Combating STDs: What Convenient Care Clinicians Should Know

Jeannette Y. Wick, RPh, MBA, FASCP
Published Online: Wednesday, August 17th, 2016
As a preventive measure against sexually transmitted infections (STIs), Rio 2016 Olympics organizers have given athletes 450,000 condoms, or an average of 42 per competitor.
 
One newly-identified STI at the forefront of our national consciousness is the Zika virus. Infected—and even symptomless—individuals can pass Zika through sex. It appears that carriers (meaning infected individuals who never develop symptoms) can also transmit the Zika virus sexually.
 
The CDC has been the point agency to monitor STIs for decades. Its representatives lament the fact that although we have better treatments and more open communication about STIs, our jobs are never done. Public health administrators indicate that STIs continue to occur in epidemic numbers, have long-term consequences, and cost the nation enormous amounts of money.
 
The 3 most common STIs in the United States are chlamydia, gonorrhea, and syphilis. More individuals contract chlamydia than any other reportable condition ever reported to CDC. Its burden is substantial, but cases of gonorrhea and syphilis have also been on the rise after years of decline.
 
Youth and women are hit hardest by these 3 STIs, but there’s been an increase overall recently. Young women are of particular concern when they contract STIs because they often miss vague symptoms, or they may lack symptoms, and undiagnosed STIs cause more than 20,000 cases of female infertility annually. For this reason, the CDC recommends testing every woman younger than 25 and older women with risk factors (unprotected sex, multiple partners) annually.
 
Symptoms and First-Line Treatment for Chlamydia, Gonorrhea, and Syphilis
Disease Symptoms Treatment
Chlamydia Women:
·      Abnormal vaginal discharge
·      Burning sensation when urinating
 
Men:
·      Penile discharge
·      Burning sensation when urinating 
·      Pain and swelling in one or both testicles (although this is less common).
Macrolide antibiotics (azithromycin, erythromycin) or doxyclyline
Gonorrhea Women:
·      Increased vaginal discharge
·      Painful urination
·      Vaginal bleeding between periods, such as after vaginal intercourse
·      Abdominal pain
·      Pelvic pain
 
Men:
·      Painful urination
·      Pus-like discharge from the tip of the penis
·      Pain or swelling in one testicle
Ceftriaxome (preferred) or azithromycin
Syphilis Develops in stages, and symptoms vary. Stages may overlap, and symptoms don't always occur in the same order.
 
The hallmark symptom is the chancre that appears at the bacterial entry point approximately 3 weeks after exposure. It may be unobservable to the patient if it occurs in the vagina or rectum.
Benzathine penicillin G, doxycycline, or tetracycline
 
This table reminds providers about the basics of STIs, but clinicians see many others and ponder endless treatment complications. Many patients have allergies and will need a second-line antibiotic. Others may be pregnant or have organ failure.
 
Reporting Requirements
Many STDs—including AIDS, chlamydia, chancroid, congenital syphilis, gonorrhea, and HIV—are reportable diseases in every state, though each state also tracks other STIs of concern in their geographic locales, and convenient care clinicians should be familiar with the reporting requirements applicable within their jurisdictions. The best place to unearth those rules is through your local health department. Its employees will educate you quickly on local and state laws.
 
Another area of particular concern is children and adolescents. Kids 15 to 24 years account for half of STI diagnoses annually. Their sexual inexperience is one factor for the high rate of infection. The CDC has guidelines specific to this group, and its critical to know your state’s reporting requirements for minors. State law governs whether you should—or more likely, shouldn’t—involve their parents. Another complicating factor is the possibility of sexual abuse, which is reportable in all states.
 
The CDC is asking clinicians to redefine their mission, refocus their efforts, modify how they deliver services, and acknowledge that they have responsibilities for identifying STIs. That means you need to be on the lookout because it will take a village—possibly an Olympic Village—to address this ongoing problem.


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