New Guidelines Issued on Sexually Transmitted Infections

Tinker Ready

June 13, 2019

MILAN — Updated guidelines on sexually transmitted infections (STIs) address a number of dermatologic manifestations that are not always included in recommendations from other specialty groups, delegates heard here at the World Congress of Dermatology 2019.

Diagnosing and treating genital lumps and lacerations are necessary, said Marco Cusini, MD, from the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, who was onsite representing the International Union Against Sexually Transmitted Diseases (IUSTI), which recently issued the guidance (J Eur Acad Dermatol Venereol. Published online April 10, 2019).

Although dermatologists play a crucial role in the prevention, diagnosis, and treatment of a range of sexually transmitted infections (STIs), there has been a decline in dermatologists specializing in STIs, Cusini pointed out, adding that dermatologists can face turf battles with specialists from immunology, urology, gynecology, and infectious diseases.

"The future is to find a way to work together, not fight one another," Cusini said.

Physicians who do treat STIs need to consider the patient's social issues and the public health policies specific to countries or centers, he added.

In Italy and in many other countries, you cannot treat any patient younger than 18 years without the written permission of both parents, said Cusini.

"It makes a lot of difference," he explained. "Young adults and adolescents are one of the major risk groups for STIs. This can be an obstacle to treatment."

High-Risk Populations

An important aspect of the updated IUSTI guidelines is that they urge doctors to be mindful of several high-risk populations, Cusini told Medscape Medical News. Sex workers, gay men, and transgender people are all at risk for STIs. The update expands information on how to treat transgender patients.

"Some people are difficult to reach, and they are the core of the epidemic," he explained.

The guidelines suggest that when clinicians treat transgender patients, they consider that the patient might have had a combination of sexual partners who are cis‐ or transmen or women, that transmen who have not undergone gender reassignment surgery could be at risk for unintended pregnancy, and that transpeople need preventive health screenings in accordance with their body parts.

We must remember that we have a patient in front of us, not a disease.

When STIs are being treated by both general practitioners and specialists, guidelines are important, said Valeria Gaspari, MD, from St. Orsola Malpighi University Hospital in Bologna, Italy, who cochaired the guidelines session.

"A guideline has the main aim of guiding the clinician to a solution," she said.

However, it is important to see patients as individuals. "We must remember that we have a patient in front of us, not a disease," she added.

Clinicians need to go beyond guidelines, said Elise Bassi, MD, a dermatologist from Milan who attended the session.

She said she does not see many STI patients, so she uses the Italian and European guidelines. They give her clear information on how to treat patients.

"I use the guidelines to choose the treatment," Bassi explained. "The other parts of the visit are personal."

Cusini, Gaspari, and Bassi have disclosed no relevant financial relationships.

World Congress of Dermatology (WCD) 2019. Presented June 11, 2019.

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