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. 


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