Opportunities and Challenges

Opportunities and challenges for STD prevention include the HPV vaccine, antimicrobial resistance in STD infections, enhanced chlamydia screening, and management of partners of infected patients.

An HPV vaccine, which can protect against types of HPV that account for 70 percent of cervical cancers¹⁴ and 90 percent of genital warts,¹⁵ presents both opportunities and challenges. While widespread preventive HPV vaccination may reduce the number of people affected by HPV, some challenges of a vaccine include the following:

• Vaccine delivery to an adolescent population.
• Coordinating resources and messages associated with both preventive vaccination and continued screening for cervical cancer.
• Determining if booster immunization is required for continued vaccine effectiveness.
  
• Evaluation of new data on vaccine effectiveness in other populations, potentially requiring revision of vaccine recommendations.

The emergence of drug-resistant strains of STDs presents problems for treatment that may affect the ability to meet STD prevention objectives. For example, increasing gonorrheal resistance to fluoroquinolone antibiotics, until recently a large part of treatment, is a growing global problem. Treatment of gonorrhea with fluoroquinolones is inadvisable in many areas, including Asia and the Pacific.¹⁶ In 2004, CDC recommended that fluoroquinolones no longer be used as first-line treatment for gonorrhea among men who have sex with men (MSM). The recommendation was made after preliminary data showed that drug-resistant gonorrhea cases increased significantly among gay and bisexual men in the United States in 2003.¹⁷ The loss of this class of antibiotics for treatment of gonorrhea leaves only a single class of antibiotics (cephalosporins) with known effectiveness available for treatment.

CDC and other professional health organizations recommend annual chlamydia screening for sexually active women aged 25 years and under to detect and treat chlamydial infection, which is largely asymptomatic, and prevent its adverse health outcomes for women.¹⁶

PID can lead to infertility, ectopic pregnancy (pregnancy occurring outside the uterus), and chronic pelvic pain.¹⁸ While STD clinics and Title X family planning clinics provide screening and treatment, the majority of chlamydial infections are reported from the private sector.¹⁰ Screening rates are low in both the public and private sectors when compared with other screening programs, such as breast and cervical cancer.¹³ Partnerships with private-sector providers to increase adherence to recommended screening guidance will be required to address the challenge of low screening rates and to take advantage of the opportunity to enhance women's health. New technologies, such as nucleic acid amplification tests, provide opportunities for expansion of screening programs beyond traditional clinical settings to reach more women. At the same time, they present challenges for followup treatment of both patients and their partners.

Effective clinical management of patients with treatable STDs requires treatment of the patients' current sex partners to prevent reinfection and curtail further transmission.¹⁹ Since recurrent infections in females may be the result of reinfections from untreated male partners, improved partner management could reduce the rate for reinfections and related consequences for health and fertility.²⁰

The standard approach to partner management has included clinical evaluation in a health care setting, with partner notification accomplished by the index patient (patient making first contact with the provider), by the provider or an agent of the provider, or a combination of these methods.²¹ In recent years, expedited partner therapy (EPT), an approach in which partners are treated without an intervening clinical assessment, has been evaluated and found to be an alternative option for partner management.²² EPT typically is effected when patients deliver medications or prescriptions to their partners. EPT represents an additional strategy for partner management, a key tool in preventing the spread of STDs. Results of recent studies suggest that improved management of partners could have a significant effect on the total national rate for chlamydia.^{23, 24}

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