Section 1: Canadian Guidelines on Sexually Transmitted Infections – Foreword

Section 1 - Foreword

Introduction

These guidelines were created as a resource for clinical and public health professionals — especially nurses and physicians — for the prevention and management of STIs across a diverse patient population, including neonates, children, adolescents and adults.

The prevention and control of STIs cannot be approached with a narrow focus. The appropriate medical management of identified cases of STIs is but one piece of the puzzle. Both primary and secondary prevention activities are paramount to reducing the incidence (newly acquired infections) and prevalence (number of cases) of STIs. Primary prevention aims to prevent exposure by identifying at-risk individuals and performing thorough assessments, patient-centred counselling and education.1 Secondary prevention involves reducing the prevalence of STIs through the detection of infections in at-risk populations, counselling, conducting partner notification and treating infected individuals and contacts in a timely manner, thus preventing and/or limiting further spread.1

Both the burden of disease, potential complications and the psychological impacts (e.g., stigma) associated with STIs are relevant and of significant consideration for health professionals and decision makers. The presence of an acute infection can increase the risk of co-infection: for example, an ulcer from an infection such as syphilis can significantly increase the risk of acquiring and transmitting an HIV infection.

Since their release, the Expert Working Group (EWG) for the guidelines which includes STI experts from the fields of medicine, nursing, laboratory, public health and research have volunteered their time and effort as authors and reviewers to maintain updated, evidence-based recommendations for the prevention, diagnosis, treatment and management of STIs in Canada.

Important considerations for Guidelines users

While these guidelines are based on current evidence and clinical practice, the prevention, diagnosis, treatment and management of STIs is an evolving field.  The Public Health Agency of Canada acknowledge that the advice and recommendations set out in this document are based upon the best current available scientific knowledge and medical practices, and they are disseminating this document to clinical and public health professionals for information purposes.

These guidelines do not supersede any provincial/territorial legislative, regulatory, policy and practice requirements or professional guidelines that govern the practice of health professionals in their respective jurisdictions, whose recommendations may differ due to local epidemiology or context

Levels and Quality of Evidence for Treatment Recommendations

This updated version contains the same levels of recommendation and quality of evidence indicators for the treatment recommendations as the 2006 Edition. The indicators used reflect a combination of the methodologies from the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care and have been modified and simplified for use in these guidelines as outlined in Tables 1 and 2.

Table 1. Levels of recommendation
(Modified from Harris RP, et al.Footnote 2)

Recommendation: A

Strongly recommends that clinicians routinely provide the treatment to eligible patients. Good evidence that the treatment improves important health outcomes and concludes that benefits substantially outweigh harms

Recommendation: B

Recommends that clinicians routinely provide the treatment to eligible patients. At least fair evidence that the treatment improves important health outcomes and concludes that benefits outweigh harms

Recommendation: C

No recommendation for or against routine provision of the treatment. At least fair evidence that the treatment can improve health outcomes but concludes that the balance of the benefits and harms is too close to justify a general recommendation

Recommendation: D

Recommends against routinely providing the treatment to asymptomatic patients. At least fair evidence that the treatment is ineffective or that harms outweigh benefits

Recommendation: I

Evidence is insufficient to recommend for or against routinely providing the treatment. Evidence that the treatment is effective is lacking, of poor quality or conflicting, and the balance of benefits and harms cannot be determined

Table 2. Quality of evidence
(Modified from Harris RP, et alFootnote 2 and Gross PA, et al.Footnote 3)

l

Evidence from at least one properly randomized, controlled trial

ll

Evidence from at least one well-designed clinical trial without randomization, from cohort or case-control analytic studies (preferably from more than one centre), from multiple time-series studies or from dramatic results in uncontrolled experiments

lll

Evidence from opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees

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