CDC Offers STD Recommendations as Care Shifts to Primary Care Setting

The US Centers for Disease Control and Prevention (CDC) has issued new guidelines to help primary care providers treat patients with sexually transmitted diseases (STDs).

The recommendations are a response to a shift in how Americans access health care for STDs.

They come amid increasing rates of STDs across the country.

“During the 1980s and 1990s, most specialized STD care was provided in STD clinics and HIV programs,” notes the report, which was published January 3 in the CDC’s Morbidity and Mortality Weekly Report. “For patients, STD clinics were unique because they provided confidential, walk-in, low-cost specialty care, and offered the expertise necessary to manage STDs.”

However, between 2008 and 2012, funding cuts led to decreases in the availability of such services. During that period, the CDC notes, more than half of public health clinics in the United States cut or reduced at least one STD-related program or service. One in 10 STD clinics closed entirely.

“Over time and with decreased availability of STD clinics, patients have sought care for STDs at primary care clinics, emergency departments, and family planning clinics,” wrote corresponding author Roxanne Y. Barrow, MD, of the Division of STD Prevention at the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, and colleagues.

In the changing health care landscape, Barrow and colleagues say STD clinics will continue to play an important role, particularly when it comes to providing patients with access to pre-exposure prophylaxis (PrEP), as well as specialty care. However, they report that primary care providers and community health clinics are increasingly at the forefront of STD care. For instance, one study found that between 71% and 80% of STD cases reported in 2018 were found in non-STD clinics.

The new recommendations aren’t meant to replace the CDC’s 2015 STD guidelines. Rather, they are meant as a supplement, offering providers with specific benchmarks for what how to provide and define STD quality care, in different types of clinical settings, for patients at risk of STDs, whether symptomatic or not. The recommendations also aim to help providers understand when it’s necessary to refer a patient to a specialist.

For instance, the guidelines recommend that sexual histories and risk assessments should be a part of an initial comprehensive exam or an annual physical. They noted that physical exams in a primary care setting can also be useful for diagnosis, in part because they might identify symptoms of which the patient is not aware.

“STD care in primary care settings might offer some of the same services as specialized STD care settings but, at a minimum, should encompass sexual history and risk assessment, screening, and treatment services,” the recommendations state.

When patients are diagnosed with an STD, the CDC suggests that primary care providers have certain medications available on site, such as medications for chlamydia and gonorrhea, first-line STD-related conditions like urethritis and cervicitis, PrEP, and emergency contraception. If the medications are not available on-site, the recommendations suggest a tracking system to ensure that patients pick up their prescribed medication from the pharmacy.

The CDC closes its recommendations by noting that much more research is needed to fully understand the challenges and opportunities of STD care in a primary care setting, as well as the impact such a setting has on patient outcomes.