AAFP Tools Offer Pointers on Assessing Patients for STIs

New Resources Cover Screening Protocols, Taking a Sexual History

September 18, 2019 12:49 pm Michael Devitt

According to the CDC,(www.cdc.gov) about 20 million new sexually transmitted infections occur each year, with adolescents and young adults accounting for more than a quarter of them. In 2017,(www.cdc.gov) chlamydia, gonorrhea and syphilis alone accounted for nearly 2.3 million new cases, and although the incidence of some STIs has increased significantly in recent years, overall screening rates(www.liebertpub.com) lag behind national targets.

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Family physicians are ideally positioned to educate patients about the dangers STIs pose, screen for these infections and provide appropriate care. To support FPs in this endeavor, the Academy has developed a new STI screening practice manual, as well as a one-page guidance document on obtaining a sexual history.

Creation of these resources was supported by a grant from Quest Diagnostics; both are available on the AAFP's Sexually Transmitted Infections webpage.

"We hope that the manual will serve as a user-friendly resource that summarizes everything the family physician needs to know about evidence-based screening for STIs," said Shannon Connolly, M.D., of Los Angeles, a member of the Academy's Commission on Health of the Public and Science and co-author of the manual.

Story Highlights
  • The AAFP, thanks to a grant from Quest Diagnostics, has published new resources on sexually transmitted infections.
  • The Screening for Sexually Transmitted Infections Practice Manual summarizes the latest evidence on screening for STIs and includes screening recommendations for several common infections.
  • A one-page guide to taking a sexual history -- included in the manual and also available as a stand-alone document -- provides a step-by-step approach to obtaining a detailed, accurate history from patients.

"It also will help family physicians undertake STI screening in a manner that promotes sensitivity, patient autonomy and shared decision-making with patients," added co-author and fellow CHPS member Scott Hartman, M.D., of Rochester, N.Y.

STI Screening Practice Manual

The Screening for Sexually Transmitted Infections Practice Manual features a table with current recommendations from the AAFP, U.S. Preventive Services Task Force and CDC, as well as preferred testing modalities for eight common STIs. The manual is organized into two general sections.

The first section, "Implementation Considerations," discusses topics such as taking a sexual history, best practices for STI screening, challenges to screening implementation, and coding and payment.

The second section, "Disease-specific Considerations and Special Populations," offers recommendations for STI screening in specific patient groups:

  • women who have sex with women,
  • men who have sex with men,
  • adolescents,
  • individuals who are transgender and gender-diverse,
  • individuals who are pregnant, and
  • individuals in correctional facilities.

An appendix includes information on screening for the following STIs: chlamydia, gonorrhea, hepatitis B, hepatitis C, HIV and syphilis. For each, the manual gives a brief summary of USPSTF screening recommendations; CMS eligibility and frequency criteria; and CPT, Healthcare Common Procedure Coding System and ICD-10 codes and descriptions.

Additional resources are listed at the end of the manual.

Sexual History Guide

The one-pager "Taking an Accurate Sexual History: Sample Script" gives FPs a step-by-step approach to obtaining a detailed, accurate history from patients. It provides guidance on how FPs can begin the conversation, which questions should be asked of every patient and how to respond to the patient's answers.

In addition, the guide offers best practice tips on how to ask patients about STIs and includes a reminder that obtaining a sexual history may lead to a longer discussion about related topics.

The sexual history guide is included as page six of the STI screening practice manual and may also be downloaded as a standalone document.

Making the Case for Screening

Hartman and Connolly stressed to AAFP News why it's important for FPs to take an active role in screening their patients for STIs.

"Many STIs cause chronic, severe, and/or life-threatening complications," Hartman explained. "Some can be present in the body for months to years before causing symptoms or complications."

That means early detection and treatment are critical, Hartman added. "The case is even stronger during pregnancy, when certain STIs can lead to life-threatening complications for a fetus or newborn," he said.

"STI screening is more important now than ever," Connolly agreed. "We have seen a terrifying increase in STI incidence nationally over the last several years at a time when a lot of public health programs to address STIs are losing funding."

Connolly noted that although she has been in practice for nearly a decade, she only recently started encountering patients with congenital syphilis, a preventable STI that can lead to loss of pregnancy or cause severe developmental delays in infants if untreated. "We must do better" about screening, "and we can," she said.

Final Thoughts

For FPs who want to further their knowledge on the subject, Hartman recommended that they review American Family Physician's collected content on prenatal care and additional AAFP resources on LGBT health.  

As for Connolly, she said she regularly refers to the CDC's STD treatment guidelines,(www.cdc.gov) as well as the U.S. Medical Eligibility Criteria for Contraceptive Use clinical practice guideline, which has received the Academy's affirmation of value.

Connolly had some closing advice for her FP colleagues: "Think of STI screening every day that you see patients," she said. "If you look for risk factors, you will find them. If you don't ask, you will never know.

"It can be hard to add one more thing to a long list of screening tasks, but don't forget STIs. They're important!"

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