HEALTHLatest CDC treatment guidelines try to rein in STDsExperts say rules are a step in the right direction, although some present implementation challenges.By Victoria Stagg Elliott, amednews staff. June 3, 2002. Women who test positive for Chlamydia should be retested for the infection within three or four months after treatment. Men who have sex with men should be tested for sexually transmitted diseases annually. And condoms with the spermicide nonoxynol-9 are out of style, STD preventionwise. These are just a few of the recommendations in the latest Centers for Disease Control and Prevention's STD guidelines issued in May. The guidelines, which are revised every four years, are the latest attempt to improve control of STDs and have been generally praised by physicians. For instance, many doctors have long been attempting to implement rescreening protocols for their patients with Chlamydia. It is also not news that condoms with nonoxynol-9 do not provide additional protection against HIV and other STDs. Other changes include recommendations that a different antibiotic be prescribed for gonorrhea because drug resistance has emerged to the fluoroquinolones in California and Hawaii. Alternate drugs should be used in these areas of the country or if the physician believes the patient acquired the infection from these states. "We have some chinks in our armor as far as the quinolones go, but the cephalosporins are hanging pretty tough," said Kevin Ault, MD, assistant professor of obstetrics and gynecology at the University of Iowa in Iowa City. New tests that indicate the type of genital herpes are also being recommended as a means of determining treatment for that STD. Hurdles aheadDoctors concede, however, that for some of these recommendations, implementation will be challenging. Calling patients back for Chlamydia tests may be very difficult, particularly among high-risk populations with little access to care. "Some will fall through the cracks," said Nancy Glick, MD, attending physician in the division of infectious disease at Mount Sinai Hospital in Chicago. "But the effort, because of the high rate of reinfection, will still make it worth it." To address related issues, for example, Dr. Glick is starting a project offering routine testing for STDs in her hospital's emergency department -- a way to reach people who rely on the ED as their sole source of medical care. Others are considering the possibility of at-home sample kits.
Gonorrhea is starting to show resistance to the fluoroquinolones.
"[Retesting for Chlamydia] has only really become practical with the development of some of these newer tests," said Michael Rein, MD, professor of medicine at the University of Virginia, Charlottesville. Dr. Rein runs a local STD clinic. And the recommendations for increased testing of men who have sex with men, seen as a way of possibly stemming the resurgence of STDs within this population, will spur doctors to be more inquisitive about the gender of a patient's sexual partners, which many admit has never been a strong suit. "If [physicians] can become comfortable with asking simple, direct questions, then patients will feel comfortable being honest," said Jason Schneider, MD, second year internal medicine resident at Emory University in Atlanta and board member of the Gay and Lesbian Medical Assn., which has developed guidelines for physicians who treat men who have sex with men. Many physicians question some guideline specifics, such as whether typing herpes infections will prove useful in the clinic. And there is concern that increased testing for antibodies will lead to more cesarean sections even though transmission by vaginal birth is only likely if the woman is experiencing an outbreak. "The intention is good because you want to empower patients," said Dr. Ault. "But I'm not sure how it's going to help me manage patients." There is also concern that the recommendations against condoms with nonoxynol-9 may lead to an increase in unplanned pregnancies. The spermicide may provide no additional protection against STDs, but it does do a better job at preventing pregnancy than condoms without it. ADDITIONAL INFORMATION:What to do about STDs
Source: "Sexually Transmitted Diseases Treatment Guidelines, 2002," MMWR, May 10 WeblinkSummary, "Sexually Transmitted Diseases Treatment Guidelines 2002," MMWR, May 10 (http://www.cdc.gov/std/treatment/) Article, "MSM: Clinician's Guide to Incorporating Sexual Risk Assessment in Routine Visits," Gay and Lesbian Medical Assn. (http://www.glma.org/medical/clinical/msm_assessment.html) Copyright 2002 American Medical Association. All rights reserved.
|
Featured stories     
« Prev
1
2
3
4
5
6
Next »
Current topicsMost-viewed
This weekUnspent war funds eyed to avoid years of Medicare doctor pay cuts Rite Aid clinics place new twist on "doc-in-a-box" Get our email alertsUse our one-step registration. Learn more Your information will not be shared. Privacy policyColumns and series
From the vaultQuotable"Our goal really is to provide the right care for patients at the right time. Not too much and not too little." Steven Weinberger, MD, co-author of a list developed by the American College of Physicians of 37 clinical situations in which screenings and medical tests provide little or no benefit |
|||||||||
SHARE
