• Prevention and Management of Sexually Transmitted Infections

    The American Academy of Family Physicians (AAFP) recognizes the need for intense and ongoing public and professional education about the prevention and management of sexually transmitted infections (STIs). The AAFP’s goals are to increase awareness of these infections, encourage effective prevention strategies, enable prompt diagnosis, ensure evidence-based treatment, and follow appropriate public health strategies for population-based control. The AAFP recognizes that the promotion of good sexual health starts with routinely obtaining a complete sexual history in a nonjudgmental manner that recognizes the wide diversity of human sexual practices and behaviors. Family physicians should encourage patients to discuss their sexual health history and practices with their partners. Additionally, the AAFP opposes discrimination against patients receiving STI-specific therapies, such as pre-exposure or post-exposure prophylaxis for HIV, in obtaining health related services and life, health, or disability insurance.

    The AAFP endorses and encourages the following prevention and management strategies:

    1. Effective ways to prevent the sexual transmission of infections vary by the nature and transmission mechanism of the organism. Abstinence and the maintenance of a mutually monogamous relationship with an uninfected partner decrease the risk for all STIs. Consistent and correct use of barrier methods reduce the risk of transmission of some infections, such as HIV, chlamydia, gonorrhea, and syphilis. Human Papilloma Virus (HPV) and hepatitis rates are significantly decreased by vaccination. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are effective in preventing the transmission of infections such as HIV in patients who are at risk for exposure or who have been exposed. Sex toys and prostheses may serve as a vehicle for STI transmission and should be used with a condom or properly cleansed between each use. Family physicians should proactively counsel patients about these strategies and prescribe PrEP and PEP as a routine part of STI prevention.
      2. Congenital and perinatal infections may be reduced through appropriate counseling, screening, diagnosis, and treatment of pregnant and breastfeeding individuals.
      3. Expedited partner therapy (EPT) and patient-delivered partner therapy (PDPT) should be provided whenever possible and in accordance with local law. With EPT and PDPT, clinicians prescribe treatment to partners of individuals known to have an infection without providing direct medical evaluation and counseling to the partner.

    Family physicians play a unique role in the prevention and management of STIs and should provide individualized screening recommendations and risk reduction counseling to their patients. The AAFP believes that any program focused on the diagnosis and treatment of STIs should emphasize family medicine and the role of primary care physicians. (1971) (2019 COD)