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Miscellaneous | Questions & Answers | 2010 Treatment Guidelines

Question 1: Please discuss the new female nitrile condom.

Answer: A new version of the female condom, made from nitrile instead of polyurethane, is now available in the United States. Laboratory studies indicate that the female condom is an effective mechanical barrier to viruses, including HIV, and to semen. However, only a limited number of clinical studies have evaluated the efficacy of female condoms in providing protection from STDs, including HIV, and no studies have directly evaluated the female nitrile condom's efficacy. A limited number of clinical studies have favorably evaluated the efficacy of female condoms in providing protection from STDs, including HIV (see 2010 STD Treatment Guidelines, page 5 and reference number 31 and 32). Originally, female condoms were made of polyurethane (FC1). Since 2005, they are made of nitrile (FC2) that does not have the "noisy" side effects of its predecessor. It is also cheaper to manufacture while offering the same safety and efficacy profile. The FC2, sold under a number of brand names (including Reality and Femidom) is the only available product under a woman's control that is approved by the FDA.

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Question 2: STD or STI — What is the correct term to use?

Answer: While it could be argued that this is a matter of more than semantics alone, there currently does not appear to be much interest in the field to settle for one or the other term. Suffice it to say that "STD" is the term most used in the U.S., while "STI" is the term preferred by colleagues abroad. In reality, both terms are used interchangeably.

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Question 3: Does CDC recommend treatment of partners in men with nongonococcal urethriris (NGU)?

Answer: "… partner management is recommended for males with NGU regardless of whether a specific etiology is identified. All sex partners within the preceding 60 days should be referred for evaluation, testing, and empiric treatment with a drug regimen effective against chlamydia. Expedited partner treatment and patient referral are alternative approaches to treating partners." (2010 STD Treatment Guidelines, page 42).

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Question 4: Since the guidelines are considered just that, "guidance" and not standards, some private providers elect not to follow the CDC lead on STD treatment and treat patients with regimens not supported in your publication. Any suggestions on how to approach provider that use regimens not recommended by CDC?

Answer: Providers are free to follow or not follow the guidelines. However, to the extent that they are committed to providing treatment on the basis of the best evidence available, they should be strongly encouraged to follow the guidelines as these have been developed in the most scientifically rigorous way. Start by asking why a provider elected to use a non-recommended treatment regimen to treat an STD. When approaching providers not adhering to the guidelines, they could be queried in an inoffensive way why they chose a certain, nonadherent treatment. It may be that they are not aware of, or are insufficiently aware of, the guidelines or that they are unaware of current availability of drug formulations (both of which have changed significantly within the past decade). In such cases, it would be reasonable to provide more up-to-date information for the provider to use and the provider could also be offered technical assistance through one of the regional STD/HIV Prevention Training Centers. Regardless, patients treated with a nonrecommended regimen should be closely followed for response to therapy, and test-of-cure could be considered as well.

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Question 5: Is rufloxacin effective for urethritis or nongonococcal urethriris (NGU)?

Answer: Rufloxacin is not available in the United States, and no studies have been published about its efficacy against NGU. Please see the 2010 STD Treatment Guidelines section for urethritis and NGU treatment recommendations (pages 40-43).

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