Infectious Diseases

Physicians need to consider which risk factors, both behavioral and demographic, place individual patients at increased risk of infection. Although the evidence base establishing risk factors for each sexually transmitted infection (STI) is based on the particulars of the individual studies examining each STI, clinicians may choose to consider high-risk sexual behaviors as having multiple current partners, having a new partner, using condoms inconsistently, having sex while under the influence of alcohol or drugs, and having sex in exchange for money or drugs. In addition to evaluation of a patient's modifiable behaviors, physicians should consider their patients' nonmodifiable demographics and social situation.

As noted earlier, all U.S. communities do not present the same infection risk. For example, both syphilis and gonorrhea have significantly higher prevalence rates in the South and many urban centers. Because of underlying social factors that increase STI risk, including poverty, discrimination, and social networks, black and Hispanic Americans have higher prevalence rates of most STIs. When considering screening for STIs, physicians should consult with local public health officials and use national, regional, and local epidemiologic data to tailor screening programs based on communities and populations they serve. In addition to behavioral risk factors, physicians should remember that for chlamydial infection and gonorrhea, all sexually active women age 24 years and younger are considered at increased risk (Meyers et al., 2008).

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