Management guidelines for sexually transmitted diseases are reviewed and updated every four years at a workshop of experts convened by the US Centers for Disease Control and Prevention. They are disseminated in paper and electronic formats, and are widely accessed. Their recommendations are graded according to quality of evidence, benefits versus harms, and applicability. In the UK, guidelines are commissioned by the Clinical Effectiveness Group, following a specific methodology, then modified after consultation within the specialty of genitourinary medicine. Some issues are problematic for both guidelines, notably areas where the evidence is weak, where diagnostics and treatments are changing rapidly, and in knowing the extent to which guidelines actually influence practice.