Published in partnership with the National Coalition of STD Directors (NCSD).
As most those of us in public health field already know, April is STD Awareness Month. As the month comes to a close, I hope we can bring attention to not only the impact that sexually transmitted diseases (STDs) have on public health, but to the important role that STD clinics play in preventing STDs.
There are 20 million new incidences of STDs in the United States every year, costing our health-care system $16 billion. These STDs are disproportionately acquired by adolescents and young adults, especially LGBT young people. The negative effects of STDs, and the unhealthy patterns learned as teens, have consequences that can last into adulthood. STDs can result in long-term health-care costs, adverse pregnancy outcomes, infertility, and chronic pain, and we can’t overestimate the damage to relationships and personal dignity.
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STD clinics around the country are doing their part to prevent STDs and protect our health. STD clinics are centers of excellence that not only provide the best care possible, but also provide quality training for all public and private providers. For example, in my home state of Washington, the STD/HIV Prevention Training Centers collaborate with the University of Washington and the Harborview STD clinic. We have a Sexual Health Education and Training Coordinator on staff who implements training for nurses, physician assistants, educators, and others throughout the state.
The work of the Washington STD Clinics and STD/HIV Prevention Training Centers highlights a recent shift in this particular part of public health. While we used to focus on specific disease states, like early syphilis or gonorrhea infection, STD prevention has moved into a sexual health framework. We aren’t focusing on the specific disease—we are focusing on the patient, their relationships, their sense of safety, and more. This shift doesn’t come easy. We often wonder if all providers really have open sexual history discussions with patients. Our goal is to continue to train providers to perform this sometimes difficult but necessary service of holistic sexual health care. Patients need to get involved as well and need to ask doctors about STD testing. That is a public service campaign waiting to happen!
The patient-provider relationship is key when it comes to treating STDs, and I’m proud to say that STD clinics bring another health advocate to the table in the form of disease intervention specialists (DIS). DIS personnel are public health outreach workers who locate and counsel individuals with STDs. They are a flexible workforce with a vital set of skills that can also be utilized during public health emergencies, such as an H1N1 outbreak.
Washington found that while many local health jurisdictions closed their STD clinics, the number of reported cases did not diminish. DIS workers interview over half of these cases and ensure that partners are referred to a network of pharmacies or clinics, or are treated via expedited partner therapy (EPT) packets. These EPT packets ensure that infected partners get the health care they need as soon as possible. Using EPT as a treatment method is highly effective at reducing re-infection rates among the original patient. This service crosses over all insurance and provider types, and will remain a core public health function in the future.
We can do more to promote sexual health. STD clinics lead the way, by training providers and skilled DIS staff. STD clinics are ready for the new health-care environment that is being ushered in by the Affordable Care Act. This law a step forward that will change public health, and all those that are involved in the field, both professionally and personally. As implementation of the law continues, we need to make sure that we include sexual health as a part of overall health. As STD clinics, I believe we should take President Obama’s words to heart when we consider our leadership role in STD prevention: “We are the change we have been waiting for.”