surveillance data and knowledge of the populations or geographic prevalence of STDs. These expanded programs should utilize diagnostic tests that are appropriate for screening persons in a variety of settings. Family planning clinics, prenatal clinics, facilities that provide pregnancy termination services, and other settings where obstetric or gynecological care is available should screen and treat women and their partners for sexually transmitted infections.

Premarital testing for syphilis, as a requirement for marriage licenses, is unnecessary and contributes little to containing syphilis because persons applying for marriage licenses are generally at lower risk for syphilis compared with the general population. Although these tests represent a source of revenue for some states, studies cited in Chapter 4 indicate that the number of previously undetected cases identified through premarital testing is extremely low; the tests are not cost-effective; and they have little public health impact. In addition, unnecessary testing may undermine public support for more appropriate screening programs, such as syphilis screening of women during early pregnancy.

Therefore, 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. The CDC, the Agency for Health Care Policy and Research, the National Institutes of Health, and other federal agencies should collaborate with health professional organizations and representatives of health plans to develop comprehensive, consensus clinical practice guidelines for primary care clinicians for STD-related services including screening, risk assessment, and counseling and other clinical interventions to promote healthy sexual behaviors. These guidelines should build on the work of the U.S. Preventive Services Task Force and the CDC STD treatment guidelines. These agencies and organizations should also work together to minimize any differences in current recommendations regarding clinical screening and management of STDs and to promote consistent clinical guidelines.
  • States that still have laws requiring premarital syphilis testing as a condition for marriage licenses should repeal these laws. Resources devoted to such testing would be more effective if used in other ways. States that rely heavily on revenue generated by such testing should consider alternative sources of revenue.
Improving Diagnosis and Treatment

The CDC's STD Treatment Guidelines are a valuable resource that represent the standard for treatment of STDs. Such treatment guidelines help to promote appropriate therapy for STDs on a national basis. Compliance with treatment guidelines is important because it helps ensure that patients receive the most



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