public, especially adolescents and young adults, to be aware of and recognize symptoms of STDs; (d) motivate prompt health-care-seeking behaviors for symptoms of STDs; (e) ensure access to health care for STDs; (f) train clinicians in risk assessment and diagnosis of STDs; (g) provide access to, and laboratory capabilities for, STD testing; (h) train clinicians how to treat STDs, including use of syndromic treatment when laboratory tests are unavailable or results are pending; (i) make single-dose therapies available for clinicians to dispense directly to patients to ensure compliance; and (j) ensure treatment of sex partners exposed to STDs. The following discussion describes interventions at each of the steps designed to reduce exposure to STDs, reduce transmission to those exposed, and reduce duration of infection.

Reducing Exposure and Transmission

STDs result from exposure to infectious organisms through sexual contact with an infected individual. Risk factors for exposure include the frequency and type of one's sexual behaviors, use or nonuse of contraceptive methods that provide protection against transmission of STDs, and the likelihood that one's partner is infected. The same behavior (e.g., unprotected intercourse with a new partner) will carry very different levels of risk of transmission, depending on the likelihood of STDs in the social network from which one's partner is chosen. For example, individuals may engage in apparently high-risk behaviors but avoid an STD if their sex partners are not infected.

An important strategy for reducing the rate of spread of STDs is to identify and treat infected individuals and their partners. However, it is necessary to supplement this approach with an understanding of how individual behaviors contribute to both exposure and transmission. This is especially important in the case of STDs for several reasons. First, medical treatment will not prevent transmission of some asymptomatic and incurable STDs, such as HIV infection and other viral STDs. For these diseases, initial exposure must be avoided to prevent infection. Second, reduction of STDs will be facilitated not only by secondary prevention through treatment of infected individuals but also by preventing initial infections. Therefore, prevention of most STDs requires modification of the behaviors that place individuals at risk.

In this section, the committee summarizes how individual factors influence exposure to and transmission of STDs. The committee then illustrates how individual factors affect condom use and summarizes behavioral and clinical methods for preventing exposure and reducing transmission of STDs.

Individual Factors

Many factors influence an individual's sexual behavior and risk for STDs. These factors include sexual and other behaviors, perception of risk, and personal



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