City Health Information
Volume 32 (2013) New York City Department of Health and Mental Hygiene No. 4; 19-27
 

IN THIS ISSUE

 

Preventing Sexually Transmitted Infections
  • Routinely ask all adolescent and adult patients about their sexual behavior.
  • Screen for and treat sexually transmitted infections (STIs) according to evidence-based clinical guidelines.
  • Counsel patients about protecting themselves and their partners from STIs.
  • Vaccinate against human papillomavirus, hepatitis A virus, and hepatitis B virus according to current guidelines.
  • When an STI is diagnosed
    • test for HIV,
    • encourage partner notification,
    • notify the Health Department if the infection is reportable.

The term "sexually transmitted infections" (STIs) refers to a variety of infections that are often asymptomatic and are acquired primarily through sexual activity. Sexually transmitted infections are an important public health concern. Chlamydia is the most common reportable infectious disease in the United States (US) and in New York City (NYC) (1-3). In 2011, there were 64,966 cases of chlamydia, 14,403 cases of gonorrhea, and 1,104 cases of early syphilis in NYC (4). In 2011, there were 3,404 newly diagnosed cases of HIV in NYC (5). In 2008, approximately 100,000 people (1.2% of NYC residents) were chronically infected with hepatitis B (HBV) (6). In 2004, nearly 28% of NYC adults were infected with herpes simplex virus type 2 (HSV-2), and 88.4% were undiagnosed (7).

Sexually transmitted infections are common, costly, and may have severe outcomes. HIV is among the top 10 causes of death in New Yorkers between 15 and 65 years of age (8), and the risk of HIV infection is increased among people with other STIs (9). Chlamydia and gonorrhea cause infertility in both women and men; in women, they can cause urethritis, cervicitis, pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy (1,10,11). Untreated syphilis can cause heart disease, brain damage, and possibly death. Perinatally transmitted syphilis and HBV can have devastating effects on the infant. Chronic HBV or hepatitis C virus (HCV) infection can lead to liver failure and liver cancer. Human papillomavirus (HPV) is the most common cause of cervical cancer and can cause oral and anogenital cancers in both men and women (1).

Because most infections are asymptomatic, proper screening is critical (1). Take a complete sexual history as part of the clinical interview and update the history routinely. The sexual history, along with pregnancy and HIV status, will determine the need for STI screening and vaccination. Treat infected patients according to evidence-based guidelines endorsed by the Centers for Disease Control and Prevention (CDC) (Resources). Counsel infected patients on measures they can take to prevent reinfection or further transmission and strongly encourage them to notify their sex partners (1). Promptly report all cases of STIs to the Health Department (see Partner Management).

 

REMEMBER THAT...
  • Adolescents and adults of all ages have sex and may get STIs.
  • Talking to adolescents about safer sex does not encourage sexual activity.
  • Sex is not just vaginal intercourse, but also oral and anal intercourse.
  • A person's sexual behavior can't be inferred from his or her appearance.
  • Gay-identified men and women may also have heterosexual sex.
  • Not all men who have sex with men (MSM) self-identify as gay.
  • Heterosexual women may practice receptive anal intercourse.
  • People may have extramarital sex with partners of any gender.

PDF version of Remember That... Box

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