt JP, Baker DJ. Six-year study of the incidence of herpes in genital and nongenital cultures in a central Kentucky medical center patient population. J Clin Microbiol. 2001;39:3321-5.
PubMed Abstract»
Sawtell NM, Thompson RL. De Novo Herpes Simplex Virus VP16 Expression Gates a Dynamic Programmatic Transition and Sets the Latent/Lytic Balance during Acute Infection in Trigeminal Ganglia. PLoS Pathog. 2016;12:e1005877.
PubMed Abstract»
Schiffer JT, Abu-Raddad L, Mark KE, et al. Frequent release of low amounts of herpes simplex virus from neurons: results of a mathematical model. Sci Transl Med. 2009;1:7ra16.
PubMed Abstract»
Schiffer JT, Corey L. Rapid host immune response and viral dynamics in herpes simplex virus-2 infection. Nat Med. 2013;19:280-90.
PubMed Abstract»
Shannon B, Yi TJ, Thomas-Pavanel J, et al. Impact of asymptomatic herpes simplex virus type 2 infection on mucosal homing and immune cell subsets in the blood and female genital tract. J Immunol. 2014;192:5074-82.
PubMed Abstract»
Thompson RL, Preston CM, Sawtell NM. De novo synthesis of VP16 coordinates the exit from HSV latency in vivo. PLoS Pathog. 2009;5:e1000352.
PubMed Abstract»
Tronstein E, Johnston C, Huang ML, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA. 2011;305:1441-9.
PubMed Abstract»
Umbach JL, Kramer MF, Jurak I, Karnowski HW, Coen DM, Cullen BR. MicroRNAs expressed by herpes simplex virus 1 during latent infection regulate viral mRNAs. Nature. 2008;454:780-3.
PubMed Abstract»
Wald A, Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA. 2001;285:3100-6.
PubMed Abstract»
Wald A, Selke S, Warren T, et al. Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding. Sex Transm Dis. 2006;33:529-33.
PubMed Abstract»
Wald A, Zeh J, Selke S, et al. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. N Engl J Med. 2000;342:844-50.
PubMed Abstract»
Whitley RJ, Roizman B. Herpes simplex virus infections. Lancet. 2001;357:1513-8.
PubMed Abstract»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases Characterized by genital, anal, or perianal ulcers: Genital HSV infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Zhu J, Hladik F, Woodward A, et al. Persistence of HIV-1 receptor-positive cells after HSV-2 reactivation is a potential mechanism for increased HIV-1 acquisition. Nat Med. 2009;15:886-92.
PubMed Abstract»
Zhu J, Peng T, Johnston C, et al. Immune surveillance by CD8αα+ skin-resident T cells in human herpes virus infection. Nature. 2013;497:494-7.
PubMed Abstract»
Module 2 » Lesson 4. Genital Herpes

Clinical Manifestations

Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329:1168-74.
PubMed Abstract»
Ashley RL, Wald A. Genital herpes: review of the epidemic and potential use of type-specific serology. Clin Microbiol Rev. 1999;12:1-8.
PubMed Abstract»
Ashley-Morrow R, Krantz E, Wald A. Time course of seroconversion by HerpeSelect ELISA after acquisition of genital herpes simplex virus type 1 (HSV-1) or HSV-2. Sex Transm Dis. 2003;30:310-4.
PubMed Abstract»
Baeten JM, Strick LB, Lucchetti A, et al. Herpes simplex virus (HSV)-suppressive therapy decreases plasma and genital HIV-1 levels in HSV-2/HIV-1 coinfected women: a randomized, placebo-controlled, cross-over trial. J Infect Dis. 2008;198:1804-8.
PubMed Abstract»
Barnabas RV, Celum C. Infectious co-factors in HIV-1 transmission herpes simplex virus type-2 and HIV-1: new insights and interventions. Curr HIV Res. 2012;10:228-37.
PubMed Abstract»
Beauman JG. Genital herpes: a review. Am Fam Physician. 2005;72:1527-34.
PubMed Abstract»
Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994;121:847-54.
PubMed Abstract»
Benedetti JK, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med. 1999;131:14-20.
PubMed Abstract»
Bergström T, Vahlne A, Alestig K, Jeansson S, Forsgren M, Lycke E. Primary and recurrent herpes simplex virus type 2-induced meningitis. J Infect Dis. 1990;162:322-30.
PubMed Abstract»
Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA. 2003;289:203-9.
PubMed Abstract»
Celum C, Wald A, Lingappa JR, et al. Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2. N Engl J Med. 2010;362:427-39.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Seroprevalence of herpes simplex virus type 2 among persons aged 14-49 years--United States, 2005-2008. MMWR Morb Mortal Wkly Rep. 2010;59:456-9.
PubMed Abstract»
Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med. 1983;98:958-72.
PubMed Abstract»
Di Lucca-Christment J, Jacobelli S, Gressier L, et al. Anogenital pseudotumoral herpes and HIV infection: a new challenge for diagnosis and treatment. AIDS. 2012;26:523-6.
PubMed Abstract»
Engelberg R, Carrell D, Krantz E, Corey L, Wald A. Natural history of genital herpes simplex virus type 1 infection. Sex Transm Dis. 2003;30:174-7.
PubMed Abstract»
Fife KH, Mugwanya K, Thomas KK, et al. Transient Increase in Herpes Simplex Virus Type 2 (HSV-2)-Associated Genital Ulcers Following Initiation of Antiretroviral Therapy in HIV/HSV-2-Coinfected Individuals. J Infect Dis. 2016;213:1573-8.
PubMed Abstract»
Franzen-Röhl E, Schepis D, Atterfelt F, et al. Herpes simplex virus specific T cell response in a cohort with primary genital infection correlates inversely with frequency of subsequent recurrences. Sex Transm Infect. 2017;93:169-174.
PubMed Abstract»
Goodell SE, Quinn TC, Mkrtichian E, Schuffler MD, Holmes KK, Corey L. Herpes simplex virus proctitis in homosexual men. Clinical, sigmoidoscopic, and histopathological features. N Engl J Med. 1983;308:868-71.
PubMed Abstract»
Horn EE, Turkheimer E, Strachan E. Psychological distress, emotional stability, and emotion regulation moderate dynamics of herpes simplex virus type 2 recurrence. Ann Behav Med. 2015;49:187-98.
PubMed Abstract»
James SH, Kimberlin DW. Neonatal herpes simplex virus infection: epidemiology and treatment. Clin Perinatol. 2015;42:47-59, viii.
PubMed Abstract»
Johnston C, Magaret A, Selke S, Remington M, Corey L, Wald A. Herpes simplex virus viremia during primary genital infection. J Infect Dis. 2008;198:31-4.
PubMed Abstract»
Kimberlin DW, Lin CY, Jacobs RF, et al. Natural history of neonatal herpes simplex virus infections in the acyclovir era. Pediatrics. 2001;108:223-9.
PubMed Abstract»
Kimberlin DW, Rouse DJ. Clinical practice. Genital herpes. N Engl J Med. 2004;350:1970-7.
PubMed Abstract»
Kimberlin DW, Whitley RJ, Wan W, et al. Oral acyclovir suppression and neurodevelopment after neonatal herpes. N Engl J Med. 2011;365:1284-92.
PubMed Abstract»
Kupila L, Vuorinen T, Vainionpää R, Hukkanen V, Marttila RJ, Kotilainen P. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006;66:75-80.
PubMed Abstract»
Langenberg AG, Corey L, Ashley RL, Leong WP, Straus SE. A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group. N Engl J Med. 1999;341:1432-8.
PubMed Abstract»
Levin MJ, Bacon TH, Leary JJ. Resistance of herpes simplex virus infections to nucleoside analogues in HIV-infected patients. Clin Infect Dis. 2004;39 Suppl 5:S248-57.
PubMed Abstract»
Manguro GO, Masese LN, Deya RW, et al. Genital HSV Shedding among Kenyan Women Initiating Antiretroviral Therapy. PLoS One. 2016;11:e0163541.
PubMed Abstract»
McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015-2016. NCHS Data Brief. 2018;304:1-8.
PubMed Abstract»
Moriuchi M, Moriuchi H, Williams R, Straus SE. Herpes simplex virus infection induces replication of human immunodeficiency virus type 1. Virology. 2000;278:534-40.
PubMed Abstract»
Nagot N, Ouédraogo A, Foulongne V, et al. Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus. N Engl J Med. 2007;356:790-9.
PubMed Abstract»
Nagot N, Ouedraogo A, Konate I, et al. Roles of clinical and subclinical reactivated herpes simplex virus type 2 infection and human immunodeficiency virus type 1 (HIV-1)-induced immunosuppression on genital and plasma HIV-1 levels. J Infect Dis. 2008;198:241-9.
PubMed Abstract»
Ong JJ, Morton AN, Henzell HR, et al. Clinical Characteristics of Herpes Simplex Virus Urethritis Compared With Chlamydial Urethritis Among Men. Sex Transm Dis. 2017;44:121-125.
PubMed Abstract»
Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Herpes simplex virus. Last updated: May 26, 2020.
HIV.gov»
Patel P, Bush T, Mayer KH, et al. Prevalence and risk factors associated with herpes simplex virus-2 infection in a contemporary cohort of HIV-infected persons in the United States. Sex Transm Dis. 2012;39:154-60.
PubMed Abstract»
Pinninti SG, Kimberlin DW. Maternal and neonatal herpes simplex virus infections. Am J Perinatol. 2013;30:113-9.
PubMed Abstract»
Pinninti SG, Kimberlin DW. Neonatal herpes simplex virus infections. Semin Perinatol. 2018;42:168-175.
PubMed Abstract»
Posavad CM, Wald A, Kuntz S, et al. Frequent reactivation of herpes simplex virus among HIV-1-infected patients treated with highly active antiretroviral therapy. J Infect Dis. 2004;190:693-6.
PubMed Abstract»
Reyes M, Shaik NS, Graber JM, et al. Acyclovir-resistant genital herpes among persons attending sexually transmitted disease and human immunodeficiency virus clinics. Arch Intern Med. 2003;163:76-80.
PubMed Abstract»
Schiffer JT, Corey L. New concepts in understanding genital herpes. Curr Infect Dis Rep. 2009;11:457-64.
PubMed Abstract»
Strick LB, Wald A, Celum C. Management of herpes simplex virus type 2 infection in HIV type 1-infected persons. Clin Infect Dis. 2006;43:347-56.
PubMed Abstract»
Tobian AA, Grabowski MK, Serwadda D, et al. Reactivation of herpes simplex virus type 2 after initiation of antiretroviral therapy. J Infect Dis. 2013;208:839-46.
PubMed Abstract»
Van Wagoner NJ, Brown E, Whitley R, Hook EW 3rd. Predictors of undiagnosed herpes simplex virus type 2 seropositivity among persons attending an HIV care clinic. Sex Transm Dis. 2012;39:857-9.
PubMed Abstract»
Wald A, Carrell D, Remington M, Kexel E, Zeh J, Corey L. Two-day regimen of acyclovir for treatment of recurrent genital herpes simplex virus type 2 infection. Clin Infect Dis. 2002;34:944-8.
PubMed Abstract»
Wald A, Zeh J, Selke S, et al. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. N Engl J Med. 2000;342:844-50.
PubMed Abstract»
Watson-Jones D, Weiss HA, Rusizoka M, et al. Effect of herpes simplex suppression on incidence of HIV among women in Tanzania. N Engl J Med. 2008;358:1560-71.
PubMed Abstract»
Module 2 » Lesson 4. Genital Herpes

Laboratory Diagnosis

Bernstein DI, Bellamy AR, Hook EW 3rd, et al. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clin Infect Dis. 2013;56:344-51.
PubMed Abstract»
Caviness AC, Oelze LL, Saz UE, Greer JM, Demmler-Harrison GJ. Direct immunofluorescence assay compared to cell culture for the diagnosis of mucocutaneous herpes simplex virus infections in children. J Clin Virol. 2010;49:58-60.
PubMed Abstract»
Eing BR, Lippelt L, Lorentzen EU, et al. Evaluation of confirmatory strategies for detection of type-specific antibodies against herpes simplex virus type 2. J Clin Microbiol. 2002;40:407-13.
PubMed Abstract»
Engelberg R, Carrell D, Krantz E, Corey L, Wald A. Natural history of genital herpes simplex virus type 1 infection. Sex Transm Dis. 2003;30:174-7.
PubMed Abstract»
Gitman MR, Ferguson D, Landry ML. Comparison of Simplexa HSV 1 & 2 PCR with culture, immunofluorescence, and laboratory-developed TaqMan PCR for detection of herpes simplex virus in swab specimens. J Clin Microbiol. 2013;51:3765-9.
PubMed Abstract»
Johnston C, Corey L. Current Concepts for Genital Herpes Simplex Virus Infection: Diagnostics and Pathogenesis of Genital Tract Shedding. Clin Microbiol Rev. 2016;29:149-61.
PubMed Abstract»
LeGoff J, Péré H, Bélec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J. 2014;11:83.
PubMed Abstract»
Morrow R, Friedrich D. Performance of a novel test for IgM and IgG antibodies in subjects with culture-documented genital herpes simplex virus-1 or -2 infection. Clin Microbiol Infect. 2006;12:463-9.
PubMed Abstract»
Morrow RA, Friedrich D, Meier A, Corey L. Use of "biokit HSV-2 Rapid Assay" to improve the positive predictive value of Focus HerpeSelect HSV-2 ELISA. BMC Infect Dis. 2005;5:84.
PubMed Abstract»
Ngo TD, Laeyendecker O, La H, Hogrefe W, Morrow RA, Quinn TC. Use of commercial enzyme immunoassays to detect antibodies to the herpes simplex virus type 2 glycoprotein G in a low-risk population in Hanoi, Vietnam. Clin Vaccine Immunol. 2008;15:382-4.
PubMed Abstract»
Scoular A. Using the evidence base on genital herpes: optimising the use of diagnostic tests and information provision. Sex Transm Infect. 2002;78:160-5.
PubMed Abstract»
Teo JW, Chiang D, Jureen R, Lin RT. Clinical evaluation of a helicase-dependant amplification (HDA)-based commercial assay for the simultaneous detection of HSV-1 and HSV-2. Diagn Microbiol Infect Dis. 2015;83:261-2.
PubMed Abstract»
Turner KR, Wong EH, Kent CK, Klausner JD. Serologic herpes testing in the real world: validation of new type-specific serologic herpes simplex virus tests in a public health laboratory. Sex Transm Dis. 2002;29:422-5.
PubMed Abstract»
Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes. 2004;11 Suppl 2:57A-64A.
PubMed Abstract»
Van Der Pol B, Warren T, Taylor SN, et al. Type-specific identification of anogenital herpes simplex virus infections by use of a commercially available nucleic acid amplification test. J Clin Microbiol. 2012;50:3466-71.
PubMed Abstract»
van Rooijen MS, Roest W, Hansen G, Kwa D, de Vries HJ. False-negative type-specific glycoprotein G antibody responses in STI clinic patients with recurrent HSV-1 or HSV-2 DNA positive genital herpes, The Netherlands. Sex Transm Infect. 2016;92:257-60.
PubMed Abstract»
Wald A, Huang ML, Carrell D, Selke S, Corey L. Polymerase chain reaction for detection of herpes simplex virus (HSV) DNA on mucosal surfaces: comparison with HSV isolation in cell culture. J Infect Dis. 2003;188:1345-51.
PubMed Abstract»
Whittington WL, Celum CL, Cent A, Ashley RL. Use of a glycoprotein G-based type-specific assay to detect antibodies to herpes simplex virus type 2 among persons attending sexually transmitted disease clinics. Sex Transm Dis. 2001;28:99-104.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers: genital herpes. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases Characterized by genital, anal, or perianal ulcers: Genital HSV infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 4. Genital Herpes

Screening for HSV-2 Infection

Feltner C, Grodensky C, Ebel C, et al. Serologic Screening for Genital Herpes: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;316:2531-43.
PubMed Abstract»
Hook EW 3rd. A Recommendation Against Serologic Screening for Genital Herpes Infection-What Now? JAMA. 2016;316:2493-4.
PubMed Abstract»
Keating TM, Kurth AE, Wald A, Kahle EM, Barash EA, Buskin SE. Clinical burden of herpes simplex virus disease in people with human immunodeficiency virus. Sex Transm Dis. 2012;39:372-6.
PubMed Abstract»
Song B, Dwyer DE, Mindel A. HSV type specific serology in sexual health clinics: use, benefits, and who gets tested. Sex Transm Infect. 2004;80:113-7.
PubMed Abstract»
US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Serologic Screening for Genital Herpes Infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316:2525-30.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: pregnant women. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases Characterized by genital, anal, or perianal ulcers: Genital HSV infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 4. Genital Herpes

Treatment

ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol. 2007;109:1489-98.
PubMed Abstract»
Andrei G, Fiten P, Goubau P, et al. Dual infection with polyomavirus BK and acyclovir-resistant herpes simplex virus successfully treated with cidofovir in a bone marrow transplant recipient. Transpl Infect Dis. 2007;9:126-31.
PubMed Abstract»
Aoki FY, Tyring S, Diaz-Mitoma F, Gross G, Gao J, Hamed K. Single-day, patient-initiated famciclovir therapy for recurrent genital herpes: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2006;42:8-13.
PubMed Abstract»
Arvin AM, Hensleigh PA, Prober CG, et al. Failure of antepartum maternal cultures to predict the infant's risk of exposure to herpes simplex virus at delivery. N Engl J Med. 1986;315:796-800.
PubMed Abstract»
Balfour HH Jr. Antiviral drugs. N Engl J Med. 1999;340:1255-68.
PubMed Abstract»
Bartlett BL, Tyring SK, Fife K, et al. Famciclovir treatment options for patients with frequent outbreaks of recurrent genital herpes: the RELIEF trial. J Clin Virol. 2008;43:190-5.
PubMed Abstract»
Bodsworth NJ, Crooks RJ, Borelli S, et al. Valaciclovir versus aciclovir in patient initiated treatment of recurrent genital herpes: a randomised, double blind clinical trial. International Valaciclovir HSV Study Group. Genitourin Med. 1997;73:110-6.
PubMed Abstract»
Brown ZA, Benedetti J, Ashley R, et al. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. N Engl J Med. 1991;324:1247-52.
PubMed Abstract»
Brown ZA, Selke S, Zeh J, et al. The acquisition of herpes simplex virus during pregnancy. N Engl J Med. 1997;337:509-15.
PubMed Abstract»
Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA. 2003;289:203-9.
PubMed Abstract»
Chosidow O, Drouault Y, Leconte-Veyriac F, et al. Famciclovir vs. aciclovir in immunocompetent patients with recurrent genital herpes infections: a parallel-groups, randomized, double-blind clinical trial. Br J Dermatol. 2001;144:818-24.
PubMed Abstract»
Conant MA, Schacker TW, Murphy RL, Gold J, Crutchfield LT, Crooks RJ. Valaciclovir versus aciclovir for herpes simplex virus infection in HIV-infected individuals: two randomized trials. Int J STD AIDS. 2002;13:12-21.
PubMed Abstract»
Corey L, Benedetti J, Critchlow C, et al. Treatment of primary first-episode genital herpes simplex virus infections with acyclovir: results of topical, intravenous and oral therapy. J Antimicrob Chemother. 1983;12 Suppl B:79-88.
PubMed Abstract»
Corey L, Nahmias AJ, Guinan ME, Benedetti JK, Critchlow CW, Holmes KK. A trial of topical acyclovir in genital herpes simplex virus infections. N Engl J Med. 1982;306:1313-9.
PubMed Abstract»
Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. 2004;350:11-20.
PubMed Abstract»
Corey L, Wald A. Maternal and neonatal herpes simplex virus infections. N Engl J Med. 2009;361:1376-85.
PubMed Abstract»
DeJesus E, Wald A, Warren T, et al. Valacyclovir for the suppression of recurrent genital herpes in human immunodeficiency virus-infected subjects. J Infect Dis. 2003;188:1009-16.
PubMed Abstract»
Deval J. Antimicrobial strategies: inhibition of viral polymerases by 3'-hydroxyl nucleosides. Drugs. 2009;69:151-66.
PubMed Abstract»
Diaz-Mitoma F, Sibbald RG, Shafran SD, Boon R, Saltzman RL. Oral famciclovir for the suppression of recurrent genital herpes: a randomized controlled trial. Collaborative Famciclovir Genital Herpes Research Group. JAMA. 1998;280:887-92.
PubMed Abstract»
Douglas JM, Critchlow C, Benedetti J, et al. A double-blind study of oral acyclovir for suppression of recurrences of genital herpes simplex virus infection. N Engl J Med. 1984;310:1551-6.
PubMed Abstract»
Efstathiou S, Field HJ, Griffiths PD, et al. Herpes simplex virus latency and nucleoside analogues. Antiviral Res. 1999;41:85-100.
PubMed Abstract»
Elion GB, Furman PA, Fyfe JA, de Miranda P, Beauchamp L, Schaeffer HJ. The selectivity of action of an antiherpetic agent, 9-(2-hydroxyethoxymethyl) guanine. Reproduced from Proc. Natl. Acad. Sci. USA 74, 5716-5720 (1977) Rev Med Virol. 1999;9:147-52.
PubMed Abstract»
Fife KH, Almekinder J, Ofner S. A comparison of one year of episodic or suppressive treatment of recurrent genital herpes with valacyclovir. Sex Transm Dis. 2007;34:297-301.
PubMed Abstract»
Fife KH, Barbarash RA, Rudolph T, Degregorio B, Roth R. Valaciclovir versus acyclovir in the treatment of first-episode genital herpes infection. Results of an international, multicenter, double-blind, randomized clinical trial. The Valaciclovir International Herpes Simplex Virus Study Group. Sex Transm Dis. 1997;24:481-6.
PubMed Abstract»
Fife KH, Crumpacker CS, Mertz GJ, Hill EL, Boone GS. Recurrence and resistance patterns of herpes simplex virus following cessation of > or = 6 years of chronic suppression with acyclovir. Acyclovir Study Group. J Infect Dis. 1994;169:1338-41.
PubMed Abstract»
Fife KH, Warren TJ, Ferrera RD, et al. Effect of valacyclovir on viral shedding in immunocompetent patients with recurrent herpes simplex virus 2 genital herpes: a US-based randomized, double-blind, placebo-controlled clinical trial. Mayo Clin Proc. 2006;81:1321-7.
PubMed Abstract»
James SH, Kimberlin DW. Neonatal herpes simplex virus infection: epidemiology and treatment. Clin Perinatol. 2015;42:47-59, viii.
PubMed Abstract»
Kaplowitz LG, Baker D, Gelb L, et al. Prolonged continuous acyclovir treatment of normal adults with frequently recurring genital herpes simplex virus infection. The Acyclovir Study Group. JAMA. 1991;265:747-51.
PubMed Abstract»
Kimberlin DW, Whitley RJ, Wan W, et al. Oral acyclovir suppression and neurodevelopment after neonatal herpes. N Engl J Med. 2011;365:1284-92.
PubMed Abstract»
Kinghorn GR, Turner EB, Barton IG, Potter CW, Burke CA, Fiddian AP. Efficacy of topical acyclovir cream in first and recurrent episodes of genital herpes. Antiviral Res. 1983;3:291-301.
PubMed Abstract»
Kopp T, Geusau A, Rieger A, Stingl G. Successful treatment of an aciclovir-resistant herpes simplex type 2 infection with cidofovir in an AIDS patient. Br J Dermatol. 2002;147:134-8.
PubMed Abstract»
Lalezari J, Schacker T, Feinberg J, et al. A randomized, double-blind, placebo-controlled trial of cidofovir gel for the treatment of acyclovir-unresponsive mucocutaneous herpes simplex virus infection in patients with AIDS. J Infect Dis. 1997;176:892-8.
PubMed Abstract»
Lascaux AS, Caumes E, Deback C, et al. Successful treatment of aciclovir and foscarnet resistant Herpes simplex virus lesions with topical imiquimod in patients infected with human immunodeficiency virus type 1. J Med Virol. 2012;84:194-7.
PubMed Abstract»
Le Cleach L, Trinquart L, Do G, et al. Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients. Cochrane Database Syst Rev. 2014;CD009036.
PubMed Abstract»
Lebrun-Vignes B, Bouzamondo A, Dupuy A, Guillaume JC, Lechat P, Chosidow O. A meta-analysis to assess the efficacy of oral antiviral treatment to prevent genital herpes outbreaks. J Am Acad Dermatol. 2007;57:238-46.
PubMed Abstract»
Levin MJ, Bacon TH, Leary JJ. Resistance of herpes simplex virus infections to nucleoside analogues in HIV-infected patients. Clin Infect Dis. 2004;39 Suppl 5:S248-57.
PubMed Abstract»
McElhiney LF Pharmd Rph. Topical cidofovir for treatment of resistant viral infections. Int J Pharm Compd. 2006;10:324-8.
PubMed Abstract»
Mertz GJ, Critchlow CW, Benedetti J, et al. Double-blind placebo-controlled trial of oral acyclovir in first-episode genital herpes simplex virus infection. JAMA. 1984;252:1147-51.
PubMed Abstract»
Mertz GJ, Loveless MO, Levin MJ, et al. Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women. A multicenter, double-blind, placebo-controlled trial. Collaborative Famciclovir Genital Herpes Research Group. Arch Intern Med. 1997;157:343-9.
PubMed Abstract»
Mostow SR, Mayfield JL, Marr JJ, Drucker JL. Suppression of recurrent genital herpes by single daily dosages of acyclovir. Am J Med. 1988;85:30-3.
PubMed Abstract»
Mujugira A, Magaret AS, Celum C, et al. Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons: a randomized controlled trial. J Infect Dis. 2013;208:1366-74.
PubMed Abstract»
Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Herpes simplex virus. Last updated: May 26, 2020.
HIV.gov»
Patel R, Bodsworth NJ, Woolley P, et al. Valaciclovir for the suppression of recurrent genital HSV infection: a placebo controlled study of once daily therapy. International Valaciclovir HSV Study Group. Genitourin Med. 1997;73:105-9.
PubMed Abstract»
Perkins N, Nisbet M, Thomas M. Topical imiquimod treatment of aciclovir-resistant herpes simplex disease: case series and literature review. Sex Transm Infect. 2011;87:292-5.
PubMed Abstract»
Pinninti SG, Angara R, Feja KN, et al. Neonatal herpes disease following maternal antenatal antiviral suppressive therapy: a multicenter case series. J Pediatr. 2012;161:134-8.e1-3.
PubMed Abstract»
Pinninti SG, Kimberlin DW. Maternal and neonatal herpes simplex virus infections. Am J Perinatol. 2013;30:113-9.
PubMed Abstract»
Piret J, Boivin G. Resistance of herpes simplex viruses to nucleoside analogues: mechanisms, prevalence, and management. Antimicrob Agents Chemother. 2011;55:459-72.
PubMed Abstract»
Reitano M, Tyring S, Lang W, et al. Valaciclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study. International Valaciclovir HSV Study Group. J Infect Dis. 1998;178:603-10.
PubMed Abstract»
Reyes M, Shaik NS, Graber JM, et al. Acyclovir-resistant genital herpes among persons attending sexually transmitted disease and human immunodeficiency virus clinics. Arch Intern Med. 2003;163:76-80.
PubMed Abstract»
Roberts SW, Cox SM, Dax J, Wendel GD Jr, Leveno KJ. Genital herpes during pregnancy: no lesions, no cesarean. Obstet Gynecol. 1995;85:261-4.
PubMed Abstract»
Romanowski B, Aoki FY, Martel AY, Lavender EA, Parsons JE, Saltzman RL. Efficacy and safety of famciclovir for treating mucocutaneous herpes simplex infection in HIV-infected individuals. Collaborative Famciclovir HIV Study Group. AIDS. 2000;14:1211-7.
PubMed Abstract»
Romanowski B, Marina RB, Roberts JN. Patients' preference of valacyclovir once-daily suppressive therapy versus twice-daily episodic therapy for recurrent genital herpes: a randomized study. Sex Transm Dis. 2003;30:226-31.
PubMed Abstract»
Safrin S, Assaykeen T, Follansbee S, Mills J. Foscarnet therapy for acyclovir-resistant mucocutaneous herpes simplex virus infection in 26 AIDS patients: preliminary data. J Infect Dis. 1990;161:1078-84.
PubMed Abstract»
Sauerbrei A, Deinhardt S, Zell R, Wutzler P. Phenotypic and genotypic characterization of acyclovir-resistant clinical isolates of herpes simplex virus. Antiviral Res. 2010;86:246-52.
PubMed Abstract»
Schacker T, Hu HL, Koelle DM, et al. Famciclovir for the suppression of symptomatic and asymptomatic herpes simplex virus reactivation in HIV-infected persons. A double-blind, placebo-controlled trial. Ann Intern Med. 1998;128:21-8.
PubMed Abstract»
Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol. 2003;102:1396-403.
PubMed Abstract»
Simmons A, Field HJ. Can HSV latency be conquered by current antiviral therapies? Sex Transm Infect. 1998;74:1-2.
PubMed Abstract»
Stone KM, Reiff-Eldridge R, White AD, et al. Pregnancy outcomes following systemic prenatal acyclovir exposure: Conclusions from the international acyclovir pregnancy registry, 1984-1999. Birth Defects Res A Clin Mol Teratol. 2004;70:201-7.
PubMed Abstract»
Strick LB, Wald A, Celum C. Management of herpes simplex virus type 2 infection in HIV type 1-infected persons. Clin Infect Dis. 2006;43:347-56.
PubMed Abstract»
Wald A, Carrell D, Remington M, Kexel E, Zeh J, Corey L. Two-day regimen of acyclovir for treatment of recurrent genital herpes simplex virus type 2 infection. Clin Infect Dis. 2002;34:944-8.
PubMed Abstract»
Wald A, Selke S, Warren T, et al. Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding. Sex Transm Dis. 2006;33:529-33.
PubMed Abstract»
Watts DH, Brown ZA, Money D, et al. A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. Am J Obstet Gynecol. 2003;188:836-43.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers: genital herpes. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases Characterized by genital, anal, or perianal ulcers: Genital HSV infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 4. Genital Herpes

Genital HSV in Pregnancy and Neonatal Herpes

ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol. 2007;109:1489-98.
PubMed Abstract»
Brown ZA, Benedetti J, Ashley R, et al. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. N Engl J Med. 1991;324:1247-52.
PubMed Abstract»
Brown ZA, Selke S, Zeh J, et al. The acquisition of herpes simplex virus during pregnancy. N Engl J Med. 1997;337:509-15.
PubMed Abstract»
Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA. 2003;289:203-9.
PubMed Abstract»
Corey L, Wald A. Maternal and neonatal herpes simplex virus infections. N Engl J Med. 2009;361:1376-85.
PubMed Abstract»
James SH, Kimberlin DW. Neonatal herpes simplex virus infection: epidemiology and treatment. Clin Perinatol. 2015;42:47-59, viii.
PubMed Abstract»
Kimberlin DW, Baley J. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Pediatrics. 2013;131:383-6.
American Academy of Pediatrics»
Kimberlin DW, Lin CY, Jacobs RF, et al. Natural history of neonatal herpes simplex virus infections in the acyclovir era. Pediatrics. 2001;108:223-9.
PubMed Abstract»
Kimberlin DW, Rouse DJ. Clinical practice. Genital herpes. N Engl J Med. 2004;350:1970-7.
PubMed Abstract»
Kimberlin DW, Whitley RJ, Wan W, et al. Oral acyclovir suppression and neurodevelopment after neonatal herpes. N Engl J Med. 2011;365:1284-92.
PubMed Abstract»
Management of Genital Herpes in Pregnancy: ACOG Practice Bulletin Summary, Number 220. Obstet Gynecol. 2020;135:1236-8.
PubMed Abstract»
Matthias J, du Bernard S, Schillinger JA, Hong J, Pearson V, Peterman TA. Estimating Neonatal Herpes Simplex Virus Incidence and Mortality Using Capture-recapture, Florida. Clin Infect Dis. 2021;73:506-12.
PubMed Abstract»
Pinninti SG, Angara R, Feja KN, et al. Neonatal herpes disease following maternal antenatal antiviral suppressive therapy: a multicenter case series. J Pediatr. 2012;161:134-8.e1-3.
PubMed Abstract»
Pinninti SG, Kimberlin DW. Maternal and neonatal herpes simplex virus infections. Am J Perinatol. 2013;30:113-9.
PubMed Abstract»
Pinninti SG, Kimberlin DW. Neonatal herpes simplex virus infections. Semin Perinatol. 2018;42:168-175.
PubMed Abstract»
Roberts SW, Cox SM, Dax J, Wendel GD Jr, Leveno KJ. Genital herpes during pregnancy: no lesions, no cesarean. Obstet Gynecol. 1995;85:261-4.
PubMed Abstract»
Sheffield JS, Hollier LM, Hill JB, Stuart GS, Wendel GD. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol. 2003;102:1396-403.
PubMed Abstract»
Slutsker JS, Schillinger JA. Assessing the Burden of Infant Deaths Due to Herpes Simplex Virus, Human Immunodeficiency Virus, and Congenital Syphilis: United States, 1995 to 2017. Sex Transm Dis. 2021;48:S4-S10.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers: genital herpes. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases Characterized by genital, anal, or perianal ulcers: Genital HSV infections. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 4. Genital Herpes

Prevention

Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329:1168-74.
PubMed Abstract»
Abdool Karim SS, Abdool Karim Q, Kharsany AB, et al. Tenofovir Gel for the Prevention of Herpes Simplex Virus Type 2 Infection. N Engl J Med. 2015;373:530-9.
PubMed Abstract»
Awasthi S, Mahairas GG, Shaw CE, et al. A Dual-Modality Herpes Simplex Virus 2 Vaccine for Preventing Genital Herpes by Using Glycoprotein C and D Subunit Antigens To Induce Potent Antibody Responses and Adenovirus Vectors Containing Capsid and Tegument Proteins as T Cell Immunogens. J Virol. 2015;89:8497-509.
PubMed Abstract»
Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367:399-410.
PubMed Abstract»
Bender Ignacio RA, Perti T, Magaret AS, et al. Oral and Vaginal Tenofovir for Genital Herpes Simplex Virus Type 2 Shedding in Immunocompetent Women: A Double-Blind, Randomized, Cross-over Trial. J Infect Dis. 2015;212:1949-56.
PubMed Abstract»
Celum C, Hong T, Cent A, et al. Herpes simplex virus type 2 acquisition among HIV-1-infected adults treated with tenofovir disoproxyl fumarate as part of combination antiretroviral therapy: results from the ACTG A5175 PEARLS study. J Infect Dis. 2017;215:907-10.
PubMed Abstract»
Celum C, Morrow RA, Donnell D, et al. Daily oral tenofovir and emtricitabine-tenofovir preexposure prophylaxis reduces herpes simplex virus type 2 acquisition among heterosexual HIV-1-uninfected men and women: a subgroup analysis of a randomized trial. Ann Intern Med. 2014;161:11-9.
PubMed Abstract»
Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381:2083-90.
PubMed Abstract»
Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. 2004;350:11-20.
PubMed Abstract»
Dropulic LK, Cohen JI. The challenge of developing a herpes simplex virus 2 vaccine. Expert Rev Vaccines. 2012;11:1429-40.
PubMed Abstract»
Fife KH, Warren TJ, Ferrera RD, et al. Effect of valacyclovir on viral shedding in immunocompetent patients with recurrent herpes simplex virus 2 genital herpes: a US-based randomized, double-blind, placebo-controlled clinical trial. Mayo Clin Proc. 2006;81:1321-7.
PubMed Abstract»
Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587-99.
PubMed Abstract»
Gupta R, Wald A, Krantz E, et al. Valacyclovir and acyclovir for suppression of shedding of herpes simplex virus in the genital tract. J Infect Dis. 2004;190:1374-81.
PubMed Abstract»
Johnston C, Zhu J, Jing L, et al. Virologic and immunologic evidence of multifocal genital herpes simplex virus 2 infection. J Virol. 2014;88:4921-31.
PubMed Abstract»
Leone P, Warren T, Hamed K, Fife K, Wald A. Famciclovir reduces viral mucosal shedding in HSV-seropositive persons. Sex Transm Dis. 2007;34:900-7.
PubMed Abstract»
Marcus JL, Glidden DV, McMahan V, et al. Daily oral emtricitabine/tenofovir preexposure prophylaxis and herpes simplex virus type 2 among men who have sex with men. PLoS One. 2014;9:e91513.
PubMed Abstract»
Marrazzo J, Rabe L, Kelly C et al. Association of tenofovir (TFV) detection with reduced risk of herpes simplex virus type-2 (HSV-2) acquisition in the VOICE (MTN 003) study. AIDS Res Hum Retroviruses 2014; 30:A31.
CROI»
Martin ET, Krantz E, Gottlieb SL, et al. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med. 2009;169:1233-40.
PubMed Abstract»
Molina JM, Capitant C, Spire B, et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med. 2015;373:2237-46.
PubMed Abstract»
Mujugira A, Magaret AS, Celum C, et al. Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons: a randomized controlled trial. J Infect Dis. 2013;208:1366-74.
PubMed Abstract»
Sobngwi-Tambekou J, Taljaard D, Lissouba P, et al. Effect of HSV-2 serostatus on acquisition of HIV by young men: results of a longitudinal study in Orange Farm, South Africa. J Infect Dis. 2009;199:958-64.
PubMed Abstract»
Sperling RS, Fife KH, Warren TJ, Dix LP, Brennan CA. The effect of daily valacyclovir suppression on herpes simplex virus type 2 viral shedding in HSV-2 seropositive subjects without a history of genital herpes. Sex Transm Dis. 2008;35:286-90.
PubMed Abstract»
Stanaway JD, Wald A, Martin ET, Gottlieb SL, Magaret AS. Case-crossover analysis of condom use and herpes simplex virus type 2 acquisition. Sex Transm Dis. 2012;39:388-93.
PubMed Abstract»
Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367:423-34.
PubMed Abstract»
Tobian AA, Kacker S, Quinn TC. Male circumcision: a globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections. Annu Rev Med. 2014;65:293-306.
PubMed Abstract»
Tobian AA, Serwadda D, Quinn TC, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med. 2009;360:1298-309.
PubMed Abstract»
Wald A, Krantz E, Selke S, Lairson E, Morrow RA, Zeh J. Knowledge of partners' genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis. 2006;194:42-52.
PubMed Abstract»
Wald A, Langenberg AG, Krantz E, et al. The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med. 2005;143:707-13.
PubMed Abstract»
Wald A, Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA. 2001;285:3100-6.
PubMed Abstract»
Wald A, Selke S, Warren T, et al. Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding. Sex Transm Dis. 2006;33:529-33.
PubMed Abstract»
Wald A, Zeh J, Barnum G, Davis LG, Corey L. Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Ann Intern Med. 1996;124:8-15.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers: genital herpes. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 4. Genital Herpes

Patient Counseling and Education

Groves MJ. Genital Herpes: A Review. Am Fam Physician. 2016;93:928-34.
PubMed Abstract»
Miyai T, Turner KR, Kent CK, Klausner J. The psychosocial impact of testing individuals with no history of genital herpes for herpes simplex virus type 2. Sex Transm Dis. 2004;31:517-21.
PubMed Abstract»
Rosenthal SL, Zimet GD, Leichliter JS, et al. The psychosocial impact of serological diagnosis of asymptomatic herpes simplex virus type 2 infection. Sex Transm Infect. 2006;82:154-7; discussion 157-8.
PubMed Abstract»
Ross K, Johnston C, Wald A. Herpes simplex virus type 2 serological testing and psychosocial harm: a systematic review. Sex Transm Infect. 2011;87:594-600.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by genital, anal, or perianal ulcers: genital herpes. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Abu-Raddad LJ, Magaret AS, Celum C, et al. Genital herpes has played a more important role than any other sexually transmitted infection in driving HIV prevalence in Africa. PLoS One. 2008;3:e2230.
PubMed Abstract»
Andrei G, Lisco A, Vanpouille C, et al. Topical tenofovir, a microbicide effective against HIV, inhibits herpes simplex virus-2 replication. Cell Host Microbe. 2011;10:379-89.
PubMed Abstract»
Bergmann M, Beer R, Kofler M, Helbok R, Pfausler B, Schmutzhard E. Acyclovir resistance in herpes simplex virus type I encephalitis: a case report. J Neurovirol. 2017;23:335-337.
PubMed Abstract»
Berrington WR, Jerome KR, Cook L, Wald A, Corey L, Casper C. Clinical correlates of herpes simplex virus viremia among hospitalized adults. Clin Infect Dis. 2009;49:1295-301.
PubMed Abstract»
Celum C, Wald A, Hughes J, et al. Effect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;371:2109-19.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Other sexually transmitted diseases. Atlanta: U.S. Department of Health and Human Services; 2016.
CDC»
Chesson HW, Spicknall IH, Bingham A, et al. The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018. Sex Transm Dis. 2021;48:215-21.
PubMed Abstract»
Delany S, Mlaba N, Clayton T, et al. Impact of aciclovir on genital and plasma HIV-1 RNA in HSV-2/HIV-1 co-infected women: a randomized placebo-controlled trial in South Africa. AIDS. 2009;23:461-9.
PubMed Abstract»
Douglas JM Jr, Berman SM. Screening for HSV-2 infection in STD clinics and beyond: a few answers but more questions. Sex Transm Dis. 2009;36:729-31.
PubMed Abstract»
Englund JA, Zimmerman ME, Swierkosz EM, Goodman JL, Scholl DR, Balfour HH Jr. Herpes simplex virus resistant to acyclovir. A study in a tertiary care center. Ann Intern Med. 1990;112:416-22.
PubMed Abstract»
Erard V, Wald A, Corey L, Leisenring WM, Boeckh M. Use of long-term suppressive acyclovir after hematopoietic stem-cell transplantation: impact on herpes simplex virus (HSV) disease and drug-resistant HSV disease. J Infect Dis. 2007;196:266-70.
PubMed Abstract»
Flechtner JB, Long D, Larson S, et al. Immune responses elicited by the GEN-003 candidate HSV-2 therapeutic vaccine in a randomized controlled dose-ranging phase 1/2a trial. Vaccine. 2016;34:5314-20.
PubMed Abstract»
Freeman EE, Weiss HA, Glynn JR, Cross PL, Whitworth JA, Hayes RJ. Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies. AIDS. 2006;20:73-83.
PubMed Abstract»
Fuchs J, Celum C, Wang J, et al. Clinical and virologic efficacy of herpes simplex virus type 2 suppression by acyclovir in a multicontinent clinical trial. J Infect Dis. 2010;201:1164-8.
PubMed Abstract»
Gilbert LK, Wyand F. Genital herpes education and counselling: testing a one-page 'FAQ' intervention. Herpes. 2009;15:51-6.
PubMed Abstract»
Goldberg LH, Kaufman R, Kurtz TO, et al. Long-term suppression of recurrent genital herpes with acyclovir. A 5-year benchmark. Acyclovir Study Group. Arch Dermatol. 1993;129:582-7.
PubMed Abstract»
Golden MR, Ashley-Morrow R, Swenson P, Hogrefe WR, Handsfield HH, Wald A. Herpes simplex virus type 2 (HSV-2) Western blot confirmatory testing among men testing positive for HSV-2 using the focus enzyme-linked immunosorbent assay in a sexually transmitted disease clinic. Sex Transm Dis. 2005;32:771-7.
PubMed Abstract»
Henry RE, Wegmann JA, Hartle JE, Christopher GW. Successful oral acyclovir desensitization. Ann Allergy. 1993;70:386-8.
PubMed Abstract»
Heslop R, Roberts H, Flower D, Jordan V. Interventions for men and women with their first episode of genital herpes. Cochrane Database Syst Rev. 2016;:CD010684.
PubMed Abstract»
Kim JH, Schaenman JM, Ho DY, Brown JM. Treatment of acyclovir-resistant herpes simplex virus with continuous infusion of high-dose acyclovir in hematopoietic cell transplant patients. Biol Blood Marrow Transplant. 2011;17:259-64.
PubMed Abstract»
Leone PA, Trottier S, Miller JM. Valacyclovir for episodic treatment of genital herpes: a shorter 3-day treatment course compared with 5-day treatment. Clin Infect Dis. 2002;34:958-62.
PubMed Abstract»
Ong JJ, Morton AN, Henzell HR, et al. Clinical Characteristics of Herpes Simplex Virus Urethritis Compared With Chlamydial Urethritis Among Men. Sex Transm Dis. 2017;44:121-125.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Patel R. Antiviral agents for the prevention of the sexual transmission of herpes simplex in discordant couples. Curr Opin Infect Dis. 2004;17:45-8.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Scott LL, Hollier LM, McIntire D, Sanchez PJ, Jackson GL, Wendel GD Jr. Acyclovir suppression to prevent recurrent genital herpes at delivery. Infect Dis Obstet Gynecol. 2002;10:71-7.
PubMed Abstract»
Scoular A, Gillespie G, Carman WF. Polymerase chain reaction for diagnosis of genital herpes in a genitourinary medicine clinic. Sex Transm Infect. 2002;78:21-5.
PubMed Abstract»
Shankar GN, Alt C. Prophylactic treatment with a novel bioadhesive gel formulation containing aciclovir and tenofovir protects from HSV-2 infection. J Antimicrob Chemother. 2014 Dec;69:3282-93.
PubMed Abstract»
Slomka MJ, Emery L, Munday PE, Moulsdale M, Brown DW. A comparison of PCR with virus isolation and direct antigen detection for diagnosis and typing of genital herpes. J Med Virol. 1998;55:177-83.
PubMed Abstract»
Spruance SL, Tyring SK, DeGregorio B, Miller C, Beutner K. A large-scale, placebo-controlled, dose-ranging trial of peroral valaciclovir for episodic treatment of recurrent herpes genitalis. Valaciclovir HSV Study Group. Arch Intern Med. 1996;156:1729-35.
PubMed Abstract»
Tata S, Johnston C, Huang ML, et al. Overlapping reactivations of herpes simplex virus type 2 in the genital and perianal mucosa. J Infect Dis. 2010;201:499-504.
PubMed Abstract»
Van Damme L, Corneli A, Ahmed K, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367:411-22.
PubMed Abstract»
Wald A, Ashley-Morrow R. Serological testing for herpes simplex virus (HSV)-1 and HSV-2 infection. Clin Infect Dis. 2002;35:S173-82.
PubMed Abstract»
Wald A, Link K. Risk of human immunodeficiency virus infection in herpes simplex virus type 2-seropositive persons: a meta-analysis. J Infect Dis. 2002;185:45-52.
PubMed Abstract»
Watson-Jones D, Wald A, Celum C, et al. Use of acyclovir for suppression of human immunodeficiency virus infection is not associated with genotypic evidence of herpes simplex virus type 2 resistance to acyclovir: analysis of specimens from three phase III trials. J Clin Microbiol. 2010;48:3496-503.
PubMed Abstract»
Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6-10.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: men who have sex with men (MSM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: persons in correctional facilities. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: pregnant women. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: transgender and gender diverse persons. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations: women who have sex with women (WSW) and women who have sex with women and men (WSWM). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Zimet GD, Rosenthal SL, Fortenberry JD, et al. Factors predicting the acceptance of herpes simplex virus type 2 antibody testing among adolescents and young adults. Sex Transm Dis. 2004;31:665-9.
PubMed Abstract»
Zuckerman RA, Lucchetti A, Whittington WL, et al. Herpes simplex virus (HSV) suppression with valacyclovir reduces rectal and blood plasma HIV-1 levels in HIV-1/HSV-2-seropositive men: a randomized, double-blind, placebo-controlled crossover trial. J Infect Dis. 2007;196:1500-8.
PubMed Abstract»

Lesson 5. Human Papillomavirus Infection

Module 2 » Lesson 5. Human Papillomavirus Infection

Introduction

Centers for Disease Control and Prevention. Cancers Associated with Human Papillomavirus, United States—2013–2017. USCS Data Brief, no 18. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services;2020.
CDC»
Doorbar J, Quint W, Banks L, et al. The biology and life-cycle of human papillomaviruses. Vaccine. 2012;30 Suppl 5:F55-70.
PubMed Abstract»
Schiffman M, Doorbar J, Wentzensen N, et al. Carcinogenic human papillomavirus infection. Nat Rev Dis Primers. 2016;2:16086.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 5. Human Papillomavirus Infection

Epidemiology in the United States

Benard VB, Castle PE, Jenison SA, et al. Population-Based Incidence Rates of Cervical Intraepithelial Neoplasia in the Human Papillomavirus Vaccine Era. JAMA Oncol. 2017;3:833-7.
PubMed Abstract»
Bosch FX, de Sanjosé S. The epidemiology of human papillomavirus infection and cervical cancer. Dis Markers. 2007;23:213-27.
PubMed Abstract»
Centers for Disease Control and Prevention. Cancers Associated with Human Papillomavirus, United States—2013–2017. USCS Data Brief, no 18. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services;2020.
CDC»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Other sexually transmitted diseases. Atlanta: U.S. Department of Health and Human Services; 2016.
CDC»
Chelimo C, Wouldes TA, Cameron LD, Elwood JM. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. J Infect. 2013;66:207-17.
PubMed Abstract»
Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine. 2012;30:6016-9.
PubMed Abstract»
Chesson HW, Spicknall IH, Bingham A, et al. The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018. Sex Transm Dis. 2021;48:215-21.
PubMed Abstract»
de Villiers EM, Fauquet C, Broker TR, Bernard HU, zur Hausen H. Classification of papillomaviruses. Virology. 2004;324:17-27.
PubMed Abstract»
de Villiers EM. Cross-roads in the classification of papillomaviruses. Virology. 2013;445:2-10.
PubMed Abstract»
Doorbar J, Quint W, Banks L, et al. The biology and life-cycle of human papillomaviruses. Vaccine. 2012;30 Suppl 5:F55-70.
PubMed Abstract»
Doorbar J. Molecular biology of human papillomavirus infection and cervical cancer. Clin Sci (Lond). 2006;110:525-41.
PubMed Abstract»
Drolet M, Bénard É, Boily MC, et al. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2015;15:565-80.
PubMed Abstract»
Drolet M, Bénard É, Pérez N, Brisson M. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019;394:497-509.
PubMed Abstract»
Dunne EF, Unger ER, Sternberg M, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007;297:813-9.
PubMed Abstract»
Flagg EW, Schwartz R, Weinstock H. Prevalence of anogenital warts among participants in private health plans in the United States, 2003-2010: potential impact of human papillomavirus vaccination. Am J Public Health. 2013;103:1428-35.
PubMed Abstract»
Flagg EW, Torrone EA. Declines in Anogenital Warts Among Age Groups Most Likely to Be Impacted by Human Papillomavirus Vaccination, United States, 2006-2014. Am J Public Health. 2018;108:112-9.
PubMed Abstract»
Gillison ML, Broutian T, Pickard RK, et al. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA. 2012;307:693-703.
PubMed Abstract»
Hariri S, Bennett NM, Niccolai LM, et al. Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States - 2008-2012. Vaccine. 2015;33:1608-13.
PubMed Abstract»
Hariri S, Johnson ML, Bennett NM, et al. Population-based trends in high-grade cervical lesions in the early human papillomavirus vaccine era in the United States. Cancer. 2015;121:2775-81.
PubMed Abstract»
Hernandez BY, McDuffie K, Zhu X, et al. Anal human papillomavirus infection in women and its relationship with cervical infection. Cancer Epidemiol Biomarkers Prev. 2005;14:2550-6.
PubMed Abstract»
Jemal A, Simard EP, Dorell C, et al. Annual Report to the Nation on the Status of Cancer, 1975-2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst. 2013;105:175-201.
PubMed Abstract»
Lewis RM, Laprise JF, Gargano JW, et al. Estimated Prevalence and Incidence of Disease-Associated Human Papillomavirus Types Among 15- to 59-Year-Olds in the United States. Sex Transm Dis. 2021;48:273-7.
PubMed Abstract»
Lin C, Franceschi S, Clifford GM. Human papillomavirus types from infection to cancer in the anus, according to sex and HIV status: a systematic review and meta-analysis. Lancet Infect Dis. 2018;18:198-206.
PubMed Abstract»
Machalek DA, Poynten M, Jin F, et al. Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis. Lancet Oncol. 2012;13:487-500.
PubMed Abstract»
Mann LM, Llata E, Flagg EW, et al. Trends in the prevalence of anogenital warts among patients at sexually transmitted disease cinics-Sexually Transmitted Disease Surveillance Network, United States, 2010-2016. J Infect Dis. 2019;219:1389-97.
PubMed Abstract»
Markowitz LE, Hariri S, Lin C, et al. Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010. J Infect Dis. 2013;208:385-93.
PubMed Abstract»
Markowitz LE, Liu G, Hariri S, Steinau M, Dunne EF, Unger ER. Prevalence of HPV After Introduction of the Vaccination Program in the United States. Pediatrics. 2016;137:e20151968.
PubMed Abstract»
National Cancer Institute: Surveillance, Epidemiology, and End Result Program (SEER) Cancer Stat Facts: Anal Cancer.
National Cancer Institute»
National Cancer Institute: Surveillance, Epidemiology, and End Result Program (SEER) Cancer Stat Facts: Cervical Cancer.
National Cancer Institute»
National Cancer Institute: Surveillance, Epidemiology, and End Result Program (SEER) Cancer Stat Facts: Oral Cavity and Pharynx Cancer.
National Cancer Institute»
National Cancer Institute. Surveillance, Epidemiology, and End Results Program.
National Cancer Institute»
Nyitray AG, Carvalho da Silva RJ, Baggio ML, et al. Six-month incidence, persistence, and factors associated with persistence of anal human papillomavirus in men: the HPV in men study. J Infect Dis. 2011;204:1711-22.
PubMed Abstract»
Perkins RB, Legler A, Hanchate A. Trends in Male and Female Genital Warts Among Adolescents in a Safety-Net Health Care System 2004-2013: Correlation With Introduction of Female and Male Human Papillomavirus Vaccination. Sex Transm Dis. 2015;42:665-8.
PubMed Abstract»
Petrosky E, Bocchini JA Jr, Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64:300-4.
PubMed Abstract»
Rosenblum HG, Lewis RM, Gargano JW, Querec TD, Unger ER, Markowitz LE. Declines in Prevalence of Human Papillomavirus Vaccine-Type Infection Among Females after Introduction of Vaccine - United States, 2003-2018. MMWR Morb Mortal Wkly Rep. 2021;70:415-20.
PubMed Abstract»
Saliba M, Ghossein R, Xu B. HPV-related head and neck cancers: Pathology and biology. J Surg Oncol. 2021;124:923-30.
PubMed Abstract»
Saraiya M, Unger ER, Thompson TD, et al. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst. 2015;107:djv086.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Shi R, Devarakonda S, Liu L, Taylor H, Mills G. Factors associated with genital human papillomavirus infection among adult females in the United States, NHANES 2007-2010. BMC Res Notes. 2014;7:544.
PubMed Abstract»
Sonawane K, Suk R, Chiao EY, et al. Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014. Ann Intern Med. 2017;167:714-24.
PubMed Abstract»
Viens LJ, Henley SJ, Watson M, et al. Human papillomavirus-associated cancers - United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2016;65:661-6.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 5. Human Papillomavirus Infection

Microbiology, Pathogenesis, and Transmission

Anic GM, Lee JH, Stockwell H, et al. Incidence and human papillomavirus (HPV) type distribution of genital warts in a multinational cohort of men: the HPV in men study. J Infect Dis. 2011;204:1886-92.
PubMed Abstract»
Arima Y, Winer RL, Feng Q, et al. Development of genital warts after incident detection of human papillomavirus infection in young men. J Infect Dis. 2010;202:1181-4.
PubMed Abstract»
Ball SL, Winder DM, Vaughan K, et al. Analyses of human papillomavirus genotypes and viral loads in anogenital warts. J Med Virol. 2011;83:1345-50.
PubMed Abstract»
Buck CB, Day PM, Trus BL. The papillomavirus major capsid protein L1. Virology. 2013;445:169-74.
PubMed Abstract»
Burchell AN, Coutlée F, Tellier PP, Hanley J, Franco EL. Genital transmission of human papillomavirus in recently formed heterosexual couples. J Infect Dis. 2011;204:1723-9.
PubMed Abstract»
Burchell AN, Tellier PP, Hanley J, Coutlée F, Franco EL. Human papillomavirus infections among couples in new sexual relationships. Epidemiology. 2010;21:31-7.
PubMed Abstract»
Bzhalava D, Eklund C, Dillner J. International standardization and classification of human papillomavirus types. Virology. 2015;476:341-4.
PubMed Abstract»
Castle PE, Schiffman M, Wheeler CM, Solomon D. Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol. 2009;113:18-25.
PubMed Abstract»
de Sanjosé S, Brotons M, Pavón MA. The natural history of human papillomavirus infection. Best Pract Res Clin Obstet Gynaecol. 2018;47:2-13.
PubMed Abstract»
de Villiers EM. Cross-roads in the classification of papillomaviruses. Virology. 2013;445:2-10.
PubMed Abstract»
Derkay CS, Bluher AE. Update on Recurrent Respiratory Papillomatosis. Otolaryngol Clin North Am. 2019;52:669-79.
PubMed Abstract»
Doorbar J, Quint W, Banks L, et al. The biology and life-cycle of human papillomaviruses. Vaccine. 2012;30 Suppl 5:F55-70.
PubMed Abstract»
Doorbar J. Molecular biology of human papillomavirus infection and cervical cancer. Clin Sci (Lond). 2006;110:525-41.
PubMed Abstract»
Garland SM, Steben M, Sings HL, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis. 2009;199:805-14.
PubMed Abstract»
Gilson R, Nugent D, Werner RN, Ballesteros J, Ross J. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2020;34:1644-53.
PubMed Abstract»
Gravitt PE, Winer RL. Natural History of HPV Infection across the Lifespan: Role of Viral Latency. Viruses. 2017;9:267.
PubMed Abstract»
Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998;338:423-8.
PubMed Abstract»
Insinga RP, Perez G, Wheeler CM, et al. Incidence, duration, and reappearance of type-specific cervical human papillomavirus infections in young women. Cancer Epidemiol Biomarkers Prev. 2010;19:1585-94.
PubMed Abstract»
Keefe KA, Schell MJ, Brewer C, et al. A randomized, double blind, Phase III trial using oral beta-carotene supplementation for women with high-grade cervical intraepithelial neoplasia. Cancer Epidemiol Biomarkers Prev. 2001;10:1029-35.
PubMed Abstract»
Kreimer AR, Pierce Campbell CM, Lin HY, et al. Incidence and clearance of oral human papillomavirus infection in men: the HIM cohort study. Lancet. 2013;382:877-87.
PubMed Abstract»
Lam JU, Rebolj M, Dugué PA, Bonde J, von Euler-Chelpin M, Lynge E. Condom use in prevention of Human Papillomavirus infections and cervical neoplasia: systematic review of longitudinal studies. J Med Screen. 2014;21:38-50.
PubMed Abstract»
Mantovani F, Banks L. The human papillomavirus E6 protein and its contribution to malignant progression. Oncogene. 2001;20:7874-87.
PubMed Abstract»
Marra E, Kovaleva A, Bruisten SM, Vermeulen W, Boyd A, Schim van der Loeff MF. Incidence and Clearance of Anal High-risk Human Papillomavirus Infections and Their Determinants Over 5 Years Among Human Immunodeficiency Virus-negative Men Who Have Sex With Men. Clin Infect Dis. 2019;68:1556-65.
PubMed Abstract»
Maturo SC, Hartnick CJ. Juvenile-onset recurrent respiratory papillomatosis. Adv Otorhinolaryngol. 2012;73:105-8.
PubMed Abstract»
McBride AA. Human papillomaviruses: diversity, infection and host interactions. Nat Rev Microbiol. 2021 Sep 14. Online ahead of print.
PubMed Abstract»
Meyskens FL Jr, Surwit E, Moon TE, et al. Enhancement of regression of cervical intraepithelial neoplasia II (moderate dysplasia) with topically applied all-trans-retinoic acid: a randomized trial. J Natl Cancer Inst. 1994;86:539-43.
PubMed Abstract»
Moscicki AB, Ma Y, Farhat S, et al. Natural history of anal human papillomavirus infection in heterosexual women and risks associated with persistence. Clin Infect Dis. 2014;58:804-11.
PubMed Abstract»
Moscicki AB, Schiffman M, Burchell A, et al. Updating the natural history of human papillomavirus and anogenital cancers. Vaccine. 2012;30 Suppl 5:F24-33.
PubMed Abstract»
Nyitray AG, Carvalho da Silva RJ, Chang M, et al. Incidence, duration, persistence, and factors associated with high-risk anal human papillomavirus persistence among HIV-negative men who have sex with men: a multinational study. Clin Infect Dis. 2016;62:1367-74.
PubMed Abstract»
Pang CL, Thierry F. Human papillomavirus proteins as prospective therapeutic targets. Microb Pathog. 2013;58:55-65.
PubMed Abstract»
Poynten IM, Jin F, Roberts JM, et al. The Natural history of anal high-grade squamous intraepithelial lesions in gay and bisexual men. Clin Infect Dis. 2021;72:853-61.
PubMed Abstract»
Ryndock EJ, Meyers C. A risk for non-sexual transmission of human papillomavirus? Expert Rev Anti Infect Ther. 2014;12:1165-70.
PubMed Abstract»
Sabeena S, Bhat P, Kamath V, Arunkumar G. Possible non-sexual modes of transmission of human papilloma virus. J Obstet Gynaecol Res. 2017;43:429-435.
PubMed Abstract»
Sapp M, Day PM. Structure, attachment and entry of polyoma- and papillomaviruses. Virology. 2009;384:400-9.
PubMed Abstract»
Schiffman M, Doorbar J, Wentzensen N, et al. Carcinogenic human papillomavirus infection. Nat Rev Dis Primers. 2016;2:16086.
PubMed Abstract»
Schiffman M, Kjaer SK. Chapter 2: Natural history of anogenital human papillomavirus infection and neoplasia. J Natl Cancer Inst Monogr. 2003;(31):14-9.
PubMed Abstract»
Schiffman M, Solomon D. Clinical practice. Cervical-cancer screening with human papillomavirus and cytologic cotesting. N Engl J Med. 2013;369:2324-31.
PubMed Abstract»
Schiffman M, Wentzensen N. Human papillomavirus infection and the multistage carcinogenesis of cervical cancer. Cancer Epidemiol Biomarkers Prev. 2013;22:553-60.
PubMed Abstract»
Schiller JT, Davies P. Delivering on the promise: HPV vaccines and cervical cancer. Nat Rev Microbiol. 2004;2:343-7.
PubMed Abstract»
Viens LJ, Henley SJ, Watson M, et al. Human papillomavirus-associated cancers - United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2016;65:661-6.
PubMed Abstract»
Wang JW, Roden RB. L2, the minor capsid protein of papillomavirus. Virology. 2013;445:175-86.
PubMed Abstract»
Wangu Z, Hsu KK. Impact of HPV vaccination on anogenital warts and respiratory papillomatosis. Hum Vaccin Immunother. 2016;12:1357-62.
PubMed Abstract»
Winer RL, Kiviat NB, Hughes JP, et al. Development and duration of human papillomavirus lesions, after initial infection. J Infect Dis. 2005;191:731-8.
PubMed Abstract»
Woodman CB, Collins SI, Young LS. The natural history of cervical HPV infection: unresolved issues. Nat Rev Cancer. 2007;7:11-22.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 5. Human Papillomavirus Infection

Clinical Manifestations

Centers for Disease Control and Prevention. Cancers Associated with Human Papillomavirus, United States—2013–2017. USCS Data Brief, no 18. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services;2020.
CDC»
Gilson R, Nugent D, Werner RN, Ballesteros J, Ross J. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2020;34:1644-53.
PubMed Abstract»
Hicks CW, Wick EC, Leeds IL, et al. Patient Symptomatology in Anal Dysplasia. JAMA Surg. 2015;150:563-9.
PubMed Abstract»
Juckett G, Hartman-Adams H. Human papillomavirus: clinical manifestations and prevention. Am Fam Physician. 2010;82:1209-13.
PubMed Abstract»
Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121:829-46.
PubMed Abstract»
Muñoz N, Bosch FX, Castellsagué X, et al. Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004;111:278-85.
PubMed Abstract»
Saraiya M, Unger ER, Thompson TD, et al. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst. 2015;107:djv086.
PubMed Abstract»
Van Dyne EA, Henley SJ, Saraiya M, Thomas CC, Markowitz LE, Benard VB. Trends in human papillomavirus-associated cancers - United States, 1999-2015. MMWR Morb Mortal Wkly Rep. 2018;67:918-24.
PubMed Abstract»
Module 2 » Lesson 5. Human Papillomavirus Infection

Diagnosis and Screening Tests

Anal Cancer Information. University of California at San Francisco.
UCSF»
Berry JM, Palefsky JM, Jay N, Cheng SC, Darragh TM, Chin-Hong PV. Performance characteristics of anal cytology and human papillomavirus testing in patients with high-resolution anoscopy-guided biopsy of high-grade anal intraepithelial neoplasia. Dis Colon Rectum. 2009;52:239-47.
PubMed Abstract»
Darragh TM, Colgan TJ, Cox JT, et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Arch Pathol Lab Med. 2012;136:1266-97.
PubMed Abstract»
Darragh TM, Colgan TJ, Thomas Cox J, et al. The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Int J Gynecol Pathol. 2013;32:76-115.
PubMed Abstract»
Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70:321-46.
PubMed Abstract»
Gudur A, Shanmuganandamurthy D, Szep Z, Poggio JL. An Update on the Current Role of High Resolution Anoscopy in Patients With Anal Dysplasia. Anticancer Res. 2019;39:17-23.
PubMed Abstract»
Hillman RJ, Berry-Lawhorn JM, Ong JJ, et al. International Anal Neoplasia Society Guidelines for the Practice of Digital Anal Rectal Examination. J Low Genit Tract Dis. 2019;23:138-46.
PubMed Abstract»
Hillman RJ, Cuming T, Darragh T, et al. 2016 IANS International Guidelines for Practice Standards in the Detection of Anal Cancer Precursors. J Low Genit Tract Dis. 2016;20:283-91.
PubMed Abstract»
Kotaniemi-Talonen L, Nieminen P, Anttila A, Hakama M. Routine cervical screening with primary HPV testing and cytology triage protocol in a randomised setting. Br J Cancer. 2005;93:862-7.
PubMed Abstract»
Marchand L, Mundt M, Klein G, Agarwal SC. Optimal collection technique and devices for a quality pap smear. WMJ. 2005;104:51-5.
PubMed Abstract»
Mayrand MH, Duarte-Franco E, Rodrigues I, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357:1579-88.
PubMed Abstract»
Michalas SP. The Pap test: George N. Papanicolaou (1883-1962). A screening test for the prevention of cancer of uterine cervix. Eur J Obstet Gynecol Reprod Biol. 2000;90:135-8.
PubMed Abstract»
Naucler P, Ryd W, Törnberg S, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med. 2007;357:1589-97.
PubMed Abstract»
Nayar R, Wilbur DC. The Pap Test and Bethesda 2014. "The reports of my demise have been greatly exaggerated." (after a quotation from Mark Twain). Acta Cytol. 2015;59:121-32.
PubMed Abstract»
Ong JJ, Grulich A, Walker S, et al. Baseline findings from the Anal Cancer Examination (ACE) study: screening using digital ano-rectal examination in HIV-positive men who have sex with men. J Med Screen. 2016;23:70-6.
PubMed Abstract»
Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Human papillomavirus disease. August 18, 2021.
HIV.gov»
Park IU, Palefsky JM. Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with Men. Curr Infect Dis Rep. 2010;12:126-33.
PubMed Abstract»
Read TR, Vodstrcil L, Grulich AE, et al. Acceptability of digital anal cancer screening examinations in HIV-positive homosexual men. HIV Med. 2013;14:491-6.
PubMed Abstract»
Ronco G, Segnan N, Giorgi-Rossi P, et al. Human papillomavirus testing and liquid-based cytology: results at recruitment from the new technologies for cervical cancer randomized controlled trial. J Natl Cancer Inst. 2006;98:765-74.
PubMed Abstract»
Schiffman M, Doorbar J, Wentzensen N, et al. Carcinogenic human papillomavirus infection. Nat Rev Dis Primers. 2016;2:16086.
PubMed Abstract»
Schiffman M, Wentzensen N. Human papillomavirus infection and the multistage carcinogenesis of cervical cancer. Cancer Epidemiol Biomarkers Prev. 2013;22:553-60.
PubMed Abstract»
Schiller JT, Davies P. Delivering on the promise: HPV vaccines and cervical cancer. Nat Rev Microbiol. 2004;2:343-7.
PubMed Abstract»
Woodman CB, Collins SI, Young LS. The natural history of cervical HPV infection: unresolved issues. Nat Rev Cancer. 2007;7:11-22.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection: anogenital warts. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection: HPV-associated cancers and precancers. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. HPV-Associated cancers and precancers. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Human papillomavirus (HPV) infection. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 5. Human Papillomavirus Infection

Screening Recommendations for HPV-Related Cancers

Chaturvedi AK, Madeleine MM, Biggar RJ, Engels EA. Risk of human papillomavirus-associated cancers among persons with AIDS. J Natl Cancer Inst. 2009;101:1120-30.
PubMed Abstract»
Committee on Practice Bulletins—Gynecology.. Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol. 2016;128:e111-30.
PubMed Abstract»
Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70:321-46.
PubMed Abstract»
Hillman RJ, Berry-Lawhorn JM, Ong JJ, et al. International Anal Neoplasia Society Guidelines for the Practice of Digital Anal Rectal Examination. J Low Genit Tract Dis. 2019;23:138-46.
PubMed Abstract»
Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121:829-46.
PubMed Abstract»
Moyer VA. Screening for oral cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160:55-60.
PubMed Abstract»
Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Human papillomavirus disease. August 18, 2021.
HIV.gov»
Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24:102-131.
PubMed Abstract»
Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012;137:516-42.
PubMed Abstract»
Stier EA, Engels E, Horner MJ, et al. Cervical cancer incidence stratified by age in women with HIV compared with the general population in the United States, 2002-2016. AIDS. 2021;35:1851-6.
PubMed Abstract»
U.S. Preventive Services Task Force. Cervical Cancer: Screening. August 21, 2018.
U.S. Preventive Services Task Force»
US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320:674-686.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection: HPV-associated cancers and precancers. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. HPV-Associated cancers and precancers. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 5. Human Papillomavirus Infection

Treatment of Anogenital Warts

D'Ambrogio A, Yerly S, Sahli R, et al. Human papilloma virus type and recurrence rate after surgical clearance of anal condylomata acuminata. Sex Transm Dis. 2009;36:536-40.
PubMed Abstract»
Filley CM, Graff-Richard NR, Lacy JR, Heitner MA, Earnest MP. Neurologic manifestations of podophyllin toxicity. Neurology. 1982;32:308-11.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection: anogenital warts. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection: HPV-associated cancers and precancers. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 5. Human Papillomavirus Infection

Prevention of HPV Infection

Advisory Committee on Immunization Practices (ACIP). Recommended Immunization Schedule for Ages 19 Years or Older, United States, 2022.
ACIP»
Advisory Committee on Immunization Practices (ACIP). Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022
ACIP»
Chow EP, Machalek DA, Tabrizi SN, et al. Quadrivalent vaccine-targeted human papillomavirus genotypes in heterosexual men after the Australian female human papillomavirus vaccination programme: a retrospective observational study. Lancet Infect Dis. 2017;17:68-77.
PubMed Abstract»
Drolet M, Bénard É, Boily MC, et al. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2015;15:565-80.
PubMed Abstract»
Drolet M, Bénard É, Pérez N, Brisson M. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019;394:497-509.
PubMed Abstract»
Dunne EF, Naleway A, Smith N, et al. Reduction in Human Papillomavirus Vaccine Type Prevalence Among Young Women Screened for Cervical Cancer in an Integrated US Healthcare Delivery System in 2007 and 2012-2013. J Infect Dis. 2015;212:1970-5.
PubMed Abstract»
Dunne EF, Unger ER, Sternberg M, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007;297:813-9.
PubMed Abstract»
Flagg EW, Torrone EA. Declines in Anogenital Warts Among Age Groups Most Likely to Be Impacted by Human Papillomavirus Vaccination, United States, 2006-2014. Am J Public Health. 2018;108:112-9.
PubMed Abstract»
Garland SM, Hernandez-Avila M, Wheeler CM, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007;356:1928-43.
PubMed Abstract»
Giuliano AR, Isaacs-Soriano K, Torres BN, et al. Immunogenicity and safety of Gardasil among mid-adult aged men (27-45 years)--The MAM Study. Vaccine. 2015;33:5640-6.
PubMed Abstract»
Giuliano AR, Palefsky JM, Goldstone S, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med. 2011;364:401-11.
PubMed Abstract»
Hall MT, Simms KT, Lew JB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health. 2019;4:e19-e27.
PubMed Abstract»
Hariri S, Bennett NM, Niccolai LM, et al. Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States - 2008-2012. Vaccine. 2015;33:1608-13.
PubMed Abstract»
Hariri S, Johnson ML, Bennett NM, et al. Population-based trends in high-grade cervical lesions in the early human papillomavirus vaccine era in the United States. Cancer. 2015;121:2775-81.
PubMed Abstract»
Joura EA, Giuliano AR, Iversen OE, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372:711-23.
PubMed Abstract»
Koutsky LA, Ault KA, Wheeler CM, et al. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med. 2002;347:1645-51.
PubMed Abstract»
Lei J, Ploner A, Elfström KM, et al. HPV Vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020;383:1340-8.
PubMed Abstract»
Machalek DA, Garland SM, Brotherton JML, et al. Very low prevalence of vaccine human papillomavirus types among 18- to 35-year old Australian women 9 Years following implementation of vaccination. J Infect Dis. 2018;217:1590-1600.
PubMed Abstract»
Mann LM, Llata E, Flagg EW, et al. Trends in the prevalence of anogenital warts among patients at sexually transmitted disease cinics-Sexually Transmitted Disease Surveillance Network, United States, 2010-2016. J Infect Dis. 2019;219:1389-97.
PubMed Abstract»
Markowitz LE, Dunne EF, Saraiya M, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63:1-30.
PubMed Abstract»
Markowitz LE, Gee J, Chesson H, Stokley S. Ten years of human papillomavirus vaccination in the United States. Acad Pediatr. 2018;18:S3-S10.
PubMed Abstract»
Markowitz LE, Hariri S, Lin C, et al. Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010. J Infect Dis. 2013;208:385-93.
PubMed Abstract»
Markowitz LE, Liu G, Hariri S, Steinau M, Dunne EF, Unger ER. Prevalence of HPV After Introduction of the Vaccination Program in the United States. Pediatrics. 2016;137:e20151968.
PubMed Abstract»
Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination - Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016;65:1405-8.
PubMed Abstract»
Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:698-702.
PubMed Abstract»
Moreira ED Jr, Block SL, Ferris D, et al. Safety Profile of the 9-Valent HPV Vaccine: A Combined Analysis of 7 Phase III Clinical Trials. Pediatrics. 2016;138:pii:e20154387.
PubMed Abstract»
Nielson CM, Harris RB, Nyitray AG, Dunne EF, Stone KM, Giuliano AR. Consistent condom use is associated with lower prevalence of human papillomavirus infection in men. J Infect Dis. 2010;202:445-51.
PubMed Abstract»
Palefsky JM, Giuliano AR, Goldstone S, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med. 2011;365:1576-85.
PubMed Abstract»
Patel C, Brotherton JM, Pillsbury A, et al. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Euro Surveill. 2018;23(41).
PubMed Abstract»
Petrosky E, Bocchini JA Jr, Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64:300-4.
PubMed Abstract»
Pierce Campbell CM, Lin HY, Fulp W, et al. Consistent condom use reduces the genital human papillomavirus burden among high-risk men: the HPV infection in men study. J Infect Dis. 2013;208:373-84.
PubMed Abstract»
Saraiya M, Unger ER, Thompson TD, et al. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst. 2015;107:djv086.
PubMed Abstract»
Schiller JT, Davies P. Delivering on the promise: HPV vaccines and cervical cancer. Nat Rev Microbiol. 2004;2:343-7.
PubMed Abstract»
U.S. Food and Drug Administration: FDA News Release. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. October 5, 2018.
U.S. Food and Drug Administration»
Viens LJ, Henley SJ, Watson M, et al. Human papillomavirus-associated cancers - United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2016;65:661-6.
PubMed Abstract»
Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354:2645-54.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection: anogenital warts. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection: HPV-associated cancers and precancers. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Human papillomavirus (HPV) infection. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

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PubMed Abstract»
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PubMed Abstract»
Bleeker MC, Hogewoning CJ, Voorhorst FJ, et al. Condom use promotes regression of human papillomavirus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia. Int J Cancer. 2003;107:804-10.
PubMed Abstract»
Brisson M, Laprise JF, Chesson HW, et al. Health and Economic Impact of Switching from a 4-Valent to a 9-Valent HPV Vaccination Program in the United States. J Natl Cancer Inst. 2016;108(1).
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010;59:626-9.
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Centers for Disease Control and Prevention (CDC). FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010;59:630-2.
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Centers for Disease Control and Prevention (CDC). Human Papillomavirus (HPV) Vaccine Safety.
CDC»
Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013 - United States. MMWR Morb Mortal Wkly Rep. 2013;62:591-5.
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Chesson HW, Spicknall IH, Bingham A, et al. The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018. Sex Transm Dis. 2021;48:215-21.
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Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019;393:169-182.
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Conard PF, Hanna N, Rosenblum M, Gross JB. Delayed recognition of podophyllum toxicity in a patient receiving epidural morphine. Anesth Analg. 1990;71:191-3.
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Conley LJ, Ellerbrock TV, Bush TJ, Chiasson MA, Sawo D, Wright TC. HIV-1 infection and risk of vulvovaginal and perianal condylomata acuminata and intraepithelial neoplasia: a prospective cohort study. Lancet. 2002;359:108-13.
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D'Souza G, Fakhry C, Sugar EA, et al. Six-month natural history of oral versus cervical human papillomavirus infection. Int J Cancer. 2007;121:143-50.
PubMed Abstract»
Daley E, Perrin K, Vamos C, et al. Confusion about Pap smears: lack of knowledge among high-risk women. J Womens Health (Larchmt). 2013;22:67-74.
PubMed Abstract»
Daley EM, Perrin KM, McDermott RJ, et al. The psychosocial burden of HPV: a mixed-method study of knowledge, attitudes and behaviors among HPV+ women. J Health Psychol. 2010;15:279-90.
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Daud II, Scott ME, Ma Y, Shiboski S, Farhat S, Moscicki AB. Association between toll-like receptor expression and human papillomavirus type 16 persistence. Int J Cancer. 2011;128:879-86.
PubMed Abstract»
De Panfilis G, Melzani G, Mori G, Ghidini A, Graifemberghi S. Relapses after treatment of external genital warts are more frequent in HIV-positive patients than in HIV-negative controls. Sex Transm Dis. 2002;29:121-5.
PubMed Abstract»
de Pokomandy A, Rouleau D, Ghattas G, et al. Prevalence, clearance, and incidence of anal human papillomavirus infection in HIV-infected men: the HIPVIRG cohort study. J Infect Dis. 2009;199:965-73.
PubMed Abstract»
Dolev JC, Maurer T, Springer G, et al. Incidence and risk factors for verrucae in women. AIDS. 2008;22:1213-9.
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Domingues E, Chaney KC, Scharf MJ, Wiss K. Imiquimod reactivation of lichen planus. Cutis. 2012;89:276-7, 283.
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Drolet M, Brisson M, Maunsell E, et al. The psychosocial impact of an abnormal cervical smear result. Psychooncology. 2012;21:1071-81.
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Dunne EF, Friedman A, Datta SD, Markowitz LE, Workowski KA. Updates on human papillomavirus and genital warts and counseling messages from the 2010 Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2011;53 Suppl 3:S143-52.
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Foster JC, Smith HL. Use of the Cytobrush for Papanicolaou smear screens in pregnant women. J Nurse Midwifery. 1996;41:211-7.
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Friedman AL, Shepeard H. Exploring the knowledge, attitudes, beliefs, and communication preferences of the general public regarding HPV: findings from CDC focus group research and implications for practice. Health Educ Behav. 2007;34:471-85.
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Frisch M, Biggar RJ, Goedert JJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst. 2000;92:1500-10.
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Garland SM, Cheung TH, McNeill S, et al. Safety and immunogenicity of a 9-valent HPV vaccine in females 12-26 years of age who previously received the quadrivalent HPV vaccine. Vaccine. 2015;33:6855-64.
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Garland SM, Waddell R, Mindel A, Denham IM, McCloskey JC. An open-label phase II pilot study investigating the optimal duration of imiquimod 5% cream for the treatment of external genital warts in women. Int J STD AIDS. 2006;17:448-52.
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Giuliano AR, Lee JH, Fulp W, et al. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet. 2011;377:932-40.
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Maniar KP, Ronnett BM, Vang R, Yemelyanova A. Coexisting high-grade vulvar intraepithelial neoplasia (VIN) and condyloma acuminatum: independent lesions due to different HPV types occurring in immunocompromised patients. Am J Surg Pathol. 2013;37:53-60.
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Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER. Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56:1-24.
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PubMed Abstract»
McCaffery K, Waller J, Nazroo J, Wardle J. Social and psychological impact of HPV testing in cervical screening: a qualitative study. Sex Transm Infect. 2006;82:169-74.
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McCredie MR, Sharples KJ, Paul C, et al. Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol. 2008;9:425-34.
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Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination - Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016;65:1405-8.
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Melnikow J, Henderson JT, Burda BU, Senger CA, Durbin S, Weyrich MS. Screening for Cervical Cancer With High-Risk Human Papillomavirus Testing: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;320:687-705.
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Mix JM, Van Dyne EA, Saraiya M, Hallowell BD, Thomas CC. Assessing Impact of HPV Vaccination on Cervical Cancer Incidence among Women Aged 15-29 Years in the United States, 1999-2017: An Ecologic Study. Cancer Epidemiol Biomarkers Prev. 2021;30:30-7.
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Moriarty AT, Schwartz MR, Eversole G, et al. Human papillomavirus testing and reporting rates: practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology in 2006. Arch Pathol Lab Med. 2008;132:1290-4.
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Moscicki AB, Shiboski S, Broering J, et al. The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women. J Pediatr. 1998;132:277-84.
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Muñoz N, Kjaer SK, Sigurdsson K, et al. Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. J Natl Cancer Inst. 2010;102:325-39.
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Nelson EL, Stockdale CK. Vulvar and vaginal HPV disease. Obstet Gynecol Clin North Am. 2013;40:359-76.
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Oriel JD. Natural history of genital warts. Br J Vener Dis. 1971;47:1-13.
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Park IU, Introcaso C, Dunne EF. Human Papillomavirus and Genital Warts: A Review of the Evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis. 2015;61 Suppl 8:S849-55.
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Parkin DM, Bray F. Chapter 2: The burden of HPV-related cancers. Vaccine. 2006;24 Suppl 3:S3/11-25.
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Practice Bulletin No. 168 Summary: Cervical Cancer Screening and Prevention. Obstet Gynecol. 2016;128:923-5.
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Reitano M. Counseling patients with genital warts. Am J Med. 1997;102:38-43.
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Ronco G, Dillner J, Elfström KM, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2014;383:524-32.
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Rothman I, Berger RE, Kiviat N, Navarro AL, Remington ML. Urethral meatal warts in men: results of urethroscopy and biopsy. J Urol. 1994;151:875-7.
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Sadler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA. 2004;291:2100-6.
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Salit IE, Lytwyn A, Raboud J, et al. The role of cytology (Pap tests) and human papillomavirus testing in anal cancer screening. AIDS. 2010;24:1307-13.
PubMed Abstract»
Saraiya M, Lee NC, Blackman D, Smith MJ, Morrow B, McKenna MA. Self-reported Papanicolaou smears and hysterectomies among women in the United States. Obstet Gynecol. 2001;98:269-78.
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Saslow D, Andrews KS, Manassaram-Baptiste D, et al. Human papillomavirus vaccination guideline update: American Cancer Society guideline endorsement. CA Cancer J Clin. 2016;66:375-85.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
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Scheller NM, Pasternak B, Mølgaard-Nielsen D, Svanström H, Hviid A. Quadrivalent HPV Vaccination and the Risk of Adverse Pregnancy Outcomes. N Engl J Med. 2017;376:1223-1233.
PubMed Abstract»
Schiffman M, Wentzensen N, Wacholder S, Kinney W, Gage JC, Castle PE. Human papillomavirus testing in the prevention of cervical cancer. J Natl Cancer Inst. 2011;103:368-83.
PubMed Abstract»
Schim van der Loeff MF, Mooij SH, Richel O, de Vries HJ, Prins JM. HPV and anal cancer in HIV-infected individuals: a review. Curr HIV/AIDS Rep. 2014;11:250-62.
PubMed Abstract»
Schlecht HP, Fugelso DK, Murphy RK, et al. Frequency of occult high-grade squamous intraepithelial neoplasia and invasive cancer within anal condylomata in men who have sex with men. Clin Infect Dis. 2010;51:107-10.
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Senkomago V, Henley SJ, Thomas CC, Mix JM, Markowitz LE, Saraiya M. Human Papillomavirus-Attributable Cancers - United States, 2012-2016. MMWR Morb Mortal Wkly Rep. 2019;68:724-8.
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Shah KV. A case for immunization of human papillomavirus (HPV) 6/11-infected pregnant women with the quadrivalent HPV vaccine to prevent juvenile-onset laryngeal papilloma. J Infect Dis. 2014;209:1307-9.
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The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer. November 17, 2020.
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The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:1915-27.
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van de Laar TJ, Richel O. Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus. Sex Transm Infect. 2017;93:368-73.
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Widdice LE, Moscicki AB. Updated guidelines for papanicolaou tests, colposcopy, and human papillomavirus testing in adolescents. J Adolesc Health. 2008;43:S41-51.
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Wiley DJ, Douglas J, Beutner K, et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis. 2002;35:S210-24.
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Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007;197:346-55.
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Wright TC Jr, Schiffman M. Adding a test for human papillomavirus DNA to cervical-cancer screening. N Engl J Med. 2003;348:489-90.
PubMed Abstract»
Yoo W, Kim S, Huh WK, et al. Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States. PLoS One. 2017;12:e0172548.
PubMed Abstract»

Lesson 6. Pelvic Inflammatory Disease

Module 2 » Lesson 6. Pelvic Inflammatory Disease

Introduction

Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039-48.
PubMed Abstract»
Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019;100:357-64.
PubMed Abstract»
Hillier SL, Bernstein KT, Aral S. A Review of the Challenges and Complexities in the Diagnosis, Etiology, Epidemiology, and Pathogenesis of Pelvic Inflammatory Disease. J Infect Dis. 2021;224:S23-S28.
PubMed Abstract»
Mitchell CM, Anyalechi GE, Cohen CR, Haggerty CL, Manhart LE, Hillier SL. Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia. J Infect Dis. 2021;224:S29-S35.
PubMed Abstract»
Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186:929-37.
PubMed Abstract»
Soper DE, Wiesenfeld HC. The Continued Challenges in the Diagnosis of Acute Pelvic Inflammatory Disease: Focus on Clinically Mild Disease. J Infect Dis. 2021;224:S75-S79.
PubMed Abstract»
Wiesenfeld HC, Hillier SL, Meyn LA, Amortegui AJ, Sweet RL. Subclinical pelvic inflammatory disease and infertility. Obstet Gynecol. 2012;120:37-43.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 6. Pelvic Inflammatory Disease

Epidemiology

Anschuetz GL, Asbel L, Spain CV, et al. Association between enhanced screening for Chlamydia trachomatis and Neisseria gonorrhoeae and reductions in sequelae among women. J Adolesc Health. 2012;51:80-5.
PubMed Abstract»
Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF. Positive Testing for Neisseria gonorrhoeae and Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease in IUD Users. J Womens Health (Larchmt). 2015;24:354-9.
PubMed Abstract»
Bohm MK, Newman L, Satterwhite CL, Tao G, Weinstock HS. Pelvic inflammatory disease among privately insured women, United States, 2001-2005. Sex Transm Dis. 2010;37:131-6.
PubMed Abstract»
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039-48.
PubMed Abstract»
Carr S, Espey E. Intrauterine devices and pelvic inflammatory disease among adolescents. J Adolesc Health. 2013;52:S22-8.
PubMed Abstract»
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. STDs in women and infants. Atlanta: U.S. Department of Health and Human Services; 2016.
PubMed Abstract»
Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65:1-103.
PubMed Abstract»
Davis A, Gaynor A. A comparison of US clinical laboratory Chlamydia and Gonorrhea testing practices before and after the 2014 Centers for Disease Control and Prevention Testing Recommendations. Sex Transm Dis. 2021;48:e73-e76.
PubMed Abstract»
Eschenbach DA, Buchanan TM, Pollock HM, et al. Polymicrobial etiology of acute pelvic inflammatory disease. N Engl J Med. 1975;293:166-71.
PubMed Abstract»
Eschenbach DA. Acute pelvic inflammatory disease. Urol Clin North Am. 1984;11:65-81.
PubMed Abstract»
Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet. 2000;356:1013-9.
PubMed Abstract»
Hay PE, Kerry SR, Normansell R, et al. Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study. Sex Transm Infect. 2016;92:63-6.
PubMed Abstract»
Jatlaoui TC, Riley HEM, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception. 2017;95:17-39.
PubMed Abstract»
Jossens MO, Eskenazi B, Schachter J, Sweet RL. Risk factors for pelvic inflammatory disease. A case control study. Sex Transm Dis. 1996;23:239-47.
PubMed Abstract»
Kreisel K, Torrone E, Bernstein K, Hong J, Gorwitz R. Prevalence of pelvic inflammatory disease in sexually experienced women of reproductive age - United States, 2013-2014. MMWR Morb Mortal Wkly Rep. 2017;66:80-3.
PubMed Abstract»
Kreisel KM, Llata E, Haderxhanaj L, et al. The burden of and trends in pelvic inflammatory disease in the United States, 2006-2016. J Infect Dis. 2021;224:S103-S112.
PubMed Abstract»
Leichliter JS, Chandra A, Aral SO. Correlates of self-reported pelvic inflammatory disease treatment in sexually experienced reproductive-aged women in the United States, 1995 and 2006-2010. Sex Transm Dis. 2013;40:413-8.
PubMed Abstract»
Ness RB, Kip KE, Hillier SL, et al. A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol. 2005;162:585-90.
PubMed Abstract»
Ness RB, Randall H, Richter HE, et al. Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease. Am J Public Health. 2004;94:1327-9.
PubMed Abstract»
Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ. 2010;340:c1642.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Rein DB, Kassler WJ, Irwin KL, Rabiee L. Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstet Gynecol. 2000;95:397-402.
PubMed Abstract»
Ross JD, Hughes G. Why is the incidence of pelvic inflammatory disease falling? BMJ. 2014;348:g1538.
PubMed Abstract»
Scholes D, Satterwhite CL, Yu O, Fine D, Weinstock H, Berman S. Long-term trends in Chlamydia trachomatis infections and related outcomes in a U.S. managed care population. Sex Transm Dis. 2012;39:81-8.
PubMed Abstract»
Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334:1362-6.
PubMed Abstract»
Sutton MY, Sternberg M, Zaidi A, St Louis ME, Markowitz LE. Trends in pelvic inflammatory disease hospital discharges and ambulatory visits, United States, 1985-2001. Sex Transm Dis. 2005;32:778-84.
PubMed Abstract»
Turok DK, Eisenberg DL, Teal SB, Keder LM, Creinin MD. A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement. Am J Obstet Gynecol. 2016;215:599.e1-599.e6.
PubMed Abstract»
Washington AE, Aral SO, Wølner-Hanssen P, Grimes DA, Holmes KK. Assessing risk for pelvic inflammatory disease and its sequelae. JAMA. 1991;266:2581-6.
PubMed Abstract»
Woodhall SC, Torrone L, Fine D, et al. How do changes in the population tested for chlamydia over time affect observed trends in chlamydia positivity? Analysis of routinely collected data from young women tested for chlamydia in family planning clinics in the Pacific Northwest (USA), between 2003 and 2010. Sex Health. 2015;12:512-9.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 6. Pelvic Inflammatory Disease

Microbiology and Pathogenesis

Bjartling C, Osser S, Persson K. Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. Am J Obstet Gynecol. 2012;206:476.e1-8.
PubMed Abstract»
Brunham RC, Binns B, Guijon F, et al. Etiology and outcome of acute pelvic inflammatory disease. J Infect Dis. 1988;158:510-7.
PubMed Abstract»
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039-48.
PubMed Abstract»
Brunham RC. Immunology. A Chlamydia vaccine on the horizon. Science. 2015;348:1322-3.
PubMed Abstract»
Burnett AM, Anderson CP, Zwank MD. Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. Am J Emerg Med. 2012;30:1114-7.
PubMed Abstract»
Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 2012;55:893-903.
PubMed Abstract»
Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019;100:357-64.
PubMed Abstract»
Eschenbach DA, Buchanan TM, Pollock HM, et al. Polymicrobial etiology of acute pelvic inflammatory disease. N Engl J Med. 1975;293:166-71.
PubMed Abstract»
Eschenbach DA, Wölner-Hanssen P, Hawes SE, Pavletic A, Paavonen J, Holmes KK. Acute pelvic inflammatory disease: associations of clinical and laboratory findings with laparoscopic findings. Obstet Gynecol. 1997;89:184-92.
PubMed Abstract»
Eschenbach DA. Acute pelvic inflammatory disease. Urol Clin North Am. 1984;11:65-81.
PubMed Abstract»
Haggerty CL, Taylor BD. Mycoplasma genitalium: an emerging cause of pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2011;2011:959816.
PubMed Abstract»
Hillier SL, Bernstein KT, Aral S. A Review of the Challenges and Complexities in the Diagnosis, Etiology, Epidemiology, and Pathogenesis of Pelvic Inflammatory Disease. J Infect Dis. 2021;224:S23-S28.
PubMed Abstract»
Landers DV, Sweet RL. Current trends in the diagnosis and treatment of tuboovarian abscess. Am J Obstet Gynecol. 1985;151:1098-110.
PubMed Abstract»
Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:418-26.
PubMed Abstract»
Mitchell CM, Anyalechi GE, Cohen CR, Haggerty CL, Manhart LE, Hillier SL. Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia. J Infect Dis. 2021;224:S29-S35.
PubMed Abstract»
Ness RB, Hillier SL, Kip KE, et al. Bacterial vaginosis and risk of pelvic inflammatory disease. Obstet Gynecol. 2004;104:761-9.
PubMed Abstract»
Ness RB, Kip KE, Hillier SL, et al. A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol. 2005;162:585-90.
PubMed Abstract»
Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186:929-37.
PubMed Abstract»
Pelvic inflammatory disease: guidelines for prevention and management. MMWR Recomm Rep. 1991;40:1-25.
PubMed Abstract»
Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med. 2004;71:233-9.
PubMed Abstract»
Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 2009;64:681-9.
PubMed Abstract»
Russell AN, Zheng X, O'Connell CM, et al. Analysis of Factors Driving Incident and Ascending Infection and the Role of Serum Antibody in Chlamydia trachomatis Genital Tract Infection. J Infect Dis. 2016;213:523-31.
PubMed Abstract»
Scholes D, Satterwhite CL, Yu O, Fine D, Weinstock H, Berman S. Long-term trends in Chlamydia trachomatis infections and related outcomes in a U.S. managed care population. Sex Transm Dis. 2012;39:81-8.
PubMed Abstract»
Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL. Clinical presentation of Mycoplasma genitalium infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis. 2009;48:41-7.
PubMed Abstract»
Soper DE, Brockwell NJ, Dalton HP, Johnson D. Observations concerning the microbial etiology of acute salpingitis. Am J Obstet Gynecol. 1994;170:1008-14.
PubMed Abstract»
Taylor BD, Darville T, Ferrell RE, Kammerer CM, Ness RB, Haggerty CL. Variants in toll-like receptor 1 and 4 genes are associated with Chlamydia trachomatis among women with pelvic inflammatory disease. J Infect Dis. 2012;205:603-9.
PubMed Abstract»
Taylor BD, Darville T, Haggerty CL. Does bacterial vaginosis cause pelvic inflammatory disease? Sex Transm Dis. 2013;40:117-22.
PubMed Abstract»
Verweij SP, Karimi O, Pleijster J, et al. TLR2, TLR4 and TLR9 genotypes and haplotypes in the susceptibility to and clinical course of Chlamydia trachomatis infections in Dutch women. Pathog Dis. 2016;74:ftv107.
PubMed Abstract»
Wasserheit JN, Bell TA, Kiviat NB, et al. Microbial causes of proven pelvic inflammatory disease and efficacy of clindamycin and tobramycin. Ann Intern Med. 1986;104:187-93.
PubMed Abstract»
Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol. 2002;100:456-63.
PubMed Abstract»
Wiesenfeld HC, Hillier SL, Meyn LA, Amortegui AJ, Sweet RL. Subclinical pelvic inflammatory disease and infertility. Obstet Gynecol. 2012;120:37-43.
PubMed Abstract»
Wiesenfeld HC, Meyn LA, Darville T, Macio IS, Hillier SL. A randomized controlled trial of ceftriaxone and doxycycline, with or without metronidazole, for the treatment of acute pelvic inflammatory disease. Clin Infect Dis. 2021;72:1181-9.
PubMed Abstract»
Module 2 » Lesson 6. Pelvic Inflammatory Disease

Clinical Manifestations

Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039-48.
PubMed Abstract»
Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 2012;55:893-903.
PubMed Abstract»
Chayachinda C, Rekhawasin T. Reproductive outcomes of patients being hospitalised with pelvic inflammatory disease. J Obstet Gynaecol. 2016;:1-5.
PubMed Abstract»
Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019;100:357-64.
PubMed Abstract»
Eschenbach DA, Wölner-Hanssen P, Hawes SE, Pavletic A, Paavonen J, Holmes KK. Acute pelvic inflammatory disease: associations of clinical and laboratory findings with laparoscopic findings. Obstet Gynecol. 1997;89:184-92.
PubMed Abstract»
Heinonen PK, Leinonen M. Fecundity and morbidity following acute pelvic inflammatory disease treated with doxycycline and metronidazole. Arch Gynecol Obstet. 2003;268:284-8.
PubMed Abstract»
Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W Jr, Westrom L. Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol. 1993;168:1503-9.
PubMed Abstract»
Landers DV, Sweet RL. Current trends in the diagnosis and treatment of tuboovarian abscess. Am J Obstet Gynecol. 1985;151:1098-110.
PubMed Abstract»
Lareau SM, Beigi RH. Pelvic inflammatory disease and tubo-ovarian abscess. Infect Dis Clin North Am. 2008;22:693-708.
PubMed Abstract»
Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186:929-37.
PubMed Abstract»
Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med. 2004;71:233-9.
PubMed Abstract»
Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 2009;64:681-9.
PubMed Abstract»
Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis. 1992;19:185-92.
PubMed Abstract»
Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol. 2002;100:456-63.
PubMed Abstract»
Wiesenfeld HC, Hillier SL, Meyn LA, Amortegui AJ, Sweet RL. Subclinical pelvic inflammatory disease and infertility. Obstet Gynecol. 2012;120:37-43.
PubMed Abstract»
Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL. Comparison of acute and subclinical pelvic inflammatory disease. Sex Transm Dis. 2005;32:400-5.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 6. Pelvic Inflammatory Disease

Diagnosis

Gaitán H, Angel E, Diaz R, Parada A, Sanchez L, Vargas C. Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2002;10:171-80.
PubMed Abstract»
Jacobson L, Weström L. Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy. Am J Obstet Gynecol. 1969;105:1088-98.
PubMed Abstract»
Kahn JG, Walker CK, Washington AE, Landers DV, Sweet RL. Diagnosing pelvic inflammatory disease. A comprehensive analysis and considerations for developing a new model. JAMA. 1991;266:2594-604.
PubMed Abstract»
Livengood CH 3rd, Hill GB, Addison WA. Pelvic inflammatory disease: findings during inpatient treatment of clinically severe, laparoscopy-documented disease. Am J Obstet Gynecol. 1992;166:519-24.
PubMed Abstract»
Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186:929-37.
PubMed Abstract»
Peipert JF, Boardman LA, Sung CJ. Performance of clinical and laparoscopic criteria for the diagnosis of upper genital tract infection. Infect Dis Obstet Gynecol. 1997;5:291-6.
PubMed Abstract»
Sellors J, Mahony J, Goldsmith C, et al. The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease. Am J Obstet Gynecol. 1991;164:113-20.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 6. Pelvic Inflammatory Disease

Treatment

Barbosa C, Macasaet M, Brockmann S, Sierra MF, Xia Z, Duerr A. Pelvic inflammatory disease and human immunodeficiency virus infection. Obstet Gynecol. 1997;89:65-70.
PubMed Abstract»
Bevan CD, Johal BJ, Mumtaz G, Ridgway GL, Siddle NC. Clinical, laparoscopic and microbiological findings in acute salpingitis: report on a United Kingdom cohort. Br J Obstet Gynaecol. 1995;102:407-14.
PubMed Abstract»
Bevan CD, Ridgway GL, Rothermel CD. Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. J Int Med Res. 2003;31:45-54.
PubMed Abstract»
Boothby M, Page J, Pryor R, Ross JD. A comparison of treatment outcomes for moxifloxacin versus ofloxacin/metronidazole for first-line treatment of uncomplicated non-gonococcal pelvic inflammatory disease. Int J STD AIDS. 2010;21:195-7.
PubMed Abstract»
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039-48.
PubMed Abstract»
Bukusi EA, Cohen CR, Stevens CE, et al. Effects of human immunodeficiency virus 1 infection on microbial origins of pelvic inflammatory disease and on efficacy of ambulatory oral therapy. Am J Obstet Gynecol. 1999;181:1374-81.
PubMed Abstract»
Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019;100:357-64.
PubMed Abstract»
Haggerty CL, Ness RB. Newest approaches to treatment of pelvic inflammatory disease: a review of recent randomized clinical trials. Clin Infect Dis. 2007;44:953-60.
PubMed Abstract»
Hemsell DL, Little BB, Faro S, et al. Comparison of three regimens recommended by the Centers for Disease Control and Prevention for the treatment of women hospitalized with acute pelvic inflammatory disease. Clin Infect Dis. 1994;19:720-7.
PubMed Abstract»
Heystek M, Ross JD. A randomized double-blind comparison of moxifloxacin and doxycycline/metronidazole/ciprofloxacin in the treatment of acute, uncomplicated pelvic inflammatory disease. Int J STD AIDS. 2009;20:690-5.
PubMed Abstract»
Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W Jr, Westrom L. Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol. 1993;168:1503-9.
PubMed Abstract»
Irwin KL, Moorman AC, O'Sullivan MJ, et al. Influence of human immunodeficiency virus infection on pelvic inflammatory disease. Obstet Gynecol. 2000;95:525-34.
PubMed Abstract»
Judlin P, Liao Q, Liu Z, Reimnitz P, Hampel B, Arvis P. Efficacy and safety of moxifloxacin in uncomplicated pelvic inflammatory disease: the MONALISA study. BJOG. 2010;117:1475-84.
PubMed Abstract»
Korn AP, Landers DV, Green JR, Sweet RL. Pelvic inflammatory disease in human immunodeficiency virus-infected women. Obstet Gynecol. 1993;82:765-8.
PubMed Abstract»
McGregor JA, Crombleholme WR, Newton E, Sweet RL, Tuomala R, Gibbs RS. Randomized comparison of ampicillin-sulbactam to cefoxitin and doxycycline or clindamycin and gentamicin in the treatment of pelvic inflammatory disease or endometritis. Obstet Gynecol. 1994;83:998-1004.
PubMed Abstract»
McNeeley SG, Hendrix SL, Mazzoni MM, Kmak DC, Ransom SB. Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess. Am J Obstet Gynecol. 1998;178:1272-8.
PubMed Abstract»
Mikamo H, Iwasaku K, Yamagishi Y, Matsumizu M, Nagashima M. Efficacy and safety of intravenous azithromycin followed by oral azithromycin for the treatment of acute pelvic inflammatory disease and perihepatitis in Japanese women. J Infect Chemother. 2014;20:429-35.
PubMed Abstract»
Mugo NR, Kiehlbauch JA, Nguti R, et al. Effect of human immunodeficiency virus-1 infection on treatment outcome of acute salpingitis. Obstet Gynecol. 2006;107:807-12.
PubMed Abstract»
Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186:929-37.
PubMed Abstract»
Reed SD, Landers DV, Sweet RL. Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens. Am J Obstet Gynecol. 1991;164:1556-61.
PubMed Abstract»
Risser WL, Risser JM, Risser AL. Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents. Adolesc Health Med Ther. 2017;8:87-94.
PubMed Abstract»
Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 2009;64:681-9.
PubMed Abstract»
Ross JD, Cronjé HS, Paszkowski T, et al. Moxifloxacin versus ofloxacin plus metronidazole in uncomplicated pelvic inflammatory disease: results of a multicentre, double blind, randomised trial. Sex Transm Infect. 2006;82:446-51.
PubMed Abstract»
Savaris RF, Teixeira LM, Torres TG, Edelweiss MI, Moncada J, Schachter J. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol. 2007;110:53-60.
PubMed Abstract»
Sweet RL, Landers DV. Pelvic inflammatory disease in HIV-positive women. Lancet. 1997;349:1265-6.
PubMed Abstract»
Sweet RL, Schachter J, Landers DV, Ohm-Smith M, Robbie MO. Treatment of hospitalized patients with acute pelvic inflammatory disease: comparison of cefotetan plus doxycycline and cefoxitin plus doxycycline. Am J Obstet Gynecol. 1988;158:736-41.
PubMed Abstract»
Sweet RL. Treatment of acute pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2011;2011:561909.
PubMed Abstract»
Trent M, Perin J, Gaydos CA, et al. Efficacy of a Technology-Enhanced Community Health Nursing Intervention vs Standard of Care for Female Adolescents and Young Adults With Pelvic Inflammatory Disease: A Randomized Clinical Trial. JAMA Netw Open. 2019;2:e198652.
PubMed Abstract»
Trent M, Perin J, Rowell J, et al. Using Innovation to Address Adolescent and Young Adult Health Disparities in Pelvic Inflammatory Disease: Design of the Technology Enhanced Community Health Precision Nursing (TECH-PN) Trial. J Infect Dis. 2021;224:S145-S151.
PubMed Abstract»
Walker CK, Kahn JG, Washington AE, Peterson HB, Sweet RL. Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy. J Infect Dis. 1993;168:969-78.
PubMed Abstract»
Walker CK, Wiesenfeld HC. Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2007;44 Suppl 3:S111-22.
PubMed Abstract»
Walters MD, Gibbs RS. A randomized comparison of gentamicin-clindamycin and cefoxitin-doxycycline in the treatment of acute pelvic inflammatory disease. Obstet Gynecol. 1990;75:867-72.
PubMed Abstract»
Wiesenfeld HC, Meyn LA, Darville T, Macio IS, Hillier SL. A randomized controlled trial of ceftriaxone and doxycycline, with or without metronidazole, for the treatment of acute pelvic inflammatory disease. Clin Infect Dis. 2021;72:1181-9.
PubMed Abstract»
Wiesenfeld HC, Sweet RL. Progress in the management of tuboovarian abscesses. Clin Obstet Gynecol. 1993;36:433-44.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 6. Pelvic Inflammatory Disease

Management of Sex Partners

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Battle TJ, Golden MR, Suchland KL, et al. Evaluation of laboratory testing methods for Chlamydia trachomatis infection in the era of nucleic acid amplification. J Clin Microbiol. 2001;39:2924-7.
PubMed Abstract»
Bender N, Herrmann B, Andersen B, et al. Chlamydia infection, pelvic inflammatory disease, ectopic pregnancy and infertility: cross-national study. Sex Transm Infect. 2011;87:601-8.
PubMed Abstract»
Bennett GL, Slywotzky CM, Giovanniello G. Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics. 2002;22:785-801.
PubMed Abstract»
Bjartling C, Osser S, Persson K. Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. Am J Obstet Gynecol. 2012;206:476.e1-8.
PubMed Abstract»
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039-48.
PubMed Abstract»
Brunham RC. Immunology. A Chlamydia vaccine on the horizon. Science. 2015;348:1322-3.
PubMed Abstract»
Burnett AM, Anderson CP, Zwank MD. Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. Am J Emerg Med. 2012;30:1114-7.
PubMed Abstract»
Cates W Jr, Rolfs RT Jr, Aral SO. Sexually transmitted diseases, pelvic inflammatory disease, and infertility: an epidemiologic update. Epidemiol Rev. 1990;12:199-220.
PubMed Abstract»
Cates W Jr, Wasserheit JN. Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol. 1991;164:1771-81.
PubMed Abstract»
Chen MJ, Kim CR, Whitehouse KC, Berry-Bibee E, Gaffield ME. Development, updates, and future directions of the World Health Organization Selected Practice Recommendations for Contraceptive Use. Int J Gynaecol Obstet. 2017;136:113-9.
PubMed Abstract»
Cherpes TL, Wiesenfeld HC, Melan MA, et al. The associations between pelvic inflammatory disease, Trichomonas vaginalis infection, and positive herpes simplex virus type 2 serology. Sex Transm Dis. 2006;33:747-52.
PubMed Abstract»
Cohen CR, Mugo NR, Astete SG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. 2005;81:463-6.
PubMed Abstract»
Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65:1-66.
PubMed Abstract»
French CE, Hughes G, Nicholson A, et al. Estimation of the rate of pelvic inflammatory disease diagnoses: trends in England, 2000-2008. Sex Transm Dis. 2011;38:158-62.
PubMed Abstract»
Gift TL, Gaydos CA, Kent CK, et al. The program cost and cost-effectiveness of screening men for Chlamydia to prevent pelvic inflammatory disease in women. Sex Transm Dis. 2008;35:S66-75.
PubMed Abstract»
Haggerty CL, Ness RB, Amortegui A, et al. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am J Obstet Gynecol. 2003;188:141-8.
PubMed Abstract»
Haggerty CL, Taylor BD. Mycoplasma genitalium: an emerging cause of pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2011;2011:959816.
PubMed Abstract»
Haggerty CL, Totten PA, Astete SG, Ness RB. Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2006;2006:30184.
PubMed Abstract»
Haggerty CL, Totten PA, Tang G, et al. Identification of novel microbes associated with pelvic inflammatory disease and infertility. Sex Transm Infect. 2016;92:441-6.
PubMed Abstract»
Han T, Nolan SM, Regard M. Mycoplasma genitalium as a Cause of Pelvic Inflammatory Disease. J Pediatr Adolesc Gynecol. 2020;33:739-41.
PubMed Abstract»
Hillis SD, Wasserheit JN. Screening for chlamydia--a key to the prevention of pelvic inflammatory disease. N Engl J Med. 1996;334:1399-401.
PubMed Abstract»
Hwang LY, Ma Y, Moscicki AB. Biological and behavioral risks for incident Chlamydia trachomatis infection in a prospective cohort. Obstet Gynecol. 2014;124:954-60.
PubMed Abstract»
Jurstrand M, Jensen JS, Magnuson A, Kamwendo F, Fredlund H. A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy. Sex Transm Infect. 2007;83:319-23.
PubMed Abstract»
Larsson PG, Platz-Christensen JJ, Thejls H, Forsum U, Påhlson C. Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study. Am J Obstet Gynecol. 1992;166:100-3.
PubMed Abstract»
Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:418-26.
PubMed Abstract»
Litt IF, Cohen MI. Perihepatitis associated with salpingitis in adolescents. JAMA. 1978;240:1253-4.
PubMed Abstract»
Mitchell C, Prabhu M. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am. 2013;27:793-809.
PubMed Abstract»
Moodley P, Wilkinson D, Connolly C, Moodley J, Sturm AW. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis. 2002;34:519-22.
PubMed Abstract»
Moore DE, Spadoni LR, Foy HM, et al. Increased frequency of serum antibodies to Chlamydia trachomatis in infertility due to distal tubal disease. Lancet. 1982;2:574-7.
PubMed Abstract»
Ness RB, Hillier SL, Kip KE, et al. Bacterial vaginosis and risk of pelvic inflammatory disease. Obstet Gynecol. 2004;104:761-9.
PubMed Abstract»
Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186:929-37.
PubMed Abstract»
Oakeshott P, Aghaizu A, Hay P, et al. Is Mycoplasma genitalium in women the "New Chlamydia?" A community-based prospective cohort study. Clin Infect Dis. 2010;51:1160-6.
PubMed Abstract»
Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ. 2010;340:c1642.
PubMed Abstract»
Owusu-Edusei K Jr, Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis. 2013;40:197-201.
PubMed Abstract»
Peipert JF, Ness RB, Blume J, et al. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Am J Obstet Gynecol. 2001;184:856-63.
PubMed Abstract»
Peipert JF, Sweet RL, Walker CK, Kahn J, Rielly-Gauvin K. Evaluation of ofloxacin in the treatment of laparoscopically documented acute pelvic inflammatory disease (salpingitis). Infect Dis Obstet Gynecol. 1999;7:138-44.
PubMed Abstract»
Rekart ML, Gilbert M, Meza R, et al. Chlamydia public health programs and the epidemiology of pelvic inflammatory disease and ectopic pregnancy. J Infect Dis. 2013;207:30-8.
PubMed Abstract»
Romosan G, Valentin L. The sensitivity and specificity of transvaginal ultrasound with regard to acute pelvic inflammatory disease: a review of the literature. Arch Gynecol Obstet. 2014;289:705-14.
PubMed Abstract»
Ross JD. Pelvic inflammatory disease. BMJ Clin Evid. 2013;2013.
PubMed Abstract»
Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334:1362-6.
PubMed Abstract»
Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL. Clinical presentation of Mycoplasma genitalium infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis. 2009;48:41-7.
PubMed Abstract»
Simms I, Eastick K, Mallinson H, et al. Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease. Sex Transm Infect. 2003;79:154-6.
PubMed Abstract»
Smith KJ, Ness RB, Wiesenfeld HC, Roberts MS. Cost-effectiveness of alternative outpatient pelvic inflammatory disease treatment strategies. Sex Transm Dis. 2007;34:960-6.
PubMed Abstract»
Taylor-Robinson D, Jensen JS, Svenstrup H, Stacey CM. Difficulties experienced in defining the microbial cause of pelvic inflammatory disease. Int J STD AIDS. 2012;23:18-24.
PubMed Abstract»
Tepper NK, Steenland MW, Gaffield ME, Marchbanks PA, Curtis KM. Retention of intrauterine devices in women who acquire pelvic inflammatory disease: a systematic review. Contraception. 2013;87:655-60.
PubMed Abstract»
Viberga I, Odlind V, Lazdane G, Kroica J, Berglund L, Olofsson S. Microbiology profile in women with pelvic inflammatory disease in relation to IUD use. Infect Dis Obstet Gynecol. 2005;13:183-90.
PubMed Abstract»
Wang SP, Eschenbach DA, Holmes KK, Wager G, Grayston JT. Chlamydia trachomatis infection in Fitz-Hugh-Curtis syndrome. Am J Obstet Gynecol. 1980;138:1034-8.
PubMed Abstract»
Washington AE, Katz P. Cost of and payment source for pelvic inflammatory disease. Trends and projections, 1983 through 2000. JAMA. 1991;266:2565-9.
PubMed Abstract»
Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6-10.
PubMed Abstract»
Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol. 2002;100:456-63.
PubMed Abstract»
Woods JL, Scurlock AM, Hensel DJ. Pelvic inflammatory disease in the adolescent: understanding diagnosis and treatment as a health care provider. Pediatr Emerg Care. 2013;29:720-5.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

Lesson 7. Vaginitis

Module 2 » Lesson 7. Vaginitis

Introduction

Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004;291:1368-79.
PubMed Abstract»
Hainer BL, Gibson MV. Vaginitis. Am Fam Physician. 2011;83:807-15.
PubMed Abstract»
Rivers CA, Adaramola OO, Schwebke JR. Prevalence of bacterial vaginosis and vulvovaginal candidiasis mixed infection in a southeastern american STD clinic. Sex Transm Dis. 2011;38:672-4.
PubMed Abstract»
Yarbrough ML, Burnham CA. The ABCs of STIs: An Update on sexually transmitted infections. Clin Chem. 2016;62:811-23.
PubMed Abstract»
Module 2 » Lesson 7. Vaginitis

Diagnostic Approach for Vaginitis

Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004;291:1368-79.
PubMed Abstract»
Bachmann LH, Hobbs MM, Seña AC, et al. Trichomonas vaginalis genital infections: progress and challenges. Clin Infect Dis. 2011;53 Suppl 3:S160-72.
PubMed Abstract»
Brown HL, Fuller DD, Jasper LT, Davis TE, Wright JD. Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis. Infect Dis Obstet Gynecol. 2004;12:17-21.
PubMed Abstract»
Campbell L, Woods V, Lloyd T, Elsayed S, Church DL. Evaluation of the OSOM Trichomonas rapid test versus wet preparation examination for detection of Trichomonas vaginalis vaginitis in specimens from women with a low prevalence of infection. J Clin Microbiol. 2008;46:3467-9.
PubMed Abstract»
Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018;56:e00342-18.
PubMed Abstract»
Dize L, Agreda P, Quinn N, Barnes MR, Hsieh YH, Gaydos CA. Comparison of self-obtained penile-meatal swabs to urine for the detection of C. trachomatis, N. gonorrhoeae and T. vaginalis. Sex Transm Infect. 2013;89:305-7.
PubMed Abstract»
Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician. 2000;62:1095-104.
PubMed Abstract»
Haefner HK. Current evaluation and management of vulvovaginitis. Clin Obstet Gynecol. 1999;42:184-95.
PubMed Abstract»
Hainer BL, Gibson MV. Vaginitis. Am Fam Physician. 2011;83:807-15.
PubMed Abstract»
Hobbs MM, Seña AC. Modern diagnosis of Trichomonas vaginalis infection. Sex Transm Infect. 2013;89:434-8.
PubMed Abstract»
Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29:297-301.
PubMed Abstract»
Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2009;200:188.e1-7.
PubMed Abstract»
Schwebke JR, Taylor SN, Ackerman R, et al. Clinical Validation of the Aptima Bacterial Vaginosis and Aptima Candida/Trichomonas Vaginitis Assays: Results from a Prospective Multicenter Clinical Study. J Clin Microbiol. 2020;58:e01643-19.
PubMed Abstract»
Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369:1961-71.
PubMed Abstract»
Van Gerwen OT, Muzny CA. Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection. F1000Res. 2019;8:F1000 Faculty Rev-1666.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by vaginal itching, burning, irritation, odor or discharge. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases characterized by vaginal discharge. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 7. Vaginitis

Bacterial Vaginosis

Abad CL, Safdar N. The role of lactobacillus probiotics in the treatment or prevention of urogenital infections--a systematic review. J Chemother. 2009;21:243-52.
PubMed Abstract»
Abbai NS, Reddy T, Ramjee G. Prevalent bacterial vaginosis infection - a risk factor for incident sexually transmitted infections in women in Durban, South Africa. Int J STD AIDS. 2016;27:1283-8.
PubMed Abstract»
Aguin T, Akins RA, Sobel JD. High-dose vaginal maintenance metronidazole for recurrent bacterial vaginosis: a pilot study. Sex Transm Dis. 2014;41:290-1.
PubMed Abstract»
Allsworth JE, Peipert JF. Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data. Obstet Gynecol. 2007;109:114-20.
PubMed Abstract»
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PubMed Abstract»
Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004;291:1368-79.
PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
Bilardi JE, Walker S, Temple-Smith M, et al. The burden of bacterial vaginosis: women's experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis. PLoS One. 2013;8:e74378.
PubMed Abstract»
Bradshaw CS, Brotman RM. Making inroads into improving treatment of bacterial vaginosis - striving for long-term cure. BMC Infect Dis. 2015;15:292.
PubMed Abstract»
Bradshaw CS, Morton AN, Garland SM, Horvath LB, Kuzevska I, Fairley CK. Evaluation of a point-of-care test, BVBlue, and clinical and laboratory criteria for diagnosis of bacterial vaginosis. J Clin Microbiol. 2005;43:1304-8.
PubMed Abstract»
Bradshaw CS, Sobel JD. Current Treatment of bacterial vaginosis-limitations and need for innovation. J Infect Dis. 2016;214 Suppl 1:S14-20.
PubMed Abstract»
Bradshaw CS, Vodstrcil LA, Hocking JS, et al. Recurrence of bacterial vaginosis is significantly associated with posttreatment sexual activities and hormonal contraceptive use. Clin Infect Dis. 2013;56:777-86.
PubMed Abstract»
Brotman RM, Erbelding EJ, Jamshidi RM, Klebanoff MA, Zenilman JM, Ghanem KG. Findings associated with recurrence of bacterial vaginosis among adolescents attending sexually transmitted diseases clinics. J Pediatr Adolesc Gynecol. 2007;20:225-31.
PubMed Abstract»
Brotman RM, Klebanoff MA, Nansel TR, et al. Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection. J Infect Dis. 2010;202:1907-15.
PubMed Abstract»
Brusselaers N, Shrestha S, van de Wijgert J, Verstraelen H. Vaginal dysbiosis and the risk of human papillomavirus and cervical cancer: systematic review and meta-analysis. Am J Obstet Gynecol. 2019221:9-18.e8.
PubMed Abstract»
Bunge KE, Beigi RH, Meyn LA, Hillier SL. The efficacy of retreatment with the same medication for early treatment failure of bacterial vaginosis. Sex Transm Dis. 2009;36:711-3.
PubMed Abstract»
Burtin P, Taddio A, Ariburnu O, Einarson TR, Koren G. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol. 1995;172:525-9.
PubMed Abstract»
Carey JC, Klebanoff MA, Hauth JC, et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 2000;342:534-40.
PubMed Abstract»
Cherpes TL, Meyn LA, Krohn MA, Lurie JG, Hillier SL. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis. 2003;37:319-25.
PubMed Abstract»
Cherpes TL, Wiesenfeld HC, Melan MA, et al. The associations between pelvic inflammatory disease, Trichomonas vaginalis infection, and positive herpes simplex virus type 2 serology. Sex Transm Dis. 2006;33:747-52.
PubMed Abstract»
Cohen CR, Lingappa JR, Baeten JM, et al. Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples. PLoS Med. 2012;9:e1001251.
PubMed Abstract»
Cohen CR, Wierzbicki MR, French AL, et al. Randomized trial of Lactin-V to prevent recurrence of bacterial vaginosis. N Engl J Med. 2020;382:1906-15.
PubMed Abstract»
Coleman JS, Gaydos CA. Molecular diagnosis of bacterial vaginosis: an update. J Clin Microbiol. 2018;56:e00342-18.
PubMed Abstract»
Eschenbach DA, Hillier S, Critchlow C, Stevens C, DeRouen T, Holmes KK. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol. 1988;158:819-28.
PubMed Abstract»
Fethers KA, Fairley CK, Morton A, et al. Early sexual experiences and risk factors for bacterial vaginosis. J Infect Dis. 2009;200:1662-70.
PubMed Abstract»
Fjeld H, Raknes G. [Is combining metronidazole and alcohol really hazardous?]. Tidsskr Nor Laegeforen. 2014;134:1661-3.
PubMed Abstract»
Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med. 2005;353:1899-911.
PubMed Abstract»
Gaydos CA, Beqaj S, Schwebke JR, et al. Clinical validation of a test for the diagnosis of vaginitis. Obstet Gynecol. 2017;130:181-9.
PubMed Abstract»
Gillis JC, Wiseman LR. Secnidazole. A review of its antimicrobial activity, pharmacokinetic properties and therapeutic use in the management of protozoal infections and bacterial vaginosis. Drugs. 1996;51:621-38.
PubMed Abstract»
Hainer BL, Gibson MV. Vaginitis. Am Fam Physician. 2011;83:807-15.
PubMed Abstract»
Heller DS, Pitsos M, Skurnick J. Does the presence of vaginitis on a Pap smear correlate with clinical symptoms in the patient? J Reprod Med. 2008;53:429-34.
PubMed Abstract»
Hemmerling A, Harrison W, Schroeder A, et al. Phase 2a study assessing colonization efficiency, safety, and acceptability of Lactobacillus crispatus CTV-05 in women with bacterial vaginosis. Sex Transm Dis. 2010;37:745-50.
PubMed Abstract»
Hillier SL, Nugent RP, Eschenbach DA, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med. 1995;333:1737-42.
PubMed Abstract»
Hillier SL, Nyirjesy P, Waldbaum AS, et al. Secnidazole treatment of bacterial vaginosis: a randomized controlled trial. Obstet Gynecol. 2017;130:379-86.
PubMed Abstract»
Jamieson DJ, Duerr A, Klein RS, et al. Longitudinal analysis of bacterial vaginosis: findings from the HIV epidemiology research study. Obstet Gynecol. 2001;98:656-63.
PubMed Abstract»
Joesoef MR, Hillier SL, Wiknjosastro G, et al. Intravaginal clindamycin treatment for bacterial vaginosis: effects on preterm delivery and low birth weight. Am J Obstet Gynecol. 1995;173:1527-31.
PubMed Abstract»
Karani A, De Vuyst H, Luchters S, et al. The Pap smear for detection of bacterial vaginosis. Int J Gynaecol Obstet. 2007;98:20-3.
PubMed Abstract»
Klebanoff MA, Andrews WW, Zhang J, et al. Race of male sex partners and occurrence of bacterial vaginosis. Sex Transm Dis. 2010;37:184-90.
PubMed Abstract»
Klebanoff MA, Nansel TR, Brotman RM, et al. Personal hygienic behaviors and bacterial vaginosis. Sex Transm Dis. 2010;37:94-9.
PubMed Abstract»
Klebanoff MA, Schwebke JR, Zhang J, Nansel TR, Yu KF, Andrews WW. Vulvovaginal symptoms in women with bacterial vaginosis. Obstet Gynecol. 2004;104:267-72.
PubMed Abstract»
Koss CA, Baras DC, Lane SD, et al. Investigation of metronidazole use during pregnancy and adverse birth outcomes. Antimicrob Agents Chemother. 2012;56:4800-5.
PubMed Abstract»
Koumans EH, Markowitz LE, Hogan V. Indications for therapy and treatment recommendations for bacterial vaginosis in nonpregnant and pregnant women: a synthesis of data. Clin Infect Dis. 2002;35:S152-72.
PubMed Abstract»
Koumans EH, Sternberg M, Bruce C, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007;34:864-9.
PubMed Abstract»
Lamont RF, Nhan-Chang CL, Sobel JD, Workowski K, Conde-Agudelo A, Romero R. Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011;205:177-90.
PubMed Abstract»
Larsson PG, Carlsson B. Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Infect Dis Obstet Gynecol. 2002;10:133-40.
PubMed Abstract»
Larsson PG, Platz-Christensen JJ, Thejls H, Forsum U, Påhlson C. Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study. Am J Obstet Gynecol. 1992;166:100-3.
PubMed Abstract»
Laxmi U, Agrawal S, Raghunandan C, Randhawa VS, Saili A. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med. 2012;25:64-7.
PubMed Abstract»
Liu CM, Hungate BA, Tobian AA, et al. Penile microbiota and female partner bacterial vaginosis in Rakai, Uganda. MBio. 2015;6:e00589.
PubMed Abstract»
Lokken EM, Balkus JE, Kiarie J, et al. Association of Recent Bacterial Vaginosis With Acquisition of Mycoplasma genitalium. Am J Epidemiol. 2017;186:194-201.
PubMed Abstract»
Manhart LE, Khosropour CM, Liu C, et al. Bacterial vaginosis-associated bacteria in men: association of Leptotrichia/Sneathia spp. with nongonococcal urethritis. Sex Transm Dis. 2013;40:944-9.
PubMed Abstract»
Marrazzo JM, Antonio M, Agnew K, Hillier SL. Distribution of genital Lactobacillus strains shared by female sex partners. J Infect Dis. 2009;199:680-3.
PubMed Abstract»
Marrazzo JM, Koutsky LA, Eschenbach DA, Agnew K, Stine K, Hillier SL. Characterization of vaginal flora and bacterial vaginosis in women who have sex with women. J Infect Dis. 2002;185:1307-13.
PubMed Abstract»
Marrazzo JM, Thomas KK, Fiedler TL, Ringwood K, Fredricks DN. Relationship of specific vaginal bacteria and bacterial vaginosis treatment failure in women who have sex with women. Ann Intern Med. 2008;149:20-8.
PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
Mastromarino P, Macchia S, Meggiorini L, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clin Microbiol Infect. 2009;15:67-74.
PubMed Abstract»
McClelland RS, Lingappa JR, Srinivasan S, et al. Evaluation of the association between the concentrations of key vaginal bacteria and the increased risk of HIV acquisition in African women from five cohorts: a nested case-control study. Lancet Infect Dis. 2018;18:554-64.
PubMed Abstract»
McClelland RS, Richardson BA, Hassan WM, et al. Improvement of vaginal health for Kenyan women at risk for acquisition of human immunodeficiency virus type 1: results of a randomized trial. J Infect Dis. 2008;197:1361-8.
PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
Mehta SD. Systematic review of randomized trials of treatment of male sexual partners for improved bacteria vaginosis outcomes in women. Sex Transm Dis. 2012;39:822-30.
PubMed Abstract»
Mergenhagen KA, Wattengel BA, Skelly MK, Clark CM, Russo TA. Fact versus Fiction: a Review of the Evidence behind Alcohol and Antibiotic Interactions. Antimicrob Agents Chemother. 2020;64:e02167-19.
PubMed Abstract»
Mills BB. Vaginitis: Beyond the Basics. Obstet Gynecol Clin North Am. 2017;44:159-177.
PubMed Abstract»
Mitchell C, Manhart LE, Thomas KK, Agnew K, Marrazzo JM. Effect of sexual activity on vaginal colonization with hydrogen peroxide-producing lactobacilli and Gardnerella vaginalis. Sex Transm Dis. 2011;38:1137-44.
PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
Muzny CA, Łaniewski P, Schwebke JR, Herbst-Kralovetz MM. Host-vaginal microbiota interactions in the pathogenesis of bacterial vaginosis. Curr Opin Infect Dis. 2020;33:59-65.
PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
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Penney GC. Preventing infective sequelae of abortion. Hum Reprod. 1997;12:107-12.
PubMed Abstract»
Petrina MAB, Cosentino LA, Rabe LK, Hillier SL. Susceptibility of bacterial vaginosis (BV)-associated bacteria to secnidazole compared to metronidazole, tinidazole and clindamycin. Anaerobe. 2017;47:115-119.
PubMed Abstract»
Piper JM, Mitchel EF, Ray WA. Prenatal use of metronidazole and birth defects: no association. Obstet Gynecol. 1993;82:348-52.
PubMed Abstract»
Ravel J, Moreno I, Simón C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol. 2021;224:251-7.
PubMed Abstract»
Reichman O, Akins R, Sobel JD. Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. Sex Transm Dis. 2009;36:732-4.
PubMed Abstract»
Reiter S, Kellogg Spadt S. Bacterial vaginosis: a primer for clinicians. Postgrad Med. 2019;131:8-18.
PubMed Abstract»
Schwebke JR, Carter BA, Waldbaum AS, et al. A phase 3, randomized, controlled trial of Astodrimer 1% Gel for preventing recurrent bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol X. 2021;10:100121.
PubMed Abstract»
Schwebke JR, Desmond R. Risk factors for bacterial vaginosis in women at high risk for sexually transmitted diseases. Sex Transm Dis. 2005;32:654-8.
PubMed Abstract»
Schwebke JR, Lee JY, Lensing S, et al. Home Screening for Bacterial Vaginosis to Prevent Sexually Transmitted Diseases. Clin Infect Dis. 2016;62:531-6.
PubMed Abstract»
Schwebke JR, Morgan FG Jr, Koltun W, Nyirjesy P. A phase-3, double-blind, placebo-controlled study of the effectiveness and safety of single oral doses of secnidazole 2 g for the treatment of women with bacterial vaginosis. Am J Obstet Gynecol. 2017;217:678.e1-678.e9.
PubMed Abstract»
Schwebke JR, Muzny CA, Josey WE. Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model. J Infect Dis. 2014;210:338-43.
PubMed Abstract»
Schwebke JR, Taylor SN, Ackerman R, et al. Clinical validation of the Aptima bacterial vaginosis and Aptima Candida/Trichomonas vaginitis assays: results from a prospective multicenter clinical study. J Clin Microbiol. 2020 Jan 28;58:e01643-19.
PubMed Abstract»
Screening for bacterial vaginosis in pregnancy to prevent preterm delivery: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148:214-9.
PubMed Abstract»
Sobel JD, Ferris D, Schwebke J, et al. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2006;194:1283-9.
PubMed Abstract»
Soper DE. Bacterial vaginosis and postoperative infections. Am J Obstet Gynecol. 1993;169:467-9.
PubMed Abstract»
Subtil D, Brabant G, Tilloy E, et al. Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet. 2018;392:2171-9.
PubMed Abstract»
Tokyol C, Aktepe OC, Cevrioğlu AS, Altindiş M, Dilek FH. Bacterial vaginosis: comparison of Pap smear and microbiological test results. Mod Pathol. 2004;17:857-60.
PubMed Abstract»
Vermeulen GM, Bruinse HW. Prophylactic administration of clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: a randomised placebo-controlled double-blind trial. Br J Obstet Gynaecol. 1999;106:652-7.
PubMed Abstract»
Vodstrcil LA, Walker SM, Hocking JS, et al. Incident bacterial vaginosis (BV) in women who have sex with women is associated with behaviors that suggest sexual transmission of BV. Clin Infect Dis. 2015;60:1042-53.
PubMed Abstract»
West B, Morison L, Schim van der Loeff M, et al. Evaluation of a new rapid diagnostic kit (FemExam) for bacterial vaginosis in patients with vaginal discharge syndrome in The Gambia. Sex Transm Dis. 2003;30:483-9.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by vaginal itching, burning, irritation, odor or discharge: bacterial vaginosis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases characterized by vaginal discharge: Bacterial vaginosis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Module 2 » Lesson 7. Vaginitis

Trichomoniasis

Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58:1-10.
PubMed Abstract»
Alcaide ML, Feaster DJ, Duan R, et al. The incidence of Trichomonas vaginalis infection in women attending nine sexually transmitted diseases clinics in the USA. Sex Transm Infect. 2016;92:58-62.
PubMed Abstract»
Anderson BL, Firnhaber C, Liu T, et al. Effect of trichomoniasis therapy on genital HIV viral burden among African women. Sex Transm Dis. 2012;39:638-42.
PubMed Abstract»
Andrea SB, Chapin KC. Comparison of Aptima Trichomonas vaginalis transcription-mediated amplification assay and BD affirm VPIII for detection of T. vaginalis in symptomatic women: performance parameters and epidemiological implications. J Clin Microbiol. 2011;49:866-9.
PubMed Abstract»
Arroyo R, González-Robles A, Martínez-Palomo A, Alderete JF. Signalling of Trichomonas vaginalis for amoeboid transformation and adhesion synthesis follows cytoadherence. Mol Microbiol. 1993;7:299-309.
PubMed Abstract»
Association of Public Health Laboratories. Advances in the laboratory detection of Trichomonas vaginalis. August 2013.
APHL»
Bachmann LH, Hobbs MM, Seña AC, et al. Trichomonas vaginalis genital infections: progress and challenges. Clin Infect Dis. 2011;53 Suppl 3:S160-72.
PubMed Abstract»
Balkus JE, Richardson BA, Mochache V, et al. A prospective cohort study comparing the effect of single-dose 2 g metronidazole on Trichomonas vaginalis infection in HIV-seropositive versus HIV-seronegative women. Sex Transm Dis. 2013;40:499-505.
PubMed Abstract»
Bochner AF, Baeten JM, Rustagi AS, et al. A cross-sectional analysis of Trichomonas vaginalis infection among heterosexual HIV-1 serodiscordant African couples. Sex Transm Infect. 2017;93:520-9.
PubMed Abstract»
Bosserman EA, Helms DJ, Mosure DJ, Secor WE, Workowski KA. Utility of antimicrobial susceptibility testing in Trichomonas vaginalis-infected women with clinical treatment failure. Sex Transm Dis. 2011;38:983-7.
PubMed Abstract»
Brown HL, Fuller DD, Jasper LT, Davis TE, Wright JD. Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis. Infect Dis Obstet Gynecol. 2004;12:17-21.
PubMed Abstract»
Campbell L, Woods V, Lloyd T, Elsayed S, Church DL. Evaluation of the OSOM Trichomonas rapid test versus wet preparation examination for detection of Trichomonas vaginalis vaginitis in specimens from women with a low prevalence of infection. J Clin Microbiol. 2008;46:3467-9.
PubMed Abstract»
Carter JE, Whithaus KC. Neonatal respiratory tract involvement by Trichomonas vaginalis: a case report and review of the literature. Am J Trop Med Hyg. 2008;78:17-9.
PubMed Abstract»
Chapin K, Andrea S. APTIMA® Trichomonas vaginalis, a transcription-mediated amplification assay for detection of Trichomonas vaginalis in urogenital specimens. Expert Rev Mol Diagn. 2011;11:679-88.
PubMed Abstract»
Cosentino LA, Campbell T, Jett A, et al. Use of nucleic acid amplification testing for diagnosis of anorectal sexually transmitted infections. J Clin Microbiol. 2012;50:2005-8.
PubMed Abstract»
Cotch MF, Pastorek JG 2nd, Nugent RP, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study Group. Sex Transm Dis. 1997;24:353-60.
PubMed Abstract»
Cu-Uvin S, Ko H, Jamieson DJ, et al. Prevalence, incidence, and persistence or recurrence of trichomoniasis among human immunodeficiency virus (HIV)-positive women and among HIV-negative women at high risk for HIV infection. Clin Infect Dis. 2002;15;34:1406-11.
PubMed Abstract»
Erickson SH, Oppenheim GL, Smith GH. Metronidazole in breast milk. Obstet Gynecol. 1981;57:48-50.
PubMed Abstract»
Flagg EW, Meites E, Phillips C, Papp J, Torrone EA. Prevalence of Trichomonas vaginalis among civilian, noninstitutionalized male and female population aged 14 to 59 years: United States, 2013 to 2016. Sex Transm Dis. 2019;46:e93-e96.
PubMed Abstract»
Fouts AC, Kraus SJ. Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis. J Infect Dis. 1980;141:137-143.
PubMed Abstract»
Francis SC, Kent CK, Klausner JD, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008;35:797-800.
PubMed Abstract»
Freeman AH, Katz KA, Pandori MW, et al. Prevalence and correlates of Trichomonas vaginalis among incarcerated persons assessed using a highly sensitive molecular assay. Sex Transm Dis. 2010;37:165-8.
PubMed Abstract»
Gaydos CA, Beqaj S, Schwebke JR, et al. Clinical validation of a test for the diagnosis of vaginitis. Obstet Gynecol. 2017;130:181-9.
PubMed Abstract»
Gaydos CA, Hobbs M, Marrazzo J, et al. Rapid diagnosis of Trichomonas vaginalis by testing vaginal swabs in an isothermal helicase-dependent AmpliVue assay. Sex Transm Dis. 2016;43:369-73.
PubMed Abstract»
Gaydos CA, Manabe YC, Melendez JH. A Narrative Review of Where We Are With Point-of-Care Sexually Transmitted Infection Testing in the United States. Sex Transm Dis. 2021;48:S71-S77.
PubMed Abstract»
Gaydos CA, Schwebke J, Dombrowski J, et al. Clinical performance of the Solana® Point-of-Care Trichomonas Assay from clinician-collected vaginal swabs and urine specimens from symptomatic and asymptomatic women. Expert Rev Mol Diagn. 2017;17:303-6.
PubMed Abstract»
Ginocchio CC, Chapin K, Smith JS, et al. Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as determined by the Aptima Trichomonas vaginalis nucleic acid amplification assay. J Clin Microbiol. 2012;50:2601-8.
PubMed Abstract»
Hainer BL, Gibson MV. Vaginitis. Am Fam Physician. 2011;83:807-15.
PubMed Abstract»
Helms DJ, Mosure DJ, Metcalf CA, et al. Risk factors for prevalent and incident Trichomonas vaginalis among women attending three sexually transmitted disease clinics. Sex Transm Dis. 2008;35:484-8.
PubMed Abstract»
Helms DJ, Mosure DJ, Secor WE, Workowski KA. Management of Trichomonas vaginalis in women with suspected metronidazole hypersensitivity. Am J Obstet Gynecol. 2008;198:370.e1-7.
PubMed Abstract»
Hobbs MM, Seña AC. Modern diagnosis of Trichomonas vaginalis infection. Sex Transm Infect. 2013;89:434-8.
PubMed Abstract»
Hollman D, Coupey SM, Fox AS, Herold BC. Screening for Trichomonas vaginalis in high-risk adolescent females with a new transcription-mediated nucleic acid amplification test (NAAT): associations with ethnicity, symptoms, and prior and current STIs. J Pediatr Adolesc Gynecol. 2010;23:312-6.
PubMed Abstract»
Hoots BE, Peterman TA, Torrone EA, Weinstock H, Meites E, Bolan GA. A Trich-y question: should Trichomonas vaginalis infection be reportable? Sex Transm Dis. 2013;40:113-6.
PubMed Abstract»
Howe K, Kissinger PJ. Single-dose compared with multidose metronidazole for the treatment of trichomoniasis in women: a meta-analysis. Sex Transm Dis. 2017;44:29-34.
PubMed Abstract»
Hughes JP, Baeten JM, Lingappa JR, et al. Determinants of per-coital-act HIV-1 infectivity among African HIV-1-serodiscordant couples. J Infect Dis. 2012;205:358-65.
PubMed Abstract»
Huppert JS, Hesse E, Kim G, et al. Adolescent women can perform a point-of-care test for trichomoniasis as accurately as clinicians. Sex Transm Infect. 2010;86:514-9.
PubMed Abstract»
Huppert JS, Hesse EA, Bernard MA, et al. Acceptability of self-testing for trichomoniasis increases with experience. Sex Transm Infect. 2011;87:494-500.
PubMed Abstract»
Huppert JS, Mortensen JE, Reed JL, et al. Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women. Clin Infect Dis. 2007;45:194-8.
PubMed Abstract»
Joyner JL, Douglas JM Jr, Ragsdale S, Foster M, Judson FN. Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic. Sex Transm Dis. 2000;27:236-40.
PubMed Abstract»
Kelley CF, Rosenberg ES, OʼHara BM, Sanchez T, del Rio C, Sullivan PS. Prevalence of urethral Trichomonas vaginalis in black and white men who have sex with men. Sex Transm Dis. 2012;39:739.
PubMed Abstract»
Kellock D, O'Mahony CP. Sexually acquired metronidazole-resistant trichomoniasis in a lesbian couple. Genitourin Med. 1996;72:60-1.
PubMed Abstract»
Kingston MA, Bansal D, Carlin EM. 'Shelf life' of Trichomonas vaginalis. Int J STD AIDS. 2003;14:28-9.
PubMed Abstract»
Kirkcaldy RD, Augostini P, Asbel LE, et al. Trichomonas vaginalis antimicrobial drug resistance in 6 US cities, STD Surveillance Network, 2009-2010. Emerg Infect Dis. 2012;18:939-43.
PubMed Abstract»
Kissinger P, Adamski A, Clark RA, Mena L, Levison J, Martin DH. Does antiretroviral therapy interfere with the treatment of Trichomonas vaginalis among HIV+ women? Sex Transm Dis. 2013;40:506-7.
PubMed Abstract»
Kissinger P, Adamski A. Trichomoniasis and HIV interactions: a review. Sex Transm Infect. 2013;89:426-33.
PubMed Abstract»
Kissinger P, Amedee A, Clark RA, et al. Trichomonas vaginalis treatment reduces vaginal HIV-1 shedding. Sex Transm Dis. 2009;36:11-6.
PubMed Abstract»
Kissinger P, Mena L, Levison J, et al. A randomized treatment trial: single versus 7-day dose of metronidazole for the treatment of Trichomonas vaginalis among HIV-infected women. J Acquir Immune Defic Syndr. 2010;55:565-71.
PubMed Abstract»
Kissinger P, Muzny CA, Mena LA, et al. Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial. Lancet Infect Dis. 2018;18:1251-9.
PubMed Abstract»
Klebanoff MA, Carey JC, Hauth JC, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med. 2001;345:487-93.
PubMed Abstract»
Mann JR, McDermott S, Gill T. Sexually transmitted infection is associated with increased risk of preterm birth in South Carolina women insured by Medicaid. J Matern Fetal Neonatal Med. 2010;23:563-8.
PubMed Abstract»
Mann JR, McDermott S, Zhou L, Barnes TL, Hardin J. Treatment of trichomoniasis in pregnancy and preterm birth: an observational study. J Womens Health (Larchmt). 2009;18:493-7.
PubMed Abstract»
Masese LN, Graham SM, Gitau R, et al. A prospective study of vaginal trichomoniasis and HIV-1 shedding in women on antiretroviral therapy. BMC Infect Dis. 2011;11:307.
PubMed Abstract»
Mayer KH, Bush T, Henry K, et al. Ongoing sexually transmitted disease acquisition and risk-taking behavior among US HIV-infected patients in primary care: implications for prevention interventions. Sex Transm Dis. 2012;39:1-7.
PubMed Abstract»
McClelland RS, Sangare L, Hassan WM, et al. Infection with Trichomonas vaginalis increases the risk of HIV-1 acquisition. J Infect Dis. 2007;195:698-702.
PubMed Abstract»
Meites E, Gaydos CA, Hobbs MM, et al. A review of evidence-based care of symptomatic Trichomoniasis and asymptomatic Trichomonas vaginalis infections. Clin Infect Dis. 2015;61 Suppl 8:S837-48.
PubMed Abstract»
Meites E, Llata E, Braxton J, et al. Trichomonas vaginalis in selected U.S. sexually transmitted disease clinics: testing, screening, and prevalence. Sex Transm Dis. 2013;40:865-9.
PubMed Abstract»
Miller M, Liao Y, Wagner M, Korves C. HIV, the clustering of sexually transmitted infections, and sex risk among African American women who use drugs. Sex Transm Dis. 2008;35:696-702.
PubMed Abstract»
Minkoff H, Grunebaum AN, Schwarz RH, et al. Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy. Am J Obstet Gynecol. 1984;150:965-72.
PubMed Abstract»
Moodley P, Wilkinson D, Connolly C, Moodley J, Sturm AW. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis. 2002;34:519-22.
PubMed Abstract»
Morris SR, Bristow CC, Wierzbicki MR, et al. Performance of a single-use, rapid, point-of-care PCR device for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: a cross-sectional study. Lancet Infect Dis. 2021;21:668-76.
PubMed Abstract»
Muzny C, Barnes A, Mena L. Symptomatic Trichomonas vaginalis infection in the setting of severe nitroimidazole allergy: successful treatment with boric acid. Sex Health. 2012;9:389-91.
PubMed Abstract»
Muzny CA, Rivers CA, Mena LA, Schwebke JR. Genotypic characterization of Trichomonas vaginalis isolates among women who have sex with women in sexual partnerships. Sex Transm Dis. 2012;39:556-8.
PubMed Abstract»
Nijhawan AE, DeLong AK, Celentano DD, et al. The association between Trichomonas infection and incarceration in HIV-seropositive and at-risk HIV-seronegative women. Sex Transm Dis. 2011;38:1094-100.
PubMed Abstract»
Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2009;200:188.e1-7.
PubMed Abstract»
Nyirjesy P, Gilbert J, Mulcahy LJ. Resistant trichomoniasis: successful treatment with combination therapy. Sex Transm Dis. 2011;38:962-3.
PubMed Abstract»
Petrin D, Delgaty K, Bhatt R, Garber G. Clinical and microbiological aspects of Trichomonas vaginalis. Clin Microbiol Rev. 1998;11:300-17.
PubMed Abstract»
Pintye J, Drake AL, Unger JA, et al. Male partner circumcision associated with lower Trichomonas vaginalis incidence among pregnant and postpartum Kenyan women: a prospective cohort study. Sex Transm Infect. 2017;93:137-43.
PubMed Abstract»
Rahman N, Ghanem KG, Gilliams E, Page KR, Tuddenham S. Factors associated with sexually transmitted infection diagnosis in women who have sex with women, women who have sex with men and women who have sex with both. Sex Transm Infect. 2021;97:423-8.
PubMed Abstract»
Rogers SM, Turner CF, Hobbs M, et al. Epidemiology of undiagnosed trichomoniasis in a probability sample of urban young adults. PLoS One. 2014;9:e90548.
PubMed Abstract»
Roth AM, Williams JA, Ly R, et al. Changing sexually transmitted infection screening protocol will result in improved case finding for Trichomonas vaginalis among high-risk female populations. Sex Transm Dis. 2011;38:398-400.
PubMed Abstract»
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40:187-93.
PubMed Abstract»
Schwebke JR, Barrientes FJ. Prevalence of Trichomonas vaginalis isolates with resistance to metronidazole and tinidazole. Antimicrob Agents Chemother. 2006;50:4209-10.
PubMed Abstract»
Schwebke JR, Gaydos CA, Davis T, et al. Clinical Evaluation of the Cepheid Xpert TV Assay for Detection of Trichomonas vaginalis with Prospectively Collected Specimens from Men and Women. J Clin Microbiol. 2018;56:e01091-17.
PubMed Abstract»
Schwebke JR, Hobbs MM, Taylor SN, et al. Molecular testing for Trichomonas vaginalis in women: results from a prospective U.S. clinical trial. J Clin Microbiol. 2011;49:4106-11.
PubMed Abstract»
Schwebke JR, Hook EW 3rd. High rates of Trichomonas vaginalis among men attending a sexually transmitted diseases clinic: implications for screening and urethritis management. J Infect Dis. 2003;188:465-8.
PubMed Abstract»
Seña AC, Miller WC, Hobbs MM, et al. Trichomonas vaginalis infection in male sexual partners: implications for diagnosis, treatment, and prevention. Clin Infect Dis. 2007;44:13-22.
PubMed Abstract»
Sheele JM, Crandall CJ, Arko BL, et al. The OSOM® Trichomonas Test is unable to accurately diagnose Trichomonas vaginalis from urine in men. Am J Emerg Med. 2019;37:1002-3.
PubMed Abstract»
Sobel J, Peipert JF, McGregor JA, et al. Efficacy of clindamycin vaginal ovule (3-day treatment) vs. clindamycin vaginal cream (7-day treatment) in bacterial vaginosis. Infect Dis Obstet Gynecol. 2001;9:9-15.
PubMed Abstract»
Sobel JD, Nyirjesy P, Brown W. Tinidazole therapy for metronidazole-resistant vaginal trichomoniasis. Clin Infect Dis. 2001;33:1341-6.
PubMed Abstract»
Stoner KA, Rabe LK, Meyn LA, Hillier SL. Survival of Trichomonas vaginalis in wet preparation and on wet mount. Sex Transm Infect. 2013;89:485-8.
PubMed Abstract»
Sutcliffe S, Newman SB, Hardick A, Gaydos CA. Prevalence and correlates of Trichomonas vaginalis infection among female US federal prison inmates. Sex Transm Dis. 2010;37:585-90.
PubMed Abstract»
Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, Markowitz L. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004. Clin Infect Dis. 2007;45:1319-26.
PubMed Abstract»
Swartzendruber A, Sales JM, Brown JL, Diclemente RJ, Rose ES. Correlates of incident Trichomonas vaginalis infections among African American female adolescents. Sex Transm Dis. 2014;41:240-5.
PubMed Abstract»
Trintis J, Epie N, Boss R, Riedel S. Neonatal Trichomonas vaginalis infection: a case report and review of literature. Int J STD AIDS. 2010;21:606-7.
PubMed Abstract»
Tsai CS, Shepherd BE, Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol. 2009;200:38.e1-8.
PubMed Abstract»
Van Der Pol B, Kraft CS, Williams JA. Use of an adaptation of a commercially available PCR assay aimed at diagnosis of chlamydia and gonorrhea to detect Trichomonas vaginalis in urogenital specimens. J Clin Microbiol. 2006;44:366-73.
PubMed Abstract»
Van Der Pol B, Kwok C, Pierre-Louis B, et al. Trichomonas vaginalis infection and human immunodeficiency virus acquisition in African women. J Infect Dis. 2008;197:548-54.
PubMed Abstract»
Van Der Pol B, Rao A, Nye MB, et al. Trichomonas vaginalis detection in urogenital specimens from symptomatic and asymptomatic men and women by use of the cobas TV/MG Test. J Clin Microbiol. 2021;59:e0026421.
PubMed Abstract»
Van Der Pol B, Torres-Chavolla E, Kodsi S, et al. Clinical Performance of the BD CTGCTV2 Assay for the BD MAX System for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections. Sex Transm Dis. 2021;48:134-40.
PubMed Abstract»
Van Der Pol B, Williams JA, Taylor SN, et al. Detection of Trichomonas vaginalis DNA by use of self-obtained vaginal swabs with the BD ProbeTec Qx assay on the BD Viper system. J Clin Microbiol. 2014;52:885-9.
PubMed Abstract»
Van Der Pol B. A profile of the cobas® TV/ MG test for the detection of Trichomonas vaginalis and Mycoplasma genitalium. Expert Rev Mol Diagn. 2020;20:381-6.
PubMed Abstract»
Van Gerwen OT, Camino AF, Bourla LN, Legendre D, Muzny CA. Management of trichomoniasis in the setting of 5-nitroimidazole hypersensitivity. Sex Transm Dis. 2021;48:e111-e115.
PubMed Abstract»
Van Gerwen OT, Craig-Kuhn MC, Jones AT, et al. Trichomoniasis and adverse birth outcomes: a systematic review and meta-analysis. BJOG. 2021;128:1907-15.
PubMed Abstract»
Van Gerwen OT, Muzny CA. Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection. F1000Res. 2019;8:F1000 Faculty Rev-1666.
PubMed Abstract»
Wendel KA, Erbelding EJ, Gaydos CA, Rompalo AM. Use of urine polymerase chain reaction to define the prevalence and clinical presentation of Trichomonas vaginalis in men attending an STD clinic. Sex Transm Infect. 2003;79:151-3.
PubMed Abstract»
Willers DM, Peipert JF, Allsworth JE, Stein MD, Rose JS, Clarke JG. Prevalence and predictors of sexually transmitted infection among newly incarcerated females. Sex Transm Dis. 2008;35:68-72.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by vaginal itching, burning, irritation, odor or discharge: trichomoniasis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Diseases characterized by vaginal discharge: Trichomoniasis. MMWR Recomm Rep. 2015;64(No. RR-3):1-137.
2015 STD Treatment Guidelines»
Yang S, Zhao W, Wang H, Wang Y, Li J, Wu X. Trichomonas vaginalis infection-associated risk of cervical cancer: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018;228:166-173.
PubMed Abstract»
Module 2 » Lesson 7. Vaginitis

Vulvovaginal Candidiasis

Anderson BL, Firnhaber C, Liu T, et al. Effect of trichomoniasis therapy on genital HIV viral burden among African women. Sex Transm Dis. 2012;39:638-42.
PubMed Abstract»
Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004;291:1368-79.
PubMed Abstract»
Aridogan IA, Izol V, Ilkit M. Superficial fungal infections of the male genitalia: a review. Crit Rev Microbiol. 2011;37:237-44.
PubMed Abstract»
Bérard A, Sheehy O, Zhao JP, et al. Associations between low- and high-dose oral fluconazole and pregnancy outcomes: 3 nested case-control studies. CMAJ. 2019;191:E179-E187.
PubMed Abstract»
Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis. 2018;18:e339-e47.
PubMed Abstract»
Duerr A, Heilig CM, Meikle SF, et al. Incident and persistent vulvovaginal candidiasis among human immunodeficiency virus-infected women: Risk factors and severity. Obstet Gynecol. 2003;101:548-56.
PubMed Abstract»
Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol. 1998;92:757-65.
PubMed Abstract»
Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016;42:905-27.
PubMed Abstract»
Ilkit M, Guzel AB. The epidemiology, pathogenesis, and diagnosis of vulvovaginal candidosis: a mycological perspective. Crit Rev Microbiol. 2011;37:250-61.
PubMed Abstract»
Kennedy MA, Sobel JD. Vulvovaginal candidiasis caused by non-albicans Candida species: new insights. Curr Infect Dis Rep. 2010;12:465-70.
PubMed Abstract»
Mølgaard-Nielsen D, Pasternak B, Hviid A. Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med. 2013;369:830-9.
PubMed Abstract»
Marchaim D, Lemanek L, Bheemreddy S, Kaye KS, Sobel JD. Fluconazole-resistant Candida albicans vulvovaginitis. Obstet Gynecol. 2012;120:1407-14.
PubMed Abstract»
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PubMed Abstract»
Schwebke JR, Hillier SL, Sobel JD, McGregor JA, Sweet RL. Validity of the vaginal gram stain for the diagnosis of bacterial vaginosis. Obstet Gynecol. 1996;88:573-6.
PubMed Abstract»
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PubMed Abstract»
Schwebke JR, Hook EW 3rd. High rates of Trichomonas vaginalis among men attending a sexually transmitted diseases clinic: implications for screening and urethritis management. J Infect Dis. 2003;188:465-8.
PubMed Abstract»
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PubMed Abstract»
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PubMed Abstract»
Screening for bacterial vaginosis in pregnancy to prevent preterm delivery: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148:214-9.
PubMed Abstract»
Seña AC, Bachmann LH, Hobbs MM. Persistent and recurrent Trichomonas vaginalis infections: epidemiology, treatment and management considerations. Expert Rev Anti Infect Ther. 2014;12:673-85.
PubMed Abstract»
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Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by vaginal itching, burning, irritation, odor or discharge: trichomoniasis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Diseases characterized by vaginal itching, burning, irritation, odor or discharge: vulvovaginal candidiasis. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Screening recommendations and considerations referenced in treatment guidelines and original sources. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
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PubMed Abstract»

Lesson 8. Mpox

Module 2 » Lesson 8. Mpox

Introduction

Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16:e0010141.
PubMed Abstract»
Laurenson-Schafer H, Sklenovská N, Hoxha A, et al. Description of the first global outbreak of mpox: an analysis of global surveillance data. Lancet Glob Health. 2023;11:e1012-e1023.
PubMed Abstract»
Philpott D, Hughes CM, Alroy KA, et al. Epidemiologic and Clinical Characteristics of Monkeypox Cases - United States, May 17-July 22, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1018-22.
PubMed Abstract»
Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022;387:679-91.
PubMed Abstract»
Module 2 » Lesson 8. Mpox

Epidemiology

Blackburn D, Roth NM, Gold JAW, et al. Epidemiologic and Clinical Features of Mpox in Transgender and Gender-Diverse Adults - United States, May-November 2022. MMWR Morb Mortal Wkly Rep. 2022 Dec 30;71:1605-1609.
CDC»
Breman JG, Kalisa-Ruti, Steniowski MV, Zanotto E, Gromyko AI, Arita I. Human monkeypox, 1970-79. Bull World Health Organ. 1980;58:165-82.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Mpox. 2022-2023 Mpox Outbreak Global Map. December 27, 2023.
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. 2022-2023 U.S. Map & Case Count. January 11, 2024.
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Mpox Cases by Age and Gender and Race and Ethnicity. January 11, 2024.
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Past U.S. Cases and Outbreaks. August 29, 2023.
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Science Brief: Detection and Transmission of Mpox (Formerly Monkeypox) Virus During the 2022 Clade IIb Outbreak. Updated February 2, 2023.
CDC»
Centers for Disease Control and Prevention (CDC). Update: multistate outbreak of monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:642-6.
CDC»
Centers for Disease Control and Prevention. Health Alert Network (HAN) Health Advisory. Mpox Caused by Human-to-Human Transmission of Monkeypox Virus with Geographic Spread in the Democratic Republic of the Congo. December 7, 2023
CDC»
Curran KG, Eberly K, Russell OO, et al. HIV and Sexually Transmitted Infections Among Persons with Monkeypox - Eight U.S. Jurisdictions, May 17-July 22, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1141-7.
CDC»
Foster SO, Brink EW, Hutchins DL, et al. Human monkeypox. Bull World Health Organ. 1972;46:569-76.
PubMed Abstract»
Gigante CM, Korber B, Seabolt MH, et al. Multiple lineages of monkeypox virus detected in the United States, 2021-2022. Science. 2022;378:560-5.
PubMed Abstract»
Kibungu EM, Vakaniaki EH, Kinganda-Lusamaki E, et al. Clade I-Associated Mpox Cases Associated with Sexual Contact, the Democratic Republic of the Congo. Emerg Infect Dis. 2024;30:172-6.
PubMed Abstract»
Laurenson-Schafer H, Sklenovská N, Hoxha A, et al. Description of the first global outbreak of mpox: an analysis of global surveillance data. Lancet Glob Health. 2023;11:e1012-e1023.
PubMed Abstract»
Likos AM, Sammons SA, Olson VA, et al. A tale of two clades: monkeypox viruses. J Gen Virol. 2005;86:2661-72.
PubMed Abstract»
Philpott D, Hughes CM, Alroy KA, et al. Epidemiologic and Clinical Characteristics of Monkeypox Cases - United States, May 17-July 22, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1018-22.
PubMed Abstract»
Reynolds MG, Yorita KL, Kuehnert MJ, et al. Clinical manifestations of human monkeypox influenced by route of infection. J Infect Dis. 2006;194:773-80.
PubMed Abstract»
Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022;387:679-91.
PubMed Abstract»
Module 2 » Lesson 8. Mpox

Virology, Pathogenesis, and Transmission

Aguilera-Alonso D, Alonso-Cadenas JA, Roguera-Sopena M, Lorusso N, Miguel LGS, Calvo C. Monkeypox virus infections in children in Spain during the first months of the 2022 outbreak. Lancet Child Adolesc Health. 2022;6:e22-e23.
PubMed Abstract»
Alarcón J, Kim M, Balanji N, et al. Occupational Monkeypox Virus Transmission to Healthcare Worker, California, USA, 2022. Emerg Infect Dis. 2023;29:435-7.
PubMed Abstract»
Beeson A, Styczynski A, Hutson CL, et al. Mpox respiratory transmission: the state of the evidence. Lancet Microbe. 2023;4:e277-e283.
PubMed Abstract»
Brosius I, Van Dijck C, Coppens J, et al. Presymptomatic viral shedding in high-risk mpox contacts: A prospective cohort study. J Med Virol. 2023;95:e28769.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Mpox. Mpox Cases by Age and Gender and Race and Ethnicity. January 11, 2024.
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Past U.S. Cases and Outbreaks. August 29, 2023.
CDC»
Cyrklaff M, Linaroudis A, Boicu M, et al. Whole cell cryo-electron tomography reveals distinct disassembly intermediates of vaccinia virus. PLoS One. 2007;2:e420.
PubMed Abstract»
Cyrklaff M, Risco C, Fernández JJ, et al. Cryo-electron tomography of vaccinia virus. Proc Natl Acad Sci U S A. 2005;102:2772-7.
PubMed Abstract»
Greseth MD, Traktman P. The Life Cycle of the Vaccinia Virus Genome. Annu Rev Virol. 2022;9:239-59.
PubMed Abstract»
Le Pluart D, Ruyer-Thompson M, Ferré VM, et al. A Healthcare-Associated Infection With Monkeypox Virus of a Healthcare Worker During the 2022 Outbreak. Open Forum Infect Dis. 2022;9:ofac520.
PubMed Abstract»
Mendoza R, Petras JK, Jenkins P, et al. Monkeypox Virus Infection Resulting from an Occupational Needlestick - Florida, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1348-9.
PubMed Abstract»
Mitjà O, Alemany A, Marks M, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023;401:939-49.
PubMed Abstract»
Muller MP, Mishra S, McGeer A, et al. Environmental Testing of Surfaces in the Room of a Patient With Mpox. Clin Infect Dis. 2023;76:179-81.
PubMed Abstract»
Pfeiffer JA, Collingwood A, Rider LE, et al. High-Contact Object and Surface Contamination in a Household of Persons with Monkeypox Virus Infection - Utah, June 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1092-1094.
PubMed Abstract»
Pfeiffer JA, Collingwood A, Rider LE, et al. High-Contact Object and Surface Contamination in a Household of Persons with Monkeypox Virus Infection - Utah, June 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1092-94.
PubMed Abstract»
Salvato RS, Rodrigues Ikeda ML, Barcellos RB, et al. Possible Occupational Infection of Healthcare Workers with Monkeypox Virus, Brazil. Emerg Infect Dis. 2022;28:2520-3.
PubMed Abstract»
Saunders KE, Van Horn AN, Medlin HK, et al. Monkeypox in a Young Infant - Florida, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1220-1.
PubMed Abstract»
Tascini C, Geminiani M, Sbrana F, Pagotto A, Martini L. Possible tattoo-transmitted monkeypox viral infection. Intern Emerg Med. 2022;17:2421-2.
PubMed Abstract»
Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022;387:679-91.
PubMed Abstract»
Thornhill JP, Palich R, Ghosn J, et al. Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series. Lancet. 2022;400:1953-65.
PubMed Abstract»
Vaughan A, Aarons E, Astbury J, et al. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerg Infect Dis. 2020;26:782-785.
PubMed Abstract»
Zayat N, Huang S, Wafai J, Philadelphia M. Monkeypox Virus Infection in 22-Year-Old Woman after Sexual Intercourse, New York, USA. Emerg Infect Dis. 2023;29:222-3.
PubMed Abstract»
Module 2 » Lesson 8. Mpox

Clinical Manifestations

Brown L, Delaney C, Hainsworth A. Monkeypox-associated proctitis and rectal wall perforation. BMJ Case Rep. 2023;16:e252168.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Mpox. Clinical Considerations for Treatment and Prophylaxis of Mpox Infection in People Who are Immunocompromised. Updated September 1, 2023
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Clinical Guidance: Clinical Recognition. Updated August 30, 2023
CDC»
Choy AM, Lyudmer M, Su S, Remotti HE, Zucker JE, Jodorkovsky D. Human Mpox Virus Proctitis With Persistent Rectal Ulcers on Sigmoidoscopy. ACG Case Rep J. 2023;10:e01002.
PubMed Abstract»
Dumont M, Guilhou T, Gerin M, et al. Myocarditis in monkeypox-infected patients: a case series. Clin Microbiol Infect. 2023;29:390.e5-390.e7.
PubMed Abstract»
Farrar JL, Lewis NM, Houck K, et al. Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons - 29 U.S. Jurisdictions, May 22-September 3, 2022. Am J Transplant. 2023;23:298-303.
PubMed Abstract»
Guzzetta G, Mammone A, Ferraro F, et al. Early Estimates of Monkeypox Incubation Period, Generation Time, and Reproduction Number, Italy, May-June 2022. Emerg Infect Dis. 2022;28:2078-81.
PubMed Abstract»
Madewell ZJ, Charniga K, Masters NB, et al. Serial Interval and Incubation Period Estimates of Monkeypox Virus Infection in 12 Jurisdictions, United States, May-August 2022. Emerg Infect Dis. 2023;29:818-21.
PubMed Abstract»
Mailhe M, Beaumont AL, Thy M, et al. Clinical characteristics of ambulatory and hospitalized patients with monkeypox virus infection: an observational cohort study. Clin Microbiol Infect. 2023;29:233-9.
PubMed Abstract»
Miller MJ, Cash-Goldwasser S, Marx GE, et al. Severe Monkeypox in Hospitalized Patients - United States, August 10-October 10, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1412-7.
PubMed Abstract»
Mitjà O, Alemany A, Marks M, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023;401:939-49.
PubMed Abstract»
Miura F, van Ewijk CE, Backer JA, et al. Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022. Euro Surveill. 2022;27(24):2200448.
PubMed Abstract»
Moody S, Lamb T, Jackson E, et al. Assessment and management of secondary bacterial infections complicating Mpox (Monkeypox) using a telemedicine service. A prospective cohort study. Int J STD AIDS. 2023;34:434-8.
PubMed Abstract»
Patel A, Bilinska J, Tam JCH, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410.
PubMed Abstract»
Philpott D, Hughes CM, Alroy KA, et al. Epidemiologic and Clinical Characteristics of Monkeypox Cases - United States, May 17-July 22, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1018-22.
PubMed Abstract»
Ritter JM, Martines RB, Bhatnagar J, et al. Pathology and monkeypox virus localization in tissues from immunocompromised patients with severe or fatal mpox. J Infect Dis. 2024 Jan 18. Online ahead of print.
PubMed Abstract»
Simmons WF, Chan JD, Budak JZ, et al. Antibiotic prescribing patterns for bacterial superinfection of mpox: A retrospective cohort study in an urban center. Antimicrob Steward Healthc Epidemiol. 2023;3:e108.
PubMed Abstract»
Thompson GR, Desai AN, Neumeister SM, Arutyunova AM, Cohen SH. Phimosis as a Complication of Resolved Mpox. Clin Infect Dis. 2023;76:178-9.
PubMed Abstract»
Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022;387:679-91.
PubMed Abstract»
Thornhill JP, Palich R, Ghosn J, et al. Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series. Lancet. 2022;400:1953-65.
PubMed Abstract»
Yakubovsky M, Shasha D, Reich S, et al. Mpox Presenting as Proctitis in Men Who Have Sex With Men. Clin Infect Dis. 2023;76:528-30.
PubMed Abstract»
Yon H, Shin H, Shin JI, et al. Clinical manifestations of human Mpox infection: A systematic review and meta-analysis. Rev Med Virol. 2023;33:e2446.
PubMed Abstract»
Module 2 » Lesson 8. Mpox

Laboratory Diagnosis

Mills MG, Juergens KB, Gov JP, et al. Evaluation and clinical validation of monkeypox (mpox) virus real-time PCR assays. J Clin Virol. 2023;159:105373.
PubMed Abstract»
Palich R, Burrel S, Monsel G, et al. Viral loads in clinical samples of men with monkeypox virus infection: a French case series. Lancet Infect Dis. 2023;23:74-80.
PubMed Abstract»
Suñer C, Ubals M, Tarín-Vicente EJ, et al. Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain. Lancet Infect Dis. 2023;23:445-53.
PubMed Abstract»
Module 2 » Lesson 8. Mpox

Treatment

Akiyama Y, Morioka S, Tsuzuki S, et al. Efficacy and viral dynamics of tecovirimat in patients with MPOX: A multicenter open-label, double-arm trial in Japan. J Infect Chemother. 2023 Nov 30. Online ahead of print
PubMed Abstract»
Aldred B, Lyles RH, Scott JY, et al. Early Tecovirimat Treatment for Mpox Disease Among People With HIV. JAMA Intern Med. 2024 Jan 8. Online ahead of print.
PubMed Abstract»
Buechler CR, Anderson Z, Kullberg SA, et al. Successful Treatment of Recalcitrant Mpox Lesions With Intralesional Cidofovir in a Patient With HIV/AIDS. JAMA Dermatol. 2023 Dec 6. Online ahead of print.
PubMed Abstract»
Cash-Goldwasser S, Labuda SM, McCormick DW, et al. Ocular Monkeypox - United States, July-September 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1343-7.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Expanded Access IND Protocol: Use of Tecovirimat (TPOXX®) for Treatment of Human Non-Variola Orthopoxvirus Infections in Adults and Children IND No. 116,039. CDC IRB No. 6402. Version 6.3 Updated on December 19, 2023
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Clinical Considerations for Pain Management of Mpox. Updated March 27, 2023.
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Clinical Considerations for Treatment and Prophylaxis of Mpox Infection in People Who are Immunocompromised. Updated September 1, 2023
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Demographics of Patients Receiving Tecovirimat (TPOXX) for Treatment of Mpox. August 7, 2023
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Guidance for Tecovirimat Use. Updated June 7, 2023
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Tecovirimat (TPOXX) IND Information. Updated July 6, 2023
CDC»
DeLaurentis CE, Kiser J, Zucker J. New Perspectives on Antimicrobial Agents: Tecovirimat for Treatment of Human Monkeypox Virus. Antimicrob Agents Chemother. 2022;66:e0122622.
PubMed Abstract»
Duraffour S, Lorenzo MM, Zöller G, et al. ST-246 is a key antiviral to inhibit the viral F13L phospholipase, one of the essential proteins for orthopoxvirus wrapping. J Antimicrob Chemother. 2015;70:1367-80.
PubMed Abstract»
Garrigues JM, Hemarajata P, Espinosa A, et al. Community spread of a human monkeypox virus variant with a tecovirimat resistance-associated mutation. Antimicrob Agents Chemother. 2023;67:e0097223.
PubMed Abstract»
Garrigues JM, Hemarajata P, Karan A, et al. Identification of Tecovirimat Resistance-Associated Mutations in Human Monkeypox Virus - Los Angeles County. Antimicrob Agents Chemother. 2023;67:e0056823.
PubMed Abstract»
Grosenbach DW, Honeychurch K, Rose EA, et al. Oral Tecovirimat for the Treatment of Smallpox. N Engl J Med. 2018;379:44-53.
PubMed Abstract»
Hyndiuk RA, Seideman S, Leibsohn JM. Treatment of Vaccinial keratitis with trifluorothymidine. Arch Ophthalmol. 1976;94:1785-6.
PubMed Abstract»
Karmarkar EN, Golden MR, Kerani RP, et al. Association of Tecovirimat Therapy With Mpox Symptom Improvement: A Cross-sectional Study-King County, Washington, May-October 2022. Open Forum Infect Dis. 2024 Mar;11:ofae029.
PubMed Abstract»
Mazzotta V, Cozzi-Lepri A, Lanini S, et al. Effect of tecovirimat on healing time and viral clearance by emulation of a target trial in patients hospitalized for mpox. J Med Virol. 2023;95:e28868.
PubMed Abstract»
Pepose JS, Margolis TP, LaRussa P, Pavan-Langston D. Ocular complications of smallpox vaccination. Am J Ophthalmol. 2003;136:343-52.
PubMed Abstract»
Perzia B, Theotoka D, Li K, et al. Treatment of ocular-involving monkeypox virus with topical trifluridine and oral tecovirimat in the 2022 monkeypox virus outbreak. Am J Ophthalmol Case Rep. 2023;29:101779.
PubMed Abstract»
Quenelle DC, Prichard MN, Keith KA, et al. Synergistic efficacy of the combination of ST-246 with CMX001 against orthopoxviruses. Antimicrob Agents Chemother. 2007;51:4118-24.
PubMed Abstract»
Raccagni AR, Candela C, Bruzzesi E, et al. Real-life use of cidofovir for the treatment of severe monkeypox cases. J Med Virol. 2023;95:e28218.
PubMed Abstract»
Stafford A, Rimmer S, Gilchrist M, et al. Use of cidofovir in a patient with severe mpox and uncontrolled HIV infection. Lancet Infect Dis. 2023;23:e218-e226.
PubMed Abstract»
Thet AK, Kelly PJ, Kasule SN, et al. The use of Vaccinia Immune Globulin in the Treatment of Severe Mpox. Virus Infection in Human Immunodeficiency Virus/AIDS. Clin Infect Dis. 2023;76:1671-3.
PubMed Abstract»
Wang J, Shahed-Ai-Mahmud M, Chen A, Li K, Tan H, Joyce R. An Overview of Antivirals against Monkeypox Virus and Other Orthopoxviruses. J Med Chem. 2023;66:4468-90.
PubMed Abstract»
Module 2 » Lesson 8. Mpox

Prevention of Mpox Infection

Advisory Committee on Immunization Practices (ACIP). Adult Immunization Schedule by Age. Recommendation for Ages 19 Years or Older, United States, 2024.
ACIP»
Advisory Committee on Immunization Practices (ACIP). Child and Adolescent Immunization Schedule by Age. Recommendations for Ages 18 Years or Younger, United States, 2024.
ACIP»
Boehmer TK, Kompaniyets L, Lavery AM, et al. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data - United States, March 2020-January 2021. MMWR Morb Mortal Wkly Rep. 2021;70:1228-32.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Mpox. JYNNEOS Vaccine. Updated September 1, 2023
CDC»
Dalton AF, Diallo AO, Chard AN, et al. Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study - United States, August 19, 2022-March 31, 2023. MMWR Morb Mortal Wkly Rep. 2023;72:553-8.
PubMed Abstract»
Delaney KP, Sanchez T, Hannah M, et al. Strategies Adopted by Gay, Bisexual, and Other Men Who Have Sex with Men to Prevent Monkeypox virus Transmission - United States, August 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1126-30.
PubMed Abstract»
Deputy NP, Deckert J, Chard AN, et al. Vaccine Effectiveness of JYNNEOS against Mpox Disease in the United States. N Engl J Med. 2023;388:2434-23.
PubMed Abstract»
Duffy J, Marquez P, Moro P, et al. Safety Monitoring of JYNNEOS Vaccine During the 2022 Mpox Outbreak - United States, May 22-October 21, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1555-9.
PubMed Abstract»
Fact Sheet for Healthcare Providers Administering Vaccine: Emergency Use Authorization of Jynneos (Smallpox and Monkeypox Vaccine, Live, Non-Replicating) for Prevention of Monkeypox Disease in Individuals Determined to be at High Risk for Monkeypox Infection
FDA»
Faix DJ, Gordon DM, Perry LN, et al. Prospective safety surveillance study of ACAM2000 smallpox vaccine in deploying military personnel. Vaccine. 2020;38:7323-30.
PubMed Abstract»
Frey SE, Wald A, Edupuganti S, et al. Comparison of lyophilized versus liquid modified vaccinia Ankara (MVA) formulations and subcutaneous versus intradermal routes of administration in healthy vaccinia-naïve subjects. Vaccine. 2015;33:5225-34.
PubMed Abstract»
Greenberg RN, Overton ET, Haas DW, et al. Safety, immunogenicity, and surrogate markers of clinical efficacy for modified vaccinia Ankara as a smallpox vaccine in HIV-infected subjects. J Infect Dis. 2013;207:749-58.
PubMed Abstract»
Hazra A, Zucker J, Bell E, et al. Mpox in people with past infection or a complete vaccination course: a global case series. Lancet Infect Dis. 2023 Sep 4:S1473-3099(23)00492-9.
PubMed Abstract»
Jamard S, Handala L, Faussat C, et al. Resurgence of symptomatic Mpox among vaccinated patients: First clues from a new-onset local cluster. Infect Dis Now. 2023;53:104714.
PubMed Abstract»
Nalca A, Zumbrun EE. ACAM2000: the new smallpox vaccine for United States Strategic National Stockpile. Drug Des Devel Ther. 2010;4:71-9.
PubMed Abstract»
Overton ET, Stapleton J, Frank I, et al. Safety and Immunogenicity of Modified Vaccinia Ankara-Bavarian Nordic Smallpox Vaccine in Vaccinia-Naive and Experienced Human Immunodeficiency Virus-Infected Individuals: An Open-Label, Controlled Clinical Phase II Trial. Open Forum Infect Dis. 2015;2:ofv040.
PubMed Abstract»
Payne AB, Ray LC, Kugeler KJ, et al. Incidence of Monkeypox Among Unvaccinated Persons Compared with Persons Receiving ≥1 JYNNEOS Vaccine Dose - 32 U.S. Jurisdictions, July 31-September 3, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1278-82.
PubMed Abstract»
Raccagni AR, Candela C, Mileto D, et al. Breakthrough monkeypox infection among individuals previously immunized with smallpox or monkeypox vaccination. J Infect. 2023;86:154-225.
PubMed Abstract»
Rao AK, Petersen BW, Whitehill F, et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:734-42.
PubMed Abstract»
Reed JL, Scott DE, Bray M. Eczema vaccinatum. Clin Infect Dis. 2012;54:832-40.
PubMed Abstract»
Tack DM, Karem KL, Montgomery JR, et al. Unintentional transfer of vaccinia virus associated with smallpox vaccines: ACAM2000(®) compared with Dryvax(®). Hum Vaccin Immunother. 2013;9:1489-96.
PubMed Abstract»
Thy M, Peiffer-Smadja N, Mailhe M, et al. Breakthrough Infections after Postexposure Vaccination against Mpox. N Engl J Med. 2022;387:2477-9.
PubMed Abstract»
US. Food and Drug Administration. JYNNEOS. FDA. Published online October 2, 2023.
FDA»
Module 2 » Lesson 8. Mpox

Counseling and Education

Centers for Disease Control and Prevention (CDC). Mpox. Infection Prevention and Control of Mpox in Healthcare Settings. Updated October 31, 2022
CDC»
Centers for Disease Control and Prevention (CDC). Mpox. Mpox in Animals and Pets. Updated August 18, 2023
CDC»
Raccagni AR, Castagna A, Nozza S. Detection of Mpox Virus in Seminal Fluids: Implications for Sexual Transmission. New Microbiol. 2024;46:317-21.
PubMed Abstract»
Seang S, Burrel S, Todesco E, et al. Evidence of human-to-dog transmission of monkeypox virus. Lancet. 2022;400:658-9.
PubMed Abstract»
Tan DHS, Pico Espinosa O, Matelski J, et al. Longitudinal Analysis of Mpox Virus DNA Detectability From Multiple Specimen Types During Acute Illness: A Cohort Study. Open Forum Infect Dis. 2024;11:ofae073.
PubMed Abstract»
Bertran M, Andrews N, Davison C, et al. Effectiveness of one dose of MVA-BN smallpox vaccine against mpox in England using the case-coverage method: an observational study. Lancet Infect Dis. 2023;23:828-35.
PubMed Abstract»
Mpox in the U.S.: 2022 Global Map and Case Count. Centers for Disease Control and Prevention. Published February 24, 2023.
CDC»
O'Laughlin K, Tobolowsky FA, Elmor R, et al. Clinical Use of Tecovirimat (Tpoxx) for Treatment of Monkeypox Under an Investigational New Drug Protocol - United States, May-August 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1190-5.
PubMed Abstract»
Oakley LP, Hufstetler K, O'Shea J, et al. Mpox Cases Among Cisgender Women and Pregnant Persons - United States, May 11-November 7, 2022. MMWR Morb Mortal Wkly Rep. 2023;72:9-14.
PubMed Abstract»
Rosenberg ES, Dorabawila V, Hart-Malloy R, et al. Effectiveness of JYNNEOS Vaccine Against Diagnosed Mpox Infection - New York, 2022. MMWR Morb Mortal Wkly Rep. 2023 May 19;72:559-63.
PubMed Abstract»
US. Food and Drug Administration. ACAM2000. FDA. Published online September 27, 2022. Accessed June 13, 2023
FDA»
Wolff Sagy Y, Zucker R, Hammerman A, et al. Real-world effectiveness of a single dose of mpox vaccine in males. Nat Med. 2023;29:748-52.
PubMed Abstract»
Zucker J, Fischer WA 2nd, Wilkin T. Tecovirimat for Mpox-Promise and Limitations. JAMA Intern Med. 2024 Jan 8. Online ahead of print.
PubMed Abstract»

Lesson 9. Mycoplasma genitalium

Module 2 » Lesson 9. Mycoplasma genitalium

Epidemiology in the United States

Balkus JE, Manhart LE, Jensen JS, et al. Mycoplasma genitalium Infection in Kenyan and US Women. Sex Transm Dis. 2018;45:514-21.
PubMed Abstract»
Balkus JE, Manhart LE, Lee J, et al. Periodic Presumptive Treatment for Vaginal Infections May Reduce the Incidence of Sexually Transmitted Bacterial Infections. J Infect Dis. 2016;213:1932-7.
PubMed Abstract»
Haderxhanaj LT, Leichliter JS, Aral SO, Chesson HW. Sex in a lifetime: Sexual behaviors in the United States by lifetime number of sex partners, 2006-2010. Sex Transm Dis. 2014;41:345-52.
PubMed Abstract»
Kreisel KM, Weston EJ, St Cyr SB, Spicknall IH. Estimates of the Prevalence and Incidence of Chlamydia and Gonorrhea Among US Men and Women, 2018. Sex Transm Dis. 2021;48:222-31.
PubMed Abstract»
Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:418-26.
PubMed Abstract»
Lokken EM, Balkus JE, Kiarie J, et al. Association of Recent Bacterial Vaginosis With Acquisition of Mycoplasma genitalium. Am J Epidemiol. 2017;186:194-201.
PubMed Abstract»
Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA. Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection. Am J Public Health. 2007;97:1118-25.
PubMed Abstract»
Manhart LE, Leipertz G, Soge OO, et al. Mycoplasma genitalium in the US (MyGeniUS): Surveillance Data From Sexual Health Clinics in 4 US Regions. Clin Infect Dis. 2023;77:1449-59.
PubMed Abstract»
Miller WC, Ford CA, Morris M, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. 2004;291:2229-36.
PubMed Abstract»
Oakeshott P, Aghaizu A, Hay P, et al. Is Mycoplasma genitalium in women the "New Chlamydia?" A community-based prospective cohort study. Clin Infect Dis. 2010;51:1160-6.
PubMed Abstract»
Rowlinson E, Hughes JP, Chambers LC, et al. Incidence of Nongonococcal Urethritis in Men Who Have Sex With Women and Associated Risk Factors. Sex Transm Dis. 2021;48:341-6.
PubMed Abstract»
Seña AC, Lee JY, Schwebke J, et al. A Silent Epidemic: The Prevalence, Incidence and Persistence of Mycoplasma genitalium Among Young, Asymptomatic High-Risk Women in the United States. Clin Infect Dis. 2018;67:73-9.
PubMed Abstract»
Torrone EA, Kruszon-Moran D, Philips C, et al. Prevalence of Urogenital Mycoplasma genitalium Infection, United States, 2017 to 2018. Sex Transm Dis. 2021;48:e160-e162.
PubMed Abstract»
Module 2 » Lesson 9. Mycoplasma genitalium

Microbiology, Pathogenesis, and Transmission

Balish M, Bertaccini A, Blanchard A, et al. Recommended rejection of the names Malacoplasma gen. nov., Mesomycoplasma gen. nov., Metamycoplasma gen. nov., Metamycoplasmataceae fam. nov., Mycoplasmoidaceae fam. nov., Mycoplasmoidales ord. nov., Mycoplasmoides gen. nov., Mycoplasmopsis gen. nov. [Gupta, Sawnani, Adeolu, Alnajar and Oren 2018] and all proposed species comb. nov. placed therein. Int J Syst Evol Microbiol. 2019;69:3650-3.
PubMed Abstract»
Björnelius E, Jensen JS, Lidbrink P. Conjunctivitis associated with Mycoplasma genitalium infection. Clin Infect Dis. 2004 Oct 1;39:e67-9.
PubMed Abstract»
Cina M, Baumann L, Egli-Gany D, et al. Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis. Sex Transm Infect. 2019 Aug;95:328-335.
PubMed Abstract»
Cohen CR, Nosek M, Meier A, et al. Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya. Sex Transm Dis. 2007 May;34:274-9.
PubMed Abstract»
Gupta RS, Sawnani S, Adeolu M, Alnajar S, Oren A. Phylogenetic framework for the phylum Tenericutes based on genome sequence data: proposal for the creation of a new order Mycoplasmoidales ord. nov., containing two new families Mycoplasmoidaceae fam. nov. and Metamycoplasmataceae fam. nov. harbouring Eperythrozoon, Ureaplasma and five novel genera. Antonie Van Leeuwenhoek. 2018;111:1583-1630.
PubMed Abstract»
Jensen JS, Hansen HT, Lind K. Isolation of Mycoplasma genitalium strains from the male urethra. J Clin Microbiol. 1996;34:286-91.
PubMed Abstract»
Jensen JS. To Test or Not to Test for Mycoplasma hominis and Ureaplasmas: That's (Not) the Question. Clin Infect Dis. 2021;73:669-71.
PubMed Abstract»
Justel M, Alexandre I, Martínez P, et al. Vertical transmission of bacterial eye infections, Angola, 2011-2012. Emerg Infect Dis. 2015;21:471-3.
PubMed Abstract»
Kim CM, Manhart LE, Wood GE. Serum and Urethral Antibody Response in Mycoplasma genitalium -Infected Men. Sex Transm Dis. 2023 Oct 1;50:e26-e29.
PubMed Abstract»
Luki N, Lebel P, Boucher M, Doray B, Turgeon J, Brousseau R. Comparison of polymerase chain reaction assay with culture for detection of genital mycoplasmas in perinatal infections. Eur J Clin Microbiol Infect Dis. 1998;17:255-63.
PubMed Abstract»
Manhart LE, Kay N. Mycoplasma genitalium: Is It a Sexually Transmitted Pathogen? Curr Infect Dis Rep. 2010;12:306-13.
PubMed Abstract»
Miyata M. Centipede and inchworm models to explain Mycoplasma gliding. Trends Microbiol. 2008;16:6-12.
PubMed Abstract»
Ring A, Balakrishna S, Imkamp F, et al. High Rates of Asymptomatic Mycoplasma genitalium Infections With High Proportion of Genotypic Resistance to First-Line Macrolide Treatment Among Men Who Have Sex With Men Enrolled in the Zurich Primary HIV Infection Study. Open Forum Infect Dis. 2022 Jun;9:ofac217.
PubMed Abstract»
Romano SS, Jensen JS, Lowens MS, et al. Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis. Clin Infect Dis. 2019;69:113-120.
PubMed Abstract»
Srinivasan S, Chambers LC, Tapia KA, et al. Urethral Microbiota in Men: Association of Haemophilus influenzae and Mycoplasma penetrans With Nongonococcal Urethritis. Clin Infect Dis. 2021;73:e1684-e1693.
PubMed Abstract»
Tosh AK, Van Der Pol B, Fortenberry JD, et al. Mycoplasma genitalium among adolescent women and their partners. J Adolesc Health. 2007 May;40:412-7.
PubMed Abstract»
Xiao L, Waites KB, Van Der Pol B, Aaron KJ, Hook EW 3rd, Geisler WM. Mycoplasma genitalium Infections With Macrolide and Fluoroquinolone Resistance-Associated Mutations in Heterosexual African American Couples in Alabama. Sex Transm Dis. 2019;46:18-24.
PubMed Abstract»
Module 2 » Lesson 9. Mycoplasma genitalium

Antimicrobial Susceptibility in Mycoplasma genitalium

Bachmann LH, Kirkcaldy RD, Geisler WM, et al. Prevalence of Mycoplasma genitalium Infection, Antimicrobial Resistance Mutations, and Symptom Resolution Following Treatment of Urethritis. Clin Infect Dis. 2020;71:e624-e632.
PubMed Abstract»
Berçot B, Charreau I, Rousseau C, et al. High Prevalence and High Rate of Antibiotic Resistance of Mycoplasma genitalium Infections in Men Who Have Sex With Men: A Substudy of the ANRS IPERGAY Pre-exposure Prophylaxis Trial. Clin Infect Dis. 2021;73:e2127-e2133.
PubMed Abstract»
Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Revised December 2019.
CDC»
Clarke EJ, Vodstrcil LA, Plummer EL, et al. Efficacy of Minocycline for the Treatment of Mycoplasma genitalium. Open Forum Infect Dis. 2023;10:ofad427.
PubMed Abstract»
Durukan D, Read TRH, Murray G, et al. Resistance-Guided Antimicrobial Therapy Using Doxycycline-Moxifloxacin and Doxycycline-2.5 g Azithromycin for the Treatment of Mycoplasma genitalium Infection: Efficacy and Tolerability. Clin Infect Dis. 2020;71:1461-8.
PubMed Abstract»
Hamasuna R, Jensen JS, Osada Y. Antimicrobial susceptibilities of Mycoplasma genitalium strains examined by broth dilution and quantitative PCR. Antimicrob Agents Chemother. 2009;53:4938-9.
PubMed Abstract»
Jensen JS, Bradshaw C. Management of Mycoplasma genitalium infections - can we hit a moving target? BMC Infect Dis. 2015;15:343.
PubMed Abstract»
Lau A, Bradshaw CS, Lewis D, et al. The efficacy of azithromycin for the treatment of genital Mycoplasma genitalium: a systematic review and meta-analysis. Clin Infect Dis. 2015;61:1389-99.
PubMed Abstract»
Le Roy C, Touati A, Balcon C, et al. Identification of 16S rRNA mutations in Mycoplasma genitalium potentially associated with tetracycline resistance in vivo but not selected in vitro in M. genitalium and Chlamydia trachomatis. J Antimicrob Chemother. 2021;76:1150-4.
PubMed Abstract»
Li Y, Le WJ, Li S, Cao YP, Su XH. Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection. Int J STD AIDS. 2017;28:1106-14.
PubMed Abstract»
Li Y, Su X, Le W, et al. Mycoplasma genitalium in Symptomatic Male Urethritis: Macrolide Use Is Associated With Increased Resistance. Clin Infect Dis. 2020;70:805-10.
PubMed Abstract»
Machalek DA, Tao Y, Shilling H, et al. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis. Lancet Infect Dis. 2020;20:1302-14.
PubMed Abstract»
Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013;56:934-42.
PubMed Abstract»
Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis. 2009;48:1649-54.
PubMed Abstract»
Murray GL, Plummer EL, Bodiyabadu K, et al. gyrA Mutations in Mycoplasma genitalium and Their Contribution to Moxifloxacin Failure: Time for the Next Generation of Resistance-Guided Therapy. Clin Infect Dis. 2023;76:2187-95.
PubMed Abstract»
Palich R, Gardette M, Bébéar C, Caumes É, Pereyre S, Monsel G. Initial Failure of Pristinamycin Treatment in a Case of Multidrug-Resistant Mycoplasma genitalium Urethritis Eventually Treated by Sequential Therapy. Sex Transm Dis. 2021;48:e163-e164.
PubMed Abstract»
Read TRH, Fairley CK, Murray GL, et al. Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation. Clin Infect Dis. 2019;68:554-60.
PubMed Abstract»
Read TRH, Jensen JS, Fairley CK, et al. Use of Pristinamycin for Macrolide-Resistant Mycoplasma genitalium Infection. Emerg Infect Dis. 2018;24:328-35.
PubMed Abstract»
Romano SS, Jensen JS, Lowens MS, et al. Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis. Clin Infect Dis. 2019;69:113-120.
PubMed Abstract»
Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis. 2011;52:163-70.
PubMed Abstract»
Waites KB, Crabb DM, Atkinson TP, Geisler WM, Xiao L. Omadacycline Is Highly Active In Vitro against Mycoplasma genitalium. Microbiol Spectr. 2022;10:e0365422.
PubMed Abstract»
Woese CR, Stackebrandt E, Ludwig W. What are mycoplasmas: the relationship of tempo and mode in bacterial evolution. J Mol Evol. 1984-1985;21:305-16.
PubMed Abstract»
Wood GE, Jensen NL, Astete S, et al. Azithromycin and Doxycycline Resistance Profiles of U.S. Mycoplasma genitalium Strains and Their Association with Treatment Outcomes. J Clin Microbiol. 2021;59:e0081921.
PubMed Abstract»
Wood GE, Kim CM, Aguila LKT, Cichewicz RH. In Vitro Susceptibility and Resistance of Mycoplasma genitalium to Nitroimidazoles. Antimicrob Agents Chemother. 2023;67:e0000623.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 9. Mycoplasma genitalium

Clinical Manifestations

Ashshi AM, Batwa SA, Kutbi SY, Malibary FA, Batwa M, Refaat B. Prevalence of 7 sexually transmitted organisms by multiplex real-time PCR in Fallopian tube specimens collected from Saudi women with and without ectopic pregnancy. BMC Infect Dis. 2015;15:569.
PubMed Abstract»
Averbach SH, Hacker MR, Yiu T, Modest AM, Dimitrakoff J, Ricciotti HA. Mycoplasma genitalium and preterm delivery at an urban community health center. Int J Gynaecol Obstet. 2013;123:54-7.
PubMed Abstract»
Bachmann LH, Kirkcaldy RD, Geisler WM, et al. Prevalence of Mycoplasma genitalium Infection, Antimicrobial Resistance Mutations, and Symptom Resolution Following Treatment of Urethritis. Clin Infect Dis. 2020;71:e624-e632.
PubMed Abstract»
Björnelius E, Jensen JS, Lidbrink P. Conjunctivitis associated with Mycoplasma genitalium infection. Clin Infect Dis. 2004 Oct 1;39:e67-9.
PubMed Abstract»
Bjartling C, Osser S, Persson K. The association between Mycoplasma genitalium and pelvic inflammatory disease after termination of pregnancy. BJOG. 2010 Feb;117:361-4.
PubMed Abstract»
Chow EPF, Lee D, Bond S, et al. Nonclassical Pathogens as Causative Agents of Proctitis in Men who Have Sex With Men. Open Forum Infect Dis. 2021;8:ofab137.
PubMed Abstract»
Chrisment D, Machelart I, Wirth G, et al. Reactive arthritis associated with Mycoplasma genitalium urethritis. Diagn Microbiol Infect Dis. 2013;77:278-9.
PubMed Abstract»
Cina M, Baumann L, Egli-Gany D, et al. Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis. Sex Transm Infect. 2019 Aug;95:328-335.
PubMed Abstract»
Clausen HF, Fedder J, Drasbek M, et al. Serological investigation of Mycoplasma genitalium in infertile women. Hum Reprod. 2001;16:1866-74.
PubMed Abstract»
Cohen CR, Mugo NR, Astete SG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. 2005;81:463-6.
PubMed Abstract»
Dubbink JH, de Waaij DJ, Bos M, et al. Microbiological Characteristics of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in South African Women. J Clin Microbiol. 2016 Jan;54:200-3.
PubMed Abstract»
Eickhoff JH, Frimodt-Møller N, Walter S, Frimodt-Møller C. A double-blind, randomized, controlled multicentre study to compare the efficacy of ciprofloxacin with pivampicillin as oral therapy for epididymitis in men over 40 years of age. BJU Int. 1999;84:827-34.
PubMed Abstract»
Falk L. The overall agreement of proposed definitions of mucopurulent cervicitis in women at high risk of Chlamydia infection. Acta Derm Venereol. 2010;90:506-11.
PubMed Abstract»
Francis SC, Kent CK, Klausner JD, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008;35:797-800.
PubMed Abstract»
Frenzer C, Egli-Gany D, Vallely LM, Vallely AJ, Low N. Adverse pregnancy and perinatal outcomes associated with Mycoplasma genitalium: systematic review and meta-analysis. Sex Transm Infect. 2022;98:222-7.
PubMed Abstract»
Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC. Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. Sex Transm Dis. 2009 Oct;36:598-606.
PubMed Abstract»
Högdahl M, Kihlström E. Leucocyte esterase testing of first-voided urine and urethral and cervical smears to identify Mycoplasma genitalium-infected men and women. Int J STD AIDS. 2007 Dec;18:835-8.
PubMed Abstract»
Ito S, Tsuchiya T, Yasuda M, Yokoi S, Nakano M, Deguchi T. Prevalence of genital mycoplasmas and ureaplasmas in men younger than 40 years-of-age with acute epididymitis. Int J Urol. 2012;19:234-8.
PubMed Abstract»
Justel M, Alexandre I, Martínez P, et al. Vertical transmission of bacterial eye infections, Angola, 2011-2012. Emerg Infect Dis. 2015;21:471-3.
PubMed Abstract»
Khosropour CM, Jensen JS, Soge OO, et al. High Prevalence of Vaginal and Rectal Mycoplasma genitalium Macrolide Resistance Among Female Sexually Transmitted Disease Clinic Patients in Seattle, Washington. Sex Transm Dis. 2020 May;47:321-325.
PubMed Abstract»
Latimer RL, Read TRH, Vodstrcil LA, et al. Clinical Features and Therapeutic Response in Women Meeting Criteria for Presumptive Treatment for Pelvic Inflammatory Disease Associated With Mycoplasma genitalium. Sex Transm Dis. 2019;46:73-9.
PubMed Abstract»
Latimer RL, Shilling HS, Vodstrcil LA, et al. Prevalence of Mycoplasma genitalium by anatomical site in men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect. 2020;96:563-570.
PubMed Abstract»
Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:418-26.
PubMed Abstract»
Lokken EM, Balkus JE, Kiarie J, et al. Association of Recent Bacterial Vaginosis With Acquisition of Mycoplasma genitalium. Am J Epidemiol. 2017;186:194-201.
PubMed Abstract»
Lokken EM, Kabare E, Oyaro B, et al. A prospective preconception cohort study of the association between Mycoplasma genitalium and fecundability in Kenyan women trying to conceive. Hum Reprod. 2023;38:2020-7.
PubMed Abstract»
Manhart LE, Gaydos CA, Taylor SN, et al. Characteristics of Mycoplasma genitalium Urogenital Infections in a Diverse Patient Sample from the United States: Results from the Aptima Mycoplasma genitalium Evaluation Study (AMES). J Clin Microbiol. 2020 Jun 24;58:.
PubMed Abstract»
Manhart LE, Leipertz G, Soge OO, et al. Mycoplasma genitalium in the US (MyGeniUS): Surveillance Data From Sexual Health Clinics in 4 US Regions. Clin Infect Dis. 2023;77:1449-59.
PubMed Abstract»
Moi H, Reinton N, Moghaddam A. Mycoplasma genitalium in women with lower genital tract inflammation. Sex Transm Infect. 2009 Feb;85:10-4.
PubMed Abstract»
Munson E, Morgan E, Sienkiewicz L, et al. Molecular screening in a longitudinal cohort of young men who have sex with men and young transgender women: associations with focus on the emerging sexually transmitted pathogen Mycoplasma genitalium. Sex Transm Infect. 2021 Sep;97:434-440.
PubMed Abstract»
Nakashima K, Shigehara K, Kawaguchi S, et al. Prevalence of human papillomavirus infection in the oropharynx and urine among sexually active men: a comparative study of infection by papillomavirus and other organisms, including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma spp., and Ureaplasma spp. BMC Infect Dis. 2014;14:43.
PubMed Abstract»
Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ. 2010 Apr 8;340:c1642.
PubMed Abstract»
Olson E, Gupta K, Van Der Pol B, Galbraith JW, Geisler WM. Mycoplasma genitalium infection in women reporting dysuria: A pilot study and review of the literature. Int J STD AIDS. 2021;32:1196-1203.
PubMed Abstract»
Peipert JF, Zhao Q, Schreiber CA, et al. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol. 2021;225:157.e1-157.e9.
PubMed Abstract»
Perin J, Coleman JS, Ronda J, Neibaur E, Gaydos CA, Trent M. Maternal and Fetal Outcomes in an Observational Cohort of Women With Mycoplasma genitalium Infections. Sex Transm Dis. 2021;48:991-6.
PubMed Abstract»
Read TRH, Murray GL, Danielewski JA, et al. Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men. Emerg Infect Dis. 2019 Apr;25:719-727.
PubMed Abstract»
Seña AC, Lee JY, Schwebke J, et al. A Silent Epidemic: The Prevalence, Incidence and Persistence of Mycoplasma genitalium Among Young, Asymptomatic High-Risk Women in the United States. Clin Infect Dis. 2018;67:73-9.
PubMed Abstract»
Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G. Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study. Fertil Steril. 2008;90:513-20.
PubMed Abstract»
Taylor-Robinson D, Gilroy CB, Horowitz S, Horowitz J. Mycoplasma genitalium in the joints of two patients with arthritis. Eur J Clin Microbiol Infect Dis. 1994;13:1066-9.
PubMed Abstract»
Taylor-Robinson D, Jensen JS. Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev. 2011;24:498-514.
PubMed Abstract»
Towns JM, Williamson DA, Bradshaw CS. Case of Mycoplasma genitalium pelvic inflammatory disease with perihepatitis. Sex Transm Infect. 2021 Dec;97:628.
PubMed Abstract»
Wetmore CM, Manhart LE, Lowens MS, et al. Demographic, behavioral, and clinical characteristics of men with nongonococcal urethritis differ by etiology: a case-comparison study. Sex Transm Dis. 2011;38:180-6.
PubMed Abstract»
Wiesenfeld HC, Meyn LA, Darville T, Macio IS, Hillier SL. A Randomized Controlled Trial of Ceftriaxone and Doxycycline, With or Without Metronidazole, for the Treatment of Acute Pelvic Inflammatory Disease. Clin Infect Dis. 2021;72:1181-9.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Zanotta N, Delbue S, Signorini L, et al. Merkel Cell Polyomavirus Is Associated with Anal Infections in Men Who Have Sex with Men. Microorganisms. 2019;7(2):54.
PubMed Abstract»
Module 2 » Lesson 9. Mycoplasma genitalium

Laboratory Diagnostic Tests and Resistance Assays

Clausen HF, Fedder J, Drasbek M, et al. Serological investigation of Mycoplasma genitalium in infertile women. Hum Reprod. 2001;16:1866-74.
PubMed Abstract»
Idahl A, Jurstrand M, Olofsson JI, Fredlund H. Mycoplasma genitalium serum antibodies in infertile couples and fertile women. Sex Transm Infect. 2015 Dec;91:589-91.
PubMed Abstract»
Jensen JS, Bradshaw CS, Tabrizi SN, Fairley CK, Hamasuna R. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect Dis. 2008;47:1546-53.
PubMed Abstract»
Jensen JS, Hansen HT, Lind K. Isolation of Mycoplasma genitalium strains from the male urethra. J Clin Microbiol. 1996;34:286-91.
PubMed Abstract»
Jurstrand M, Jensen JS, Magnuson A, Kamwendo F, Fredlund H. A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy. Sex Transm Infect. 2007;83:319-23.
PubMed Abstract»
Le Roy C, Pereyre S, Hénin N, Bébéar C. French Prospective Clinical Evaluation of the Aptima Mycoplasma genitalium CE-IVD Assay and Macrolide Resistance Detection Using Three Distinct Assays. J Clin Microbiol. 2017;55:3194-3200.
PubMed Abstract»
Murray GL, Bodiyabadu K, Vodstrcil LA, et al. parC Variants in Mycoplasma genitalium: Trends over Time and Association with Moxifloxacin Failure. Antimicrob Agents Chemother. 2022;66:e0027822.
PubMed Abstract»
Murray GL, Plummer EL, Bodiyabadu K, et al. gyrA Mutations in Mycoplasma genitalium and Their Contribution to Moxifloxacin Failure: Time for the Next Generation of Resistance-Guided Therapy. Clin Infect Dis. 2023;76:2187-95.
PubMed Abstract»
Peipert JF, Zhao Q, Schreiber CA, et al. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol. 2021;225:157.e1-157.e9.
PubMed Abstract»
Svenstrup HF, Fedder J, Kristoffersen SE, Trolle B, Birkelund S, Christiansen G. Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study. Fertil Steril. 2008;90:513-20.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 9. Mycoplasma genitalium

Diagnostic Testing and Screening Guidelines

Centers for Disease Control and Prevention: US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 Update: a clinical practice guideline. December 2021:1-108.
CDC»
Chow EPF, Lee D, Bond S, et al. Nonclassical Pathogens as Causative Agents of Proctitis in Men who Have Sex With Men. Open Forum Infect Dis. 2021;8:ofab137.
PubMed Abstract»
Francis SC, Kent CK, Klausner JD, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008;35:797-800.
PubMed Abstract»
Jensen JS, Cusini M, Gomberg M, Moi H, Wilson J, Unemo M. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol. 2022;36:641-50.
PubMed Abstract»
Johnson KA, Sankaran M, Kohn RP, Bacon O, Cohen SE. Testing for Mycoplasma genitalium and Using Doxycycline as First-Line Therapy at Initial Presentations for Non-Gonococcal Urethritis (NGU) Correlate With Reductions in Persistent NGU. Clin Infect Dis. 2023;76:1674-7.
PubMed Abstract»
Khosropour CM, Jensen JS, Soge OO, et al. High Prevalence of Vaginal and Rectal Mycoplasma genitalium Macrolide Resistance Among Female Sexually Transmitted Disease Clinic Patients in Seattle, Washington. Sex Transm Dis. 2020 May;47:321-325.
PubMed Abstract»
Manhart LE, Geisler WM, Bradshaw CS, Jensen JS, Martin DH. Weighing Potential Benefits and Harms of Mycoplasma genitalium Testing and Treatment Approaches. Emerg Infect Dis. 2022:28:e220094.
PubMed Abstract»
Munson E, Morgan E, Sienkiewicz L, et al. Molecular screening in a longitudinal cohort of young men who have sex with men and young transgender women: associations with focus on the emerging sexually transmitted pathogen Mycoplasma genitalium. Sex Transm Infect. 2021 Sep;97:434-440.
PubMed Abstract»
Read TRH, Murray GL, Danielewski JA, et al. Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men. Emerg Infect Dis. 2019 Apr;25:719-727.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Module 2 » Lesson 9. Mycoplasma genitalium

Treatment of Mycoplasma genitalium Infection

Bar-Oz B, Moretti ME, Boskovic R, O'Brien L, Koren G. The safety of quinolones—a meta-analysis of pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol. 2009;143:75-8.
PubMed Abstract»
Cina M, Baumann L, Egli-Gany D, et al. Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis. Sex Transm Infect. 2019 Aug;95:328-335.
PubMed Abstract»
Cohlan SQ. Tetracycline staining of teeth. Teratology. 1977;15:127-9.
PubMed Abstract»
Czeizel AE, Rockenbauer M. Teratogenic study of doxycycline. Obstet Gynecol. 1997;89:524-8.
PubMed Abstract»
Durukan D, Read TRH, Murray G, et al. Resistance-Guided Antimicrobial Therapy Using Doxycycline-Moxifloxacin and Doxycycline-2.5 g Azithromycin for the Treatment of Mycoplasma genitalium Infection: Efficacy and Tolerability. Clin Infect Dis. 2020;71:1461-8.
PubMed Abstract»
Haggerty CL, Totten PA, Astete SG, Ness RB. Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2006;2006:30184.
PubMed Abstract»
Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013;56:934-42.
PubMed Abstract»
Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis. 2009;48:1649-54.
PubMed Abstract»
Murray GL, Plummer EL, Bodiyabadu K, et al. gyrA Mutations in Mycoplasma genitalium and Their Contribution to Moxifloxacin Failure: Time for the Next Generation of Resistance-Guided Therapy. Clin Infect Dis. 2023;76:2187-95.
PubMed Abstract»
Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis. 2011;52:163-70.
PubMed Abstract»
Watanabe T, Fujikawa K, Harada S, Ohura K, Sasaki T, Takayama S. Reproductive toxicity of the new quinolone antibacterial agent levofloxacin in rats and rabbits. Arzneimittelforschung. 1992;43:374-7.
PubMed Abstract»
Wiesenfeld HC, Meyn LA, Darville T, Macio IS, Hillier SL. A Randomized Controlled Trial of Ceftriaxone and Doxycycline, With or Without Metronidazole, for the Treatment of Acute Pelvic Inflammatory Disease. Clin Infect Dis. 2021;72:1181-9.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Xiao L, Waites KB, Van Der Pol B, Aaron KJ, Hook EW 3rd, Geisler WM. Mycoplasma genitalium Infections With Macrolide and Fluoroquinolone Resistance-Associated Mutations in Heterosexual African American Couples in Alabama. Sex Transm Dis. 2019;46:18-24.
PubMed Abstract»
Balkus JE, Manhart LE, Lee J, et al. Periodic Presumptive Treatment for Vaginal Infections May Reduce the Incidence of Sexually Transmitted Bacterial Infections. J Infect Dis. 2016;213:1932-7.
PubMed Abstract»
Francis SC, Kent CK, Klausner JD, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008;35:797-800.
PubMed Abstract»
Haggerty CL, Totten PA, Astete SG, Ness RB. Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2006;2006:30184.
PubMed Abstract»
Jurstrand M, Jensen JS, Magnuson A, Kamwendo F, Fredlund H. A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy. Sex Transm Infect. 2007;83:319-23.
PubMed Abstract»
Lau A, Bradshaw CS, Lewis D, et al. The efficacy of azithromycin for the treatment of genital Mycoplasma genitalium: a systematic review and meta-analysis. Clin Infect Dis. 2015;61:1389-99.
PubMed Abstract»
Le Roy C, Pereyre S, Bébéar C. Evaluation of two commercial real-time PCR assays for detection of Mycoplasma genitalium in urogenital specimens. J Clin Microbiol. 2014;52:971-3.
PubMed Abstract»
Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:418-26.
PubMed Abstract»
Lokken EM, Balkus JE, Kiarie J, et al. Association of Recent Bacterial Vaginosis With Acquisition of Mycoplasma genitalium. Am J Epidemiol. 2017;186:194-201.
PubMed Abstract»
Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis. 2013;56:934-42.
PubMed Abstract»
Miller WC, Ford CA, Morris M, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. 2004;291:2229-36.
PubMed Abstract»
Oakeshott P, Aghaizu A, Hay P, et al. Is Mycoplasma genitalium in women the "New Chlamydia?" A community-based prospective cohort study. Clin Infect Dis. 2010;51:1160-6.
PubMed Abstract»
Schwebke JR, Rompalo A, Taylor S, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis. 2011;52:163-70.
PubMed Abstract»
Soni S, Horner P, Rayment M, et al. British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018). Int J STD AIDS. 2019:956462419825948.
PubMed Abstract»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187.
2021 STI Treatment Guidelines»

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