CDC December 2010 update to gonorrhea treatment recommendations

The Buzz: The CDC recently changed the recommended gonorrhea treatment regimen.

Citation: Sexually Transmitted Diseases Treatment Guidelines, 2010. CDC Morbidity and Mortality Weekly Report: December 17, 2010 / Vol. 59 / No. RR-12

Summary:

The CDC recently changed the recommended gonorrhea treatment regimen to Ceftriaxone 250 mg IM in a single dose PLUS either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days. This decision was made due to the following factors: 1) increasing global distribution of isolates demonstrating cephalosporin resistance, 2) reports of ceftriaxone 125mg treatment failures, 3) the need for better efficacy against gonococcal pharyngeal infections, which are often unrecognized, and 4) to provide a single treatment regimen regardless of the anatomic site of infection. Alternative regimens include Cefixime 400 mg orally in a single dose PLUS either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days OR cefpodoxime 400 mg orally in a single dose PLUS either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days. Patients with a prior severe reaction to penicillin may be treated with azithromycin 2 g orally. Due to the potential for N. gonorrhoeae to develop resistance to macrolides, use of this regimen should be used with caution and providers treating such patients could consider consulting an infectious disease specialist. Clinicians should advise patients to refer all sex partners in the 60 days prior to the onset of symptoms or diagnosis for evaluation and treatment, and patients themselves should be retested 3 months after treatment to screen for reinfection.

Commentary: An important change that can affect many of our patients, and a reminder that antibiotic resistance is a reality.

By: Christopher A Cox, MS3, UCSF Medical School

USPSTF 2011 Recommendations for Testicular Cancer Screening

The Buzz: USPSTF 2011 Recommendations Regarding Screening for Testicular Cancer

Citation:

Screening for Testicular Cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. Annals of Internal Medicine April 5, 2011 Vol 154 p483-6.

Lin K and Sharangpani R. Screening for Testicular Cancer: An Evidence Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine September 21, 2010 Vol 153 396-9.

Summary:

Because of the low incidence and high cure rate of testicular cancer, the USPSTF recommends against routine screening, which includes self exams and clinical exams, in asymptomatic adolescent and adult men (Grade D Recommendation); the benefit would be minimal (if any) and the theoretical risks include the psychological effects of false-positives and harms from diagnostic procedures. Even though patients themselves discover most cases of testicular cancer, there is no evidence that teaching young men to do self-testicular exams would improve health outcomes. The USPSTF instead recommends that clinicians consider testicular cancer in the differential diagnosis when young men present with testicular signs and symptoms. They conclude that prompt assessment and better evaluation of testicular complaints are much more beneficial than widespread screening for early detection.

The American Academy of Family Physicians does not support routine screening, the American Cancer Society does not recommend testicular self-examination, and the American Academy of Pediatrics does not believe in screening for testicular cancer as part of preventive health care.

Commentary:

The USPSTF recommends against screening for testicular cancer in asymptomatic men ages 15-34 years. Instead, more effort should be devoted to prompt assessment and thorough evaluation of adolescent or adult men who present with testicular complaints.

By: Lien Le, MS3, UCSF Medical School