One in five people in the United States had a sexually transmitted infection (STI) on any given day in 2018, totaling nearly 68 million estimated infections. STIs are often asymptomatic (especially in women) and are therefore often undiagnosed and unreported. Untreated STIs can have severe health consequences, including chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological effects. In light of this, the Centers for Disease Control and Prevention, through the National Association of County and City Health Officials, commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee to examine the prevention and control of sexually transmitted infections in the United States and provide recommendations for action.

In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Although significant scientific advances have been made since that time, many of the problems and barriers described in that report persist today; STIs remain an underfunded and comparatively neglected field of public health practice and research. The committee reviewed the current state of STIs in the United States, and the resulting report, Sexually Transmitted Infections: Advancing a Sexual Health Paradigm, provides advice on future public health programs, policy, and research.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED INFECTIONS IN THE UNITED STATES
• Reviewers
• Preface
• Acknowledgments
• Acronyms and Abbreviations
• Abstract
• Summary
  • COMMITTEE’S APPROACH
  • 1. ADOPT A SEXUAL HEALTH PARADIGM
  • 2. BROADEN OWNERSHIP AND ACCOUNTABILITY FOR RESPONDING TO STIs
  • 3. BOLSTER EXISTING SYSTEMS AND PROGRAMS FOR RESPONDING TO STIs
  • 4. EMBRACE INNOVATION AND POLICY CHANGES TO IMPROVE SEXUAL HEALTH
  • CONCLUSION
• 1. Addressing STI Epidemics: Integrating Sexual Health, Intersectionality, and Social Determinants
  • INTRODUCTION
  • URGENCY OF ADDRESSING STIs
  • COMMITTEE’S APPROACH
  • CHANGES IN THE STI LANDSCAPE IN THE PAST 20 YEARS
  • STUDY PROCESS AND REPORT OVERVIEW
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 2. Patterns and Drivers of STIs in the United States
  • INTRODUCTION
  • INTERPRETATION OF SURVEILLANCE DATA
  • PATTERNS OF STIs IN THE UNITED STATES
  • DRIVERS OF STI OUTCOMES AND INEQUITIES
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 3. Priority Populations
  • INTRODUCTION
  • STIs ACROSS THE LIFE SPAN
  • PREGNANCY AND INFANCY
  • CHILDREN
  • ADOLESCENTS
  • CISGENDER HETEROSEXUAL ADULTS
  • SEXUAL AND GENDER DIVERSE POPULATIONS
  • MEN WHO HAVE SEX WITH MEN
  • TRANSGENDER AND GENDER DIVERSE ADULTS
  • LESBIAN, BISEXUAL, AND OTHER SEXUAL MINORITY WOMEN
  • LGBTQ+ YOUTH
  • OTHER POPULATIONS THAT REQUIRE FOCUSED CONSIDERATION
  • AMERICAN INDIAN/ALASKA NATIVE PEOPLE
  • PEOPLE WITH MILITARY EXPERIENCE
  • PEOPLE WITH DISABILITIES
  • PEOPLE WITH CRIMINAL LEGAL SYSTEM INVOLVEMENT
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 4. STI Economics, Public-Sector Financing, and Program Policy
  • INTRODUCTION
  • ROLE OF GOVERNMENT IN PREVENTION AND CONTROL OF STIs
  • OVERVIEW OF FEDERAL PROGRAMS
  • STATE AND LOCAL EFFORTS
  • ECONOMIC BURDEN OF STIs
  • CONCLUSIONS
  • REFERENCES
• 5. Intersection of HIV and STIs
  • INTRODUCTION
  • HISTORY
  • CONSEQUENCES OF STIs IN PEOPLE LIVING WITH HIV
  • IMPORTANT LESSONS FROM THE HIV PANDEMIC
  • CONCLUSIONS
  • REFERENCES
• 6. Role of Technology and New Media in Preventing and Controlling STIs
  • INTRODUCTION
  • TECHNOLOGIES
  • IMPLEMENTATION CONSIDERATIONS: COSTS AND FEASIBILITY
  • IMPLEMENTATION CONSIDERATIONS: ETHICS AND THE RAPIDLY CHANGING ENVIRONMENT
  • CONCLUSION AND RECOMMENDATION
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 7. Biomedical Tools for STI Prevention and Management
  • INTRODUCTION
  • TOOLS FOR STI DIAGNOSIS
  • ANTIMICROBIAL TOOLS FOR STI TREATMENT
  • TOOLS FOR STI PREVENTION
  • CONCLUSIONS AND RECOMMENDATION
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 8. Psychosocial and Behavioral Interventions
  • INTRODUCTION
  • CONTRIBUTIONS OF PSYCHOSOCIAL AND BEHAVIORAL INTERVENTIONS ON STI PREVENTION AND CONTROL
  • PSYCHOSOCIAL AND BEHAVIORAL INTERVENTIONS
  • INDIVIDUAL-LEVEL INTERVENTIONS
  • INTERPERSONAL-LEVEL INTERVENTIONS
  • COMMUNITY-LEVEL INTERVENTIONS
  • COST EFFECTIVENESS OF PSYCHOSOCIAL AND BEHAVIORAL INTERVENTIONS
  • TECHNOLOGY-BASED INTERVENTIONS
  • DISSEMINATION OF EVIDENCE-BASED BEHAVIORAL INTERVENTIONS
  • IMPLEMENTATION SCIENCE
  • CONCLUSIONS AND RECOMMENDATION
  • REFERENCES
• 9. Structural Interventions
  • INTRODUCTION
  • STRUCTURAL INTERVENTIONS TO DECREASE STIs IN MARGINALIZED U.S. GROUPS AND REDUCE STI INEQUITIES
  • MACRO-LEVEL STRUCTURAL INTERVENTIONS TO DECREASE STIs IN THE U.S. POPULATION OVERALL
  • MESO-LEVEL STRUCTURAL INTERVENTIONS TO DECREASE OVERALL STI RATES AND STI INEQUITIES
  • COMMUNITY MOBILIZATION FOR STRUCTURAL CHANGE RELATED TO STIs AND HIV
  • CONCLUSIONS AND RECOMMENDATION
  • REFERENCES
• 10. Paying for and Structuring STI Services
  • INTRODUCTION
  • PAYING FOR STI PREVENTION AND TREATMENT SERVICES
  • HEALTH INSURANCE COVERAGE REQUIREMENTS
  • ASSESSING SYSTEMS OF CARE AND ACCOUNTABILITY
  • CLINICAL STI SERVICES
  • STI SYSTEMS OF CARE
  • CONCLUSIONS AND RECOMMENDATION
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 11. Supporting and Expanding the Future STI Workforce
  • INTRODUCTION
  • SEXUAL HEALTH AND ETHICS AS AN ORGANIZING FRAMEWORK FOR THE STI WORKFORCE
  • CURRENT STI WORKFORCE IN THE UNITED STATES
  • LEVERAGING HEALTH CARE SYSTEMS AND PRACTITIONERS NOT TRADITIONALLY INVOLVED IN STI SERVICE DELIVERY
  • STRENGTHENING THE NATIONAL PUBLIC HEALTH WORKFORCE
  • STI WORKFORCE GAPS AND NEEDS
  • STI WORKFORCE EDUCATION AND DEVELOPMENT
  • CONCLUSION AND RECOMMENDATION
  • REFERENCES
• 12. Preparing for the Future of the STI Response
  • INTRODUCTION
  • REVIEW OF RECENTLY PUBLISHED REPORTS ADDRESSING STI PREVENTION IN THE UNITED STATES
  • NATIONAL ACADEMY OF PUBLIC ADMINISTRATION STI REPORTS
  • TREATMENT ACTION GROUP GONORRHEA, CHLAMYDIA, AND SYPHILIS PIPELINE REPORT 2019
  • STI NATIONAL STRATEGIC PLAN FOR THE UNITED STATES (2021–2025)
  • CHARTING A PATH FORWARD
  • ADOPT A SEXUAL HEALTH PARADIGM
  • BROADEN OWNERSHIP AND ACCOUNTABILITY FOR RESPONDING TO STIs
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• A. Characteristics of Major STIs in the United States
• B. STI Screening and Treatment Guidelines Issued by Health Professional Societies
• C. Measuring the Impact of Worrying About STIs on Quality of Life
• D. Public Meeting Agendas
• E. Committee Member and Staff Biographies

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2021. Sexually transmitted infections: Adopting a sexual health paradigm. Washington, DC: The National Academies Press. https://doi.org/10.17226/25955.

Digital Object Identifier: https://doi.org/10.17226/25955

Library of Congress Control Number: 2021935093

This activity was supported by a contract between the National Academy of Sciences and the Centers for Disease Control and Prevention through the National Association of County and City Health Officials (#2019-011503). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-68395-1 International Standard Book Number-10: 0-309-68395-5 Digital Object Identifier: https://doi.org/10.17226/25955 Library of Congress Control Number: 2021935093

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