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STDs and Testing in CPCs

July 2000
By: Joe McIlhaney and Joshua Mann

Crisis pregnancy centers are making a difference. It's a difference that is being felt throughout communities, not just within small segments of society. In addition to traditional pregnancy testing and counseling, many CPCs provide medical and other services. These services include pregnancy testing; ultrasonography; prenatal care; counseling about pregnancy and STD prevention; parenting and childbirth classes; nutritional counseling; and referrals to public and private agencies for assistance such as Medicaid; the Women, Infants, and Children (WIC) program; Temporary Aid to Needy Families (TANF); shelters for battered women; and health care.

Testing for sexually transmitted diseases can be an important function for CPC-based medical clinics. Some women served by CPCs are at high risk for STDs.

Studies of young, sexually active women have revealed alarmingly high rates of STDs. A recent study of sexually active female students at Rutgers University showed that 60 percent were infected with the human papillomavirus (HPV), the primary cause of cervical cancer, at some point during the three-year study (Ho, 1998). At their induction physicals, approximately 10 percent of female United States Army recruits were found to be infected with Chlamydia trachomatis, a common cause of infertility among women (Gaydos, 1998). Similarly, new data show that 9.6 percent of teens requesting pregnancy testing at family planning clinics are infected with chlamydia, and 14 percent report having had an STD previously (STD Advisor, 2000). On the basis of these statistics, researchers from Johns Hopkins University have recommended that all sexually active adolescent females receive screening for chlamydia infection every six months (Burstein, 1998).

Testing and counseling regarding STDs can provide an opportunity to emphasize the need for unmarried women to avoid sexual activity. Unmarried individuals who have been sexually active, even those who have had multiple sexual partners, should be counseled about the benefits of abstaining from sexual intercourse from that point until marriage. Abstinence prevents both future pregnancies and STDs. There is a direct correlation between the risk of STDs and the number of lifetime sexual partners. For example, 10 percent of Americans with one lifetime sexual partner have been infected with genital herpes compared to 21 percent of those with two to four partners, 26 percent of those with five to nine partners, and 31 percent of those with 10 to 49 partners (Fleming, 1997). Similarly, the risk of HPV infection is strongly associated with the number of lifetime partners and partners in the previous year (Ho, 1998).

Because of this data, The Medical Institute for Sexual Health advocates that every sexually active single individual receive STD testing every time he or she has a new sexual partner or any time a sexual partner admits to having had another partner. Even if a single woman reports being monogamous, she should be tested every six months to one year, since her sexual partner may have other sexual partners about which she is unaware. Tests should be done for chlamydia, gonorrhea, syphilis, herpes, HIV, HPV, and hepatitis B. Hepatitis B testing is not necessary for women who have been completely vaccinated against this infection. Those who have not been vaccinated and test negative for infection should be referred for vaccination.

Chlamydia and gonorrhea typically are diagnosed by culture or DNA testing of samples taken during a pelvic examination. Tests to detect the infections in urine are available but may be too expensive for use by most CPCs. Trichomoniasis is typically diagnosed by microscopically examining a sample obtained during pelvic examination. A test for culture of trichomonas is also available. Screening for syphilis, herpes, hepatitis, and HIV is conducted using blood tests. HPV typically is not tested for directly, but Pap smears to detect pre-cancerous changes in the cervix caused by HPV should be performed yearly on all women who have ever had sexual intercourse.

The standards set by the Clinical Laboratory Improvement Act apply to CPCs providing clinical services. CPCs should consult with local health agencies prior to becoming involved in screening activities. It is also advisable to seek direction from one of the major crisis pregnancy center networks about the requirements for becoming licensed to provide STD testing services.

Finally, before beginning any new services, it is advisable for the CPC to assess the needs of its clients and to determine what services are available locally already. It may be more effective to provide these services in collaboration with other agencies. For example, a CPC located next door to a physician's office or a public health clinic may find it more cost effective to refer clients to that clinic for screening or treatment. Of course, this assumes that the other office agrees to handle the extra patients and that clients will go to receive the services. It is also prudent to ensure that collaborating agencies will provide services in a way that is consistent with the philosophy and goals of the CPC. In general, screening programs will be most successful when a client can receive the screening and counseling services while in the CPC for her initial visit. Budgetary constraints may determine which arrangement is preferable.

CPCs are uniquely positioned to detect undiagnosed STDs in sexually active single women. The women they serve are likely to be at high risk for STDs and their complications. Clients who are found to be infected with an STD can be treated or referred for treatment. Early treatment can minimize the impact of these diseases and even save lives. By providing these services, CPCs demonstrate compassion for their clientele and gain opportunities for additional counseling. In that context, women may be more likely to heed the advice offered and make choices in the best interest of themselves, their families, and future children.

Joe S. McIlhaney, Jr., M.D., is a board-certified obstetrician/gynecologist who resides in Austin, Texas. In 1995, he left his private practice of 28 years to devote his full-time attention to working with The Medical Institute for Sexual Health, which he established in 1992.

Currently, he spends his time speaking and writing about the twin epidemics of STDs and non-marital pregnancy. Additionally, Dr. McIlhaney is the author of six books including his latest publication, Sex: What You Don't Know Can Kill You.

Dr. Joshua Mann is a board-eligible preventive medicine physician who resides in Austin, Texas. He received his Master in Public Health from the University of South Carolina and completed residency training in preventive medicine from the University of South Carolina. During residency training he became interested in the promotion of abstinence as the only truly safe method of preventing sexually transmitted disease and unwed pregnancy. He is the Director of Research at The Medical Institute for Sexual Health.

Dr. McIlhaney and Dr. Mann can be reached at The Medical Institute for Sexual Health, P.O. Box 162306, Austin, TX. Phone: 512-328-6268.

Additional Sources: Burstein, G.R.; Gaydos, C.A.; Diener-West, M.; Howell, M.R.; Zenilman, J.M.; and Quinn, T.C.; "Incident Chlamydia trachomatis infections among inner-city adolescent females," Journal of the American Medical Assoc., 280: 521-526, Aug. 12, 1998.

"Chlamydia rampant in teens seeking pregnancy tests," STD Advisor, 3:30-31, Mar., 2000.

Fleming, D.T.; McQuillan, G.M.; Johnson, R.E.; et al.; "Herpes simplex virus type 2 in the United States, 1976 to 1994," The New England Journal of Medicine, 337:1105-1111, October 16, 1997.

Gaydos, C.A.; Howell M.R.; Pare B.; et al., "Chlamydia trachomatis infections in female military recruits," The New England Journal of Medicine, 339:739-744, September 10, 1998.

5. Ho, G.Y.F.; Bierman R.; Beardsley N.P.; Chang C.J.; and Burk R.D., "Natural history of cervicovaginal papillomavirus infection in young women," The New England Journal of Medicine, 338:423-428, February 12, 1998.

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