Trending Clinical Topic: STI Guidelines

Ryan Syrek


September 24, 2021

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Interest in guidelines that were released over the summer and recently reaffirmed screening practices resulted in this week's top trending clinical topic. For the first time since 2015, the Centers for Disease Control and Prevention (CDC) has updated its guidance for the screening, testing, and treatment of sexually transmitted infections (STIs). The comprehensive recommendations contain a multitude of changes (see Infographic below). In addition to updated treatment approaches, the guidelines contain information on rectal and oral tests used to diagnose chlamydia and gonorrhea, two-step testing for diagnosing genital herpes simplex virus, and expanded risk factors for syphilis testing in pregnancy.

The guidelines come at a critical time. According to the World Health Organization , more than 1 million STIs are acquired every day worldwide. In the United States, annual cases have risen 6 years in a row. A CDC report released in April showed 129,813 cases of syphilis in 2019, up 74% since 2015. Almost 2000 cases of congenital syphilis were reported, up 279% since 2015, and 128 infants died. The report also noted 1.8 million cases of chlamydia in 2019, a jump of 19% in 4 years, and a 56% increase in gonorrhea in that time period, to a total of 616,392 cases. Experts hope that the new guidelines will help reduce the impact and stem the tide of the STI wave.

In regard to screening recommendations, the US Preventive Services Task Force (USPSTF) recently announced that it is standing by recommendations that sexually active girls and women be screened for chlamydia and gonorrhea. The recommendations were published on September 14 in JAMA and are identical to the panel's 2014 recommendations. Screening for chlamydia and gonorrhea is suggested for all sexually active females aged 24 years or younger and for sexually active women aged 25 or older if they have certain risk factors (eg, new or multiple sex partners). However, the USPSTF did not provide any guidance for men, despite an outbreak of STIs among MSM. "For men in general, there's not enough evidence to determine whether screening will reduce the risk of complications or spreading infections to others," Marti Kubik, PhD, RN, a professor at the George Mason University School of Nursing and a member of the task force, told Medscape.

Similarly, a lack of guidance for STI screening among heterosexual men was a concern for some after the recent CDC guidelines were released. "It's a pretty obvious discrepancy," said Jodie Dionne-Odom, MD, who studies infectious disease in women at the University of Alabama at Birmingham Hospital. Dionne-Odom points to cost-benefit concerns as part of the reasoning. "With limited healthcare dollars, you focus your resources on where the biggest bang for the buck is," Dionne-Odom said. STIs in men are often benign, rarely leading to serious consequences, unlike STIs in women. "Data are insufficient to draw definitive conclusions about the effectiveness of screening heterosexual men at low risk for gonorrhea and chlamydia," Laura Bachmann, MD, chief medical officer for the CDC's Division of STD Prevention, wrote in an email.

Whether or not men, specifically heterosexual men, will be included in further guidelines is unclear. What is clear is that interest in recently released recommendations suggest an urgency and concern regarding STIs, leading to this week's top trending clinical topic.

Read more on the new STI guidelines.


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