AMA Launches Screening Effort for STIs, Other Infections

Concerned that sexually transmitted diseases (STDs) and other serious infections have gone undetected during the COVID-19 pandemic, the American Medical Association has announced the creation of a toolkit for the nation's physicians to promote screening. 

The AMA said the move comes in the wake of a steep decline in physician visits involving screening for HIV, sexually transmitted infections (STIs), viral hepatitis, and latent tuberculosis.

The lack of access to preventive services caused by the pandemic resulted in many people being unaware they had these infections, increasing their risk of passing them on to others, according to the association. 

AMA President Jack Resneck Jr, MD, said routine screening and early detection of these illnesses were critical to ensuring patients receive treatment as well as lowering their risk of transmitting these infectious diseases to others. Although the toolkit has yet to be finalized, the group said it will focus on six areas: community outreach, patient intake, standardized screening protocols, testing and diagnosis, patient education and counseling after testing, and linkage to care. 

"Given that access to preventive services was interrupted by the COVID-19 pandemic, many individuals may not even be aware they have an infection and are at risk of contributing to new infections," Resneck said in a statement announcing the initiative. "The new toolkit will help increase screenings and prevent further spread of these infectious diseases." 

Resneck added that the outbreak of monkeypox is also a target of the new initiative. "[W]e look forward to the opportunity to work with the clinic sites in addressing this public health threat," he said.  

The AMA worked with the Centers for Disease Control and Prevention (CDC) to implement routine screening and developed the toolkit. The AMA is also collaborating with six community health center sites in Arizona, Illinois, Louisiana, Maryland, and Mississippi that will test quality improvement strategies outlined in the toolkit to determine their effect on routine screening, as well as provide overall feedback on the toolkit before it is disseminated more broadly.

STDs on the Rise

In its Sexually Transmitted Disease Surveillance, 2020 report, the CDC said that although reported cases of these infections in the United States decreased during the early months of the pandemic, most resurged by the end of that year. 

Reported cases of gonorrhea, syphilis, and congenital syphilis surpassed 2019 levels, while chlamydia declined. The CDC noted that STDs affect individuals of all ages but take a particularly heavy toll on young people. Youth ages 15-24 accounted for almost half of the 26 million new STDs that occurred in the United States in 2018, according to the agency.

Among the CDC's findings: 

• Reported cases of gonorrhea and primary and secondary syphilis in 2020 were up 10% and 7%, respectively, compared with 2019.

• Syphilis among newborns also increased, with reported cases up nearly 15% from 2019, and 235% from 2016. Early data indicate cases of primary, secondary syphilis, and congenital syphilis increased in 2021, as well.

• Reported cases of chlamydia declined 13% from 2019.

The CDC attributed the decline in reported cases of chlamydia — which historically accounts for the largest proportion of STDs in the United States — to a drop in screening and underdiagnosis during the pandemic rather than a reduction in new infections. The CDC said these factors also contributed to an overall decrease in the number of reported STDs in 2020, from 2.5 million reported cases in 2019 to 2.4 million in 2020.

Steven Morse, PhD, an infectious disease expert at Columbia University Medical Center, New York City, said, "The SARS-CoV-2/COVID-19 pandemic strained our public health and healthcare systems to their limit. We desperately need to reinvest in public health, and routine screening and prevention should be the absolute norm."

Georges Benjamin, MD, executive director of the American Public Health Association, called the new recommendations "a good reminder for healthcare professionals and patients about the importance of screenings for illnesses such as STDs and HIV and hepatitis C that often go neglected." 

He noted that although doctors routinely screen for hypertension and diabetes, they don't always screen for STDs and HIV due to assumptions about the types of populations that have them. "It is important that we screen everyone," Benjamin said. "I applaud the AMA for this reminder, especially since there were so many barriers to screenings during the height of the pandemic."

Sarah Lovinger, MD, an internist and addiction medicine specialist who spent 25 years working at Federally Qualified Health Centers in the Chicago area, also applauded the AMA's initiative.

But she said she wished the group offered specific recommendations for clinicians. 

"I understand that the AMA is a policy-making organization and not used to telling healthcare professionals how to practice, but it would have been nice if the AMA had given guidance on how often healthcare professionals should be testing for STDs and HIV and about where the funding for more screening is going to come from," she said. 

David Levine is an independent journalist and co-chairman of Science Writers in New York. He has written articles for The New York Times, Scientific American, Nature Medicine, the Los Angeles Times, Nautilus, and NEO.LIFE. 

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Cite this: AMA Launches Screening Effort for STIs, Other Infections - Medscape - Aug 16, 2022.