B
STI Screening and Treatment Guidelines Issued by Health Professional Societies
SUMMARY
The Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force (USPSTF) provide national guidance to prevent, screen/test for, and treat sexually transmitted infections (STIs). This analysis compared the CDC/USPSTF recommendations to STI guidelines published by various health professional organizations, including the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), the American College of Physicians (ACP), the American Academy of Physician Assistants (AAPA), the American Public Health Association (APHA), and various nursing organizations (American Nurses Association [ANA]). Some organizations required a membership in order to view the entirety of materials on their site, so additional guidelines may have been published that are not publicly available and thus not included in this analysis.
Professional organizations overall provided recommendations that are consistent or mostly consistent with CDC and USPSTF guidelines. It was more common for professional organizations to publish a paucity of information rather than inaccurate information. Many organizations directed readers to CDC or USPSTF for more detailed guidelines and focused more on the guidelines that pertained only to their population of specialization (such as women for ACOG and pediatrics for AAP). It was also more common for medical societies to offer specific screening/-
treatment recommendations, in contrast to organizations for nursing, physician’s assistants, or public health, which tended to publish policy recommendations.
Recommendations are coded as follows:
- Recommendations consistent with CDC/USPSTF recommendations are noted with a plus sign+
- Recommendations that are partially inconsistent with CDC/USPSTF are noted with a number sign#
CHLAMYDIA
Summary Statement
While some professional organizations have not published guidelines regarding chlamydia (ACP, AAPA, ANA), those from ACOG, AAP, and AAFP are largely in consensus with CDC/USPSTF, with some minor differences. AAFP recommends screening for men who have sex with men (MSM) if at risk (rather than all sexually active MSM), while ACOG recommends routinely screening all pregnant women (rather than just those under 25 and those >25 with risk factors).
TABLE B-1 Screening and Treatment Recommendations, Chlamydia
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| CDC | Women: Sexually active women under 25 years of age. Sexually active women aged 25 years and older if at increased risk (new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection). Retest approximately 3 months after treatment. Pregnant Women: All pregnant women under 25 years of age. Pregnant women, aged 25 and older if at increased risk (see above). Retest during the third trimester for women under 25 years of age or at risk. Pregnant women with chlamydial infection should have a test of cure 3–4 weeks after treatment and be retested within 3 months. Men: *Consider screening young men in high prevalence clinical settings (adolescent clinics, correctional facilities, STD clinics) or in populations with high burden of infection (e.g., MSM). |
Recommended Regimens: Azithromycin 1 g orally in a single dose OR Doxycycline 100 mg orally twice per day for 7 days (Azithromycin in pregnancy) Alternative Regimens: Erythromycin base 500 mg orally four times per day for 7 days OR Erythromycin ethylsuccinate 800 mg orally four times per day for 7 days OR Levofloxacin 500 mg orally once daily for 7 days OR Ofloxacin 300 mg orally twice per day for 7 days |
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
|
MSM: At least annually for sexually active MSM at sites of contact (urethra, rectum) regardless of condom use. Every 3–6 months if at increased risk (including those with HIV infection if risk behaviors persist or if they or their sexual partners have multiple partners). Persons with HIV: For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter. More frequent screening might be appropriate depending on individual risk behaviors and the local epidemiology. (CDC, 2015) |
Expedited Partner Therapy (EPT): Unless prohibited by law or other regulations, medical providers should routinely offer EPT to heterosexual patients with chlamydia or gonorrhea infection when the provider cannot confidently ensure that all of a patient’s sex partners from the prior 60 days will be treated. If the patient has not had sex in the 60 days before diagnosis, providers should attempt to treat a patient’s most recent sex partner. (Workowski and Bolan, 2015) |
|
| USPSTF |
Women: Screening for chlamydia in sexually active women age 24 years and younger and in older women who are at increased risk for infection (Grade B). Men: Current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men (Grade I). (USPSTF, 2014) |
|
| AAFP |
Screening:
|
Treatment:+
EPT:+ EPT and patient-delivered partner therapy should be provided whenever possible and in accordance with local law. (AAFP, n.d.-a) |
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| AAP |
Screening:+
Testing
(AAP, n.d.-b; AAP and ACOG, 2017; Committee on Adolescence and Society for Adolescent Health and Medicine, 2014) |
Treatment: No guidelines found EPT:+ Support as option for partners or heterosexual males/females within past 60 days if partner unlikely to access in-person care. Support research to evaluate EPT effectiveness in MSM and WSW. (Burstein et al., 2009) |
| ACOG |
Screening: (For women only)
Testing:
|
Treatment: No guidelines found—references CDC STI treatment guidelines website for more information EPT:+ Support EPT for GC/CT for partner(s) within past 2 months if unwilling or unable to seek care; should include written treatment instructions for partner(s). Clinician should first assess risk of IPV with partner notification. (ACOG Committee Opinion, 2018) |
| ACP | No explicit guidelines for STIs on its Clinical Guidelines and Recommendations page: “For more screening and preventive care guidelines, the ACP recommends visiting the United States Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care websites.” (ACP, n.d.) | |
| AAPA | Did not find screening/treatment guidelines | |
| Nursing Orgs. | Did not find screening/treatment guidelines | |
NOTE: For CDC, if marked by asterisk, not a formal recommendation.
GONORRHEA
Summary Statement
While some professional organizations have not published guidelines regarding gonorrhea (ACP, AAPA, ANA), those from ACOG and AAP are in consensus with CDC/USPSTF. AAFP guidelines may be slightly out of date; they differ from those of the CDC/USPSTF by recommending screening for MSM at risk (rather than all sexually active MSM), and their treatment lacks azithromycin (needed given growing antibiotic resistance).
TABLE B-2 Screening and Treatment Recommendations, Gonorrhea
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| CDC |
Women: Sexually active women under 25 years of age. Sexually active women age 25 years and older if at increased risk (new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI, inconsistent condom use among persons who are not in mutually monogamous relationships; previous or coexisting sexually transmitted infections; and exchanging sex for money or drugs). Retest 3 months after treatment. Pregnant Women: All pregnant women under 25 years of age and older women if at increased risk. Retest 3 months after treatment. Men: No recommendation. MSM: At least annually for sexually active MSM at sites of contact (urethra, rectum, pharynx) regardless of condom use. Every 3–6 months if at increased risk. Persons with HIV: For sexually active individuals, screen at first HIV evaluation and at least annually thereafter. More frequent screening for might be appropriate depending on individual risk behaviors and the local epidemiology. (CDC, 2015) |
Recommended Regimen for uncomplicated infection of cervix, urethra, rectum, and pharynx: Ceftriaxone 250 mg IM in a single dose PLUS Azithromycin 1 g orally in a single dose. |
| NOTE: Toward the end of the development of this report, the treatment guidelines for gonorrhea were updated by CDC (on December 18, 2020) as follows: A single 500 mg intramuscular dose of ceftriaxone for uncomplicated gonorrhea. Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (100 mg twice daily for 7 days) should be administered when chlamydial infection has not been excluded (St. Cyr et al., 2020). The treatment comparisons made in this table reflect the treatment guidelines prior to this change. |
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
|
Alternative Regimens if ceftriaxone is not available: Cefixime 400 mg orally in a single dose PLUS Azithromycin 1 g orally in a single dose (in December 2020 this was changed to 800 mg oral dose of cefixime [St. Cyr et al., 2020]). EPT: Unless prohibited by law or other regulations, medical providers should routinely offer EPT to heterosexual patients with chlamydia or gonorrhea infection when the provider cannot confidently ensure that all of a patient’s sex partners from the prior 60 days will be treated. If the patient has not had sex in the 60 days before diagnosis, providers should attempt to treat a patient’s most recent sex partner. |
||
|
NOTE: CDC has more information about treatment for conjunctivitis, disseminated disease, neonates). (Workowski and Bolan, 2015) |
||
| USPSTF |
Women: Screening for gonorrhea in sexually active women age 24 years and younger and in older women who are at increased risk for infection (Grade B). Men: Current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men (Grade I). (USPSTF, 2014) |
|
| AAFP |
Screening:
|
Treatment:#
EPT:+ EPT and patient-delivered partner therapy should be provided whenever possible and in accordance with local law. |
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| AAP |
Screening:+ All sexually active females <25, annual screen.
Testing:
(AAP, n.d.-b; AAP and ACOG, 2017; Committee on Adolescence and Society for Adolescent Health and Medicine, 2014) |
Treatment: No guidelines found |
| EPT:+ Support as option for partners or heterosexual males/females within past 60 days if partner unlikely to access in-person care. Support research to evaluate EPT effectiveness in MSM and WSW. (Burstein et al., 2009) | ||
| ACOG |
Screening:+
Testing:
|
Treatment:+
|
| EPT:+ Support EPT for GC/CT for partner(s) within last 2 months if unwilling or unable to seek care; should include written treatment instructions for partner(s). Clinician should first assess risk of IPV with partner notification. (ACOG Committee Opinion, 2018) | ||
| ACP | No explicit guidelines for STIs on its Clinical Guidelines and Recommendations page: “For more screening and preventive care guidelines, the ACP recommends visiting the United States Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care websites.” (ACP, n.d.) | |
| AAPA | Did not find screening/treatment guidelines | |
| Nursing Orgs. | Did not find screening/treatment guidelines | |
SYPHILIS
Summary Statement
While some professional organizations have not published guidelines regarding syphilis (ACP, AAPA, ANA), those that have are in consensus with CDC/USPSTF.
TABLE B-3 Screening and Treatment Recommendations, Syphilis
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| CDC |
Women: No recommendation. Pregnant Women: All pregnant women at the first prenatal visit. Retest early in the third trimester and at delivery if at high risk. Men: No recommendation. MSM: At least annually for sexually active MSM. Every 3–6 months if at increased risk (those with HIV infection if risk behaviors persist or if they or their sexual partners have multiple partners). Persons with HIV: For sexually active individuals, screen at first HIV evaluation and at least annually thereafter. More frequent screening might be appropriate depending on individual risk behaviors and the local epidemiology. (CDC, 2015) |
Primary and Secondary Syphilis Recommended Regimen for Adults: Benzathine penicillin G 2.4 million units IM in a single dose. |
| Recommended Regimen for Infants and Children: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose. | ||
|
See CDC treatment guidelines for recommendations for latent syphilis, tertiary syphilis, neurosyphilis, and considerations for persons with HIV infection and pregnant women. (Workowski and Bolan, 2015) |
||
| USPSTF |
Pregnant Women: Early screening for syphilis infection in all pregnant women (Grade A). At Risk: Screening for syphilis infection in persons who are at increased risk for infection (Grade A). (USPSTF, 2016) |
|
| AAFP |
Screening:+
|
Treatment:+ Penicillin G benzathine (AAFP, n.d.-a) |
| AAP | Screening:+ Screen based on individual risk factors (MSM annually or every 3–6 months if high risk, pregnant people). (AAP, n.d.-b; AAP and ACOG, 2017; Committee on Adolescence and Society for Adolescent Health and Medicine, 2014) | Treatment: No recommendations found |
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| ACOG |
Screening:+
|
Treatment:+ Treat patient and sex partner(s) with penicillin. (AAP and ACOG, 2017) |
| ACP | No explicit guidelines for STIs on its Clinical Guidelines and Recommendations page: “For more screening and preventive care guidelines, the ACP recommends visiting the United States Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care websites.” | |
| AAPA | Did not find screening/treatment guidelines | |
| Nursing Orgs. | Did not find screening/treatment guidelines | |
HERPES SIMPLEX VIRUS (HSV)
Summary Statement
While some professional organizations have not published guidelines regarding HSV (ACP, AAPA, ANA), those that have are in consensus with CDC/USPSTF.
TABLE B-4 Screening and Treatment Recommendations, HSV
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| CDC | Women: *Type-specific HSV serologic testing should be considered for women presenting for an STD evaluation (especially for women with multiple sex partners). Pregnant Women: *Evidence does not support routine HSV-2 serologic screening among asymptomatic pregnant women. However, type-specific serologic tests might be useful for identifying pregnant women at risk for HSV infection and guiding counseling regarding the risk for acquiring genital herpes during pregnancy. Men: *Type-specific HSV serologic testing should be considered for men presenting for an STD evaluation (especially for men with multiple sex partners). |
First Clinical Episode Recommended Regimens* Acyclovir 400 mg orally three times per day for 7–10 days OR Acyclovir 200 mg orally five times per day for 7–10 days OR Valacyclovir 1 g orally twice per day for 7–10 days OR Famciclovir 250 mg orally three times per day for 7–10 days *Treatment can be extended if healing is incomplete after 10 days of therapy. |
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
|
MSM: *Type-specific serologic tests can be considered if infection status is unknown in MSM with previously undiagnosed genital tract infection. Persons with HIV: *Type-specific HSV serologic testing should be considered for persons with HIV infection. (CDC, 2015) |
See CDC treatment guidelines for suppressive therapy, episodic therapy for recurrent genital herpes, severe disease, neonatal herpes, etc. (Workowski and Bolan, 2015) |
|
| USPSTF |
The USPSTF recommends against routine serologic screening for genital herpes simplex virus (HSV) infection in asymptomatic adolescents and adults, including those who are pregnant (Grade D). (USPSTF, 2016) |
|
| AAFP |
Screening:+ Do not recommend routine screening. Test based on clinical history. (AAFP, 2019) |
Treatment:+ Acyclovir, famiciclovir or valacyclovir (doses depend on if primary outbreak, recurrent, or for suppression). (AAFP, 2019) |
| AAP |
Screening: No recommendations found. Testing: For mucocutaneous HSV, clinical diagnosis typically enough. (AAP, n.d.-b) |
Treatment in Neonates: Acyclovir (treatment for other populations not found). (AAP and ACOG, 2017) |
| ACOG |
Screening:+
Testing:+
|
Treatment:+
|
| ACP | No explicit guidelines for STIs on its Clinical Guidelines and Recommendations page: “For more screening and preventive care guidelines, the ACP recommends visiting the United States Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care websites.” (ACOG, 2020c) | |
| AAPA | Did not find screening/treatment guidelines | |
| Nursing Orgs. | Did not find screening/treatment guidelines | |
HUMAN PAPILLOMAVIRUS (HPV)
Summary Statement
Discussion of HPV in publications by professional organizations mostly focuses on the oncogenic strains: how to screen for cervical cancer and encourage the HPV vaccine. Discussion of genital warts caused by the nononcogenic HPV strains is less common. For cervical cancer screening, organizations are in consensus with CDC/USPSTF; however, for the HPV vaccination, ACP only recommends it for boys aged 22–26 if they have additional risk factors, while AAPA recommends it for people aged 27–45 if indicated, which has been the subject of ongoing debate and research.
TABLE B-5 Screening and Treatment Recommendations, HPV
| Screening/Testing Recommendations | Vaccine/Treatment Recommendations | |
|---|---|---|
| CDC |
Screening for Cervical Cancer: Women: Women 21–29 years of age every 3 years with cytology. Women 30–65 years of age every 3 years with cytology, or every 5 years with a combination of cytology and HPV testing. Pregnant Women: Screened at same intervals as nonpregnant women. Persons with HIV: Women should be screened within 1 year of sexual activity or initial HIV diagnosis using conventional or liquid-based cytology; testing should be repeated 6 months later. (CDC, 2015) |
HPV Vaccines: Three-dose series of IM injections over a 6-month period, with the second and third doses given 1–2 and 6 months after the first dose, respectively. The same vaccine product should be used for the entire three-dose series. For Girls/Women: Either vaccine (quadrivalent or 9-valent) is recommended routinely at ages 11–12 years and can be administered beginning at 9 years of age (16); girls and women aged 13–26 years who have not started or completed the vaccine series should receive the vaccine. |
| For Boys/Men: The quadrivalent or 9-valent HPV vaccine is recommended routinely for boys aged 11–12 years; boys can be vaccinated beginning at 9 years of age. Boys and men aged 13–21 years who have not started or completed the vaccine series should receive the vaccine. |
| Screening/Testing Recommendations | Vaccine/Treatment Recommendations | |
|---|---|---|
| Other Populations: For previously unvaccinated, immunocompromised persons (including persons with HIV infection) and MSM, vaccination is recommended through age 26 years. The vaccines are not licensed or recommended for use in men or women aged >26 years. HPV vaccines are not recommended for use in pregnant women. | ||
| Treatment (oncogenic HPV): Treatment is directed to the macroscopic (e.g., genital warts) or pathologic precancerous lesions caused by HPV. Subclinical genital HPV infection typically clears spontaneously; therefore, specific antiviral therapy is not recommended to eradicate HPV infection. | ||
|
Treatment (nononcogenic HPV): Recommended regimens for external anogenital warts (i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus) patient-applied: Imiquimod 3.75% or 5% cream OR Podofilox 0.5% solution or gel OR Sinecatechins 15% ointment provider–administered: Cryotherapy with liquid nitrogen or cryoprobe OR Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser, or electrosurgery OR trichloroacetic acid or bichloroacetic acid 80%–90% solution. (Workowski and Bolan, 2015) |
| Screening/Testing Recommendations | Vaccine/Treatment Recommendations | |
|---|---|---|
| USPSTF | Women Aged 21–65: Screening for cervical cancer every 3 years with cervical cytology alone in women aged 21–29 years. For women aged 30–65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) (Grade A). | |
|
Women >65: Recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer (Grade D). Women <21: Recommends against screening for cervical cancer in women younger than 21 years (Grade D). (USPSTF, 2018) |
||
| AAFP |
Screening:
|
Vaccination:+ Endorses HPV vaccination. (AAFP, n.d.-a) |
| AAP | Screening: n/a for adolescents | Vaccination:+ Support routine HPV immunization for all 11- and 12-year-olds and catch-up vaccination for adolescents and young adults 13–26 years. (AAP, n.d.-a) |
| Screening/Testing Recommendations | Vaccine/Treatment Recommendations | |
|---|---|---|
| ACOG |
Screening+ for Cervical Cancer:
|
Vaccination:+ Recommend routine vaccination for boys/girls aged 11–26 (can be given at age 9). (ACOG Committee Opinion, 2020) |
| ACP |
Screening:+
|
Vaccination:
|
| AAPA |
Screening:
|
Vaccination:
|
| Nursing Orgs. | Did not find screening/treatment guidelines | |
HEPATITIS B
Summary Statement
Hepatitis B is mentioned less often (or in less detail) than other STIs in publications by professional organizations. Despite this, consensus is apparent on screening recommendations, particularly for pregnant women, and on routine vaccination.
TABLE B-6 Screening and Treatment Recommendations, Hepatitis B
| Screening/Testing Recommendations | Vaccine/Treatment Recommendations | |
|---|---|---|
| CDC |
Women: Women at increased risk. Pregnant Women: Test for HBsAg at first prenatal visit of each pregnancy regardless of prior testing; retest at delivery if at high risk. Men: Men at increased risk. MSM: All MSM should be tested for HBsAg. Persons with HIV: Test for HBsAg and anti-HBc and/or anti-HBs. Increased risk = (persons born in regions of high endemicity ≥ 2% prevalence), IDU, MSM, persons on Immunosuppresive therapy, Hemodialysis patients, individuals with HIV, and others. (CDC, 2015) |
Vaccine: Two products have been approved for hepatitis B prevention: hepatitis B immune globulin (HBIG) for post-exposure prophylaxis and hepatitis B vaccine. The recommended hepatitis B virus (HBV) dose and schedule varies by product and age of recipient. Treatment: No specific therapy is available for persons with acute hepatitis B; treatment is supportive. Persons with chronic HBV infection should be referred for evaluation to a provider experienced in the management of chronic HBV infection. Therapeutic agents cleared by FDA for treatment of chronic hepatitis B can achieve sustained suppression of HBV replication and remission of liver disease. (Workowski and Bolan, 2015) |
| USPSTF | Pregnant Women: Screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit (Grade A). (USPSTF, 2019) | |
| Persons at High Risk: Screening for hepatitis B virus (HBV) infection in persons at high risk for infection (Grade B). (USPSTF, 2020b) |
| Screening/Testing Recommendations | Vaccine/Treatment Recommendations | |
|---|---|---|
| AAFP |
Screening:+
|
Vaccination:+ Endorses Hepatitis B vaccination. (AAFP, n.d.-a) |
| AAP | No mention found | No mention found |
| ACOG | Screening:+ In pregnancy, routine prenatal screening recommended. (AAP and ACOG, 2017) |
Vaccination:+ Universal vaccination of all infants born in the United States. Treatment:+ Newborns born to Hepatitis B carriers should be treated with immunoprophylaxis (HBIG and hepatitis B vaccine) within 12 hours. (AAP and ACOG, 2017) |
| ACP |
Screening for HBV:+
|
Vaccination:+
Treatment: |
| AAPA | Did not find screening/treatment guidelines | |
| Nursing Orgs. | Did not find screening/treatment guidelines | |
TRICHOMONIASIS
Summary Statement
Publications by professional organizations mention trichomoniasis less often (or in less detail) than other STIs, despite that being one of the more common infections. The consensus appears to be that routine screening for average-risk women is not advised and testing should be determined by symptoms. For women living with HIV, there is also consensus that annual screening is recommended. ACOG, in line with CDC guidance, suggests that EPT may be helpful. While this does not seem to be routine practice now, it may constitute a new opportunity in the field.
TABLE B-7 Screening and Treatment Recommendations, Trichomoniasis
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| CDC |
Women: *Consider for women receiving care in high-prevalence settings (e.g., STD clinics and correctional facilities) and for women at high risk for infection (e.g., women with multiple sex partners, exchanging sex for payment, illicit drug use, and a history of STD). Pregnant Women: No recommendation. Men: No recommendation. MSM: No recommendation. Persons with HIV: Recommended for sexually active women at entry to care and at least annually thereafter. (CDC, 2015) |
Recommended Regimen: Metronidazole 2 g orally in a single dose OR Tinidazole 2 g orally in a single dose. Alternative Regimen: Metronidazole 500 mg orally twice per day for 7 days. EPT might have a role in partner management for trichomoniasis and can be used in states where permissible by law. (Workowski and Bolan, 2015) |
| USPSTF | No recommendation. | |
| AAFP |
Screening:+ Routine screening not advised. Testing if symptoms (saline wet mount, rapid antigen testing, or culture). (AAFP, 2019) |
Treatment:+ Metronidazole or tinidazole. (AAFP, 2019) |
| AAP | Screening:+ Routine screening not recommended. Screen if HIV+ female annually, or those at high risk (new or multiple partners, history of STIs, or those who exchange sex for payment, intravenous-drug users). (Committee on Adolescence and Society for Adolescent Health and Medicine, 2014) | Treatment: No mention found |
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| ACOG | Screening:+ For women with HIV, annual screen recommended. | EPT:+ Committee opinion on EPT suggests this may be helpful for trichomoniasis as well. (ACOG Committee Opinion, 2018) |
| ACP | No explicit guidelines for STIs on its Clinical Guidelines and Recommendations page: “For more screening and preventive care guidelines, the ACP recommends visiting the United States Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care websites.” (ACP, n.d.) | |
| AAPA | Did not find screening/treatment guidelines | |
| Nursing Orgs. | Did not find screening/treatment guidelines | |
HEPATITIS C
Summary Statement
CDC describes hepatitis C as an emerging issue but writes that “HCV is not efficiently transmitted through sex…. However, data indicate that sexual transmission of HCV can occur, especially among persons with HIV infection.” Information about hepatitis C was hardly ever included in STI resources/guidelines from professional societies, as it was instead considered more as a blood-borne infection, indicating that it may not be routinely thought of as an STI. For reference, the CDC and USPSTF guidelines regarding hepatitis C are shown below.
TABLE B-8 Screening and Treatment Recommendations, Hepatitis C
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
| CDC | Women: Women born between 1945 and 1965. Other women if risk factors are present. Pregnant Women: Pregnant women born between 1945 and 1965. Other pregnant women if risk factors are present. Men: Men born between 1945 and 1965. Other men if risk factors are present. MSM: MSM born between 1945 and 1965. Other MSM if risk factors are present. Annual HCV testing in MSM with HIV infection. Persons with HIV: Serologic testing at initial evaluation. Annual HCV testing in MSM with HIV infection. |
Treatment: Providers should consult with specialists knowledgeable about management of hepatitis C infection. Furthermore, they can consult existing guidelines to learn about the latest advances in the management of hepatitis C. (Workowski and Bolan, 2015) |
| Screening/Testing Recommendations | Treatment Recommendations | |
|---|---|---|
|
Risk factors = Past or current injection drug use, receipt of blood transfusion before 1992, long-term hemodialysis, born to mother with hepatitis C, intranasal drug use, receipt of an unregulated tattoo, and other percutaneous exposures. (CDC, 2015) |
||
| USPSTF |
Adults at High Risk: For adults aged 18 to 79 years screen for hepatitis C virus (HCV) infection (Grade B). (USPSTF, 2020c) |
SEXUAL HEALTH/STI RECOMMENDATIONS (MISCELLANEOUS)
TABLE B-9 General Sexual Health/STI Recommendations
| CDC | Several recommendations regarding (1) sexual history and physical examination, (2) prevention, (3) screening, (4) partner services, (5) evaluation of STD-related conditions, (6) laboratory, (7) treatment, and (8) referral to a specialist for complex STD or STD-related conditions. (Barrow et al., 2020) |
| USPSTF | Intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for STIs (Grade B). (USPSTF, 2020a) |
| AAFP |
Endorses the following prevention and management strategies:
|
| AAP |
|
| ACOG |
|
| ACP | No specific policies/recommendations |
| AAPA | No specific policies/recommendations |
| APHA |
|
| Nursing Orgs. | ANA: Position statement: Education and Barrier Use for Sexually Transmitted Diseases and HIV Infection → identifies STIs are major public health issue. Supports condom use and advertising. Supports educational and preventative health measures. (ANA, 1991) |
| American Journal of Nursing: Article: Improving Adolescent Sexual and Reproductive Health Across Health Care Settings → Table 2 gives recommend Counseling, Screening, Vaccination, and Testing Talking Points for Nurses. (Santa Maria et al., 2017) |
REFERENCES
AAFP (American Academy of Family Physicians). 2019. Screening for sexually transmitted infections: Practice manual. Leawood, KS: AAFP.
AAFP. n.d.-a. Prevention and management of sexually transmitted infections. https://www.aafp.org/about/policies/all/prevention-sti.html (accessed February 10, 2021).
AAFP. n.d.-b. Women’s health clinical recommendations & guidelines. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/recommendations-by-topic/women-health-clinical-recommendations-guidelines.html (accessed February 10, 2021).
AAP (American Academy of Pediatrics). 2016. Confidentiality protections for adolescents and young adults in the health care billing and insurance claims process (statement of endorsement). https://pediatrics.aappublications.org/content/pediatrics/137/5/e20160593.full.pdf (accessed February 15, 2021).
AAP. n.d.-a. Human papillomavirus (HPV). https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/adolescent-sexual-health/Pages/HPV.aspx (accessed February 10, 2021).
AAP. n.d.-b. STI screening guidelines. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/adolescent-sexual-health/Pages/STI-Screening-Guidelines.aspx (accessed February 10, 2021).
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