The U.S. needs a more holistic approach to control the spread of sexually transmitted infections, a leading expert in the field says.

Health officials should search social networking websites and use more-comprehensive screening tests to trace the spread and treat of such infections, Dr. Peter Leone, professor of medicine and epidemiology at University of North Carolina, said.

“We really need to prioritize. Given the at-risk population, we really need to ask what the primary drivers are” for STIs, Leone said in a conference presentation here. “Otherwise, we’re continuing to treat the pathogen when the problem is not the pathogen, it’s the environment” where the pathogen spreads.

Leone, who is also medical director of the North Carolina HIV/STD Prevention and Control Branch, addressed other experts March 14, the last day of the four-day International Conference on Emerging Infectious Diseases here.

Social networks and STIs

Leone emphasized the use of social networks when an infection is found. By working with a patient to identify the people he or she had sexual contact with, efforts can be focused on higher-risk individuals, he said.

Currently doctors inform patients about laws requiring patients to notify their past partners, but it would be more effective if health care workers reached out through social networks to people who know someone who is infected. This could lead to the screening of people who, based on their behavior, are at high risk, instead of just the people along a single path of infection.

This is important, Leone said, because STIs are often asymptomatic and can spread without the person’s knowledge. Furthermore, many men are not accessing the health care system regularly for physicals and therefore may have infections that are being missed.

Leone noted that some public health officials have expanded their screening efforts by creating a system for people to mail in samples for testing.

A broader view

Another needed step, Leone said, is to begin considering how to best curb the spread of all STIs together, rather than as individual diseases.

The narrower focus has created some problems in the past, he said. As an example, Leone cited public health messages that informed people that the risk of contracting HIV is lower for oral sex than for vaginal intercourse. When those efforts were put in place, he said, health care providers should have been made aware that they needed to be more vigilant in oral screening tests for other STIs.

As it is, screening tests are often conducted only on the genitals. That approach “misses the overwhelming majority of STIs that are out there,” Leone said.

One 2005 study of nearly 600 HIV patients in San Francisco, for example, found that nearly all chlamydia and gonorrhea infections were in body parts other than the genitals. Over 10 percent of patients had an infection, but researchers concluded that without throat and rectal testing, they would have missed 79 percent of chlamydia infections and 100 percent of gonorrhea infections.

Leone added that the inflammation caused by one STD can make a person more susceptible to another, even when the symptoms aren’t enough to send the person in for testing.

The conference was sponsored by the Centers for Disease Control and Prevention and managed by the American Society for Microbiology.

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