Fast Facts

• Many STIs are asymptomatic, meaning you can't tell you if have one without being tested. It's important to get tested regularly if you're sexually active.
• Latex condoms used the right way every time will greatly reduce your risk of getting an STI.
• If diagnosed with an STI, it's important to take all medication exactly as prescribed. You and any partners should wait 7 days after treatment before having sex again to avoid reinfection.
• Some STIs, like chlamydia and gonorrhea, can cause irreversible damage to the reproductive system if not treated.

Looking for a clinic near you? Check out our STI Clinics Map of agencies that partner with the IDOH STI Chlamydia/Gonorrhea (CT/GC) Prevention Program. Enter your zip code to find a testing facility close to you. A list of those CT/GC clinics can be found here. Additional agencies that do not participate in the CT/GC Prevention Program but provide STI services can be found here.

Your role in interrupting the chain of transmission for sexually transmitted diseases is vital to the health of Hoosiers. Many communities rely on urgent care or emergency room care for screening and treatment of STIs, and the Indiana Department of Health (IDOH) STI Prevention Program would like to provide your agency with the tools and materials to ensure exceptional sexual healthcare to Hoosiers in accordance with CDC’s recommendations. Your efforts in STI prevention and attention to detail are assisting clients with getting access to critical care in order to lower the disease burden among Indiana communities. Below are links to five resources for healthcare providers when managing the sexual healthcare of your patient:

• A Provider's Guide to Managing STIs
• Information for talking with Teens
• Additional Resources for Providers
• Role of Disease Intervention Specialists (DIS)
• STI/HIV Partner Services

Expedited Partner Therapy for Health Care Professionals in Indiana

Expedited Partner Therapy, or EPT, is the practice of treating sexual partners of patients diagnosed with an STI (specifically chlamydia and/or gonorrhea) without an intervening medical evaluation. This practice helps prevent re-infection of patients and is considered an effective partner management strategy. Prescribing treatment to partners is a protected activity under the Indiana Administrative Code. See the resources below for more information.

• Updated EPT Guidance for Providers
• Expanded Use of EPT during COVID-19

National and Statewide Increase in Syphilis Cases

Once on a trajectory for elimination in the United States, the rate of syphilis infection has been increasing every year since 2001. National rates of primary and secondary (P&S) stages of syphilis-- the most infectious stages-- have increased almost every year, increasing 28.6% during 2020–2021. Rates increased among both males and females, in all regions of the United States, and in all age groups. Rates of P&S syphilis increased in all racial/Hispanic ethnicity groups, with greatest increases among non-Hispanic American Indian or Alaska Native persons who also had the highest P&S syphilis rate in 2021.¹ Indiana is at a record-high rate of P&S syphilis cases with 10.8 cases per 100,000 in 2021. Congenital syphilis cases have also increased at the state and national levels, which is a major public health concern. Indiana reported 20 cases of congenital syphilis (rate of 25.0 cases per 100,000 live births). The 2021 national congenital syphilis rate was 77.9 cases per 100,000 live birth, which was an 30.5% increase relative to 2020.¹

Please use the documents at the links provided below for guidance on managing syphilis diagnosed in your patients.

• Syphilis Testing Reminders from the State Health Commissioner
• CDC Syphilis Pocket Guide for Providers

1. National Overview of STIs -  https://www.cdc.gov/sti-statistics/about/index.html

The Centers for Disease Control and Prevention (CDC) provides guidelines for recommended courses of treatment for STIs. On July 23, 2021, the CDC released the newest treatment guidelines (2021). The links below include the most recently updated guidelines in a wall chart and a pocket guide, including the changes to the treatment of Neisseria gonorrhoeae infections in December 2020. The second link provides more details about the changes to the gonorrhea treatment guidelines.

Use the fact sheets provided here to learn more about STDs, how they are spread, and who is at risk. All resources are shown in English and Spanish. Resources in other languages are available on the CDC's website.

• Sexually transmitted infections (STIs) caused by Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum are at an all-time high in the United States.  Chlamydia, gonorrhea, and syphilis disproportionately affect gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW). DoxyPEP studies have been shown to reduce syphilis and chlamydia infections by >70% and gonococcal infections by approximately 50%.
• The Centers for Disease Control and Prevention (CDC) recommends DoxyPEP among MSM and TGW who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhea) diagnosed in the past 12 months.
• DoxyPEP should be combined with counseling that it may be used as PEP to prevent these infections. It should be implemented following shared decision-making between the patient and provider in the context of a comprehensive sexual health approach, including:
  • Risk-reduction counseling
  • STI screening and treatment
  • CDC recommended vaccination(s)
  • Linkage to HIV PrEP, HIV care, or other services as appropriate
• The Indiana Department of Health (IDOH) recommends that individuals prescribed DoxyPEP:
  • Undergo bacterial STI testing at anatomic sites of exposure at baseline and every 3 to 6 months thereafter.
    • Specifically, IDOH recommends that providers of recipients of DoxyPEP conduct syphilis screening using the reverse-sequence algorithm.
    • Reassess ongoing need for DoxyPEP every 3 to 6 months.
  • Additionally, IDOH recommends that HIV screening be performed for men who have sex with men and transgender women according to current recommendations.

For more information about DoxyPEP please click here.

Click here for IDOH’s adult and congenital syphilis toolkit.