COMMENTARY

Protect Patients From a Surge in STDs

Gail Bolan, MD

Disclosures

January 16, 2018

Editorial Collaboration

Medscape &

Hi. I'm Dr Gail Bolan, director of the Division of Sexually Transmitted Disease Prevention at the Centers for Disease Control and Prevention (CDC). I'm reaching out to healthcare providers to make sure you know this critical health news: Sexually transmitted diseases (STDs) are once again tightening their grip on the nation's health. Rates of chlamydia, gonorrhea, and syphilis have all increased for a third year in a row. In 2016, more than two million cases of these three infections were reported in the United States—the highest number ever. Congenital syphilis cases have spiked above 600—a number higher than we've seen since 1998.[1]

Although STDs can affect anyone, some groups are more affected than others. Adolescents aged 15-24 years—who account for some of the highest rates of chlamydia and gonorrhea—are now experiencing an increase in syphilis. Gay, bisexual, and other men who have sex with men (MSM) make up the majority of syphilis cases, and nearly half of these men are living with HIV. Data suggest that rates of gonorrhea have also increased among MSM. And the continued surge in congenital syphilis reminds us that pregnant women face some of the harshest, yet preventable, outcomes from untreated STDs.[1]

Yes, the numbers are staggering, but we can interrupt the steady climb in STD rates. And, unlike for some infectious diseases, we are fortunate enough to know how to detect and treat STDs.

Everyone has a role to play to reverse these trends, but none is more important than that of the frontline clinician. Your daily interaction with patients and on-the-ground understanding of health in your community make you instrumental in treating and preventing these infections.

So how can you help? Take regular sexual histories for every patient. Test, rapidly diagnose, and treat patients and their partners as CDC recommends. CDC's Guide to Taking a Sexual History and the STD Treatment Guidelines can help to ensure the best care for your patients. We've also developed a Syphilis Pocket Guide for Providers that expands on the treatment guidelines to include images of typical and atypical symptoms, as well as information needed to diagnose and stage syphilis. An online clinical consultation tool, available through the National Network of STD Clinical Prevention Training Centers, allows clinicians to submit clinical questions and receive a response within 1-5 days.

CDC also recommends expedited partner therapy (EPT) as another effective prevention strategy for patients diagnosed with chlamydia or gonorrhea. EPT—which is available in most states—is the clinical practice of providing treatment for sex partners of your patient to reduce opportunities for reinfection and to stop further transmission in your community. Here's how it works: Talk to your patient to assess whether their partner has access to timely treatment. If not, and if permissible by state laws or regulations, you can then give medications or a prescription to your patient to take to their sex partner along with health information explaining why and how to take it. This is an important but underutilized STD prevention option.

STDs are too often underestimated, but the health consequences for your patients—when undiagnosed and untreated—can be devastating. Diseases will spread further into communities, with related increases in conditions that can cause infertility, congenital infections in pregnant women, and the likelihood of HIV transmission.

STD prevention is about more than stopping a single disease—it's about safeguarding quality of life. I know it. You know it. Let's help make sure your patients know it, too.

Web Resources

A Guide to Taking a Sexual History
Covers five key areas to openly discuss with patients, including sample dialogue.

Sexual Health and Your Patient: A Provider's Guide
Providers can use this guide to better integrate sexual health conversations and related preventive sexual health services into routine adolescent and adult visits.

STD Treatment Guidelines
Comprehensive, evidence-based diagnostic and treatment information for specific STDs; printable wall charts and pocket guides, as well as a downloadable mobile app.

STD Clinical Consultation Network
The National Network of STD Clinical Prevention Training Centers provides healthcare professionals and STD program staff with online clinical consultation for STD treatment and care.

National STD Curriculum
A modular learning experience that helps users learn how to manage STDs. It is continuously updated and integrates CDC's most recent STD treatment guidelines. Free CME/CNE available.

Syphilis: A Provider's Guide to Treatment and Prevention
This pocket guide is a complement to CDC's STD treatment guidelines and includes images of typical and atypical symptoms, as well as information to help address syphilis diagnostic challenges.

Reducing Syphilis Rates: A Healthcare Provider's Role
This video overviews three key actions providers can take to reduce the rise in syphilis.

Let's Work Together to Stem the Tide of Rising Syphilis in the United States
CDC's Call to Action includes specific steps providers can take to reduce syphilis among gay and bisexual men and pregnant women.

Expedited Partner Therapy (EPT)
From this page, you can find guidance for EPT, as well as research about its use and the legal status where you live.

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