UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Prevention of sexually transmitted infections

Authors
Cynthia L Gay, MD, MPH
Myron S Cohen, MD
Section Editor
Noreen A Hynes, MD, MPH, DTM&H
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

Sexually transmitted infections (STIs) are common and preventable causes of morbidity and serious complications. Untreated chlamydial and gonococcal infection may result in pelvic inflammatory disease, which can lead to infertility, ectopic pregnancy, and chronic pelvic pain in 10 to 20 percent of cases [1]. STIs can also result in adverse outcomes in pregnancy, including spontaneous abortion, still birth, premature birth, and congenital infection [2]. Finally, the presence of STIs can facilitate HIV transmission [3-5]. Thus, primary prevention of STIs needs to be given high priority.

This topic addresses issues related to the prevention of sexually transmitted infections. Prevention of HIV infection is discussed in more detail elsewhere. (See "HIV infection: Risk factors and prevention strategies".)

Screening for sexually transmitted infections is discussed elsewhere. (See "Screening for sexually transmitted infections".)

EPIDEMIOLOGY

A key strategy in the prevention of STIs involves the screening, diagnosis, and treatment of patients, as well as their sexual partners, to interrupt transmission. Routine sexual histories are critical to allow targeted STI screening and prevention counseling. Assessment of any history of substance abuse, which can lead to disinhibition and risk-taking behaviors, is also important. Risk factors are listed below:

Unmarried status

                                                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Nov 05 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Weström L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol 1980; 138:880.
  2. Goldenberg RL, Andrews WW, Yuan AC, et al. Sexually transmitted diseases and adverse outcomes of pregnancy. Clin Perinatol 1997; 24:23.
  3. Galvin SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol 2004; 2:33.
  4. Wasserheit JN. Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992; 19:61.
  5. Røttingen JA, Cameron DW, Garnett GP. A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known? Sex Transm Dis 2001; 28:579.
  6. Centers for Disease Control and Prevention (CDC). Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. MMWR Recomm Rep 2008; 57:1.
  7. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance - United States, 2015. MMWR Surveill Summ 2016; 65:1.
  8. Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6.
  9. http://www.cdc.gov/std/treatment/2010/default.htm (Accessed on October 16, 2014).
  10. COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE and, BRIGHT FUTURES PERIODICITY SCHEDULE WORKGROUP. 2016 Recommendations for Preventive Pediatric Health Care. Pediatrics 2016; 137:1.
  11. Crepaz N, Marks G, Liau A, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis. AIDS 2009; 23:1617.
  12. Johnson WD, Diaz RM, Flanders WD, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev 2008; :CD001230.
  13. Guimarães MD, Grinsztejn B, Chin-Hong PV, et al. Behavior surveillance: prevalence and factors associated with high-risk sexual behavior among HIV-infected men in Brazil in the post-HAART era. AIDS Behav 2008; 12:741.
  14. Ng BE, Butler LM, Horvath T, Rutherford GW. Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection. Cochrane Database Syst Rev 2011; :CD001220.
  15. United States Department of Health and Human Services, Health Resources and Services Administration. Guide for HIV/AIDS Clinical Care, January 2011. http://hab.hrsa.gov/deliverhivaidscare/clinicalguide11/ (Accessed on October 16, 2012).
  16. Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep 2006; 55:1.
  17. Trepka MJ, Weisbord JS, Zhang G, Brewer T. Hepatitis B virus infection risk factors and immunity among sexually transmitted disease clinic clients. Sex Transm Dis 2003; 30:914.
  18. Poovorawan Y, Chongsrisawat V, Theamboonlers A, et al. Long-term benefit of hepatitis B vaccination among children in Thailand with transient hepatitis B virus infection who were born to hepatitis B surface antigen-positive mothers. J Infect Dis 2009; 200:33.
  19. Liang X, Bi S, Yang W, et al. Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China. J Infect Dis 2009; 200:39.
  20. Chang MH, You SL, Chen CJ, et al. Decreased incidence of hepatocellular carcinoma in hepatitis B vaccinees: a 20-year follow-up study. J Natl Cancer Inst 2009; 101:1348.
  21. Harper DM, Franco EL, Wheeler CM, et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet 2006; 367:1247.
  22. Villa LL, Costa RL, Petta CA, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol 2005; 6:271.
  23. Centers for Disease Control and Prevention (CDC). Notes from the field: serogroup C invasive meningococcal disease among men who have sex with men - New York City, 2010-2012. MMWR Morb Mortal Wkly Rep 2013; 61:1048.
  24. European Center for Disease Prevention and Control. Invasive meningococcal disease among men who have sex with men. July 2013. http://www.ecdc.europa.eu/en/publications/Publications/rapid-risk-assessment-invasive-meningococcal-disease-among-MSM.pdf (Accessed on October 31, 2013).
  25. Feinstone SM, Hu DJ, Major ME. Prospects for prophylactic and therapeutic vaccines against hepatitis C virus. Clin Infect Dis 2012; 55 Suppl 1:S25.
  26. Hook EW 3rd. An ounce of prevention. Ann Intern Med 2005; 143:751.
  27. World Health Organization. Guidelines for the management of sexually transmitted infections. Geneva: World Health Organization 2003. www.who.int/reproductive-health/publications/rhr_01_10/0110.pdf (Accessed on November 15, 2011).
  28. Workshop summary: scientific evidence on condom effectiveness for sexually transmitted diseases (STD) prevention. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Service, Herndon, VA 2000.
  29. Hariri S, Warner L. Condom use and human papillomavirus in men. J Infect Dis 2013; 208:367.
  30. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ 2004; 82:454.
  31. Isbey SF, Alcorn TM, Davis RH, et al. Characterisation of Neisseria gonorrhoeae in semen during urethral infection in men. Genitourin Med 1997; 73:378.
  32. Sánchez J, Campos PE, Courtois B, et al. Prevention of sexually transmitted diseases (STDs) in female sex workers: prospective evaluation of condom promotion and strengthened STD services. Sex Transm Dis 2003; 30:273.
  33. García PJ, Holmes KK, Cárcamo CP, et al. Prevention of sexually transmitted infections in urban communities (Peru PREVEN): a multicomponent community-randomised controlled trial. Lancet 2012; 379:1120.
  34. Crosby RA, DiClemente RJ, Wingood GM, et al. Value of consistent condom use: a study of sexually transmitted disease prevention among African American adolescent females. Am J Public Health 2003; 93:901.
  35. Ahmed S, Lutalo T, Wawer M, et al. HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS 2001; 15:2171.
  36. Rosenberg MJ, Davidson AJ, Chen JH, et al. Barrier contraceptives and sexually transmitted diseases in women: a comparison of female-dependent methods and condoms. Am J Public Health 1992; 82:669.
  37. Warner L, Stone KM, Macaluso M, et al. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33:36.
  38. Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med 2006; 354:2645.
  39. Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis 2002; 29:725.
  40. Hogewoning CJ, Bleeker MC, van den Brule AJ, et al. Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial. Int J Cancer 2003; 107:811.
  41. Bleeker MC, Hogewoning CJ, Voorhorst FJ, et al. Condom use promotes regression of human papillomavirus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia. Int J Cancer 2003; 107:804.
  42. Nielson CM, Harris RB, Nyitray AG, et al. Consistent condom use is associated with lower prevalence of human papillomavirus infection in men. J Infect Dis 2010; 202:445.
  43. Pierce Campbell CM, Lin HY, Fulp W, et al. Consistent condom use reduces the genital human papillomavirus burden among high-risk men: the HPV infection in men study. J Infect Dis 2013; 208:373.
  44. Repp KK, Nielson CM, Fu R, et al. Male human papillomavirus prevalence and association with condom use in Brazil, Mexico, and the United States. J Infect Dis 2012; 205:1287.
  45. Al-Tawfiq JA, Harezlak J, Katz BP, Spinola SM. Cumulative experience with Haemophilus ducreyi 35000 in the human model of experimental infection. Sex Transm Dis 2000; 27:111.
  46. Koss CA, Dunne EF, Warner L. A systematic review of epidemiologic studies assessing condom use and risk of syphilis. Sex Transm Dis 2009; 36:401.
  47. Ness RB, Randall H, Richter HE, et al. Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease. Am J Public Health 2004; 94:1327.
  48. Wilkinson D, Tholandi M, Ramjee G, Rutherford GW. Nonoxynol-9 spermicide for prevention of vaginally acquired HIV and other sexually transmitted infections: systematic review and meta-analysis of randomised controlled trials including more than 5000 women. Lancet Infect Dis 2002; 2:613.
  49. Wetmore CM, Manhart LE, Wasserheit JN. Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future. Epidemiol Rev 2010; 32:121.
  50. Siegfried N, Muller M, Deeks J, et al. HIV and male circumcision--a systematic review with assessment of the quality of studies. Lancet Infect Dis 2005; 5:165.
  51. Mutabazi V, Kaplan SA, Rwamasirabo E, et al. HIV prevention: male circumcision comparison between a nonsurgical device to a surgical technique in resource-limited settings: a prospective, randomized, nonmasked trial. J Acquir Immune Defic Syndr 2012; 61:49.
  52. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007; 369:657.
  53. Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009; 374:229.
  54. Mahiane SG, Legeai C, Taljaard D, et al. Transmission probabilities of HIV and herpes simplex virus type 2, effect of male circumcision and interaction: a longitudinal study in a township of South Africa. AIDS 2009; 23:377.
  55. Tobian AA, Serwadda D, Quinn TC, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med 2009; 360:1298.
  56. Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect 2006; 82:101.
  57. Van Howe RS. Genital ulcerative disease and sexually transmitted urethritis and circumcision: a meta-analysis. Int J STD AIDS 2007; 18:799.
  58. Langeni T. Male circumcision and sexually transmitted infections in Botswana. J Biosoc Sci 2005; 37:75.
  59. Mehta SD, Moses S, Parker CB, et al. Circumcision status and incident herpes simplex virus type 2 infection, genital ulcer disease, and HIV infection. AIDS 2012; 26:1141.
  60. Mehta SD, Gaydos C, Maclean I, et al. The effect of medical male circumcision on urogenital Mycoplasma genitalium among men in Kisumu, Kenya. Sex Transm Dis 2012; 39:276.
  61. Tobian AA, Charvat B, Ssempijja V, et al. Factors associated with the prevalence and incidence of herpes simplex virus type 2 infection among men in Rakai, Uganda. J Infect Dis 2009; 199:945.
  62. Mehta SD, Moses S, Agot K, et al. Medical male circumcision and herpes simplex virus 2 acquisition: posttrial surveillance in Kisumu, Kenya. J Infect Dis 2013; 208:1869.
  63. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007; 369:643.
  64. Mehta SD, Moses S, Agot K, et al. Adult male circumcision does not reduce the risk of incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis infection: results from a randomized, controlled trial in Kenya. J Infect Dis 2009; 200:370.
  65. Gray RH, Serwadda D, Kong X, et al. Male circumcision decreases acquisition and increases clearance of high-risk human papillomavirus in HIV-negative men: a randomized trial in Rakai, Uganda. J Infect Dis 2010; 201:1455.
  66. Serwadda D, Wawer MJ, Makumbi F, et al. Circumcision of HIV-infected men: effects on high-risk human papillomavirus infections in a randomized trial in Rakai, Uganda. J Infect Dis 2010; 201:1463.
  67. Senkomago V, Backes DM, Hudgens MG, et al. Acquisition and persistence of human papillomavirus 16 (HPV-16) and HPV-18 among men with high-HPV viral load infections in a circumcision trial in Kisumu, Kenya. J Infect Dis 2015; 211:811.
  68. Wawer MJ, Tobian AA, Kigozi G, et al. Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda. Lancet 2011; 377:209.
  69. Golden MR, Wasserheit JN. Prevention of viral sexually transmitted infections--foreskin at the forefront. N Engl J Med 2009; 360:1349.
  70. Schechter M, do Lago RF, Mendelsohn AB, et al. Behavioral impact, acceptability, and HIV incidence among homosexual men with access to postexposure chemoprophylaxis for HIV. J Acquir Immune Defic Syndr 2004; 35:519.
  71. Kahn JO, Martin JN, Roland ME, et al. Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: the San Francisco PEP Study. J Infect Dis 2001; 183:707.
  72. Heuker J, Sonder GJ, Stolte I, et al. High HIV incidence among MSM prescribed postexposure prophylaxis, 2000-2009: indications for ongoing sexual risk behaviour. AIDS 2012; 26:505.
  73. Mayer KH, Mimiaga MJ, Gelman M, Grasso C. Raltegravir, tenofovir DF, and emtricitabine for postexposure prophylaxis to prevent the sexual transmission of HIV: safety, tolerability, and adherence. J Acquir Immune Defic Syndr 2012; 59:354.
  74. Sonder GJ, Prins JM, Regez RM, et al. Comparison of two HIV postexposure prophylaxis regimens among men who have sex with men in Amsterdam: adverse effects do not influence compliance. Sex Transm Dis 2010; 37:681.
  75. Diaz-Brito V, León A, Knobel H, et al. Post-exposure prophylaxis for HIV infection: a clinical trial comparing lopinavir/ritonavir versus atazanavir each with zidovudine/lamivudine. Antivir Ther 2012; 17:337.
  76. Pirrone V, Thakkar N, Jacobson JM, et al. Combinatorial approaches to the prevention and treatment of HIV-1 infection. Antimicrob Agents Chemother 2011; 55:1831.
  77. Cutler B, Justman J. Vaginal microbicides and the prevention of HIV transmission. Lancet Infect Dis 2008; 8:685.
  78. Saxena BB, Han YA, Fu D, et al. Sustained release of microbicides by newly engineered vaginal rings. AIDS 2009; 23:917.
  79. Skoler-Karpoff S, Ramjee G, Ahmed K, et al. Efficacy of Carraguard for prevention of HIV infection in women in South Africa: a randomised, double-blind, placebo-controlled trial. Lancet 2008; 372:1977.
  80. Van Damme L, Govinden R, Mirembe FM, et al. Lack of effectiveness of cellulose sulfate gel for the prevention of vaginal HIV transmission. N Engl J Med 2008; 359:463.
  81. http://www.mdp.mrc.ac.uk/archive.html (Accessed on January 11, 2012).
  82. McCormack S, Ramjee G, Kamali A, et al. PRO2000 vaginal gel for prevention of HIV-1 infection (Microbicides Development Programme 301): a phase 3, randomised, double-blind, parallel-group trial. Lancet 2010; 376:1329.
  83. Obiero J, Mwethera PG, Wiysonge CS. Topical microbicides for prevention of sexually transmitted infections. Cochrane Database Syst Rev 2012; :CD007961.
  84. Patel S, Hazrati E, Cheshenko N, et al. Seminal plasma reduces the effectiveness of topical polyanionic microbicides. J Infect Dis 2007; 196:1394.
  85. Rohan LC, Hillier SL, Dezzutti CS. Preventing the sexual transmission of HIV-1 with topical microbicides: another piece of the equation. J Infect Dis 2007; 196:1285.
  86. Fuchs EJ, Lee LA, Torbenson MS, et al. Hyperosmolar sexual lubricant causes epithelial damage in the distal colon: potential implication for HIV transmission. J Infect Dis 2007; 195:703.
  87. Padian NS, van der Straten A, Ramjee G, et al. Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet 2007; 370:251.
  88. Ramjee G, van der Straten A, Chipato T, et al. The diaphragm and lubricant gel for prevention of cervical sexually transmitted infections: results of a randomized controlled trial. PLoS One 2008; 3:e3488.
  89. LeFevre ML, U.S. Preventive Services Task Force. Behavioral counseling interventions to prevent sexually transmitted infections: U.S. PreventiveServices Task Force recommendation statement. Ann Intern Med 2014; 161:894.
  90. O'Connor EA, Lin JS, Burda BU, et al. Behavioral sexual risk-reduction counseling in primary care to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 161:874.
  91. Kamb ML, Fishbein M, Douglas JM Jr, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. JAMA 1998; 280:1161.
  92. Dilley JW, Woods WJ, Loeb L, et al. Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: results from a randomized controlled trial using paraprofessional counselors. J Acquir Immune Defic Syndr 2007; 44:569.
  93. Metsch LR, Feaster DJ, Gooden L, et al. Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial. JAMA 2013; 310:1701.
  94. Haukoos JS, Thrun MW. Eliminating prevention counseling to improve HIV screening. JAMA 2013; 310:1679.
  95. Ciesielski C, Kahn RH, Taylor M, et al. Control of syphilis outbreaks in men who have sex with men: the role of screening in nonmedical settings. Sex Transm Dis 2005; 32:S37.
  96. Denno DM, Chandra-Mouli V, Osman M. Reaching youth with out-of-facility HIV and reproductive health services: a systematic review. J Adolesc Health 2012; 51:106.
  97. Sullivan PS, Grey JA, Simon Rosser BR. Emerging technologies for HIV prevention for MSM: what we have learned, and ways forward. J Acquir Immune Defic Syndr 2013; 63 Suppl 1:S102.
  98. Taylor M, Aynalem G, Smith L, et al. Correlates of Internet use to meet sex partners among men who have sex with men diagnosed with early syphilis in Los Angeles County. Sex Transm Dis 2004; 31:552.
  99. McFarlane M, Bull SS, Rietmeijer CA. The Internet as a newly emerging risk environment for sexually transmitted diseases. JAMA 2000; 284:443.
  100. Elford J, Bolding G, Sherr L. Seeking sex on the Internet and sexual risk behaviour among gay men using London gyms. AIDS 2001; 15:1409.
  101. Klausner JD, Levine DK, Kent CK. Internet-based site-specific interventions for syphilis prevention among gay and bisexual men. AIDS Care 2004; 16:964.
  102. McFarlane M, Kachur R, Klausner JD, et al. Internet-based health promotion and disease control in the 8 cities: successes, barriers, and future plans. Sex Transm Dis 2005; 32:S60.
  103. Swartzendruber A, Zenilman JM. A national strategy to improve sexual health. JAMA 2010; 304:1005.
  104. Michael Harrington. The Other America: Poverty in the United States, Scribner, 1962.
  105. Baird SJ, Garfein RS, McIntosh CT, Ozler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet 2012; 379:1320.
  106. Pettifor A, McCoy SI, Padian N. Paying to prevent HIV infection in young women? Lancet 2012; 379:1280.
  107. Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005; 352:676.
  108. Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis 2005; 41:623.