Kshamica S. Nimalasuriya, MD, MPH


July 20, 2011

In This Article

Sexually Transmitted Infections: A Relatively Hidden Epidemic

Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs), including HIV, remain a leading public health challenge in the United States. Approximately 19 million new STIs occur each year, and most are asymptomatic and cannot be correctly managed without appropriate diagnosis and treatment.[1] Without treatment, STIs can cause serious health concerns ranging from reproductive problems to an increased risk for HIV infection. STIs also incur substantial costs to the healthcare system. The estimated direct medical costs of treating STIs and their sequelae are $16.4 billion each year.[2]

STIs continue to be underreported 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.[3]

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.[4]

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[5]; discomfort and lack of confidence in one's counseling skills[6]; inaccurate perception of STI prevalence in their target patient population[7]; time constraints[8]; and clinicians' personal STI-related attitudes, such as low confidence in the efficacy of STI counseling.[9]


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