Prevention and Management of Sexually Transmitted Infections
The American Academy of Family Physicians (AAFP) recognizes the need for ongoing public and professional education about the prevention and management of sexually transmitted infections (STIs). The AAFP’s goals are to increase awareness of STIs, 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 sexual health starts with routinely obtaining a complete sexual history in a nonjudgmental manner and recognizing the wide diversity of human gender identity, relationships, sexual practices and behaviors. Patient-centered physical examination practices, individualized screening and treatment recommendations, and safer sex counseling are also key. 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:
- Effective ways to prevent the transmission of STIs vary by the nature and transmission mechanism of the organism. In addition to recommending indicated screening tests, family physicians should encourage patients to discuss their sexual health history and practices in an open and honest manner with their partners. Abstinence and the maintenance of a mutually monogamous relationship with an uninfected partner are two of several strategies that 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. Treatment as prevention (TasP) pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are effective strategies for preventing the transmission of HIV. 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. Patients with more than one sexual partner or who are otherwise in non-monogamous sexual relationships may consider multiple safer sex strategies such as limiting total number of partners or partners with unknown sexual health history in addition to other strategies detailed above. Family physicians should proactively counsel patients about these strategies and prescribe PrEP and PEP for HIV as a routine part of STI prevention.
- Congenital and perinatal infections may be reduced through appropriate counseling, screening, diagnosis, and treatment of pregnant and breastfeeding individuals.
- 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. For persons who are being treated for an STI (or whose partners are undergoing treatment), counseling that encourages abstinence from sexual intercourse until completion of the entire course of medication is vital for preventing transmission or reinfection.
- While several current screening recommendations are stratified by “men” and “women,” the net benefit estimates are driven by sex designation at birth (i.e., male/female) rather than gender identity. Regardless of gender identity, family physicians should consider designated sex at birth and current anatomy in addition to factors such as sexual practices when determining what recommendations to offer their patients.
- Screening for extragenital infection is an important strategy in the prevention and management of STIs. Extragenital STIs may occur concurrently with urogenital infection or in isolation. Patients should be offered site-specific screening based on their anatomy and sexual practices, not their gender identity or sexual orientation.
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. The AAFP opposes policies that require the use of stigmatizing diagnosis codes for coverage of human immunodeficiency virus (HIV) pre-exposure prophylaxis services and medications.(1971) (October 2023 COD)