Doctors Uncomfortable Talking To Patients About STDs

Doctors Uncomfortable Talking To Patients About STDs

Julie Lopez, 21, gets regular testing for sexually transmitted diseases – has been since she was a teen. However, when she asked her primary care physician about getting tested, she said he was surprised.

Lopez, who is a college student in California, said her doctor said the majority of people don’t ask about them. For herself, Lopez usually goes to Planned Parenthood for testing because the staff always asks the questions that must be asked.

With the increase in the number of STDs around the nation, public health officials are urging primary care doctors to take the initiative and ask patients for screening and treatment.

National Coalition of STD Directors Executive Director David Harvey said the organization knows doctors are not going what they have to do screen for STDs, which is why there is a rise in STD rates. Harvey said the blame also lies in funding cutbacks and a reduced public awareness about the risks that have led to the STD infection rise.

The Centers for Disease Control and Prevention have put into place guidelines for yearly screening for people who are sexually active. One such guideline is to test all sexually-active women – 25 and under – for chlamydia or gonorrhea. Men who engage in sexual activity with other men should be tested for syphilis, gonorrhea and chlamydia.

Despite the recommendations, testing doesn’t typically happen. In fact, in 2015, half of sexually active women between 16 and 24 years of age who have Medicaid or a private health plan got tested for chlamydia.

According to CDC information, the rates for three common STDs are at a record high. Between 2016 and 2017, syphilis rise 11 percent, gonorrhea rose by 19 percent and chlamydia increased by seven percent. There was also a 44 percent increase in the number of congenital syphilis – babies born with syphilis whose mother had it while pregnant or during delivery.

One-third of those cases were in California.

Screening is very important since most STD infections have no obvious symptoms. STIs that don’t get treated can cause serious health complications such as infertility, chronic pain and death.

CDC Division of STD Chief Medical Officer Dr. Laura Bachmann said primary care doctors play an important role in combating the rise in STD rates. She said if they fail to ask the right questions and don’t screen patients, most STDs are missed.

Harvey said state governments lack the money needed to battle the increased number of STI cases, mainly due to the federal STI funding staying stagnant. He said federal funding for 2017 was $152.3million – the same amount as eight years before.

Experts believe there are numerous reasons why doctors don’t routinely screen and treat STDs such as the worry of not being compensated for offering these STI services. They may also lack the current testing and treatment recommendations. In 2015, the CDC updated its recommendations.

Another common problem is that many doctors are hesitant to talk about sexual health with patients. In one study, one-third of teens who get yearly visits had no talks about sexual health.

University of Alabama at Birmingham School of Medicine professor Dr. Edward Hook said the situation is the result of doctors waiting for patients to start the conversation about sexual health. He said doctors are concerned that asking patients about their sex life and history will come off as rude and offensive.

American Academy of Family Physicians President Dr. Michael Munger said he remembers conversations with patients about sexual health being uncomfortable. He said it’s a challenging conversation, but it’s important to have it. If doctors don’t bring it up, who is going to, Munger said.

Rob Nola, is a writer in Los Angeles who said he gets tested for STDs every six months, but at the LGBT Center instead of his doctor who he said rarely asks him about his sexual health. He said the LGBT Center’s staff comes across as more knowledgeable about sexual health than his own doctor.

Doctors also have other health problems they have to immediately address in the short time they see patients, which is why talking about sexual health isn’t a huge priority.

Julie Brewer is a nurse practitioner is a Northeast Community Clinic in Hawthorne, California who regularly screens women for STIs as part of their health exams. She said many of her colleagues would give her their cases instead of dealing with the conversations.

She said doctors are concerned about high blood pressure and diabetes, which is why sexual health often takes a back seat.

LA County Public Health Department recognizes that STIs are an important issue, which is why they have sent representatives to area doctor’s offices to teach them how to talk about STDs. They also provided them with information on sexual history questions, screening recommendations and treatment guidelines.

The Los Angeles County Medical Association will also use social media and other efforts to spread the word to the doctors about the epidemic, which is the way people should be seeing it.

Dr. Heidi Bauer is head of the state’s Department of Public Health STD Control Branch, and she said the state wants to educate doctors to ensure they screen their patients routinely. She said the department offers both online and in-person training for doctors to learn more about STDs and allows them to download information with the latest guidelines.

Bauer also urges the federal government to ensure its own screening recommendations are more inclusive. For example, right now the only time a woman is tested for syphilis is if she is pregnant. Bauer said there has been a huge rise in the number of people with syphilis and a lack of testing for this difficult to diagnose STD.

Bachmann said the CDC is going to look at implementing newer recommendations within the next year.

Written by Mark Riegel, MD

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