Understanding the role of perceived severity in STD-related care-seeking delays

Cervicitis: To Treat or Not To Treat? The Role of Patient Preferences and Decision Analysis

“…Our analysis makes a novel contribution, as it graphically illustrates that there are significant costs as well as benefits to empirically treating mucopurulent cervicitis as an STD. This is because most teenagers with this common physical finding do not have a treatable lower genital tract infection [2][3][4][5][6], and being diagnosed with an STD can have damaging psychological sequelae [12][13][14][15][16][17]. Because most STDs are asymptomatic and other factors can cause uninfected cervices to appear inflamed and cervical exudates to become purulent, routine periodic screening with highly sensitive nucleic acid amplification tests is the mainstay of disease detection [1,8].…”

“…In another study, it was reported that approximately 25% of young adults felt that the diagnosis of an STD would cause them to feel angry and depressed [14]. The results of a third study demonstrated that teenagers tend to be as psychologically risk-averse to STDs as they are physically [17]. Similar documentation exists for the serious public health problem posed by the indiscriminate use of antibiotics [18].…”

“…Based on our review of the literature, we estimated that: 1) approximately 40% of teenage girls with PID would develop physical sequelae [8,22,23], and 2) approximately 30% of teenagers who are told they have an STD would develop significant psychological sequelae, ranging from dysphoric feelings, anxiety, and depression to decreased self-esteem, disrupted romantic relationships, and domestic violence [12][13][14][15][16][17]. Such psychological angst is an unavoidable morbidity for teenagers who have STDs, but an unnecessary morbidity for those who do not.…”

“…In comparison with most other groups, they have higher sexually transmitted disease (STD) prevalence rates, are especially vulnerable to the adverse reproductive consequences of untreated STDs, and are generally perceived as noncompliant with follow-up [1,8]. However, taken together, the low positive predictive value of mucopurulent cervicitis for treatable infections [2][3][4][5][6], the futility of treating index cases if their sexual networks are not treated [9 -11], the adverse psychological effects of being diagnosed with an STD [12][13][14][15][16][17], and the serious public health problem created by the indiscriminate use of antibiotics [18], raise serious concerns about the wisdom of empirically treating this common gynecologic problem as an STD.…”

“…This is not because researchers are unaware them. It has been documented repeatedly that the diagnosis of an STD evokes dysphoric feelings, causes anxiety, depression, and decreased self-esteem, disrupts romantic relationships, and precipitates domestic violence [12][13][14][15][16][17]. In one study, it was found that after controlling for potential confounders, the incidence of depressive symptoms among previously nondepressed participants in the National Longitudinal Study of Adolescent Health averaged 30% during the following year if there was an STD diagnosis and 11% if there was not [13].…”