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STDs: Docs Don't Ask

Nearly half fail to discuss topic with women

FRIDAY, Dec. 14, 2001 (HealthDayNews) -- If you're a woman at risk for sexually transmitted diseases, don't expect your doctor to bring up the matter. A new study says nearly half of 767 doctors surveyed said they don't usually talk to sexually active women patients about STDs.

But the true percentage may be even lower. A previous study which questioned female patients found that as few as 28 percent of doctors discussed STDs.

"You wind up with this 'don't ask, don't tell' kind of situation," says Tina Hoff, a vice president with the Kaiser Family Foundation, which commissioned the new survey. "There's a real gap in counseling. Not all of these women would require testing, but having a conversation with a physician about risk is critical."

The foundation surveyed 566 obstetrician-gynecologists (OB-GYNs) and 201 family practice physicians in 2000. The results were released in October.

Slightly more than half the doctors -- 54 percent of the OB-GYNs and 57 percent of the general practitioners -- said they talked about STDs with all or most of their gynecological patients who were pregnant. In both groups, about one in seven doctors admitted they hardly ever talked to anyone about STDs.

The doctors were even more hesitant about discussing AIDS. Only 43 percent of OB-GYNs and 53 percent of family physicians discussed it with most or all female patients.

This isn't the first time researchers have tracked how doctors handle STD discussions. Another study, published in 2000 in the American Journal of Preventative Medicine, found that only about a fourth of adults surveyed in 1994 said their doctors brought up STDs during their most recent checkup.

Kaiser researchers found that doctors who avoid the STD topic assume that female patients will raise the topic if they are concerned, Hoff says. "When you're talking about a situation where the average doctor visit is 15 minutes or less, there's a lot to cover," she says. "Physicians are moving quickly through their exams. If an issue isn't raised, they're going to go straight through it."

Many diseases are impossible to ignore. But STDs are different. They often wreak havoc without creating symptoms. Female patients "may have one and not know it," Hoff says.

STDs are also much more common than many people realize. The three most common STDs in the United States -- human papilloma virus (HPV), trichomoniasis and chlamydia -- strike nearly 14 million people a year, mostly women. An estimated one-third of 24-year-old women have had an STD.

The survey finds that doctors who advised or ordered tests typically did so to detect chlamydia (95 percent for OB-GYNs and 91 percent for family doctors), gonorrhea (81 percent and 61 percent), HIV and AIDS (37 percent and 51 percent) and syphilis (28 percent and 38 percent).

Following the advice of experts, the doctors surveyed typically didn't order routine testing for other STDs, like herpes, hepatitis B and human papilloma virus (HPV).

It's easy to blame doctors for not venturing into discussions about STDs, but patients aren't blameless, says Dr. Hunter Handsfield, director of the STD Control Program for Seattle-King County.

"They may signal their own discomfort [through] body language. A patient might give the impression that he or she is not open to inquiries in that area," Handsfield says.

Echoing Hoff's views, Handsfield says many doctors are just too busy to bring up the topic of sex. "There's a fear among doctors that it's time consuming. Their hesitancy in raising it isn't because they're uncomfortable with sexuality. It's because … they don't want to open up a can of worms. The same thing can be said about mental health, drugs and spousal abuse and all sorts of other things that are hard to talk about."

What To Do

If you have even a small risk of contracting an STD, don't wait for your doctor to bring up the subject. Do it yourself.

Many experts think questions about STDs should be part of any general health evaluation, Handsfield says. Of course, exceptions can be made. A 70-year-old man married for decades may need less counseling than a 30-year-old single man, he says.

To find out more about STDs, check the Centers for Disease Control and Prevention or the American Social Health Association.

Planned Parenthood also has a section on STDs.

SOURCES: Interviews with Tina Hoff, vice president, public health information and partnerships program, Kaiser Family Foundation, Menlo Park, Calif.; Hunter Handsfield, M.D., director, STD Control Program, public health department, King County, Seattle; October 2001 Kaiser Family Foundation study
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