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STDs

Sexually transmitted diseases (STDs)

Health-care providers should routinely (i.e., at baseline, periodically, and as clinically indicated) obtain sexual histories from their patients and address management of risk reduction. High-intensity behavioral counseling is recommended for all sexually active adolescents and for adults at increased risk for STDs and HIV infection. Questions to identify risk related to illicit use of drugs include questions on whether the patients have ever injected drugs illicitly or have partners who have exchanged sex or money for illicit drugs. Persons seeking treatment or screening for a particular STD should be evaluated for all common bacterial and parasitic STDs (e.g., chlamydia, gonorrhea, syphilis, and trichomoniasis) and informed if testing for any common STD has not been performed. Although no comprehensive national guidelines regarding STD care and management have been developed for correctional populations, the utility of expanded STD services in correctional settings has been reported. Universal screening of some populations (e.g., adolescent females) for chlamydia and gonorrhea is recommended at intake in juvenile detention and jail facilities. Universal screening for syphilis should be conducted based on local and institutional prevalence.

Sources

Annual chlamydia screening for all sexually active women 25 years or younger and screening of older women with risk factors (e.g., those who have a new sex partner or multiple sex partners) are recommended. Chlamydia-infected women and men should be retested approximately 3 months after treatment. Among persons in correctional facilities, universal screening of adolescent females for chlamydia should be conducted at intake. Universal screening of adult females should be conducted at intake among women up to age 35 years (or on the basis of local institutional prevalence data).

Pregnant women should be screened routinely for chlamydia at the first prenatal visit. Pregnant women at increased risk for chlamydia and women found to have chlamydial infection during the first trimester should be retested during the third trimester to prevent postnatal complications and chlamydial infection in the infant.

Sexually active men who have sex with men (MSM) who have had insertive or receptive anal intercourse or who have had oral sex in the past year should be screened for chlamydia. Testing should be performed on specimens obtained from the pharynx, urethra, or rectum depending on the site of exposure. Screening at 3-to 6-month intervals is recommended for MSM who have multiple or anonymous sex partners, have sex in conjunction with illicit use of drugs, use methamphetamine, or have partners who participate in these activities.

Sources: Agency for Healthcare Research and Quality. Guide to clinical preventive services, 2010–2011, section 2, infectious diseases.Exit Disclaimer: You Are Leaving www.ihs.gov 
CDC. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010;59(No. RR-12) Exit Disclaimer: You Are Leaving www.ihs.gov 
US Preventive Services Task Force. Screening for chlamydial infection.
CDC. Sexually transmitted diseases. Exit Disclaimer: You Are Leaving www.ihs.gov 

Screening all sexually active women for gonorrhea, including those who are pregnant, if they are at increased risk, is recommended. Women aged 25 years and under are at highest risk for gonorrhea. Other risk factors for gonorrhea include a previous gonococcal infection, other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and illicit drug use. Infected women and men should be retested approximately 3 months after treatment.

Among people in correctional facilities, universal screening of adolescent females for gonorrhea should be conducted at intake in juvenile detention or jail facilities. Universal screening of adult females should be conducted at intake among females up to age 35 years (or on the basis of local institutional prevalence data).

Pregnant women should be screened at the first prenatal visit. Pregnant women found to have gonococcal infection during the first trimester should be retested in 3–6 months, preferably in the third trimester.

Sexually active men who have sex with men (MSM) who have had insertive, receptive anal or oral intercourse during the previous year should be screened for urethral, rectal, and pharyngeal infection with Neisseria gonorrhoeae using specimens obtained from exposed sites. Screening at 3–6 month intervals is recommended for MSM who have multiple or anonymous sex partners, have sex in conjunction with illicit use of drugs, use methamphetamine, or have partners who participate in these activities.

Sources: Agency for Healthcare Research and Quality. Guide to clinical preventive services, 2010–2011, section 2, infectious diseases.Exit Disclaimer: You Are Leaving www.ihs.gov 
CDC. Sexually transmitted diseases. Exit Disclaimer: You Are Leaving www.ihs.gov 
US Preventive Services Task Force. Screening for gonorrhea.

Syphilis serology should be performed at least annually for sexually active MSM, including MSM with or without established HIV infection. More frequent screening (at 3–6 month intervals) is indicated for MSM who have multiple or anonymous sex partners, have sex in conjunction with illicit drug use, use methamphetamine, or have sex partners who participate in these activities.

A serologic test for syphilis should be performed for all pregnant women at the first prenatal visit. Women who are at high risk for syphilis, live in areas of high syphilis morbidity, are previously untested, or have positive serology in the first trimester should be screened again early in the third trimester (28 weeks of gestation) and at delivery. Among persons in correctional facilities, universal screening should be conducted on the basis of the local area and institutional prevalence of early (primary, secondary, and early latent) infectious syphilis.

Sources: Agency for Healthcare Research and Quality. Guide to clinical preventive services, 2010–2011, section 2, infectious diseases. Exit Disclaimer: You Are Leaving www.ihs.gov 
CDC. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010;59(No. RR-12) Exit Disclaimer: You Are Leaving www.ihs.gov 
CDC. Sexually transmitted diseases. Exit Disclaimer: You Are Leaving www.ihs.gov 

HSV serologic testing should be considered for persons presenting for an STD evaluation (especially for those persons with multiple sex partners), persons with HIV infection, and MSM at increased risk for HIV acquisition.

Sources: CDC. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010;59(No. RR-12) Exit Disclaimer: You Are Leaving www.ihs.gov 
CDC. Sexually transmitted diseases.Exit Disclaimer: You Are Leaving www.ihs.gov