CDC STI guidelines update some ‘old questions’

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The recently released and long-awaited sexually transmitted infection (STI) screening guidelines from the Centers for Disease Control and Prevention (CDC) introduce new ways to approach some common questions you are probably used to asking your patients. patients.

Michael S. Policar, MD, MPH, Professor Emeritus, Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, addressed attendees of the North American Menopause Society meeting (NAMS) which is being held this week. in Washington, DC, and said that some of the old questions about sexual partners, such as “do you have sex with men, women, or both,” have been replaced with “do you currently have sex?” sex of any kind, oral, vaginal or anal with someone?1 Also, asking patients if they have sex with another person, and if so, what types of sexual contact do they have and how they met their partners are important questions to discuss.

Policar also touched on the importance of discussing the “5 Ps of Sexual History,” including partners, protection, history of STIs and intention to get pregnant, but added what he said. called a 6th P – “the pleasure you want to ask, are you satisfied with your sexual relationship with your partner.” This is a particularly important question for middle-aged patients, as studies have shown that up to 43% of women report sexual problems during this time of their life.

Discussing sexual history is essential during an exam, Policar said, especially since CDC data showed continued spikes in STIs year after year until 2020, when rates fell, he said. he says, but that was likely due to the fewer people tested during the pandemic and less access to testing for these infections.

Before 2020, however, CDC data showed an almost 30% increase in chlamydia, gonorrhea, and syphilis between 2015 and 2019. In the CDC’s latest update, health officials gave the priority to prevention and control, noting the importance of risk assessment and education; pre-exposure vaccination for vaccine-preventable STIs, such as human papillomavirus; screening of people with an STI; and effective diagnosis and treatment.

Policar said that when screening patients for gonorrhea and chlamydia, focus on patients with previous or concurrent STIs; patients with new or multiple sexual partners, a sexual partner with an STI; patients who demonstrate irregular condom use; people who are not in monogamous relationships; and patients who report having exchanged sex for money, housing or other needs.

He noted that treatment recommendations have also been updated in the new guidelines, with the treatment of chlamydia increasing from a single dose of doxycycline to 100 mg orally twice daily for 7 days.

A new alternative treatment for gonorrhea with cefixime 800 mg Po x 1 has also been proposed in the guidelines for people with uncomplicated infections of the cervix or rectum, if ceftriaxone is not available.

Policar ended their discussion by reviewing the ‘checklist’ for the management of chlamydia and gonorrhea, including ensuring prompt and appropriate treatment within 14 days of specimen collection, screening for other STIs , patient education and counseling, reporting the case to the local health department, scheduling a follow-up test in 3 months, and finally, making sure all sexual partners are treated.

Reference

1. Policar MS. Sexually Transmitted Infections in Mature Women: What Clinicians Need to Know. Presented at the North American Menopause Society Annual Meeting. September 24, 2021.

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