Also in the Spring 2009 issue of the Guttmacher Policy Review:
Screening and treatment to keep sexually transmitted infections (STIs) from causing serious harm is a critical, if under-appreciated public health intervention, according to a new policy analysis published in the Spring 2009 issue of the Guttmacher Policy Review.
Such "secondary prevention" strategies focused on testing and treatment—rather than preventing the infection itself—have long been effective in averting cervical cancer, the most harmful consequence of the human papillomavirus (HPV). Even though millions of Americans are infected with HPV each year, Pap smears have proven extremely effective at detecting precursors to the cancer early on when they can be treated easily and quickly. This secondary prevention strategy has made cervical cancer rare in relation to the total number of HPV infections, with fewer than 4,000 deaths occurring each year.
"Secondary prevention is a tried and proven approach to limiting STIs’ most harmful consequences, such as cancers or infertility," says Adam Sonfield, author of the new analysis. "Rather than focusing so much on the total numbers of infections in the country, policymakers and the public should concentrate more on ways to block the consequences of these infections. Even for HIV and other dangerous STIs, secondary prevention tactics have a major role to play."
Recent studies have shown, for example, that drugs commonly used to treat and suppress herpes can reduce transmission by half. And for HIV-positive individuals who—thanks to antiretroviral drugs and other high-quality treatment and care—have no detectable viral loads, the risk of infecting a partner may be extremely low.
One approach to treating STIs that has generated considerable interest in recent years is known as expedited partner therapy, in which a health care provider will make antibiotics available to their patient’s partner without an actual diagnosis for that individual. This tactic works best with infections like chlamydia and gonorrhea, where effective single-dose therapies are available to minimize the chance of improper or incomplete treatment and in situations where it is difficult to convince the partner to come in for testing.
"Expedited partner therapy is a crucial innovation. It not only benefits the partner, but also prevents reinfection of the original patient by their partner. It’s another approach where treatment also works as prevention," says Sonfield. "Expedited partner therapy enjoys broad support among public health and medical experts, including the Centers for Disease Control and Prevention. Right now, Illinois is poised to become the 10th state since 2006 to address questions about the therapy’s legality and officially add it to clinicians’ toolbox for fighting STIs."
Another challenge to STI prevention is that sexual activity typically occurs within a relatively closed network, where even a small number of people with several concurrent partners can have profound ripple effects. In response, public health officials have launched community-based efforts to identify the people who are "hubs" of such networks to help educate them about their STI status and the risks their behavior poses for others, and to cure or suppress the infection.
"It’s clear no one tactic is the silver bullet in stemming the spread of sexually transmitted infections," says Sonfield. "Chronically underfunded public health budgets will need to be increased substantially. And it will take a combination of interventions, including comprehensive sex education, partner services and community-based efforts to promote testing and treatment. These steps must be accompanied by efforts to address broad underlying problems in the community, such as a lack of access to health care."
"It remains to be seen whether a solution, in the form of national health care reform, will fare better in Congress than funding for combating sexually transmitted infections has in the past," says Sonfield.
Click here for "For Some Sexually Transmitted Infections, Secondary Prevention May Be Primary," by Adam Sonfield, in the Spring 2009 issue of the Guttmacher Policy Review.