Integrating antimicrobial stewardship into outpatient STI prevention and sexual health care

Abstract

Antimicrobial stewardship (AMS) is important in outpatient sexual health care because bacterial sexually transmitted infection (STI) management frequently involves recurrent antimicrobial exposure within select populations. Antimicrobial resistance (AMR) has narrowed treatment options and prompted repeated revisions to treatment guidelines, specifically for gonorrhea. Doxycycline postexposure prophylaxis and recurrent antibiotic exposure have intensified stewardship concerns in sexual health care. As outpatient AMS programs grow nationally, merging expertise on sexual health could optimize care and address AMR. We propose a practical operational framework for integrating AMS into outpatient sexual health care through clinical decision support, appropriate diagnostic testing and stewardship-informed antimicrobial prescribing, coupling prescribing practices with AMR surveillance, coordinated oversight between STI and stewardship programs, and patient-centered counseling. Stewardship integration must preserve timely access to care and trust within sexual health services. AMS integration may help sustain antimicrobial effectiveness, strengthen clinical decision-making, and support equitable, evidence-informed sexual health care amid evolving STI epidemiology and emerging AMR threats.