# INTRODUCTION LABORATORY DIAGNOSIS
There have been major developments in the diagnosis of C. trachomatis Although C. trachomatis can be diagnosed by and laboratory-based and point-of-care enzymedue to their superior performance characteristics. used for a wide range of samples, including urine and vulvovaginal, cervical and urethral swabs. Several available. The increased sensitivity of NAATs compared with other diagnostic tests, such as culture and antigen of non-invasive specimens, which can be collected conveniently at the primary level of care. Commercially available NAATs are not yet licensed for the diagnosis of extra-genital samples but have shown to be reliable for detection of chlamydial infection in rectal and pharyngeal swabs. Several commercially available tests for chlamydia are combined with tests for gonorrhoea. Further information is available in the WHO publication on laboratory diagnosis of STIs including HIV (6).

# RATIONALE FOR NEW RECOMMENDATIONS
The guidelines for treatment of chlamydial infections need to be updated to respond to the changes in epidemiology and antimicrobial susceptibility for chlamydia that have occurred since the previous WHO Guidelines for the management of sexually transmitted (7).
LGV is increasingly some settings, and treatment failure has been reported of cases (8) the only international guidelines that still recommend treating chlamydial infections with amoxicillin or tetracycline. As recommended by the WHO STI treatment recommendations for C. trachomatis needed to be reviewed and revised based on the most recent available evidence.
The objectives of these guidelines are:
- to provide evidence-based guidance on treatment of infection with C. trachomatis
- to support countries to update their national guidelines for treatment of chlamydial infection.

# TARGET AUDIENCE
These guidelines are primarily intended for health-care of the health-care system involved in the treatment and management of people with STIs in low-, middleand high-income countries. They are also intended for individuals working in sexual and reproductive health programmes, such as HIV/AIDS, family planning, maternal and child health and adolescent health, to ensure appropriate STI diagnosis and management.
The guidelines are also useful for policy-makers, in the health sector who are responsible for implementing STI management interventions at regional, national and subnational levels.

# STRUCTURE OF THE GUIDELINES
These guidelines provide evidence-based clinical conditions caused by C. trachomatis. These guidelines provide direction for countries as however, national guidelines should also take into account the local pattern of AMR, as well as health service capacity and resources.
Updated treatment recommendations based on the most recent evidence are included for the most important common conditions caused by C. trachomatis. Recommendations were not updated for rare conditions and other conditions for which no new information has become available since the Treatment recommendations for the following conditions caused by C. trachomatis are included in these guidelines:
- uncomplicated genital infections
- anorectal infections
- uncomplicated genital infections in pregnant women
- methods outlined in the 2014 edition of the (9) (see Annex B for a detailed description).

# GUIDELINE DEVELOPMENT GROUP (GDG)
To update the WHO guidelines for the prevention, treatment and management of STIs, a GDG was established, comprising 33 international STI experts, including clinicians, researchers and programme the guidelines related to chlamydia was created within the GDG, to provide more intensive feedback participated in meetings and teleconferences to prioritize the questions to be addressed, discuss the of the guidelines.

# QUESTIONS AND OUTCOMES
to identify and agree on the key PICO (population, formed the basis for the systematic reviews and the recommendations. Following this meeting, a survey of GDG members was conducted to prioritize the questions and outcomes according to clinical relevance the update on the treatment of genital and anorectal chlamydial infections, treatment of LGV, and prevention These questions pertained to adults and other special populations, namely adolescents, pregnant women, people living with HIV, and populations at high risk of acquiring and transmitting STIs, such as men Only outcomes that were ranked as critical or important to patients and decision-making were included: clinical

# REVIEWS OF THE EVIDENCE
The systematic reviews for each priority question were conducted by McMaster University, the WHO Collaborating Centre for Evidence-Informed Policy. Evidence for desirable and undesirable outcomes, patient values and preferences, resources, acceptability, equity and feasibility were reviewed from published and unpublished literature. Comprehensive searches for previously conducted systematic reviews, randomized controlled trials and non-randomized studies were searches were conducted to identify studies on patient values and preferences (e.g. qualitative research screened studies, extracted and analysed the data, and assessed the quality/certainty of the evidence using the Grading of Recommendations Assessment, 1 1 For more information, see: /
The quality/certainty of the evidence was assessed at four levels:
In addition, the direct costs of medicines were estimated International drug price indicator guide (10). References for all the reviewed evidence are listed in Annex C. All evidence was summarized in GRADE evidence

# MAKING RECOMMENDATIONS
Recommendations were developed during a second facilitated by two co-chairs, one with expertise in GRADE and the other with clinical STI expertise. The methodologist presented the GRADE evidence meeting. When formulating the recommendations, the GDG considered and discussed the desirable and placed on the outcomes, the associated costs and use of resources, the acceptability of the interventions to the impact on health equity and the feasibility of implementation. Treatments were judged according recommendations were agreed. The discussion was facilitated by the co-chairs with the goal of reaching consensus across the GDG. Disagreements among the GDG members were noted in the evidence-to-decision framework for each judgement. In the case of failure to reach consensus for a recommendation, the planned procedure was for the GDG to take a vote and record the results. However, no votes were taken because the GDG reached consensus during discussion for all of the recommendations. Following the meeting, the electronically. These guidelines were subsequently written up in full and then peer reviewed. The External Review Group approved the methods and agreed with the recommendations made by the GDG (members According to the GRADE approach, the strength of each recommendation was rated as either strong or conditional. Strong recommendations are presented using the wording "The WHO STI guideline recommends...", while conditional recommendations are worded as "The WHO STI guideline suggests..." throughout the guidelines. The implications of the clinicians and policy-makers are explained in detail in Table 3.

# MANAGEMENT OF CONFLICTS OF INTEREST
throughout the process of guideline development. WHO experts were implemented (11). DOI statements were obtained from all GDG members prior to assuming their roles in the group. At the GDG meetings (December their interests, if any, at the beginning of the meeting. Their DOI statements are summarized in Web annex F.
After analysing each DOI, the STI team concluded commercial grants or interests. The STI team concluded would exclude any member from participating fully in the guideline development process. Therefore, options for conditional participation, partial or total exclusion of any GDG member were not discussed.
Strong recommendation "The WHO STI guideline recommends..."
Conditional recommendation "The WHO STI guideline suggests..."
For patients Most individuals in this situation would want the recommended course of action, and only a small proportion would not.
Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.
The majority of individuals in this situation would want the suggested course of action, but many would not.

# For clinicians
Most individuals should receive the recommended course of action.
Adherence to this recommendation according to the guidelines could be used as a quality criterion or performance indicator.
choices will be appropriate for each individual and that clinicians must help each individual arrive at a management decision consistent Decision aids may be useful to help individuals make decisions consistent with their values and preferences.

# For policymakers
The recommendation can be adopted as policy in most situations.
Policy-making will require substantial debate and involvement of various stakeholders. Reference to this document will be made within other relevant WHO guidelines. These guidelines will also be disseminated at major conferences related to STIs and HIV and the aforementioned programme areas.

# UPDATING THE GUIDELINES AND USER FEEDBACK
A system of monitoring relevant new evidence and become available will be established within a year of implementing the guidelines. An electronic follow-up survey of key end-users of the STI guidelines will be conducted after the release of the guidelines.
The results of the survey will be used to identify challenges and barriers to the uptake of the guidelines, to evaluate their usefulness for improving service delivery, and to identify topics or gaps in treatment that need to be addressed in future editions.

# IMPLEMENTATION OF THE WHO GUIDELINES FOR THE TREATMENT OF C. TRACHOMATIS ADAPTATION, IMPLEMENTATION AND MONITORING
These guidelines provide recommendations for treatment of chlamydial infection based on the best global evidence available at the time of compilation. However, the epidemiology and AMR of STIs vary by geographical location and are constantly changing, sometimes rapidly. It is recommended that countries conduct good quality studies to gather the information needed to adapt these guidelines to the local STI situation as they update their national guidelines.
In areas lacking local data as a basis for adaptation, the recommendations in these guidelines can be adopted as presented.

# DISSEMINATION, UPDATING AND IMPLEMENTATION OF THE GUIDELINES
For further guidance on adaptation, implementation and monitoring of national guidelines please refer to and tools into national programmes: principles and processes of adaptation and implementation (12).
In adapting the guidelines for national use, of at least 95%. The criteria to be considered for the selection of medicines are listed in Box 1.
Recommended medicines should meet as many of the criteria as possible, taking into account local availability,

# IDENTIFYING AND PROCURING STI DRUGS
It is important not only to identify medicines that will also the estimated quantities of the medicines that will be required. Quantifying medication needs is important in order to estimate costs, to reconcile make orders in advance so that the unit and freight costs can be minimized.
In order to estimate the quantity of medicines needed, it will be necessary to review the medicines that are recommended for treatment, their unit prices, the quantity required per treatment and the epidemiological information on the prevalence of infection.

# UNCOMPLICATED GENITAL CHLAMYDIA

# RECOMMENDATION 1
For people with uncomplicated genital chlamydia, the WHO STI guideline suggests one of the following options:
- azithromycin 1 g orally as a single oral dose
- or one of these alternatives:
Conditional recommendation, moderate quality evidence developed for ophthalmia neonatorum caused by C. trachomatis.
Remarks: While good practice based on evidence treated for chlamydial infection, the choice of treatment may depend on the convenience of dosage, the cost and considerations. When high value is placed on reducing costs, doxycycline in a standard dose may be the best azithromycin in a single dose may be the best choice. A delayed-release formulation of doxycycline may be an alternative to twice daily dosing of doxycycline, but the high cost of the delayed-release formulation may prohibit its use. Note that doxycycline, tetracycline

# RECOMMENDATIONS FOR TREATMENT OF CHLAMYDIAL INFECTIONS
there are no data for adverse events related to very high doses. Higher doses of any tetracycline compared with lower doses may lead to more cures but will probably also lead to more adverse events. Tetracyclines compared with quinolones may lead to fewer cures but also slightly fewer adverse events. Erythromycin compared with quinolones may lead to fewer cures and more adverse events.
There is no evidence relating to patient values and preferences but the Guideline Development Group the values people place on the outcomes. Research related to other conditions indicates that adherence may be improved with simpler medication regimens.
The GDG therefore agreed that azithromycin may be more acceptable to patients since it is a single dose regimen (a majority of the GDG members considered single-dose regimens to be preferable for patient little to no evidence for equity issues and feasibility.
Resistance in other infections (e.g. gonorrhoea and chlamydia may restrict the use of some medicines, azithromycin and doxycycline may be large due to greater numbers of people requiring treatment.
In summary, there was moderate quality evidence azithromycin and doxycycline, and although the cost of azithromycin is higher, the single dose may make it more convenient to use than doxycycline. While the the evidence is low quality and these are therefore provided as alternatives, with the exception of delayedrelease doxycycline, which is currently expensive.
See Annex C for list of references of reviewed evidence, and Web annex D for details of the evidence reviewed,

# ANORECTAL CHLAMYDIAL INFECTION

# RECOMMENDATION 2
In people with anorectal chlamydial infection, the orally twice daily for 7 days over azithromycin 1 g orally single dose.

# Conditional recommendation, low quality evidence
Remarks: This recommendation applies to people with known anorectal infection and to people with suspected anorectal infections with genital coinfection. Clinicians should ask men, women and key populations (e.g. men who have sex with men anal sex and treat accordingly. Doxycycline should not be used in pregnant women because of adverse

# Research implications:
The global incidence of chlamydial anorectal infections should be determined.
used for anorectal infections, particularly azithromycin, which is currently not on the WHO essential medicines list for anorectal chlamydial infections (13) should be assessed in both men and women, and in key populations (e.g. MSM, transgender persons and

# SUMMARY OF THE EVIDENCE
There is low quality evidence from eight nonno data for amoxicillin, erythromycin and quinolones.
there are fewer women than men in the studies, the men and women. There is no evidence relating to patient values and preferences, but the GDG agreed that there are no known reasons to suspect values would for acceptability, but research in other conditions indicates that adherence may be improved with simpler medication regimens. There is also little to no evidence for equity issues and feasibility, but azithromycin is more expensive and typically the cost is transferred to consumers. The GDG agreed that equity may vary between the medicines depending on the population: in some populations, azithromycin may be more acceptable since it is a single-dose treatment, and some people may experience stigma related to visibility of a multi-dose regimen with doxycycline. Therefore, suggesting doxycycline over azithromycin could create inequity for people sensitive to stigma related to multi-dose regimens. Azithromycin is currently not listed as an essential medicine for anorectal chlamydial infection.
In summary, doxycycline may result in more cures, but although it is less expensive than azithromycin, azithromycin may be better accepted due to the single-dose treatment.
See Annex C for list of references of reviewed evidence, and Web annex D for details of the evidence reviewed,

# CHLAMYDIAL INFECTION IN PREGNANT WOMEN RECOMMENDATION 3A
In pregnant women with genital chlamydial infection, the WHO STI guideline recommends using azithromycin over erythromycin.

# Strong recommendation, moderate quality evidence

# RECOMMENDATION 3B
In pregnant women with genital chlamydial infection, the WHO STI guideline suggests using azithromycin over amoxicillin.

# Conditional recommendation, low quality evidence

# RECOMMENDATION 3C
In pregnant women with genital chlamydial infection, the WHO STI guideline suggests using amoxicillin over erythromycin.

# Conditional recommendation, low quality evidence
- azithromycin 1 g orally as a single dose - - days.
Remarks: treatment but may not be available in some settings.
Azithromycin is less expensive than erythromycin and since it is provided as a single dose, may result in better adherence and therefore better outcomes.
Research implications: Research in pregnant women comparing these treatments and the recommended dosages should be conducted. Although these medicines are relatively safe in pregnancy, maternal and fetal complications (e.g. adverse pregnancy outcomes, and other infections should be monitored, collected and analysed to inform updated recommendations in the future. When conducting these studies, costs and acceptability of the treatments could be measured.

# SUMMARY OF THE EVIDENCE
Overall, there is moderate to low quality evidence from 14 randomized controlled trials, two non-randomized comparative studies and two large cohort studies and amoxicillin in pregnant women with chlamydial intervals included the possibility of greater or lesser medicines. Moderate quality evidence found that there are probably 94 more people microbiologically evidence found that there may be 72 more people azithromycin compared with erythromycin or amoxicillin Much of the evidence was uncertain for fetal outcomes as it came from indirect comparisons in large cohort studies. There were few events, and included the potential for fewer or more events between comparisons.
In summary, the GDG agreed that azithromycin is preferred over erythromycin because of greater however, it may not be available in all settings due to misconceptions that it is costly. Amoxicillin is preferred over erythromycin as it is less costly and may result in See Annex C for list of references of reviewed evidence, and Web annex D for details of the evidence reviewed,

# SUMMARY OF THE EVIDENCE
There is very low quality evidence from 12 nonrandomized studies with no comparisons between treatments. These studies assessed treatment with azithromycin and doxycycline for 21 days, and erythromycin for 14 days. Evidence for doxycycline uncertain, with only 14 people receiving azithromycin and 31 people receiving erythromycin in the studies. chlamydial infections. There is no evidence relating to patient values and preferences, but the GDG agreed that there are no known reasons to suspect to no evidence for acceptability, but research in other conditions indicates that adherence may be improved with simpler medication regimens. There is little evidence for equity issues and feasibility, but the GDG agreed that these may be dependent on individuals and countries. Data for medicine prices and procurement indicate that doxycycline is cheaper than azithromycin and erythromycin, although the latter medicines are still inexpensive.
In summary, there is very low quality evidence for all medicines for treatment of LGV. The evidence suggests doxycycline is the least expensive.
See Annex C for list of references of reviewed evidence, and Web annex D for details of the evidence reviewed, 4.5 OPHTHALMIA NEONATORUM

# RECOMMENDATION 5
In neonates with chlamydial conjunctivitis, the WHO STI guideline recommends using oral azithromycin doses daily for 14 days.

# Strong recommendation, very low quality evidence
Remarks: This is a strong recommendation given the potential for the risk of pyloric stenosis with the use of erythromycin in neonates. In some settings, azithromycin suspension is not available and therefore monitored with the use of either medication.
Research implications: Additional research should be medications such as trimethoprim should also be investigated. Pyloric stenosis should be monitored or research conducted to evaluate this risk with the medicines suggested.

# SUMMARY OF THE EVIDENCE
There is low quality evidence for a cure rate of 98% with small numbers of neonates receiving azithromycin in quality evidence for 7 more instances of pyloric stenosis of erythromycin use in children. There are no data evaluating pyloric stenosis due to use of azithromycin.
trimethoprim. There is no evidence for variation in patient values and preferences, but compliance with treatments ranged from 77% to 89%. The costs for treatments are relatively low and similar, and most treatments are currently being used.
In summary, azithromycin is preferred over erythromycin because of the potential risk of serious adverse events with erythromycin, and there are no data for trimethoprim.
See Annex C for list of references of reviewed evidence, and Web annex D for details of the evidence reviewed, For all neonates, the WHO STI guideline recommends topical ocular prophylaxis for the prevention of gonococcal and chlamydial ophthalmia neonatorum.

# Strong recommendation, low quality evidence

# RECOMMENDATION 7
For ocular prophylaxis, the WHO STI guideline suggests one of the following options for topical application to both eyes immediately after birth:
- tetracycline hydrochloride 1% eye ointment - 
- silver nitrate 1% solution
- chloramphenicol 1% eye ointment.

# Conditional recommendation, low quality evidence
Remarks: prevention of both chlamydial and gonococcal ophthalmia neonatorum. Cost and local resistance to erythromycin, tetracycline and chloramphenicol in gonococcal infection may determine the choice of medication. Caution should be taken to avoid touching eye tissue when applying the topical treatment and to provide a water-based solution of povidone iodine. Alcohol-based povidone iodine solution must not be applied. The topical application should be administered immediately after birth.

# Research implications:
The prevalence of gonococcal ophthalmia should be determined given the high prevalence of maternal gonorrhoea in some settings. The state of resistance to the medications should be explored and it should be established whether these organisms would be killed by ocular prophylaxis despite resistant strains being established in the organisms.
comparisons with chloramphenicol.

# SUMMARY OF THE EVIDENCE
Overall, the quality of evidence is low to very low non-randomized study with two comparison for prophylaxis compared with no prophylaxis, in particular in babies born to women with known infection of tetracycline hydrochloride, erythromycin or povidone iodine may be slightly greater than for silver nitrate.
Few data are available for the incidence of noninfectious conjunctivitis after prophylaxis or no prophylaxis. Low quality evidence shows a slight medications. There is little evidence relating to patient values and preferences, but the GDG agreed that placed on avoiding long-term consequences of both gonococcal and chlamydial conjunctivitis. The GDG also equity and feasibility, as prophylaxis is currently used in many countries. The GDG reported that alcoholbased povidone iodine has erroneously been used as prophylaxis resulting in serious harm to babies. Silver nitrate is the most expensive prophylaxis option.
-utweigh the risk of non-infectious conjunctivitis due to prophyalaxis with any of the topical medications. Some topical medications may provide greater protection (tetracycline hydrochloride, erythromycin See Annex C for list of references of reviewed evidence, and Web annex D for details of the evidence reviewed, WHO regional STI focal points Region

# Lali Khotenashvili
Copenhagen -Denmark guidelines 11 that were selected by the GDG to be reviewed and updated in the new WHO STI guidelines. These are important and common conditions. guidelines that were selected by the GDG to be reviewed and added in the new WHO STI guidelines. These are important and common conditions. guidelines that were not updated but were selected by the GDG to be included in the new WHO STI guidelines. These STI conditions are rare and diagnosis is not often made in the majority of settings, or it is unlikely that there is new information available as a basis for making any changes to the guidelines that are part of other national guidelines, but were not selected by the GDG to be included in the new WHO STI guidelines. These conditions of settings, or it is unlikely that new research or recommendations for these conditions that can be applied in other settings (e.g. reference hospitals decided on the initial list of population, intervention, by WHO. After the meeting, surveys pertaining to each of the four STI topic areas (i.e. gonorrhoea, chlamydia, administered among subgroups of the GDG members with expertise relating to the relevant STIs. The goal of the surveys was to rank the population, interventions importance. The surveys required the members of the STI subgroups to rank the population, interventions and outcomes on a scale of 1 to 9, from lowest to highest priority.
from the STI subgroup members. The survey results for priority populations, interventions and outcomes were analysed. Populations, interventions and outcomes with 3 were considered "not important" and were thus not covered in the guidelines. Some questions that scored less than 7 were kept for consistency.
The number of comparisons in each question was also with each other and with important interventions. Thus, "important" interventions were not compared to each other.
A revised list of questions was then compiled and all members of the full STI GDG were requested to review the priority questions. The priority questions were then revised based on this feedback. chlamydial infections guideline. Each question is framed using the PICO format (population, intervention, to a recommendation.

# REVIEWS OF THE EVIDENCE

# SEARCH FOR EVIDENCE FOR EFFECTS OF INTERVENTIONS
To avoid duplication of reviews that have been previously published, evidence was searched using synthesized evidence then searched the primary studies for all the factors needed to complete the evidence-to-decision framework for each question
The hierarchical approach consisted of identifying pre-existing synthesized evidence, including from previously published guidelines that included systematic reviews of the literature. When synthesized evidence available or the synthesized evidence was not up to date, a new systematic review of randomized controlled trials
The search strategies were developed by an information specialist trained in systematic reviews. The strategies included the use of keywords from the controlled vocabulary of the database and text words based on the PICO questions. There were no restrictions based on language, publication status or study design. RCTs were included for critical and important outcomes, and non-randomized studies for critical outcomes when no evidence was available from RCTs. Additional strategies included contacting Cochrane review groups and authors of study protocols. For dichotomous outcomes, we calculated relative risks randomized studies with one group were included, a were calculated across the studies using the generic inverse variance. For continuous outcomes, a mean was calculated. When possible, the forest plots of the meta-analyses were made available to the GDG.
When data could not be pooled across studies, narrative synthesis methods were used (see .

# PATIENT VALUES AND PREFERENCES, ACCEPTABILITY, EQUITY AND FEASIBILITY
Studies on patient values and preferences, acceptability, equity and feasibility were searched for and screened using two methods. First, while screening studies for Secondly, a separate search was conducted in MEDLINE, used in combination with words such as "preference", "adherence", "satisfaction", "attitudes", "health utilities" and "value", "equity" and "feasibility". The results
for full text retrieval. Any study design was included that addressed equity or feasibility. In addition, when adherence was measured in RCTs or nonrandomized studies, the data were collected, for each PICO question.
The following study designs were included: Patients are asked about how desirable or aversive a particular outcome is for them. This category includes some studies that use questionnaires or scales.
views, attitudes, satisfactions or preferences related research methods including focus group discussions, interviews, etc.
From the search, we included 17 studies reporting data for all infections informed the evidence for
We searched the published literature for evidence on use of resources and obtained data on direct costs of medicines.
the GDG, an estimate of the cost associated with each alternative was calculated. This costing estimate refers only to the actual market price of the medication and does not include the costs of other resources that could be involved, such as syringes, injection time or needle disposal.
Data were presented in a table and included: treatment, dose per day, treatment duration, days, medicine cost per dose, medicine cost per full course of treatment,
price for a full course of treatment for each medicine by dosage was calculated as the number of doses per day, multiplied by the number of days of the treatment, plus 25% of the procurement costs for the medicines used. The unit price of the medicine was obtained from the drug price indicator guide and information available on the Internet. In order to determine a precise and reliable estimate, the price per unit (all expressed in available matched the dosage of interest (grams per based on assumptions about the cost per unit of hypothetical packaging not listed in the directory.
The major medical databases were also searched (MEDLINE, Embase and the Cochrane Library for Economic Evaluation and Technology Assessment strategies for chlamydia. In addition, while screening and abstracted data regarding possible resources to be considered during the decision-making process.

# APPLYING THE GRADE APPROACH TO MAKING THE RECOMMENDATIONS EVIDENCE PROFILES
quality of evidence according to the GRADE domains 14 approach assesses the quality of evidence for treatment interventions using well-established criteria for the design, risk of bias, inconsistency, indirectness, the evidence. Two investigators used the GRADE approach to assess the quality and level of each recommendation are available in Web annex D.
Evidence-to-decision frameworks were also developed Evidence-to-decision frameworks present the desirable of the outcomes, the costs and resource use, the acceptability of the interventions to all stakeholders, the impact on health equity, and the feasibility of implementation (i.e. the GRADE criteria for making are based on a population perspective for these recommendations. All GRADE criteria were considered from this perspective.

# MAKING THE RECOMMENDATIONS
recommendations. This meeting was facilitated by two co-chairs -one with expertise in GRADE and the other with clinical expertise of chlamydia. During the frameworks were presented by the methodologists.
The GDG discussed each GRADE criterion and judged and guideline recommendation was developed.
The goal was to arrive at agreement across all members of the GDG and this was facilitated by the chairpersons through discussion. When there was disagreement for a criterion, it was noted in the evidence-to-decision framework for the relevant judgement. If there was the plan was for the GDG to vote and the numbers to be recorded. Because there was no disagreement were not taken or reported in these guidelines.
The GDG made a strong or conditional recommendation for or against each intervention and described special circumstances in the remarks. Research implications were also developed and presented, based on the gaps electronically. All decisions and discussions from the GDG for each recommendation are available in the evidence-to-decision frameworks in Web annex D.
Additional references 1. Amin A, Garcia Moreno C. Addressing gender-based violence to reduce risk of STI and HIV. Sex Transm Infect.
regional, and national incidence, prevalence, and years lived

# RECOMMENDATION 4
Treatments for adults and adolescents with lymphogranuloma venereum