STDs. Other factors that influence a clinician's ability to provide comprehensive services, including practice format constraints, also need to be addressed.

With respect to the above issues, the committee makes the following recommendation:

• The training of primary care providers should be improved by focusing on core clinical competencies, expanding training opportunities, gaining additional federal support, and monitoring and improving STD-related education.³

Major components of effective clinical management of STDs include screening, diagnosis and treatment, risk reduction counseling and education, identification and treatment of partners, and access to quality laboratory services for STDs. Screening allows for the detection of infected persons who would otherwise remain undetected, develop complications of STDs, and transmit the infection to their sex partners. Screening for STDs is cost-effective and sometimes cost-saving. Some screening programs, however, such as mandatory premarital testing for syphilis, are not cost-effective and contribute little to STD prevention. Therefore, screening should be appropriately focused and should be based on surveillance data and knowledge of the populations or prevalence of STDs. Screening programs for STDs such as chlamydial infection need to be expanded, because such programs can dramatically reduce rates of STD-related complications. Family planning clinics, prenatal clinics, and other settings where obstetric or gynecological care is available should screen and treat women and their partners for STDs.

With respect to the above issues, the committee makes the following recommendations:

• All primary care providers, including managed care organizations and other health plans, should implement the recommendations of the U.S. Preventive Services Task Force and the CDC regarding clinical screening and management of STDs.
• States that still have laws requiring premarital syphilis testing as a condition for marriage licenses should repeal these laws.

National treatment guidelines for STDs help promote appropriate therapy for STDs. However, because there is limited awareness of and compliance with these guidelines, especially among private sector health care professionals, such guidelines