Sexually transmitted infections (STIs) are on the rise in the United States and have significant health and economic impacts, but pharmacists can help combat the spread as they work with affected patients.
Despite the amusing session title, there was not a lot to chuckle about during a session called “What Happens in Vegas, Does Not Always Stay in Vegas: Sexually Transmitted Infections Treatment and Prevention Updates” during the 2022 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exhibition.
The United States has one of the highest rates of sexually transmitted infections (STIs) compared with other high-income countries, said Raul A. Santiago, PharmD, BCPS, BCIDP, a clinical pharmacy specialist in infectious diseases at Brigham and Women's Faulkner Hospital in Boston, Massachusetts.
An underfunded and neglected public health system, the hidden nature of symptoms once an infection is no longer asymptomatic, and discrimination against racial/ethnic minorities as well as sexual/gender minorities are just some of the factors driving the increase.
For comparisons, Santiago contrasted the United States with 3 other similar countries.
The US rate of chlamydia per 100,000 individuals is nearly 540, compared with 427.5 for Australia, 363.2 for Canada, and 365.7 for the United Kingdom. For gonorrhea, the US rate is 179, while Australia’s is 126.8, Canada’s is 95.8, and the United Kingdom’s is 93.2.
Gonorrhea was dropping in the United States until 2000, but there has been a 1.4-fold increase since then, and an 80% increase from a historically low rate in 2009.
Chlamydia has also seen a 2-fold increase since 2000 and primary/secondary syphilis has increased 5-fold. Between 2014 to 2018, congenital syphilis spiked 185%.
The myriad consequences of STIs include links to cancer, reproductive complications, perinatal transmission, and an increased HIV risk. Direct medical costs in 2018 were nearly $16 billion.
Adolescents and young adults aged 15 to 24 years bear the most disproportionate impact of STIs, and while most of the factors that affect their rate are the same that affect all marginalized populations (eg, cost of treatment, medical mistrust, availability of care, inadequate/misleading sexual education, low health literacy), there are some that factors that are unique to this age group.
For instance, providers may have some discomfort around this issue or have their own beliefs about adolescent sexual behavior that present a barrier, or may have concerns around parental permission/confidentiality.
However, all 50 states allow minors to be screened for STIs without parental permission, although 18 of them allow notification of parents.
Two ways pharmacists can raise awareness of STIs and encourage treatment are getting familiar with expedited partner therapy (EPT) and making sure their sites have sexual health services available, including availability of HIV PEP and PrEP.
EPT is the practice of treating the sex partners of patients diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the patient to take to their partner without the health care provider first examining the partner, according to the CDC.
Although it is legal in 46 states, and potentially allowable in 4, there is a lack of awareness about it, Santiago said.
One survey of 133 pharmacists in New England and New York found that half were familiar with EPT as a concept, but 80% did not know which STIs were covered by their state regulations.
When communicating with patients, pharmacists should also take care to be mindful of body language and reactions, use neutral and inclusive terminology, and avoid assumptions.
The session also included updates on STI treatment issued last year by the CDC.