|
By
Mary Ann Hellinghausen Sexually transmitted diseases are a silent epidemic in the United States. Sometimes the diseases themselves are silent, with no outwardly detectable symptoms. And sometimes the silence comes from nurses who are uncomfortable talking with their patients about STDs. According to a recent survey by the Kaiser Family Foundation in Menlo Park, and Glamour magazine, most men and women 18 to 44 years old underestimate how common STDs are. Very few believe themselves to be at risk of getting an STD—a finding mirrored by another study, published in the March/April 1998 edition of the Journal of Obstetric, Gynecologic, and Neonatal Nursing (JOGNN), the journal of the Association of Women’s Health, Obstetric, and Neonatal Nurses. "Nearly all of the women in the [JOGNN] study rated themselves to be at no risk or low risk for STDs and/or HIV. Men’s perceptions of self-risk and estimates of their partner’s risk were nearly identical to those of the women," wrote the study’s author, M. Katherine Hutchinson, PhD, MS, RN. common problem
Every year, 12 million men and women, two-thirds of whom are under age 25, get an STD, and as many as 100 million people are living with an incurable viral STD such as herpes or human papilloma virus (HPV), according to the Kaiser/Glamour report. "We have the worst STD epidemic in the industrialized world, and we’re looking to healthcare providers to help spread the word," said Margaret Anderson, program director for the Society for the Advancement of Women’s Health Research in Washington. "One in four college kids has herpes—if it’s one in four now, what does that say for the next five to 15 years?" Despite the fact that STDs are very common and a giant proportion of women are at risk, the important questions aren’t getting asked, and testing isn’t happening," said Felicia H. Stewart, MD, director of reproductive health programs at the Kaiser Family Foundation. "Nurses can play a critical role in making sure everyone who should be is screened and tested." One reason STDs get so little attention is the perception that they’re not very serious. Many of them are curable, if detected and treated. But some can lead to serious complications and even death. Chlamydia can develop into pelvic inflammatory disease, which can cause infertility, miscarriage, or stillbirths, and twice as many American women die of HPV-related cervical cancer than from AIDS each year, according to the Glamour report. right questions It’s sometimes difficult for nurses to talk with patients about their sexual habits. "We’re seeing more patients in less time, and providers are often reluctant to get into that can of worms," said Kathy Jensen, MS, RN, an adult nurse practitioner who works at a Planned Parenthood clinic in Portland, Ore. "STDs should be addressed during a regular exam."Many nurses don’t know how to ask the right questions to get patients talking about their sexual conduct. Gail Bolan, MD, chief of the STD Control Branch of the California Department of Health Services and director of the STD/HIV Training Center in Berkeley, blames part of the problem on medical and nursing schools, which she says do not offer enough training on how to deal with patients’ sexual issues. "Because of secrecy about sex in our society, there’s a lot of personal issues [health] staff members have to overcome,’’ Bolan said. "Training would help clinicians to not feel awkward.’’ Surveys have shown that patients, particularly women, expect to be asked about their sex lives and believe they are getting a more comprehensive exam when they are asked. "The providers have to open that door,’’ Bolan said. She suggests incorporating sex risk questions into medical history forms. "Then it’s easier to segue into discussing [sex issues] with patients," Bolan said. The California Department of Health Services offers training on how to notify partners and have them treated. "There’s a failure to recognize that if the partner is not treated, the patient can get re-infected,’’ Bolan said. "The patient needs to know it ’s important for their health that their partner gets treated as well.’ Determine patients’ level of knowledge about sex and STDs, and try to discuss it at their level. Discussing prevention, testing, and treatment can make an impact on a patient. "People really trust the information they get from their healthcare provider," Anderson said. partner notification
Once a patient is diagnosed and treated, it is important to ensure that sex partners are notified, or STDs will continue to be transmitted. Experts suggest that nurses discuss how the patient will tell a partner that he or she should be tested for an STD. "Many times [the patient] doesn’t tell their partner because they haven’t been coached on how to do it," Nolt said. Adds Jensen, "Give them literature, brochures—that gives them some good sentences to say." It is important not to imply blame in the conversation between partners, Nolt said, adding that "no test can say who gave it [an STD] to whom." She suggests that clients tell their partners that they are telling them they may be infected because they care about them and want them to get tested. She also recommends setting an appointment for the partner’s testing or giving the partner a card telling them where it’s possible to get tested. If telling a partner is too difficult for a patient—possibly even hazardous in an abusive relationship—local or state health officials in most states can notify the partner confidentially, without divulging who notified them of the potential infection. Hutchinson in her report says it may be helpful for nurses to ask patients to consider the timing of sex and motivations for sexual intercourse in a relationship. "Perhaps we can pose the question, ‘If you are not even comfortable talking about sex, do you really want to take the risk and have a sexual relationship?’ [and] then help young women to answer the question for themselves." |