An STI upsurge requires a nimble approach to care

,; ,; ,

doi:doi: 10.12788/jfp.0641

Applied Evidence

An STI upsurge requires a nimble approach to care

J Fam Pract. 2023 July;72(6):E1-E12 | doi: 10.12788/jfp.0641

PDF Download

References

1. Pagaoa M, Grey J, Torrone E, et al. Trends in nationally notifiable sexually transmitted disease case reports during the US COVID-19 pandemic, January to December 2020. Sex Transm Dis. 2021;48:798-804. doi: 10.1097/OLQ.0000000000001506

2. Chesson HW, Spicknall IH; Bingham A, et al. The estimated direct lifetime medical costs of sexually transmitted infections acquired in the United States in 2018. Sex Transm Dis. 2021;48:215-221. doi: 10.1097/OLQ.0000000000001380

3. Kreisel KM, Spicknall IH, Gargano JW, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2018. Sex Transm Dis. 2021;48:208-214. doi: 10.1097/OLQ.0000000000001355

4. CDC. Sexually transmitted infections treatment guidelines, 2021: Chlamydial infections among adolescents and adults. US Department of Health and Human Services. July 21, 2021. Accessed April 19, 2023. www.cdc.gov/std/treatment-guidelines/chlamydia.htm

5. CDC. Sexually transmitted infections treatment guidelines, 2021: Gonococcal infections among adolescents and adults. US Department of Health and Human Services. September 21, 2022. Accessed April 23, 2023. www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm

6. Van Gerwen OT, Muzny CA. Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection. F1000Res. 2019;8:F1000 Faculty Rev-1666. Published 2019 Sep 20. doi:10.12688/f1000research.19972.1

7. CDC. Sexually transmitted infections treatment guidelines, 2021. Trichomoniasis. US Department of Health and Human Services. September 21, 2022. Accessed April 23, 2023. December 27, 2021. www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

8. Spicknall IH, Flagg EW, Torrone EA. Estimates of the prevalence and incidence of genital herpes, United States, 2018. Sex Transm Dis. 2021;48:260-265. doi: 10.1097/OLQ.0000000000001375

9. Mark H, Gilbert L, Nanda J. Psychosocial well-being and quality of life among women newly diagnosed with genital herpes. J Obstet Gynecol Neonatal Nurs. 2009;38:320-326. doi: 10.1111/j.1552-6909.2009.01026.x

10. Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force. Screening for syphilis infection in nonpregnant adults and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2016;315:2321-2327. doi: 10.1001/jama.2016.5824

11. Ricco J, Westby A. Syphilis: far from ancient history. Am Fam Physician. 2020;102:91-98.

12. Goza M, Kulwicki B, Akers JM, et al. Syphilis screening: a review of the Syphilis Health Check rapid immunochromatographic test. J Pharm Technol. 2017;33:53-59. doi:10.1177/8755122517691308

13. Henao-Martínez AF, Johnson SC. Diagnostic tests for syphilis: new tests and new algorithms. Neurol Clin Pract. 2014;4:114-122. doi: 10.1212/01.CPJ.0000435752.17621.48

14. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70:1-187. doi:10.15585/mmwr.rr7004a1

15. CDC. Sexually Transmitted Disease Surveillance 2021. National overview of STDs. US Department of Health and Human Services. April 2023. Accessed May 9, 2023. www.cdc.gov/std/statistics/2021/overview.htm#Chlamydia

16. CDC. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae—2014. MMWR Recomm Rep. 2014;63:1-19.

17. Kong FYS, Tabrizi SN, Law M, et al. Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials. Clin Infect Dis. 2014;59:193-205. doi: 10.1093/cid/ciu220

18. Páez-Canro C, Alzate JP, González LM, et al. Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women. Cochrane Database Syst Rev. 2019;1:CD010871. doi: 10.1002/14651858.CD010871.pub2

19. Dombrowski JC, Wierzbicki MR, Newman LM, et al. Doxycycline versus azithromycin for the treatment of rectal chlamydia in men who have sex with men: a randomized controlled trial. Clin Infect Dis. 2021;73:824-831. doi: 10.1093/cid/ciab153

20. CDC. Sexually transmitted infections treatment guidelines, 2021: Expedited partner therapy. US Department of Health and Human Services. July 22, 2021. Accessed April 19, 2023. www.cdc.gov/std/treatment-guidelines/clinical-EPT.htm

21. Golden MR, Whittington WLH, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352:676-685. doi: 10.1056/NEJMoa041681

22. Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. 2003;30:49-56. doi: 10.1097/00007435-200301000-00011

23. Cameron ST, Glasier A, Scott G, et al. Novel interventions to reduce re-infection in women with chlamydia: a randomized controlled trial. Hum Reprod. 2009;24:888-895. doi: 10.1093/humrep/den475

24. McNulty A, Teh MF, Freedman E. Patient delivered partner therapy for chlamydial infection—what would be missed? Sex Transm Dis. 2008;35:834-836. doi: 10.1097/OLQ.0b013e3181761993

25. Stekler J, Bachmann L, Brotman RM, et al. Concurrent sexually transmitted infections (STIs) in sex partners of patients with selected STIs: implications for patient-delivered partner therapy. Clin Infect Dis. 2005;40:787-793. doi: 10.1086/428043

26. Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. 2003;30:49-56. doi: 10.1097/00007435-200301000-00011

27. Stupiansky NW, Van der Pol B, Williams JA, et al. The natural history of incident gonococcal infection in adolescent women. Sex Transm Dis. 2011;38:750-754. doi: 10.1097/OLQ.0b013e31820ff9a4

28. CDC. Sexually transmitted infections treatment guidelines, 2021: Screening recommendations and considerations referenced in treatment guidelines and original sources. US Department of Health and Human Services. June 6, 2022. Accessed May 9, 2023. www.cdc.gov/std/treatment-guidelines/screening-recommen dations.htm

29. Cantor A, Dana T, Griffen JC, et al. Screening for chlamydial and gonococcal infections: a systematic review update for the US Preventive Services Task Force. Evidence Synthesis No. 206. AHRQ Report No. 21-05275-EF-1. Agency for Healthcare Research and Quality. September 2021. www.ncbi.nlm.nih.gov/books/NBK574045

30. CDC. Update to CDC’s sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007;56:332-336.

31. Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019:97:548-562P. doi: 10.2471/BLT.18.228486

32. Patel EU, Gaydos CA, Packman ZR, et al. Prevalence and correlates of Trichomonas vaginalis infection among men and women in the United States. Clin Infect Dis. 2018;67:211-217. doi: 10.1093/cid/ciy079

33. CDC. Sexually transmitted infections treatment guidelines, 2021. Mycoplasma genitalium. US Department of Health and Human Services. July 22, 2021. Accessed April 23, 2023. www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm

34. Manhart LE, Broad JM, Bolden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis. 2011;53(suppl 3):S129-S142. doi:10.1093/cid/cir702.

35. Corey L, Wald A. Genital herpes. In: Holmes KK, Sparling PF, Stamm WE, et al, eds. Sexually Transmitted Diseases. 4th ed. McGraw-Hill; 2008:399-437.

36. CDC. Sexually transmitted infections treatment guidelines, 2021: Genital herpes. US Department of Health and Human Services. September 21, 2022. Accessed April 23, 2023. www.cdc.gov/std/treatment-guidelines/herpes.htm

37. Looker KJ, Elmes JAR, Gottlieb SL, et al. Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis. Lancet Infect Dis. 2017;17:1303-1316. doi: 10.1016/S1473-3099(17)30405-X

38. Rollenhagen C, Lathrop M, Macura SL, et al. Herpes simplex virus type-2 stimulates HIV-1 replication in cervical tissues: implications for HIV-1 transmission and efficacy of anti-HIV-1 microbicides. Mucosal Immunol. 2014;7:1165-1174. doi: 10.1038/mi.2014.3

39. Cogliano V, Baan R, Straif K, et al; WHO International Agency for Research on Cancer. Carcinogenicity of human papillomaviruses. Lancet Oncol. 2005;6:204. doi: 10.1016/s1470-2045(05)70086-3

40. Simon MA, Tseng CW, Wong JB. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320:674-686. doi:10.1001/jama.2018.10897

41. Perkins RB, Guido RS, Castle PE, et al; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24:102-131. doi: 10.1097/LGT.0000000000000525

42. Meites E, Szilagyi PG, Chesson HW, et al. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:698-702. doi: 10.15585/mmwr.mm6832a3

43. Schmidt R, Carson PJ, Jansen RJ. Resurgence of syphilis in the United States: an assessment of contributing factors. Infect Dis (Auckl). 2019;12:1178633719883282. doi: 10.1177/1178633719883282

44. Boog GHP, Lopes JVZ, Mahler JV, et al. Diagnostic tools for neurosyphilis: a systematic review. BMC Infect Dis. 2021;21:568. doi: 10.1186/s12879-021-06264-8

45. CDC. Sexually transmitted infections treatment guidelines, 2021. Syphilis. US Department of Health and Human Services. April 20, 2023. Accessed April 24, 2023. www.cdc.gov/std/treatment-guidelines/syphilis.htm

46. Matthias JM, Rahman MM, Newman DR, et al. Effectiveness of prenatal screening and treatment to prevent congenital syphilis, Louisiana and Florida, 2013-2014. Sex Transm Dis. 2017;44:498-502. doi: 10.1097/OLQ.0000000000000638

47. Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA. 2014;312:1905-1917. doi: 10.1001/jama.2014.13259

48. Davidson KW, Barry MJ, Mangione CM, et al; US Preventive Services Task Force. Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement. JAMA. 2021;326:949-956. doi: 10.1001/jama.2021.14081

49. Krist AH, Davidson KW, Mangione CM, et al; US Preventive Services Task Force. Screening for hepatitis B virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2020;324:2415-2422. doi: 10.1001/jama.2020.22980

50. Owens DK, Davidson KW, Krist AH, et al; US Preventive Services Task Force. Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2020;323:970-975. doi: 10.1001/jama.2020.1123

51. Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force. Serologic screening for genital herpes infection: US Preventive Services Task Force recommendation statement. JAMA. 2016;316:2525-2530. doi: 10.1001/jama.2016.16776

52. Curry SJ, Krist AH, Owens DK, et al; US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320:674-686. doi: 10.1001/jama.2018.10897

53. Owens DK, Davidson KW, Krist AH, et al; US Preventive Services Task Force. Screening for HIV infection: US Preventive Services Task Force recommendation statement. JAMA. 2019;321:2326-2336. doi: 10.1001/jama.2019.6587

54. Farley TA, Cohen DA, Elkins W. Asymptomatic sexually transmitted diseases: the case for screening. Prev Med. 2003;36:502-509. doi: 10.1016/s0091-7435(02)00058-0

55. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update. A clinical practice guideline. Centers for Disease Control and Prevention. Accessed April 24, 2023. www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

56. CDC. Sexually transmitted infections treatment guidelines, 2021: Sexual assault and abuse and STIs—adolescents and adults, 2021. US Department of Health and Human Services. July 22, 2021. Accessed April 24, 2023. www.cdc.gov/std/treatment-guidelines/sexual-assault-adults.htm

Human papillomavirus

Condylomata acuminata (genital warts) are caused by human papillomavirus (HPV), most commonly types 6 and 11, which manifest as soft papules or plaques on the external genitalia, perineum, perianal skin, and groin. The warts are usually asymptomatic but can be painful or pruritic, depending on size and location.

Diagnosis is made by visual inspection and can be confirmed by biopsy if lesions are atypical. Lesions can resolve spontaneously, remain unchanged, or grow in size or number.

Treatment. The aim of treatment is relief of symptoms and removal of warts. Treatment does not eradicate HPV infection. Multiple treatments are available that can be applied by the patient as a cream, gel, or ointment or administered by the provider, including cryotherapy, surgical removal, and solutions. The decision on how to treat should be based on the number, size, and location of lesions; patient preference; cost; convenience; and the modality’s adverse effects (TABLE 2¹⁴).

HPV-associated cancers and precancers. This is a broad (and separate) topic. HPV types 16 and 18 cause most cases of cervical, penile, vulvar, vaginal, anal, and oropharyngeal cancer and precancer.³⁹ The USPSTF, the American Cancer Society, and the American College of Obstetricians and Gynecologists all have recommendations for cervical cancer screening in the United States.⁴⁰ Refer to guidelines of the ASCCP for recommendations on abnormal screening tests.⁴¹

Prevention of genital warts. The 9-valent HPV vaccine available in the United States is safe and effective and helps protect against viral types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Types 6 and 11 are the principal causes of genital warts. Types 16 and 18 cause 66% of cervical cancer. The vaccination series can be started at age 9 years and is recommended for everyone through age 26 years. Only 2 doses are needed if the first dose is given prior to age 15 years; given after that age, a 3-dose series is utilized. Refer to CDC vaccine guidelines⁴² for details on the exact timing of vaccination.

Trichomoniasis can manifest as a yellowgreen vaginal discharge with or without vaginal discomfort, dysuria, epididymitis, and prostatitis; most cases, however, are asymptomatic.

Vaccination for women ages 27 to 45 years is not universally recommended because most people have been exposed to HPV by that age. However, the vaccine can still be administered, depending on clinical circumstances and the risk for new infection.⁴²

Syphilis

Caused by the spirochete Treponema pallidum, syphilis manifests across a spectrum—from congenital to tertiary. The inability of medical science to develop a method for culturing the spirochete has confounded diagnosis and treatment.

Continue to: Since reaching a historic...