1993 Sexually Transmitted Diseases Treatment Guidelines

Article excerpt

Prevention and control of STDs is based on four major concepts: education of those at risk on the means of reducing the risk of transmission; detection of asymptomatically infected individuals and of persons who are symptomatic but unlikely to seek diagnostic and treatment services; effective diagnosis|1~ and treatment of those who are infected; and evaluation, treatment, and counseling of sex partners for persons who have an STD. Although these guidelines deal largely with secondary prevention, namely clinical aspects of STD control, primary prevention of STDs is based on changing sexual behaviors that place patients at risk. Physicians and other health care providers play an important role in preventing STDs. In addition to interrupting transmission by treating persons with bacterial and parasitic STDs, clinicians can provide patient education and counseling and participate in identifying and treating infected sex partners.

Prevention Methods

Condoms. When used consistently and correctly, condoms are very effective in preventing a variety of STDs, including HIV infection. Multiple cohort studies, including those of serodiscordant couples, demonstrated a strong protective effect of condom use against HIV infection. Condoms are regulated as medical devices and subject to random sample and testing by the U.S. Food and Drug Administration (FDA). Each latex condom manufactured in the United States is tested electronically for holes before packaging. Condom breakage rates during use are low in the United States (|greater than~ 2 per 100 condoms tested). Condom failure usually results from inconsistent or incorrect use rather than condom breakage.

Patients should be advised that condoms must be used consistently and correctly to be effective in preventing STDs. Patients also should be instructed in the correct use of condoms. The following recommendations ensure proper use of condoms:

* Use a new condom with each act of intercourse;

* Carefully handle the condom to avoid damaging it with fingernails, teeth, or other sharp objects;

* Put the condom on after the penis is erect and before any genital contact with the partner;

* Ensure that no air is trapped in the tip of the condom;

* Ensure that adequate lubrication exists during intercourse, possibly requiring use of exogenous lubricants;

* Use only water-based lubricants, such as K-Y Jelly |TM~ or glycerine, with latex condoms; oil-based lubricants such as petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil can weaken latex and should never be used; and

* Hold the condom firmly against the base of the penis during withdrawal, and withdraw while the penis still is erect to prevent slippage.

Condoms and Spermicides. Effectiveness of spermicides in preventing HIV transmission is unknown. No data exist to indicate condoms lubricated with spermicides are more effective than other lubricated condoms in protecting against transmission of HIV infection and other STDs. Therefore, latex condoms with or without spermicides are recommended.

Female Condoms. Laboratory studies indicate the female condom (Reality |TM~) -- a lubricated polyurethane sheath with a ring on each end that is inserted into the vagina -- is an effective mechanical barrier to viruses, including HIV. Aside from a small study of trichomoniasis, no clinical studies have been completed to evaluate protection from HIV infection or other STDs. However, an evaluation of the female condom's effectiveness in pregnancy prevention was conducted during a six-month period for 147 U.S. women. The estimated 12-month failure rate for pregnancy prevention among the 147 women was 26%.

Vaginal Spermicides, Sponges, Diaphragms. As demonstrated in several cohort studies, vaginal spermicides, either film, gel, or suppositories, (contraceptive foam has not been studied) used alone without condoms reduce the risk for cervical gonorrhea and chlamydia, but protection against HIV infection has not been established in human studies. …