Sexually transmitted infections: clinical guidance and practice resources
Sexually transmitted infections (STIs) are common and can lead to serious complications.
Sexually transmitted infections (STIs) are common and affect patients across the lifespan. Many STIs are asymptomatic, making routine, evidence-based screening and timely treatment essential components of preventive and primary care.
Family physicians play a key role in normalizing STI prevention and screening, identifying infections early, providing treatment and counseling, and supporting patients in reducing transmission and long-term health impacts. This hub offers clinical guidance and practice resources to support family physicians in the prevention, screening, treatment, and patient-centered counseling of STIs.
Guidelines and recommendations
Clinical practice guidelines
The CDC’s Sexually Transmitted Infections (STI) Treatment Guidelines, 2021
(Affirmation of Value, 2021)
The 2021 Sexually Transmitted Infections (STI) Treatment Guidelines were developed by the Centers for Disease Control and Prevention (CDC) and designated as affirmation of value by the American Academy of Family Physicians.
These guidelines provide evidence-based clinical guidance to support the prevention, diagnosis, and management of STIs in diverse care settings. Updated from the 2015 guidelines, they reflect advances in clinical evidence and evolving epidemiology, with the overarching goal of reducing STI transmission, complications, and health disparities while improving patient outcomes.
The guidelines emphasize timely, effective treatment; integration of prevention strategies (including vaccination); and comprehensive, patient-centered care across the continuum of sexual health.
Clinical preventive service recommendations
The U.S. Preventive Services Task Force (USPSTF) recommends behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. The USPSTF found moderate certainty that counseling interventions reduce the likelihood of acquiring an STI, offering a meaningful net benefit for patients with identified risk factors such as a current STI, multiple partners or inconsistent condom use. Read the guidance.
Syphilis has seen a troubling resurgence in recent years. Congenital syphilis has similarly increased, posing severe health risks to pregnant patients and newborns. Early diagnosis and appropriate treatment of syphilis can prevent severe health complications and the transmission of the disease, including to newborns. Family physicians should be vigilant in screening and treating syphilis, especially among pregnant individuals.
While early treatment can cure the infection and prevent severe complications such as neurological and cardiovascular damage, the CDC recommends pregnant individuals get tested up to three times:
At their first prenatal visit
During the third trimester
At delivery if at high risk
Penicillin remains the treatment of choice for all stages of syphilis. The FDA has also approved the temporary importation of Extencilline® to mitigate the Bicillin L-A® shortage, crucial for syphilis treatment.
The AAFP is actively monitoring the current situation and working closely with the CDC, HHS and other public health organizations to provide up-to-date information and resources to family physicians. For additional information and resources, see the CDC’s dedicated pages on syphilis and congenital syphilis as well as the American Academy of Family Physicians' (AAFP) resources on screening and management of STIs.
Syphilis is an STI that can progress through multiple stages and cause serious longterm health problems if untreated. Rates have been rising in the U.S., especially among men and increasingly among women. The USPSTF finds substantial net benefit and recommends screening asymptomatic, nonpregnant adolescents and adults who are at increased risk to enable early treatment and prevent complications and transmission.
Chlamydia and gonorrhea are common sexually transmitted infections (STIs), especially among adolescents and young adults, and are often asymptomatic. In women, untreated infection can lead to pelvic inflammatory disease, infertility and pregnancy complications. Newborns can develop serious infections if exposed during birth. Infections in men may cause urethritis or epididymitis. The USPSTF finds screening provides moderate benefit for all sexually active women aged 24 and younger and for women 25 and older who are at increased risk. Evidence is currently insufficient to determine the balance of benefits and harms of routine screening in men.
Genital herpes is a lifelong sexually transmitted infection that is often asymptomatic. Routine blood tests have a high false-positive rate and can cause unnecessary anxiety and follow-up testing. The USPSTF finds that for asymptomatic adolescents, adults and pregnant persons, the harms of routine serologic screening outweigh the benefits. Screening is not recommended for people without symptoms or a known history of infection.
STI screening practice manual
Lower STI screening rates stem from factors such as stigma, limited time during routine visits, reimbursement challenges and gaps in clinician confidence or resources. An AAFP survey showed while most family physicians do screen for STIs, lack of time was the most common barrier. The STI practice manual responds to those needs with practical guidance, sample sexual history tools, workflow support and resources to help identify at-risk patients and improve screening in everyday practice. Learn more.
Policies
These AAFP policies outline core principles for preventing, identifying and managing sexually transmitted infections across clinical settings.
Patient education
The AAFP patient education website FamilyDoctor.org provides many patient-facing resources.