level. The management and quality of services provided by dedicated public STD clinics, as described in Chapter 5, need significant improvement to ensure confidential, comprehensive, high-quality STD-related services for all persons. The committee has witnessed the wide variation in the quality, scope, accessibility, and availability of services provided by public STD clinics firsthand during their site visits and through their professional experience. Some public programs, usually university-affiliated, provide STD-related services that are personalized and efficient, and provide STD diagnostic and treatment services along with counseling and education, HIV testing and counseling, and family planning services. Many local health departments, especially in metropolitan areas, however, operate dedicated STD clinics that are isolated from other public health and personal health services, including HIV screening and counseling clinics. In many clinics, quality of care, monitoring, and assessment have not been a priority.

Ensuring Access and Quality

As discussed in Chapter 5, dedicated public STD clinics historically have emphasized serving large numbers of patients and their sex partners, who are identified through patient interviews. These clinics seldom emphasize the long-term disease management that chronic viral STDs require or effective long-term behavioral interventions that require multiple sessions. Examples of other appropriate long-term disease management activities include early management of HIV and hepatitis B virus infection, suppression of recurrent genital herpes, Pap smear screening and managing cervical dysplasia, administration of complete vaccination series for hepatitis B, and treatment of genital warts. In large cities, public STD clinics tend to be overwhelmed with patients, and provide impersonal care. Recruiting high-quality health care professionals to work in these settings is also difficult. In many small communities, dedicated STD clinics may be open for only several hours each week, relying on health personnel who may be inadequately trained in STDs and may have too many competing responsibilities. Moreover, these clinics often suffer from fragmentation and frequently are inefficiently managed.

Dedicated STD clinics help set community standards and train health professionals in STD prevention, including screening, risk assessment, diagnosis and treatment, partner notification, and education and counseling. In some areas, dedicated STD clinics serve as the focus for training of health professionals, performing clinical research in STDs, and setting standards for STD services in the public and private sectors. Although many small communities and communities with low STD rates do not require dedicated public STD clinics, nearly all states in the United States have one or more cities with such clinics. Again, local health officials need to assess the status of clinical services in their communities and determine the most appropriate model for delivering services. In all cases, health departments that operate dedicated public STD clinics should ensure that

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