Sexually transmitted infections (STIs) are the stuff of myths, misinformation, and misperceptions—and doctors are in a good position to help their patients separate fact from fiction. It’s a good thing, then, that the CDC just published updated guidelines covering STIs in its Morbidity and Mortality Weekly Report (MMWR). The wide-ranging guidelines are intended to support the medical community in the prevention and management of STIs.
“Physicians and other healthcare providers have a crucial role in preventing and treating STIs,” the authors wrote. “These guidelines are intended to assist with that effort. Although the guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed.”
Here’s a look at some highlights from the CDC guidance.
This term refers to clinical evaluation, counseling, diagnostic testing, and treatment to boost the number of treated persons with STIs and mitigate infection in sexual networks. Such efforts involve health departments, medical providers, and patients.
The authors noted that diagnosing clinicians should take note of public health practices in their area and discuss the treatment of partners with STIs with the patient. “State laws require a good faith effort by the provider to inform partners, and providers should familiarize themselves with public health laws,” the CDC wrote.
Where the practice isn’t prohibited by state law, the CDC recommends that physicians provide written information and medications for a patient’s sexual partners. Both would be passed from the patient to the patient’s partners. The physician can also evaluate and treat the sexual partners, as well as work with state and local health departments. These efforts can decrease the spread of STIs and risk of reinfection.
One form of partner services is expedited partner therapy (EPT). EPT is a harm-reduction strategy. Using this strategy, physicians could provide the sexual partners of persons with undiagnosed chlamydia or gonorrhea, who are unlikely or unable to obtain timely treatment, with medications or therapies via their partner. In these cases, the partner is undiagnosed by the clinician. The CDC recommends that physicians use EPT unless it’s prohibited by state law.
Rectal and pharyngeal testing
The authors stressed the importance of rectal and pharyngeal testing for gonorrhea and chlamydia using a nucleic acid amplification test (NAAT).
Importantly, pharyngeal infections with gonorrhea or chlamydia could serve as a nidus for urethral infections. According to the CDC, urogenital-only testing could miss nearly 70% of gonococcal and chlamydial infections, since the majority of pharyngeal and rectal infections are asymptomatic. If necessary, patients can self-collect swabs for pharyngeal and rectal specimens, improving patient comfort and decreasing clinical workloads.
Of note, rectal gonorrhea and chlamydia are related to HIV infection; men with repeat rectal infections are at higher risk for HIV infection.
The CDC recommended that healthcare providers “assess eligibility of all persons seeking STI services for HIV PrEP [pre-exposure prophylaxis] and PEP [post-exposure prophylaxis]. For persons with substantial risk whose results are HIV negative, providers should offer or provide referral for PrEP services, unless the last potential HIV exposure occurred <72 hours, in which case PEP might be indicated.”
Of note, sexually active persons seeking HIV PEP should be assessed for PrEP after completing PEP and testing negative for HIV. For more from the CDC on PEP, click here.
The CDC stressed that transgender persons experience higher rates of stigma and socioeconomic/structural barriers that limit healthcare usage and increase odds of HIV and STIs. The CDC recommends that clinicians express sensitivity and compassion for transgender individuals.
“Providers should create welcoming environments that facilitate disclosure of gender identity and sexual orientation. Clinics should document gender identity and sex assigned at birth for all patients to improve sexual health care for transgender and gender nonbinary persons,” they wrote.
The points touched on in this article are just a portion of the updated guidance provided by the CDC. Anyone interested in learning more can peruse the full document here.