Why Education and Prevention Should Be Prioritized Over Antibiotics for STI Control

Sexually transmitted infections (STIs) are becoming increasingly common in the United States and other countries, a concerning trend acknowledged by healthcare professionals. As a urologist, I have observed a rise in patients seeking treatment for STIs. Recently, while browsing through Twitter, I stumbled upon a USA TODAY news article that referenced a study published in the New England Journal of Medicine. The study suggested the use of an antibiotic called doxycycline as a preventive measure to reduce the risk of contracting STIs such as gonorrhea, chlamydia, or syphilis within 72 hours of engaging in risky sexual activity.

Initially, the headline appeared promising, as the availability of a medication that could be taken after a sexual encounter to prevent infection seemed like a positive development. Naturally, we strive to reduce the spread of STIs within the general population. However, as I delved deeper into the article, I realized that non-medical professionals might misinterpret the study's message.

In this digital age of easily accessible and widespread information sharing, why aren't governments prioritizing comprehensive sexual education programs aimed at preventing both pregnancy and STIs? It is crucial to understand why these infections are on the rise and why we have shifted our focus from education and prevention to treatment-based policies as the primary approach. Our global society's values and priorities may be misaligned, and it is time to recommit ourselves to education and prevention. The study on the use of antibiotics for STI treatment did not arise in isolation. The Centers for Disease Control recently published a preliminary report highlighting the increase in STI cases, particularly syphilis and congenital syphilis transmitted from mother to child during pregnancy, from 2020 to 2021 (2.5 million cases).

STIs, also known as sexually transmitted diseases, pose a public health problem not only in the United States but worldwide. The World Health Organization estimates that over one million STIs are acquired daily, with the majority being asymptomatic. This leads to severe consequences such as infertility, fetal and neonatal deaths, cervical cancer, increased risk of contracting HIV, and psychological and socio-economic burdens associated with these infections. As a urologist, I find this deeply concerning. The approach to reducing STI cases should not solely rely on prophylactic measures; the importance of condom usage cannot be overstated as it easily prevents cases of syphilis, gonorrhea, chlamydia, and HIV. The population must be educated about how STIs work and how they can protect themselves and others. While abstinence is a valid approach, relying solely on it ignores the realities we face.

Promoting sexual education campaigns is critical, and governments should refocus their efforts by utilizing digital tools such as social media, which provide cost-effective and easily accessible platforms to reach a wide audience.

There are three significant reasons why using antibiotics as a preventive measure for STIs may not be the most effective approach. Firstly, it may encourage unprotected sexual intercourse by creating the misconception that taking the medication afterward will automatically cure the infection, thus negating the need for protection during the sexual encounter. Secondly, the indiscriminate use of antibiotics following risky sexual behavior could lead to antibiotic resistance in both the individual and the general population. Lastly, if such medications are widely available and used in this manner, individuals may forego getting tested for STIs and be less inclined to consult healthcare professionals about their sexual health.

This is an opportune time to reintroduce large-scale campaigns aimed at preventing sexually transmitted diseases, leveraging the increased accessibility to young people through platforms like Instagram and TikTok. As someone who grew up in the 1990s, I remember public service campaigns being broadcasted on radio and TV, which incurred significantly higher costs compared to what is feasible today.

While it is important to continue researching new methods for promptly preventing and treating STIs, it is equally crucial to ensure that our focus on finding cures does not come at the expense of prevention, vaccination, detection, monitoring, and comprehensive sexual education.

Dr. Marcos Del Rosario Santiago is a urologist in the Mexican Navy (Armada de Mexico), a member of the American Urological Association, and a freelance writer. You can follow him on Twitter: @theurologist1.

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