Although, currently, venereology is a fundamental area of knowledge for dermatovenereologists, we know that, in many Spanish outpatient dermatology services (excluding emergency departments in our specialty), these are generally uncommon reasons for consultation.1 And this is so despite living in a time of an unstoppable increase in venereal or sexually transmitted infections (STIs) of mandatory reporting,2 where specialized centers, ERs, primary care, and some infectious disease services are practically taking over all patients with or at risk of such infections.

Although, overall, dermatovenereology services tend to follow specific protocols, not all follow the same criteria, which may lead to some variability in clinical practice.

In this article, we aim to review the different clinical guidelines regarding screening frequency, treatment, and the need for follow-up after treatment (or test of cure [TOC]) for the most common and relevant infections. We will focus on the 3 most relevant guidelines, those drafted by the Centers for Disease Control and Prevention (CDC), the International Union against Sexually Transmitted Infections (IUSTI), and the British Association for Sexual Health and HIV (BASHH).

Table 1 illustrates the screening recommendations and their frequency if needed. Unlike the IUSTI and CDC guidelines, the BASHH ones do not specify them individually for each infectious agent but rather indicate a series of risk factors and situations in which screening is advised. The CDC recommendations focus on the level of detail in the recommendations, including detailed inclusion based on sex and gender diversities and considering screening for HPV and trichomoniasis.

Table 2 shows the treatments recommended by the guidelines. Motivated by keeping a practical approach and to achieve a reasonably concise table, we have not included treatments proposed in special situations, children, or pregnant women or active ingredients currently not marketed in Spain (such as josamycin, probenecid, or tetracycline), which only affects the absence of a third-line option in chlamydia treatment according to IUSTI (josamycin). However, alternatives are kept in all lines and guidelines. Similarly, we have not included chancroid and donovanosis, as they are uncommon in our setting and have a clear reference in the IUSTI guidelines without evident changes in other guidelines.

Several differences stand out in this table. First, in the therapeutic management of chlamydia. Second, in the management of gonorrhea: despite there is consensus that ceftriaxone is the first-line therapy, discrepancies abound surrounding dosage and the suitability of combination therapy. Therefore, the IUSTI guidelines recommend ceftriaxone monotherapy only if ceftriaxone resistance is ruled out, and if the patient can undergo follow-up after treatment. Furthermore, since single-dose azithromycin treatment has been associated with the development of antimicrobial resistance—mainly of Mycoplasma genitalium but also in gonococcus—neither combination therapy with this drug nor monotherapy for chlamydia or gonorrhea seems appropriate. Therefore, the BASHH guidelines even consider using ciprofloxacin as first-line therapy if susceptibility has been confirmed. Third, the fact that clindamycin vaginal ovules are only recommended by the CDC as a second-line alternative treatment, considering its frequent use in our setting in cases of bacterial vaginosis.

Table 3 summarizes the TOC recommendations made for the infections where it is recommended. Some differences in criteria can be seen among the 3 guidelines. Practically, we consider it most useful in our setting (if confirmation of lymphogranuloma venereum variant is not possible) to perform TOC in cases of rectal chlamydia infection treated with a 1-week single-dose regimen of azithromycin or doxycycline. Similarly, although it is not a TOC per se, the table includes the periodicity of the recommended follow-ups after the diagnosis of syphilis following the reviewer's suggestion.

We believe this article (and its tables) is useful for the daily management of venereal disease, as it allows for quick consultation of the guidelines applicable in our setting while highlighting the discrepancies found in some recommendations. Although we understand that guidelines must stick to the epidemiological characteristics of the geographic area in which they are issued, and that the extrapolation of any of the 3 to our setting seems reasonable, venereologists must apply them critically and individually to the specific situation of our center and municipality.