How Physicians Can Encourage STI Screenings Amid Rising Infection Rates

A decline in preventive care and screenings was among the ripple effects of the pandemic, meaning that health issues such as diabetes, high blood pressure and other chronic conditions have gone undetected and untreated. According to the American Medical Association, screenings for HIV, sexually transmitted infections (STIs), viral hepatitis and latent tuberculosis (LTBI) have also sharply declined.

“Routine screening and early detection of HIV, STIs, viral hepatitis and LTBI are critical to ensure patients receive treatment and also lower their risk of transmitting these infectious diseases to others,” said AMA President Jack Resneck Jr., M.D. in a press release. “Given that access to preventive services were interrupted by the COVID-19 pandemic, many individuals may not even be aware they have an infection and are at risk of contributing to new infections.”

Following is a deeper look at the problem and how physicians and healthcare providers can lead patient conversations, promote screening and testing and provide effective treatment. 

The Issue: COVID-19’s Impact on the STI Epidemic

The Center for Disease Control and Prevention’s (CDC) “Sexually Transmitted Disease Surveillance 2020” report indicates that even during the pandemic—when social distancing was encouraged and often mandated—2.4 million cases of chlamydia, gonorrhea and syphilis were reported.

The CDC indicates that although reported cases of STDs dipped at the beginning of the pandemic, most resurged by the end of 2020 and rates of gonorrhea, syphilis and congenital syphilis surpassed those of 2019. According to the CDC, rates of chlamydia declined, but the drop is attributed to underdiagnosis and reduced screenings rather than a decrease in infections.

Within the United States, New York State is highly ranked for rates of STI cases, according to the CDC’s 2020 report. Specifically, New York State reported:

• 97,722 cases of chlamydia (No. 17);
• 42,517 cases of gonorrhea (No. 19); and
• 3,022 cases of primary and secondary syphilis (No. 11).

Physicians Can Slow STI Epidemic by Screening *All* Patients

Physicians play an important role in mitigating this epidemic by educating patients, encouraging testing and providing treatment. However, some healthcare professionals may be unaware that all patients should be screened for STIs.

Citing American Public Health Association executive director Georges Benjamin, MD, Medscape author David Levine explains that doctors know to screen for conditions such as hypertension and diabetes but may overlook screening for STDs and HIV due to assumptions about which patients may be most at risk. “It is important that we screen everyone,” Benjamin emphasizes.

Talk-Test-Treat Approach Can Support Patient Interactions

According to the CDC’s “Talk-Test-Treat” Approach, learning about a patient’s sexual history should be part of routine care. These tips can help make these sensitive conversations easier:

• Build trust with your patients by creating an inclusive environment.
• Reassure patients that their health information is confidential.
• Normalize conversations by emphasizing that sexual health is an important aspect of overall health.
• Provide counseling on safe sex.
• Empower patients to take control of their sexual health and make sure they are aware of the many ways they can access STI care. In addition to in-person visits, these options include express visits, pharmacy partnerships, telemedicine appointments and at-home specimen collection. 

Conversations specific to the patient’s sexual history can help physicians determine whether further testing is needed. The CDC states there are different STD screening recommendations for different patient populations but offers these general guidelines:

• Test all individuals ages 13 to 64 at least once for HIV.
• Test some patients for gonorrhea and chlamydia every year, including all sexually active women younger than 25 years and any women 25 years and older with certain risk factors, such as a new partner, multiple sexual partners or a sex partner who has an STD.
• Test individuals who are pregnant for syphilis, HIV, hepatitis B and hepatitis C starting early in pregnancy and repeat testing as necessary.
• Test all sexually active gay, bisexual and other men who have sex with men at least once a year for syphilis, chlamydia, gonorrhea and HIV. Some individuals may require more frequent testing.
• Test men living with HIV at least once a year for hepatitis C.
• Test individuals who participate in sexual behaviors that could put them at risk for infection or who share injection drug equipment at least once a year for HIV.

Lastly, after patients have been tested, be sure to let them know how they will receive test results.

For patients who require treatment, physicians should review the CDC’s latest STI Treatment Guidelines. It’s important to note that reinfection can be common with some STIs and therefore, some patients should return for follow-up testing every few months. 

To navigate this important topic with patients, MLMIC recommends reviewing some of our existing resources that can help physicians provide patient-centered care and create a welcoming environment for individuals of all backgrounds.