Health Care Providers
While the idea of Talk. Test. Treat. is simple, STD prevention and treatment are not one-size-fits-all. We encourage you, our nation’s health care providers, to revisit the many ways that you can empower your patients to take charge of their sexual health.
The U.S. was already battling steep, sustained STD rates when facility-based services and in-person patient-clinician contact was limited by the current COVID-19 pandemic. In this context, innovative strategies are critical for STD prevention. By expanding these strategies, not only can we reduce STDs, but we can also address the challenges of health care access that existed before – and have been magnified by COVID-19.
Make sure your patients are aware of the different ways they may be able to access critical STD care. In addition to traditional, in-person visits, other options include:
- Express visits allow STD testing and treatment without a full clinical exam.
- Partnerships with pharmacies & retail health clinics can provide new access points for STD services, such as on-site testing & treatment
- Telehealth/telemedicine can close gaps in STD testing and treatment, ensure access to health care providers, and support self-testing. This is especially critical in rural areas
- At-home specimen collection allows patients to collect their own sample and take or mail it to a lab for testing. There is also an FDA-approved HIV self-test. These options could be useful when in-person services are not available or feasible.
Providing the best medical care possible means talking to your patients about sexual health.
Taking a sexual historypdf iconexternal icon should be a part of routine care.
Talking about sexual health can be challenging, but studies show that patients want to be asked about sex. The following tips can help to ensure the most productive conversations with your patients:
- Help foster trust with your patient before their visit even starts by creating a welcoming and inclusive clinic or office environment. For example, you can use these tips to make your office teen-friendlypdf iconexternal icon.
- Make sure your patients are comfortable and in a private space, especially before asking sensitive questions; this includes assuring patients their confidentiality is being protected by everyone in your office.
- Help normalize sexual health questions and STD/HIV testing recommendations by letting your patients know you ask these questions and offer these services to all patients, as sexual health is a normal part of a person’s overall health and well-being.
- Avoid making assumptions about your patients; asking is the only way to know for sure. Standardize sexual orientation/gender identity (SOGI) questions and use open-ended questions when taking a sexual history.
- If your patient is hesitant to answer a question, try rephrasing it or briefly explain why you are asking it.
- Ensure that you and your patient share an understanding of the terms being used to avoid confusion.
Counsel your patients on safe sex, and ensure that they know about today’s many prevention options. With condoms, hepatitis B and HPV vaccines, and even a daily medication to prevent HIV infection – there have never been more ways for your patients to protect themselves.
Certain STD diagnoses can cause fear and anxiety in your patient.
- Use CDC counseling messages in the 2015 STD Treatment Guidelines to help alleviate these concerns.
Test your patients for STDs as recommended.
STD screening recommendations for different patient populations are available. Below is a brief overview.
- Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women starting early in pregnancy, with repeat testing as needed, will protect the health of mothers and their infants. (NOTE: Detailed screening recommendations for pregnant women also are available here.)
- Annual chlamydia and gonorrhea screening of all sexually-active women younger than 25 years, as well as older women with risk factors, such as new or multiple sex partners, or a sex partner who has an STD.
- Screening at least once a year for syphilis, chlamydia, and gonorrhea for all sexually active gay, bisexual, and other men who have sex with men (MSM).
- MSM who have multiple or anonymous partners should be screened more frequently for STDs (i.e., every three to six months)
- All adults and adolescents from age 13 to age 64 should be tested at least once for HIV
- Sexually-active gay and bisexual men may benefit from more frequent testing (i.e., perhaps every three to six months).
New CDC analysis suggests gay, bisexual, and other men who have sex with men (MSM) are at increased risk for extragenital STDs [i.e., chlamydia or gonorrhea in the throat or rectum] (April 11, 2019)
Keep in mind that screening recommendations are sources of clinical guidance, not prescriptive standards. Always consider a patient’s sexual history and the burden of disease in their community.
Once a patient has been tested, make sure they know how they will get their test results.
Follow CDC’s STD Treatment Guidelines to ensure appropriate treatment and care.
The 2015 STD Treatment Guidelines are the most current recommendations for treating patients who have, or who are at risk for STDs.
- Download the free STD Tx Guide app to your Apple or Android devices to easily access the guidelines any time you need them.
Important treatment topics to be aware of:
Expedited Partner Therapy (EPT) may be an option in cases where a patient’s partner is unwilling or unable to access care.
- Learn about EPT on CDC’s website or contact your state or territorial health department to obtain jurisdiction-specific information.
Reinfection is common for some STDs. Encourage your patients to return for follow-up testing in three months.
Drug-resistant gonorrhea is an immediate public health threat requiring urgent and aggressive action.
Preserve our last treatment option by only treating your patients with the recommended treatment (ceftriaxone 500mg intramuscularly in a single dose).