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Sexually Transmitted Diseases (STD) Services

image of a doctor speaking to a female patientSTD services for persons with HIV can identify sexual risk behaviors and can prevent, detect, and treat specific STDs that may increase HIV transmission. Routine evaluation for STD is beneficial because 1) many STDs are objective markers of unprotected sexual activity, which may result in HIV or STD transmission, and 2) certain STDs can increase HIV viral load and genital HIV shedding that may increase risk of sexual and perinatal transmission.54 Studies demonstrate that at least five STDs can increase the risk of transmitting HIV: syphilis, gonorrhea, chlamydia, and herpes simplex virus type 2 (HSV-2) in men and women, and trichomoniasis in women.54

Nearly all of the forthcoming recommendations about STD services for persons with HIV are consistent with these recommendations from existing federal government guidance for clinicians:

Clinicians serving persons with HIV 54,55

  • Assess persons with HIV for sexual behaviors that lead to HIV and STD transmission. For patients with an STD or high-risk behaviors, provide or make referrals for behavioral risk-reduction interventions.
  • Educate persons with HIV about methods to reduce risk of HIV and STD transmission.
  • Inform persons with HIV (and their partners, if seen) that the presence of STD may increase HIV transmission and of the importance of periodic STD screening.
  • Provide the following services at the initiation of HIV medical care:
    • obtain detailed sexual history (e.g., number of sex partners, type of sexual behaviors, anatomic sites of exposure, condom use), previous STD diagnoses and treatments, and alcohol and substance use history;
    • review current symptoms and signs of STD, including urethral, vaginal, anal, and oropharyngeal discharge or exudate; dysuria; anogenital and oropharyngeal sores, ulcers, or pain; regional lymphadenopathy; and skin rashes;
    • perform physical examination, including an oral, anogenital, and gynecologic examination for women, and an oral and anogenital examination for men;
    • screen all sexually active patients with HIV for STD, regardless of STD signs and symptoms (see below); and
    • treat all patients with HIV for specific STDs based on clinical diagnosis or diagnostic tests.
  • Provide these services at routine follow-up HIV medical care visits: 54, 55
    • review sexual and alcohol and substance use histories since last visit to determine whether more frequent STD screening or sexual risk-reduction interventions are warranted;
    • review current symptoms and signs of STD since last visit (as above); and
    • screen for STD at least annually or more frequently if indicated by recent infection or risk behaviors (see below).
  • Screen patients with HIV for STD as follows:7, 54, 56
Recommended STD screening for persons with HIV
When to Screen Population Diseases to Screen for
At the initial HIV care visit and at least annually thereafter Males and females
  • urogenital N. gonorrhoeae (using NAAT)8
  • urogenital C. trachomatis (using NAAT)9
  • syphilis serology (using Rapid Plasma Reagin [RPR] or Venereal Disease Research Laboratory [VDRL ] tests)
Males who report receptive anal intercourse (regardless of condom use) with men during the preceding year10
  • rectal N. gonorrhoeae (using NAAT)11
  • rectal C. trachomatis (using NAAT)12
Females
  • vaginal trichomoniasis (using culture or NAAT)
At prenatal visits of pregnant females14 All females attending initial prenatal visit
  • urogenital C. trachomatis (using NAAT)15
  • syphilis serology (using RPR or VDRL)
  • urogenital N. gonorrhoeae (using NAAT) if at high risk for gonorrhea16
All females attending later prenatal visits who have ongoing risk of STD infection
  • syphilis serology (using RPR or VDRL)

7The 2010 CDC STD Treatment Guidelines strongly recommend these STD tests. They also indicate that type-specific testing for HSV-2 infection can be considered if herpes infection status is unknown.
8Men and women who are diagnosed with this infection should also be retested 3 months after treatment. Optimal specimen types for nucleic acid amplification tests are first-catch urine from men and vaginal swabs from women.
9See footnote 8.
10More frequent STD screening (i.e., at 3–6 month intervals) may be indicated for MSM who have multiple or anonymous partners, have sex in conjunction with illicit drug use (particularly methamphetamine use), or whose sex partners participate in these activities.
11Commercially available NAATs are not FDA cleared for these indications, but they can be used by laboratories that have met all regulatory requirements for an off-label procedure.
12See footnote 11.
13See footnote 11.
14The 2010 STD Treatment Guidelines also provide advice on repeat STD testing during pregnancy.
15Vaginal swabs are the optimal specimen types for this test.
16Defined by CDC 2010 STD Treatment Guidelines as a woman living in an area with a high prevalence of N. gonorrhoeae, previous gonorrhea infection, concurrent STD, new or multiple sex partners, inconsistent condom use, commercial sex work, illicit drug use, and/or age <25.

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