Sexually Transmitted Infections: A Relatively Hidden Epidemic

Medscape Education Public Health & Prevention

Kshamica S. Nimalasuriya, MD, MPH

There are approximately 19 million cases of sexually transmitted infections (STIs) in the United States each year, and many of these infections are asymptomatic. Primary care physicians are in a special position to identify and treat STIs, but performing a good sexual history and adequate screening examinations can be difficult. The current review highlights some barriers in identifying STIs and focuses on overcoming these barriers using best practices in sexual health.
STIs continue to be under reported nationwide despite the benefits of accurate and timely reporting.
The current reportable STIs are syphilis, gonorrhea, Chlamydia, chancroid, HIV infection, and AIDS. However, each state has different reporting requirements, so healthcare professionals are encouraged to contact state and local agencies.
Although the prevention and control of this relatively hidden epidemic requires multiple clinical and community health strategies, primary care providers (PCPs) are now primarily responsible for STI-related care. Controlling this epidemic requires high-quality prevention efforts through education, testing, and counseling, but PCPs often fail to address STI prevention.
This article reviews STI screening and counseling barriers typical in primary care practice and recommends strategies for overcoming these barriers to address the burden and improve outcomes related to STIs in the United States.

Barriers to Screening and Counseling

The list of common barriers includes insufficient provider knowledge with respect to STI management and follow-up; discomfort and lack of confidence in one's counseling skills; inaccurate perception of STI prevalence in their target patient populatioⁿ; time constraints; and clinicians' personal STI-related attitudes, such as low confidence in the efficacy of STI counseling.
Exceptionally useful clinical recommendations for STI screening include:

• Screening sexually active, nonpregnant women at increased risk* forchlamydial, gonorrheal, HIV, and syphilis infections;
• Screening all pregnant women for hepatitis B, HIV, and syphilis; additionally, screen all pregnant women at increased risk* for chlamydial and gonorrheal infections;
• Screening sexually active men at increased risk* for HIV and syphilis infection;
• Not routinely screening women and men who are not at increased risk* for STIs.

*Patients should be considered at increased risk if they have a current STI, have had an STI within the past year, have had multiple sexual partners, or are sexually active in nonmonogamous relationships in communities with high rates of STIs.