Hello. I’m Dr Arefa Cassoobhoy, a primary care internist, Medscape advisor, and senior medical director for WebMD. Welcome to Medscape Morning Report, our 1-minute news story for primary care.
The United States has the highest sexually transmitted disease (STD) rates in the industrialized world. After decades of watching rates decline, the incidence of three sexually transmitted infections hit an all-time high in 2017.
Chlamydia, gonorrhea, and syphilis combined were diagnosed in 200,000 more people in 2017 compared with 2016. Rates of syphilis, in particular, have doubled in the past 4 years. About half of these cases are in men who have sex with men. Another major concern is the rise in gonorrhea that is resistant to ceftriaxone.
These alarming trends point to a public health crisis. One reason for the increase is a lack of awareness. It can be an uncomfortable conversation. Patients rarely ask for STD testing or treatment. And providers often fail to take sexual histories or screen for STDs. The opioid crisis adds to the problem, as individuals trade sex for drugs, becoming infected.
When testing for chlamydia or gonorrhea, clinicians should ask patients if they have had anal-receptive intercourse. If so, a rectal culture should also be obtained, because genital testing alone will miss about 20% of STDs.
When treating gonorrhea, give a single injection of ceftriaxone, plus an oral dose of azithromycin, to prevent the development of resistance. For syphilis, screen any patient at elevated risk—including pregnant women—at the earliest opportunity, without waiting for symptoms.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.