Some of my patients take a very relaxed approach to safe sex and sexually transmitted diseases (STDs). They have sex with multiple partners and are inconsistent with condom use. Many of those who are subsequently diagnosed with an STD fail to get treatment, inform their partners to get treated or take action to prevent another infection.
Remind your patients that chlamydia and gonorrhea can be silent, causing minimal to no symptoms until the infection has progressed, particularly among women.As a result, the CDC estimates that only about half of all STD cases are detected and treated each year.
Yet both chlamydia and gonorrhea have serious complications if they spread into the uterus and/or fallopian tubes, causing pelvic inflammatory disease (PID). If left untreated, PID can cause permanent damage to the reproductive organs, leading to infertility, chronic pelvic pain, ectopic pregnancy and infertility. Both infections also increase the chance of acquiring HIV in individuals exposed to the virus.
It’s sad to say, but since the public awareness of HIV/AIDS has increased during the past 30 years, STDs such as chlamydia and gonorrhea have fallen off the radar and seem to be less threatening to many patients. But these diseases are far from gone. Approximately 2.8 million chlamydia infections and more than 700,000 new gonorrhea infections occur in the United States annually, the CDC estimates.
In addition to emphasizing the importance of prevention, I constantly remind patients about the relative ease of STD testing and treatment. Both chlamydia and gonorrhea can currently be treated with a single dose of antibiotic, but that may be changing.
In early June, the CDC reported the incidence of cephalosporin-resistant gonorrhea is increasing in Australia, France, Japan, Norway, Sweden and the United Kingdom.
Cephalosporins are currently considered the last line of defense against Neisseria gonorrhoeae, as it has already developed resistance to sulfas, penicillins, tetracycline and fluoroquinolones. There are no new drugs in the pipeline to treat gonorrhea, so if antimicrobial-resistant gonorrhea becomes widespread, the effects will be devastating and costly. Prevention may soon be our only defense against gonorrhea.
Simultaneously, STD prevention funding is dwindling. This makes it imperative that clinicians routinely screen at-risk populations and educat every patient about transmission, prevention and the possible long-term sequelae associated with STDs.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.