Clinical guidelines on sexually transmitted infections (STIs) were released in 2019 by the International Union Against Sexually Transmitted Diseases (IUSTI).
A facility that manages patients presenting with STI should be staffed by administrative, nursing, medical, and laboratory personnel.
A research team, health advisors/contract tracers, counsellors, and psychologists may also benefit such a clinic.
Staff safety should be considered in all settings.
Confidentiality and Other Ethical Considerations
The nature of STI screening and treatment demands strict confidentiality. The patient should be informed of how information will be managed and shared and under what circumstances confidentiality may be breached.
Measures should be taken to safeguard patients from harm and abuse. Potential harms should be assessed, and steps should be taken to reduce them.
The patient’s dignity should be maintained, and they should be allowed to undress and dress in privacy and expose only areas that need to be examined.
Patients should be offered a chaperone for all intimate examinations.
The sociocultural and religious values of the patient should be taken into account when sexual health services are delivered.
The history taking should be approached systematically, with sensitive questions saved for later in the interview.
Language used by the healthcare provider should be modified, as necessary, to ensure it is comprehensible to the patient.
In some cases, self-completed questionnaires and computer-assisted structured interviews (CASI) via online consultation/"no-talk" services may elicit a more reliable history than face-to-face interviews.
All patients should be asked about the following:
Sexual difficulties or dissatisfaction with sexual life
Female patients should also be asked about the following:
Lower genital tract symptoms, including details about vaginal discharge and vulval symptoms
Upper genital tract symptoms, including pelvic pain, deep dyspareunia, and menstrual cycle abnormalities
Male patients should also be asked about genital lumps, genital ulceration, urethral discharge, testicular symptoms, lower urinary tract symptoms, and genital itching, soreness, or rash.
Following symptomatic history, patients should be asked about general health, sexual history, and social history.
The sexual history should elicit the following:
Date of last sexual contact
Sexual partner's gender
Anatomical sites of exposure
Condom use, including condom accidents
Partner's suspected infections or symptoms, if any
Sexual contacts within the preceding 3 months
Any history of "swinging"
History of alcohol and recreational drug use (may be relevant in terms of risk-taking behaviors)
History of "chemsex"
Considerations for Transgender and Gender-Diverse Populations
Appropriate terminology and pronouns should be used by the healthcare provide when interviewing transgender and gender-diverse patients in an effort to create a welcoming, inclusive, and affirming clinical environment. Such personnel should also be knowledgeable about transgender health.
Transgender people may have any combination of sexual partners who are cisgender or transmen or transwomen.
Transmen who have not undergone gender reassignment surgery (GRS) and who have sex with men may be at risk of pregnancy.
Preventive health screenings for transpeople should involve the body parts of the individual patient, regardless of the patient's gender identity, and may include breast, cervical, and prostate cancer screening, as necessary.
Examination is rarely necessary in asymptomatic patients.
Physical examination in patients with suggestive symptoms should include the following:
Speculum examination in females
Bimanual pelvic examination in females who report symptoms of the upper genital tract
Proctoscopy in all patients reporting rectal symptoms
Digital rectal examination when prostatic or rectal pathology is suspected
Other examinations depending on history
Examination of sexual assault victims should occur after considering any requirement for forensic examination within an appropriate time frame for evidence recovery.
All patients should be offered testing for Chlamydia trachomatis (NAAT), Neisseria gonorrhoeae (NAAT), syphilis, and HIV. Testing for other infections should be based on history findings, examination findings, and local availability of tests.
A pregnancy test should be administered to at-risk patients, particularly those in whom ectopic pregnancy is among the differential diagnoses.
Additional tests among men who have sex with men (MSM) may include rectal and pharyngeal NAAT testing, proctoscopy, and lymphogranuloma venereum (LGV) testing.
Testing Results Delivery and Treatment
Patients should be told when and how they will receive their results, when applicable.
Diagnoses should be adequately explained and an opportunity offered for questions by the patient.
Prompt availability of relevant treatment should be ensured.
When possible, single-dose treatment administered in the clinic is preferred for compliance.
Women who are pregnant or breastfeeding or in whom pregnancy cannot be excluded should receive appropriate treatment.
Patients should be provided information about preventing onward transmission or reinfection.
Motivational interviewing is more effective than giving advice.
Partner Notification/Contact Tracing
Partner notification (PN) should be done by an appropriately trained healthcare professional and be based on relevant guidelines for specific infections.
The sexual partner(s) should be notified of infection by the patient or by a provider referral.
Follow-up should always be considered and can take place face-to-face or through methods such as telephone, text, or email.
In-person follow-up should be arranged for patients with certain infections if test of cure is recommended (eg, gonorrhea, various STIs in pregnancy).
Follow-up for repeat screening may be necessary.
For more information, please go to Chlamydia (Chlamydial Genitourinary Infections).
For more Clinical Practice Guidelines, please go to Guidelines.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Sexually Transmitted Infection Clinical Practice Guidelines (2019) - Medscape - Aug 05, 2019.