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effective therapy. However, as documented in Chapter 5, there is limited awareness of, and compliance with, these guidelines, especially among private sector health care professionals in some regions. Appropriate diagnosis and treatment of STDs is most effectively accomplished by improving awareness and training of clinicians. Clinicians are ultimately responsible for ensuring that patients and their sex partners who are diagnosed with STDs are appropriately followed up and treated. When the diagnosis of an STD is laboratory-based, a mechanism for communicating results and following up on treatment should be established between the patient and the clinician.
Single-dose therapy for bacterial STDs is important in preventing complications and further transmission of STDs because it averts the problems of ineffective treatment associated with the failure of infected individuals to return for subsequent treatment or to take multiple doses of drugs. This attribute is especially valuable when treating disenfranchised persons. Single-dose therapy is most effective when it is directly provided and observed by the clinician, thereby ensuring patient compliance. Although single-dose therapy is more expensive than multidose therapy, it may be more cost-effective from a public health perspective for those populations in which compliance or follow-up are problematic.
Therefore, the committee makes the following recommendations:
All clinicians should follow STD treatment guidelines recommended by the CDC and national medical professional organizations. The CDC should continue to publish and update the STD Treatment Guidelines. All health plans and national and state professional organizations, such as the American Medical Association, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, and the American Academy of Family Practitioners, should assist in the dissemination of these guidelines to their members and clinical staff.
Single-dose therapy for bacterial and other curable STDs should be available and reimbursable in all clinical settings where STD-related clinical care is routinely provided to populations in which treatment compliance or follow-up are problems. Such therapy should be reimbursed by Medicaid programs and private health insurance plans. Although the pharmaceutical industry has been willing to provide single-dose therapies to public STD clinics at reduced contract prices, some public STD clinics and other public programs still lack sufficient funds to offer single-dose therapy in all situations where it is clinically indicated. Therefore, the pharmaceutical industry should consider further price reductions for public providers of STD treatment.
Improving Counseling and Education
Risk reduction counseling and education of patients during routine clinical encounters and during evaluations for potential STDs are important components