CDC guidelines on STIs update some 'old questions'

The recently-released and long-awaited guidelines on screening for sexually transmitted infections (STIs) from the Centers for Disease Control and Prevention (CDC) introduce some new ways of approaching some common questions you’re probably used to asking your patients.

Michael S. Policar, MD, MPH, who is professor emeritus, obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, School of Medicine, addressed attendees of the North American Menopause Society (NAMS) meeting 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 now been replaced with “are you currently have sex of any kind, oral, vaginal, or anal, with anyone?”¹ Also, asking patients if they are having sex with another person, and if so, what kinds of sexual contact do they have, and how they met their partners are important questions to discuss.

Policar also addressed the importance of discussing the “5 P’s of sexual history,” including partners, protection, past history of STIs, and intention to become pregnant, but he added what he called a 6th P – “pleasure, you want to ask, are you satisfied with your sexual relationship with your partner.” This is a particularly important question for patients at midlife, as studies have shown up to 43% of women report sexual problems during this period of their lives.

Discussing sexual history is key during an examination, Policar said, especially as CDC data have shown continual spikes in STIs year after year up until 2020, when rates went down, he said but that was likely due to less people being screened during the pandemic and less access to testing for those infections.

Prior to 2020, however, CDC data showed a nearly 30% increase in chlamydia, gonorrhea, and syphilis between 2015 and 2019. In the most recent CDC update, health officials prioritized prevention and control, noting the importance of risk assessment and education; pre-exposure vaccination for vaccine-preventable STIs, like human papillomavirus; screening for people with an STI; and effective diagnosis and treatment.

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

He noted that treatment recommendations were updated in the new guidelines as well, with treatment shifting for chlamydia from a single dose of doxycycline to 100 mg orally twice daily for 7 days.

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

Policar completed his discussion by reviewing the “checklist” of chlamydia and gonorrhea management, including, ensuring timely and appropriate treatment within 14 days of specimen collection, testing for other STIs, patient education and counseling, reporting of the case to the local health department, scheduling a follow up test in 3 months, and finally, ensuring that all sex partners are treated.

Reference

1. Policar MS. Sexually transmitted infections in midlife women: what clinicains need to know. Presented at The North American Menopause Society Annual Meeting. September 24, 2021.