Frequently Asked Questions
|
|
- Florence French
- 8 years ago
- Views:
Transcription
1 Frequently Asked Questions Testing for Gonorrhea Q1: What test should be completed for accurately diagnosing gonorrhea? A1: Testing is done with either a culture or a NAAT (nucleic acid amplification test). Regardless of symptoms, it is important to test all sites that may have been exposed, including rectum or pharynx. Over the past several years, gonorrhea has become harder to treat because drug-resistant strains of gonorrhea are increasing in many parts of the world and Canada. In order to monitor drug-resistant gonorrhea in Saskatchewan and to better guide treatment, testing should be conducted as outlined in the algorithm in Question #4. Successful culturing of N. gonorrhea is dependent on several factors associated with specimen collection, transportation and storage. For example: collection method, transport (loss of viability due to transport or storage temperature or duration of transport,) overgrowth of N. gonorrhea by competing organisms in the sample collected, and dilution of the organism in collection medium. The result of any of these factors may lead false negative culture results (Association of Public Health Laboratories, 2014). NAAT is an appropriate alternative to cultures when the above criteria cannot be met. Q2: What are the signs and symptoms consistent with gonorrhea infection? A2: Individuals with gonorrhea may have mucopurulent discharge of the urethra or cervix. Symptoms of rectal infection may include discharge, anal itching, soreness, bleeding or painful bowel movements. Individuals with a history of oral sex may have pharyngeal infection, however these infections are usually asymptomatic. Q3: What are the risk factors for gonorrhea? A3: Individuals are at increased risk for gonorrhea if one or more of the following apply: Sexual contact with a person with a confirmed or suspected gonococcal infection; Unprotected sex with a resident of an area with high gonorrhea burden or high risk of antimicrobial resistance; History of previous gonococcal infection; History of other STIs, including HIV; Sex workers and their sexual partners; Sexually active youth < 25 years of age; Street-involved youth and other homeless populations; Men who have unprotected sex with men; and Sex with multiple partners. September 2014 Page 1
2 Q4: What testing should be completed for patients? A4: The following algorithm outlines the most appropriate testing based on client risk factors and clinical presentation. Obtain cultures (cervix or urethra) prior to NAAT specimens from symptomatic individuals with risk factors. Screen asymptomatic individuals for infection by NAAT on genital tract specimens (urine or cervix). Obtain cultures and NAATs from rectal or pharyngeal sites from individuals who have unprotected sexual exposure at these sites. NOTE: Chlamydia should be tested at the same time as gonorrhea in all cases. Gonorrhea Screening Recommendations Does the Patient Have Risk Factors (see Q#3)? If yes, proceed in the chart: Symptoms No Symptoms Is there Rectal or Pharyngeal Exposures*? Males Females Males and Females Culture AND Endocervial culture Urethral Culture (1st) and Urine NAAT and Endocrevical, vaginal or urine NAAT Urine NAAT (and cervical swab if doing pelvic exam) NAAT * For all symptomatic individuals and asymptomatic men who have sex with men and women with a history of performing oral sex. Source: Public Health Agency of Canada (2013) Adapted from Public Health Ontario (2013) Q5: What are the specimen collection and transport requirements? A5: Refer to the Saskatchewan Disease Control Laboratory (SDCL) Compendium of Tests ( Bacteriology: Gonococcal Culture for details and contact your regional lab to obtain appropriate materials that are not supplied by SDCL. September 2014 Page 2
3 Treatment Recommendations Q6: What is the recommended treatment for uncomplicated gonorrhea (ano-genital or pharyngeal gonorrhea) in Saskatchewan? A6: Until further notice, first-line treatment for persons above nine years of age (including pregnant women and nursing mothers) with confirmed or suspected uncomplicated urogenital gonorrhea (cervix, vagina, pharynx or rectum) and their sex partners is Ceftriaxone 250 mg intramuscularly plus azithromycin 1g orally. Q7: Why are two antimicrobials recommended to treat gonorrhea? A7: Treatment of gonorrhea with two antimicrobials is recommended nationally to improve the efficacy of treatment and delay the emergence and spread of resistance in N. gonorrhoeae. Cephalosporin-azithromycin combination therapy has also been found to be more effective in treating pharyngeal infections, which are usually asymptomatic. Q8: Is azithromycin being used to treat chlamydia or gonorrhea? A8: Both. Individuals with gonorrhea are commonly co-infected with chlamydia. Azithromycin treats chlamydia and also acts synergistically with cephalosporin to treat gonorrhea. Q9: When should treatment be provided? A9: In general, do not provide treatment for gonorrhea until there is laboratory evidence of gonorrhea infection. However, provide empiric treatment prior to receiving confirmatory lab results in the following circumstances: Patient presents with urethra/cervical mucopurulent discharge: If the partner is infected with gonorrhea, ceftriaxone and azithromycin should be provided; OR If follow-up is not assured, ceftriaxone and azithromycin should be provided; OR Provide azithromycin to treat chlamydia and if local prevalence of gonorrhea is high (contact your medical health officer if you require details of local epidemiology), consider treating with ceftriaxone. Patient presents without urethral/cervical mucopurulent discharge: If the individual is at high risk for infection and follow-up is not assured, provide ceftriaxone and azithromycin; OR If the sexual partner is infected with gonorrhea, provide ceftriaxone and azithromycin. Q10: What is the recommendation for second line treatment for gonorrhea? A10: Because cefixime is currently not available, second line options are Spectinomycin 2 g intramuscular plus Azithromycin 1 g orally OR Azithromycin 2 g orally (SEE BOX BELOW: Cautions regarding Azitthromycin). Note: Spectinomycin is only available through Health Canada s Special Access Programme using Form A September 2014 Page 3
4 Cautions regarding Azithromycin Azithromycin 2 g PO in a single dose should only be considered as an alternate treatment option if there is a history of severe allergy to cephalosporins. There are also significant gastrointestinal side effects associated with high dose azithromycin (Public Health Agency of Canada, 2013). Azithromycin is not recommended as monotherapy because of concern over the emergence of resistance. Instead, a 1 g dose of azithromycin is recommended as a component of dual therapy for gonorrhea, in conjunction with a cephalosporin (i.e., 250 mg of ceftriaxone) (CDC, 2011). An azithromycin-resistant variant of gonorrhea that developed in just 12 days was detected with genotyping highlighting the rapid emergence of clinical gonococcal resistance (Hill, 2012). Azithromycin can cause potentially life-threatening arrhythmias, especially in individuals taking a multi-day course of the medication. Individuals most at risk of this are those who have prolonged QT interval, other cardiac conditions (bradycardia, heart failure) or are elderly (Public Health Agency of Canada, 2013). Q11: What do I do if my patient has an allergy to penicillin? A11: Patients with a history of a severe reaction to penicillin, or any allergic reaction to the cephalosporins should be prescribed a non-cephalosporin based regimen for any suspected or confirmed gonorrhea infection and referred to a drug allergy clinic if available. Therapies to consider in this context include Spectinomycin 2 g intramuscular plus azithromycin 1g orally, or azithromycin 2 g orally (note cautions around using azithromycin as monotherapy noted above). Both of these treatments require a test of cure. Only a small number of patients that are told that they have a penicillin allergy will have any reaction if they take a cephalosporin. The estimated rates of severe reactions to the administration of a cephalosporin to an individual with a history of a penicillin allergy are between and 0.1%. Q12: What do I do if my patient has an allergy to azithromycin? A12: Allergies to azithromycin are extremely rare. In the instance of allergy to azithromycin, doxycycline 100 mg PO BID x 7 days is recommended in addition to ceftriaxone 250 mg IM. This treatment requires a test of cure. Doxycycline is contraindicated in pregnant and breastfeeding women. Q13: What do I do if my patient did not receive first line therapy (ceftriaxone and azithromycin)? A13: A test of cure is recommended to ensure the infection has been cleared. If infection is cleared, no additional treatment is necessary. If gonorrhea infection is still present, treatment with both ceftriaxone and azithromycin is recommended. Chlamydia testing should also be ruled out as a possible co-infection for all individuals who have been identified with gonorrhea. If chlamydia infection is identified, treatment is suggested as per the Saskatchewan Communicable Disease Control Manual September 2014 Page 4
5 Q14: What is a Test of Cure? A14: A Test of Cure is laboratory tests conducted at a defined timeframe following the completion of treatment to ensure the infection has resolved. Q15: How do I do a Test of Cure? A15: For Test of Cure, regardless of presence or absence of symptoms, the preferred testing method is culture. Test of Cure using culture should be performed four to five days after completion of therapy. If culture is not locally available, NAAT testing is a second-line option, but should be performed four weeks post-treatment at the earliest. Q16: When should I do a Test of Cure? A16: Test of Cure by culture should be completed whenever ceftriaxone AND azithromycin has not been provided. In addition to the above, Test of Cure by culture (4-5 days post treatment) if the client has: pharyngeal infection; persistent post-treatment symptoms; and been linked to drug resistance or treatment failure. Test of Cure by culture (4-5 days post treatment) or PCR (urine NAAT) (4 weeks post treatment) if the client: Is 16 years of age or under; Is pregnant; Has concomitant infections; Is concerned about re-infection; Is a man who has sex with men; Is a prepubertal child; Is diagnosed with pelvic inflammatory disease (PID); and Experienced treatment failure previously. Q17: How long do cases have to abstain from sex following this new treatment? A17: Advise patients and contacts to abstain from unprotected intercourse until 7 days after completion of treatment. Q18: What information should be provided to my patients about treatment? A18: Patient information sheets on gonorrhea and the medications are available. Inform your patients about contraindications, side effects, drug interactions and the length of time that they should abstain from unprotected intercourse (i.e. for seven days following completion of treatment). Q19: When should treated cases of gonorrhea be re-screened for STI? A19: Individuals diagnosed with gonorrhea are at high risk of reinfection. Rescreen patients who are diagnosed with gonorrhea six months after initial diagnosis, or when they next seek medical care within the next 12 months (Public Health Agency of Canada, 2013). September 2014 Page 5
6 Management of Contacts Q20: Who is a contact? A20: All partners who have had sexual contact with the case (including oral, anal and vaginal) within 60 days prior to symptom onset or when the specimen was collected if the case was asymptomatic. If your patient indicates having no partners in the past 60 days, the most recent partner should be notified (Public Health Agency of Canada, 2013). Q21: How do I manage a contact? A21: All contacts should be assessed, tested, treated empirically and counseled. Q22: What is required as part of an assessment? A22: In addition to the physical assessment, a risk assessment should be completed to determine if the contact has more risks than the known exposure. See Attachment Risk Assessment Questionnaire in the Saskatchewan Communicable Disease Control Manual: Q23: What testing is required for contacts? A23: Testing (culture versus NAAT) should be conducted based on symptoms. See Questions #1 and #4 for Gonorrhea Testing Recommendations (Symptomatic or Asymptomatic Patients). In addition to completing gonorrhea tests, test contacts for chlamydia, syphilis and HIV due to the increased risk of co-infection with other STIs. Additional tests should be completed based on the risk assessment. Q24: How do I treat a contact? A24: Give empiric treatment with ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally as soon as possible to all sexual contacts of cases regardless of clinical findings and without waiting for test results (Public Health Agency of Canada, 2013). Empiric treatment is recommended to reduce the risk of further transmission and the potential of re-infecting their treated partner. Q25: What counseling should be provided to contacts? A25: Patient information sheets on gonorrhea and the medications are available. Provide contacts information about contraindications, side effects, drug interactions and the length of time that they should abstain from unprotected intercourse (i.e. for 7 days following completion of treatment). Recommend STI testing every six months for at-risk individuals. September 2014 Page 6
7 Administration and Access to STI medications Q26: Who is eligible to access publicly-funded STI medications in Saskatchewan? A26: In Saskatchewan, STI medications are publicly funded to facilitate effective treatment in a timely manner for individuals who have laboratory confirmed STI or who are eligible for empiric treatment (See Question #9). To order publicly-funded STI medications, please contact your local public health unit. To find the public health unit nearest you, please visit: Publicly funded medications are available for treatment of notifiable sexually transmitted infections. As such, for each dose of medication provided, an accompanying notification form must be completed indicating if the disease that is suspected or confirmed. See attached. Q27: Should health care practitioners keep a limited stock of STI medications in the clinic? A27: Yes. To facilitate timely treatment of patients and reduced transmission of STIs, it is recommended that health care practitioners keep a limited stock of STI medications in their clinic to provide treatment of clients with a STI (i.e., laboratory confirmed case or those requiring empiric treatment) at their clinic. Consult with your local public health unit Q28: How should ceftriaxone for IM injection be stored? A28: Ceftriaxone for injection sterile powder should be stored at C (room temperature) and protected from light. Solutions should be reconstituted immediately before use. If storage is required (after reconstitution), these solutions may be stored under refrigeration and should be used within 48 hours. See product monograph: all%20strengths_rev2.pdf: Q29: What diluents should be used for reconstitution of ceftriaxone for IM injection? A29: The preferred diluent for reconstituting ceftriaxone is lidocaine (1%) and is publicly funded when used for this purpose. The following solutions may also be used for reconstitution for intramuscular injection in the event of a contraindication to lidocaine, but these solutions are not publicly funded. Sterile Water for Injection 0.9% Sodium Chloride Injection 5% Dextrose Injection Bacteriostatic Water for Injection For detailed information about the agent used as a diluent for the specific product received from your local health unit please refer to the product monographs at _all%20strengths_rev2.pdf and September 2014 Page 7
8 Q30: Should ceftriaxone 250 mg IM be administered with safety engineered needles? A30: As per Section 474.1(3) of the Saskatchewan Occupational Health and Safety regulations 1, the use of safety engineered needles are required by workers or self-employed persons. Q31: How do I prepare the injection? A31: Refer to the product monographs for ceftriaxone for full details and other diluent options: all%20strengths_rev2.pdf. Q32: How should ceftriaxone be administered? A32: The medication should be administered IM into the intragluteal region. Aspirate following needle placement to avoid injecting intravenously. See below for description and images of appropriate land marking 2. Dorsogluteal site Draw an imaginary line from the posterior superior iliac spine to the greater trochanter. Insert the needle at a 90-degree angle above and outside the drawn line. You can administer a Z-track injection through this site. After drawing up the drug, change the needle, displace the skin lateral to the injection site, withdraw the needle, and then release the skin. Ventrogluteal site With the palm of your hand, locate the greater trochanter of the femur. Spread your index and middle fingers posteriorly from the anterior superior iliac spine to the furthest area possible. This is the correct injection site. Remove your fingers and insert the needle at a 90-degree angle Source: September 2014 Page 8
9 Follow-Up of Individuals Q33: What is the definition of Gonorrhea Treatment Failure? A33: Gonorrhea Treatment Failures are defined as treated individuals with confirmed gonorrhea and a positive test of cure (NAAT or culture) in the absence of risk of reinfection (i.e., patient denies potential sexual re-exposure) (Public Health Agency of Canada, 2014). False positive results may occur if a culture was taken less than 4 days after treatment or the NAAT was taken less than 4 weeks after treatment. Q34: What do I do if I am concerned that my patient has had treatment failure? A34: If first-line treatment was not used initially, use the first-line treatment, if no contraindications. Perform a test of cure using culture four to five days post re-treatment. Report any suspected or confirmed gonorrhea treatment failures to your local public health unit. Once notified of a suspected or confirmed case of gonorrhea treatment failure, the public health unit will work with the responsible health care practitioner to provide notification to Saskatchewan Ministry of Health and to discuss any further public health action that may be required. Q35: Why do I need to disclose treatment failures to my local Medical Health Officer? A35: Disclosure is required in order to monitor resistance patterns of multi-drug resistant N. gonorrhoeae, to ensure individuals are being treated effectively for gonorrhea, and to limit ongoing transmission. In order to do this, health care practitioners, local public health units and the Saskatchewan Ministry of Health must work together to make sure each is aware of treatment failures. Resources Q36: Where can I go to get more information? A36: There are several resources to turn to for more information regarding multi-drug resistant gonorrhea, and the assessment and management of gonorrhea and sexually transmitted infections in general. Your local public health office or medical health officer can answer questions you may have. You can also access the Saskatchewan Communicable Disease Control Manual online at Also see The Canadian Guidelines on Sexually Transmitted Infections (Public Health Agency of Canada): September 2014 Page 9
10 References Guidelines for Testing and Treatment of Gonorrhea in Saskatchewan, 2014 Association of Public Health Laboratories (2014) Specimens-for-Neisseria-gonorrhoeae-Culture.pdf British Columbia Centers for Disease Control - Public Health Agency of Canada - and Public Health Ontario (2013) - Saskatchewan Communicable Disease Control Manual - US Centers for Disease Prevention and Control - Hill (2012) Gonorrhea Develops Rapid Resistance to Azithromycin. Medscape. Mar 15, Centers for Disease Control and Prevention (2011) Neisseria gonorrhoeae with Reduced Susceptibility to Azithromycin, Morbidity and Mortality Weekly Report. 2011;60(18): September 2014 Page 10
Frequently Asked Questions
Guidelines for Testing and Treatment of Gonorrhea in Ontario, 2013 Frequently Asked Questions Table of Contents Background... 1 Treatment Recommendations... 2 Treatment of Contacts... 4 Administration
More informationTHIS IS AN OFFICIAL NH DHHS HEALTH ALERT
THIS IS AN OFFICIAL NH DHHS HEALTH ALERT Distributed by the NH Health Alert Network Health.Alert@nh.gov August 13, 2015 1400 EDT (2:00 PM EDT) NH-HAN 20150813 Updated Centers for Disease Control (CDC)
More informationGONORRHOEA. Use of lidocaine as a diluent when using ceftriaxone (see Appendix 1)
Key practice notes: 1 st line therapy GONORRHOEA Decreasing sensitivity of gonorrhoea to cephalosporins is now a real threat: CEFTRIAXONE 500mg IM stat first-line for all gonococcal infections AZITHROMYCIN
More informationTREATMENT OF STI CONTACTS
This decision support tool is effective as of October 2014. For more information or to provide feedback on this or any other decision support tool, email certifiedpractice@crnbc.ca TREATMENT OF STI CONTACTS
More informationCDC 2015 STD Treatment Guidelines: Update for IHS Providers Sharon Adler M.D., M.P.H.
CDC 2015 STD Treatment Guidelines: Update for IHS Providers Sharon Adler M.D., M.P.H. Clinical Faculty, CA Prevention Training Center Disclosure Information Sharon Adler MD, MPH I have no financial relationships
More informationExpedited Partner Therapy (EPT) for Sexually Transmitted Diseases Protocol for Health Care Providers in Oregon
Expedited Partner Therapy (EPT) for Sexually Transmitted Diseases Protocol for Health Care Providers in Oregon Oregon Health Authority Center for Public Health Practice HIV/STD/TB Section Principles of
More informationsigns suggesting chlamydia:
Chlamydia - uncomplicated genital - Management View full scenario When should I suspect and test for chlamydia? Women: o Test for chlamydia if they are sexually active with symptoms and signs suggesting
More informationDeveloped by: California Department of Public Health (CDPH) Sexually Transmitted Diseases (STD) Control Branch. In collaboration with:
Best Practices for the Prevention and Early Detection of Repeat Chlamydial and Gonococcal Infections: Effective Partner Treatment and Patient Retesting Strategies for Implementation in California Health
More informationCalifornia Gonorrhea Treatment Guidelines
Califnia Gonrhea Treatment Guidelines These guidelines were developed by the Califnia Department of Public Health (CDPH) Sexually Transmitted Diseases (STD) Control Branch in conjunction with the Califnia
More informationCalifornia Guidelines for STD Screening and Treatment in Pregnancy
California Guidelines for STD Screening and Treatment in Pregnancy These guidelines were developed by the California Department of Public Health (CDPH) Sexually Transmitted Diseases (STD) Control Branch
More informationChanges in the 2010 STD Treatment Guidelines: What Adolescent Health Care Providers Should Know February 2011
Changes in the 2010 STD Treatment Guidelines: What Adolescent Health Care Providers Should Know February 2011 Gale Burstein, MD, MPH, FAAP, FSAHM 1 Amanda Jacobs, MD, FAAP, 2 Dmitry Kissin, MD, MPH, 3
More informationThe Minnesota Chlamydia Strategy: Action Plan to Reduce and Prevent Chlamydia in Minnesota Minnesota Chlamydia Partnership, April 2011
The Minnesota Chlamydia Strategy: Action Plan to Reduce and Prevent Chlamydia in Minnesota Minnesota Chlamydia Partnership, April 2011 Section 5: Screening, Treating and Reporting Chlamydia While the information
More informationSTI case management. Francis Ndowa - GFMER Theodora Wi - WHO
Training Course in Sexual and Reproductive Health Research 2014 Module: Principles and Practice of Sexually Transmitted Infections Prevention and Care STI case management Francis Ndowa - GFMER Theodora
More informationSTD Treatment Chart Nancy Harris, N.P. Women s Health Coordinator August 2003 Disease Treatment Alternative treatment
STD Treatment Chart Nancy Harris, N.P. Women s Health Coordinator August 2003 Disease Treatment Alternative Pregnancy Chlamydia Chancroid Epdidymitis Gonorrhea: Uncomplicated (cx, urethra, and rectum):
More informationRhode Island Department of Health Division of Infectious Diseases and Epidemiology
Rhode Island Department of Health Division of Infectious Diseases and Epidemiology STD (Sexually Transmitted Disease) PROGRAM Expedited Partner Therapy (EPT) for STDs Guidance for Medical Providers in
More informationTitle: Antibiotic Guideline for Acute Pelvic Inflammatory Disease
Title: Antibiotic Guideline for Acute Pelvic Inflammatory Disease Version 3 Date ratified December 2007 Review date December 2009 Ratified by NUH Antimicrobial Guidelines Committee Gynaecology Directorate
More informationDiseases that can be spread during sex
Diseases that can be spread during sex Did you know... over 65 million people in the United States have a chronic, incurable sexually transmitted disease (STD)? and that every year another 19 million persons
More informationChlamydia THE FACTS. How do people get Chlamydia?
What is Chlamydia? Chlamydia is a common bacterial infection that is sexually transmitted and often causes no symptoms. If not treated, chlamydia can damage reproductive organs and make it difficult for
More informationSCREENING FOR SEXUALLY TRANSMITTED INFECTIONS
SCREENING FOR SEXUALLY TRANSMITTED INFECTIONS Take history:- History of presenting problem Full sexual history (refer to guideline on sexual history taking) Relevant past medical history, including previous
More informationSlide 1: Chlamydia and Gonorrhea: What You and Your Clients Need to Know. Welcome to Chlamydia and Gonorrhea: What You and Your Clients Need to Know.
Slide 1: Chlamydia and Gonorrhea: What You and Your Clients Need to Know Welcome to Chlamydia and Gonorrhea: What You and Your Clients Need to Know. This is a presentation for healthcare providers about
More informationSTANDARD PROTOCOL STD AND HIV SCREENING AND EPIDEMIOLOGIC STD TREATMENT
STANDARD PROTOCOL STD AND HIV SCREENING AND EPIDEMIOLOGIC STD TREATMENT RELEASE DATE: REVIEW INTERVAL: YEARLY REVIEW DATE: SITE/SERVICE UNIT: IMPLEMENTATION DATE: REVIEWED BY: CONTACT: APPROVED BY: CONTENTS
More informationTreatment of sexually transmitted and other genital infections
www.bpac.org.nz keyword: sti Treatment of sexually transmitted and other genital infections Key reviewer: Dr Murray Reid, Sexual Health Physician, Auckland Sexual Health Service General points: If one
More informationSpecimen collection and transport for Chlamydia trachomatis and Neisseria gonorrhoeae testing
Specimen collection and transport for Chlamydia trachomatis and Neisseria gonorrhoeae testing Overview Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are two of the most common sexually
More informationSexually Transmitted Infections (STI) One Day Update
Sexually Transmitted Infections (STI) One Day Update February 2015 Overview STI Guideline Changes National STI Services Results Reporting High Transmission Areas: Key Populations STI Guideline Changes
More informationImmunization Healthcare Branch. Human Papillomavirus Vaccination Program Questions and Answers. Prepared by
Immunization Healthcare Branch Human Papillomavirus Vaccination Program Questions and Answers Prepared by Immunization Healthcare Branch (IHB), Defense Health Agency Last Updated: 02 Jan 14 www.vaccines.mil
More informationSexual Health and Sexually Transmitted Infections Prevention and Control Protocol, 2013 (Revised)
Sexual Health and Sexually Transmitted Infections Prevention and Control Protocol, 2013 (Revised) Preamble The Ontario Public Health Standards (OPHS) are published by the Minister of Health and Long- Term
More information12/3/2015. M genitalium and urethritis and cervicitis. Consider M gent Rx in persistent /recurrent urethritis and in persistent cervicitis and PID
M genitalium and urethritis and cervicitis Consider M gent Rx in persistent /recurrent urethritis and in persistent cervicitis and PID Azithromycin 1 gm more effective odoxy ineffective oaz Resistance
More information2. Characteristics of staff Qualifications required. Additional requirements. Continued education & training requirements
Patient Group Direction The supply of Azithromycin 1g as a single dose by accredited Community Pharmacists to patients in receipt of a positive test result to Chlamydia trachomatis, and treatment of their
More informationAlberta Treatment Guidelines for Sexually Transmitted Infections (STI) in Adolescents and Adults 2012
Alberta Treatment Guidelines for Sexually Transmitted Infections (STI) in Adolescents and Adults 2012 General for STI Given the current rates of STI in Alberta, Some STI are under the Patients and contacts
More informationSexually Transmitted Infections (STIs) and the STI Clinic
Patient & Family Guide 2016 Sexually Transmitted Infections (STIs) and the STI Clinic Where to go. What to know. STIs are more common than you might think! www.nshealth.ca Sexually Transmitted Infections
More information2014 CDC Treatment Guidelines for STDs What s New, What s Important, What s Essential. STD Treatment Guidelines. How are the guidelines prepared?
2014 CDC Treatment Guidelines for STDs What s New, What s Important, What s Essential Bradley Stoner, MD, PhD Associate Professor, Washington University School of Medicine Medical Director, St. Louis STD/HIV
More informationTHE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE
THE UNITED REPUBLIC OF TANZANIA Treat for Lymphogranuloma venereum MINISTRY OF HEALTH AND SOCIAL WELFARE Appoint to return after Patient complains of Use Discharge from Continue to 2nd Refer to surgeon
More informationChlamydia. Looking after your sexual health
Chlamydia Looking after your sexual health 2 Chlamydia Chlamydia is one of the most common sexually transmitted infections (STIs). It is very easy to treat and cure. Up to one in 10 sexually active young
More informationWA Endemic Regions STI/HIV Control Supplement
WA Endemic Regions STI/HIV Control Supplement MAY 2013 Contents INTRODUCTION... 2 HEALTH UNITS CONTACTS... 3 RATES OF CHLAMYDIA, GONORRHOEA AND SYPHILIS NOTIFICATIONS IN THE GOLDFIELDS, KIMBERLEY, MIDWEST
More informationChlamydia trachomatis genital infection is the
CME Activity Inside and Online CHLAMYDIA TESTING AND TREATMENT Take a sexual history of all patients, including adolescents anyone who is sexually active is at risk for chlamydia infection. Screen sexually
More informationSYNDROMIC CASE MANAGEMENT OF RTIs Advantages, Limitations, Optimization
WHO COLLABORATING CENTRE FOR RESEARCH IN HUMAN REPRODUCTION Hôpitaux Universitaires de Genève SYNDROMIC CASE MANAGEMENT OF RTIs Advantages, Limitations, Optimization Dr SALONEY NAZEER Department of Gynaecology
More informationHIV/AIDS Tool Kit. B. HIV/AIDS Questionnaire for Health Care Providers and Staff
8 HIV/AIDS Tool Kit B. HIV/AIDS Questionnaire for Health Care Providers and Staff FOR STAFF USE ONLY: SURVEY ID # HIV/AIDS KAP Questionnaire for Health Care Providers and Staff Introduction The goal of
More informationGonorrhoea. Looking after your sexual health
Gonorrhoea Looking after your sexual health 2 Gonorrhoea Gonorrhoea is a bacterial sexually transmitted infection (STI). It can be painful and can cause serious health problems such as infertility in both
More informationLeader's Resource. Note: Both men and women can have an STD without physical symptoms.
Leader's Resource Information on Sexually Transmitted Diseases (STDs) Signs and Symptoms of STDs Note: Both men and women can have an STD without physical symptoms. Any of the following can indicate to
More informationPatient Information Sheet
Healthcare Worker exposure to a patient s blood What is a healthcare worker exposure? Patient Information Sheet Occasionally, health care workers come into contact with the blood or body fluids of their
More informationTrichomonas vaginalis. Looking after your sexual health
Trichomonas vaginalis Looking after your sexual health 2 3 Trichomonas vaginalis Trichomonas vaginalis is a sexually transmitted infection (STI). It is sometimes referred to as trichomonas or trichomoniasis,
More informationNational Chlamydia Screening Programme September 2012 PATIENT GROUP DIRECTION FOR THE ADMINISTRATION OF AZITHROMYCIN FOR CHLAMYDIA TRACHOMATIS
PATIENT GROUP DIRECTION FOR THE ADMINISTRATION OF AZITHROMYCIN FOR CHLAMYDIA TRACHOMATIS Below is a template that can be used to produce a local patient group direction (PGD) for the administration of
More informationNurse Initiated STI Treatment Code
Nurse Initiated STI Treatment Code Public Health and Clinical Services Division June 2012 FORWARD The Nurse Initiated STI Treatment Code establishes the competencies which must be achieved and criteria
More informationClinical Scenarios CODING AND BILLING 101. Daryn Eikner, Family Planning Council Ann Finn, Ann Finn Consulting
Clinical Scenarios CODING AND BILLING 101 Daryn Eikner, Family Planning Council Ann Finn, Ann Finn Consulting 1 Always remember Follow coding guidelines If you didn t write it down, it didn t happen The
More informationHIV/AIDS: General Information & Testing in the Emergency Department
What Is HIV? HIV/AIDS: General Information & Testing in the Emergency Department HIV is the common name for the Human Immunodeficiency Virus. HIV is a retrovirus. This means it can enter the body s own
More informationSexually Transmitted Infections
Introduction and General Considerations Date Reviewed: July, 2010 Section: 5-10 Page 1 of 13 Background Information The incidence of Sexually Transmitted Infections (STIs) in Saskatchewan has been increasing
More informationChlamydia Challenge. CONTENTS 2010 CDC STD Treatment Guidelines SPRING 11. Texas Oklahoma Louisiana Arkansas New Mexico
Chlamydia Challenge SPRING 11 Region VI Infertility Prevention Advisory Committee (RIPAC) Arkansas, Louisiana, New Mexico, Oklahoma and Texas CONTENTS 2010 CDC STD Treatment Guidelines REGIONAL UPDATES:
More informationAntimicrobial Resistance & Infections. Clinical Perspectives
Antimicrobial Resistance & Sexually Transmitted Infections Clinical Perspectives Outline Neisseria gonorrhoeae Global threat of untreatable gonorrhoea Mycoplasma genitalium Rapid loss of treatment options
More informationLaboratory confirmation requires isolation of Bordetella pertussis or detection of B. pertussis nucleic acid, preferably from a nasopharyngeal swab.
Pertussis Epidemiology in New Zealand New Zealand has continued to experience outbreaks of pertussis in recent decades. This is in part due to historically low immunisation rates and in part because immunity
More informationAcute pelvic inflammatory disease: tests and treatment
Acute pelvic inflammatory disease: tests and treatment Information for you Information for you Published August 2010 Published in August 2010 (next review date: 2014) Acute What is pelvic inflammatory
More informationBirth Control Options
1 of 5 6/2/2014 9:46 AM Return to Web version Birth Control Options What is contraception? Contraception means preventing pregnancy, also called birth control. Most people know about options such as birth
More informationExpedited Partner Therapy for Chlamydia Trachomatis and Neisseria Gonorrhoeae: Guidance for Health Care Professionals in Indiana
Indiana State Department of Health Introduction Expedited Partner Therapy for Chlamydia Trachomatis and Neisseria Gonorrhoeae: Guidance for Health Care Professionals in Indiana Indiana State Department
More informationPreventing Cervical Cancer with Gardasil Jana Ogden RN, MSN, MBA-HCA, IHCC Nursing Faculty. Upon Completion of the Lesson the student will be able to:
Preventing Cervical Cancer with Gardasil Jana Ogden RN, MSN, MBA-HCA, IHCC Nursing Faculty Upon Completion of the Lesson the student will be able to: Review statistics related to cervical cancer and HPV
More informationSafe & Unsafe. abortion
Safe & Unsafe Facts About abortion WHAT IS THE DIFFERENCE BETWEEN UNSAFE AND SAFE ABORTION? What is unsafe abortion? Unsafe abortion is a procedure for terminating an unplanned pregnancy either by a person
More informationYes, I know I have genital herpes:
Counseling Messages for Herpes Simplex Type II (HSV-II) Genital herpes Always take the time to attend to the participant s feelings and emotional state; for some people, this is the most devastating news
More informationNew Brunswick Health Indicators
New Brunswick Health Indicators Issue 8, July 2013 A population health bulletin published by the Office of the Chief Medical Officer of Health Youth Sexual Health Sexual health is an important aspect of
More informationCONTROL OF NEISSERIA GONORRHOEAE INFECTION IN THE UNITED STATES
CONTROL OF NEISSERIA GONORRHOEAE INFECTION IN THE UNITED STATES REPORT OF AN EXTERNAL CONSULTANTS MEETING CONVENED BY THE DIVISION OF STD PREVENTION, NATIONAL CENTER FOR HIV, STD, AND TB PREVENTION, CENTERS
More informationGARPR Online Reporting Tool
GARPR Online Reporting Tool 0 Narrative Report and Cover Sheet 1) Which institutions/entities were responsible for filling out the indicator forms? a) NAC or equivalent Yes b) NAP Yes c) Others Yes If
More informationPreface. TTY: (888) 232-6348 or cdcinfo@cdc.gov. Hepatitis C Counseling and Testing, contact: 800-CDC-INFO (800-232-4636)
Preface The purpose of this CDC Hepatitis C Counseling and Testing manual is to provide guidance for hepatitis C counseling and testing of individuals born during 1945 1965. The guide was used in draft
More informationInfection caused by the transmission of Trichomonas vaginalis (T. vaginalis) during sexual contact in which body fluids are exchanged.
This decision support tool is effective as of November 2015. For more information or to provide feedback on this or any other decision support tool, email certifiedpractice@crnbc.ca TRICHOMONIASIS DEFINITION
More informationNOTICE OF PUBLIC HEARING REGARDING PROPOSED CHANGES IN HEALTH CARE SERVICES PROVIDED BY FRESNO COUNTY
NOTICE IS HEREBY GIVEN that a public hearing will commence on Tuesday, September 23, 2008, at 9:00 a.m. (subject to continuance on that date of the hearing) at the Fresno County Board of Supervisors Chambers,
More informationGonoccocal Resistance to Antimicrobials Surveillance Programme (GRASP) Action Plan for England and Wales: Informing the Public Health Response
// The main title of the report Gonoccocal Resistance to Antimicrobials Surveillance Programme (GRASP) Action Plan for England and Wales: Informing the Public Health Response February 2013 Contents Foreword
More informationHIV Pre-Exposure Prophylaxis (PrEP): A brief guide for providers updated January 2016
HIV Pre-Exposure Prophylaxis (PrEP): A brief guide for providers updated January 2016 Daily emtricitabine/tenofovir (Truvada ) is safe and effective for reducing the risk of HIV acquisition in sexually
More informationUrinary Tract Infections
Urinary Tract Infections Overview A urine culture must ALWAYS be interpreted in the context of the urinalysis and patient symptoms. If a patient has no signs of infection on urinalysis, no symptoms of
More informationAccent on Health Obgyn, PC HERPES Frequently Asked Questions
1. What is herpes? 2. How common is herpes? 3. Is there a cure for herpes? 4. What is oral herpes (cold sores)? 5. How is oral herpes spread? 6. What is genital herpes? 7. How is genital herpes spread?
More informationSEXUALLY TRANSMITTED INFECTIONS (STIs)
SEXUALLY TRANSMITTED INFECTIONS (STIs) The importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health STIs: LARGE BURDEN AND SERIOUS CONSEQUENCES
More informationUrinary Tract Infections
1 Infections in the urinary tract are relatively common. These infections are often referred to as bladder infections. They are also known as UTI s or urinary tract infections. When an infection is confined
More informationPartner Services Providers. Quick Guide
Partner Services Providers Quick Guide This pamphlet is meant for use by Disease Intervention Specialists and others conducting partner services activities. High Priority Index Patients for Partner Services
More informationSyphilis. Looking after your sexual health
Syphilis Looking after your sexual health 2 Syphilis Syphilis is a sexually transmitted infection (STI). It is not as common as some sexually transmitted infections but if left untreated it can cause very
More informationThe Basics of Drug Resistance:
CONTACT: Lisa Rossi +1-412-641-8940 +1-412- 916-3315 (mobile) rossil@upmc.edu The Basics of Drug Resistance: QUESTIONS AND ANSWERS HIV Drug Resistance and ARV-Based Prevention 1. What is drug resistance?
More informationTransportation of Specimens for Neisseria gonorrhoeae Culture
TRANSPORTATION OF SPECIMENS FOR NEISSERIA GONORRHOEAE MARCH 2014 ation of Specimens for Neisseria gonorrhoeae Culture There is a critical need to ensure accurate antimicrobial resistance testing for Neisseria
More informationGLOBAL OVERVIEW OF ANTIMICROBIAL RESISTANCE STD AGENTS
GLOBAL OVERVIEW OF ANTIMICROBIAL RESISTANCE STD AGENTS IN Dr.P.Bhalla Director Professor and Head Dept. of Microbiology Maulana Azad Medical College New Delhi, INDIA STDs & RTIs l HIV l Gonococcal infections/
More informationGuidelines for Preventative Health Care in LGBT Populations
+ Guidelines for Preventative Health Care in LGBT Populations Katie Imborek, MD Department of Family Medicine Co-Director UI LGBTQ Clinic April 2 nd, 2014 + Objectives n Understand CDC screening guidelines
More informationHPTN 073: Black MSM Open-Label PrEP Demonstration Project
HPTN 073: Black MSM Open-Label PrEP Demonstration Project Overview HIV Epidemiology in the U.S. Overview of PrEP Overview of HPTN HPTN 061 HPTN 073 ARV Drug Resistance Conclusions Questions and Answers
More informationThe challenge of herpes
The challenge of herpes Herpes is a common and personally challenging disease Herpes is very common. One out of four adults has genital herpes. When people first hear that they are infected, many become
More informationHIV/AIDS Tool Kit. D. Answer Key for the HIV/AIDS Questionnaire for Health Care Providers and Staff
8 HIV/AIDS Tool Kit D. Answer Key for the HIV/AIDS Questionnaire for Health Care Providers and Staff Answer Key. HIV/AIDS KAP Questionnaire for Health Answer Key Legend Care Providers and Staff Each survey
More informationFAQs HIV & AIDS. What is HIV? A virus that reduces the effectiveness of your immune system, meaning you are less protected against disease.
HIV & AIDS What is HIV? A virus that reduces the effectiveness of your immune system, meaning you are less protected against disease. What does HIV stand for? Human Immunodeficiency Virus Where did HIV
More informationNURSE LED SERVICES IN CARDIFF AND VALE NHS TRUST. Sandra Smith Senior Nurse Manager Cardiff and Vale NHS Trust 28 th June 2007
NURSE LED SERVICES IN CARDIFF AND VALE NHS TRUST Sandra Smith Senior Nurse Manager Cardiff and Vale NHS Trust 28 th June 2007 Reasons for increasing Nurse Led Services The advent of HIV and the dramatic
More informationEtiology and treatment of chronic bacterial prostatitis the Croatian experience
Etiology and treatment of chronic bacterial prostatitis the Croatian experience Višnja Škerk University Hospital for Infectious Diseases "Dr. Fran Mihaljevic" Zagreb Croatia Milano, Malpensa, 14 Nov 2008
More informationGlossary. amenorrhea, primary - from the beginning and lifelong; menstruation never begins at puberty.
Glossary amenorrhea - absence or cessation of menstrual periods. amenorrhea, primary - from the beginning and lifelong; menstruation never begins at puberty. A amenorrhea, secondary - due to some physical
More informationDiagnosis and Management of Gonococcal Infections
Diagnosis and Management of Gonococcal Infections MEJEBI T. MAYOR, MD, JD, Providence Hospital, Washington, District of Columbia MICHELLE A. ROETT, MD, MPH, Georgetown University/Providence Hospital Family
More informationYukon Treatment Guidelines for Sexually Transmitted Infections (STI) in Adolescents and Adults 2015
Yukon Treatment Guidelines f Sexually Transmitted Infections (STI) in Adolescents and Adults 2015 The Yukon Treatment Guidelines f Sexually Transmitted Infections (STI) in Adolescents and Adults 2015 has
More informationPERTUSSIS SURVEILLANCE AND RESPONSE PROTOCOL
PERTUSSIS SURVEILLANCE AND RESPONSE PROTOCOL Public Health Action 1. Educate the public, particularly parents of infants, about the dangers of whooping cough and the advantages of initiating immunization
More informationAntibiotic Guidelines: Ear Nose and Throat (ENT) Infections. Contents
Antibiotic Guidelines: Ear Nose and Throat (ENT) Infections. Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Authors Division: DCSS & Tertiary Medicine
More information4/30/2013 HPV VACCINE AND NORTH DAKOTA HPV IMMUNIZATION RATES HUMAN PAPILLOMAVIRUS (HPV) HUMAN PAPILLOMAVIRUS HPV CONTINUED
HPV VACCINE AND NORTH DAKOTA HPV IMMUNIZATION RATES HUMAN PAPILLOMAVIRUS (HPV) HUMAN PAPILLOMAVIRUS What is human papillomavirus (HPV)? HPV is the most common sexually transmitted infection. There are
More informationORIGINAL STUDY. Sexually Transmitted Infection Testing of Adult Film Performers: Is Disease Being Missed?
ORIGINAL STUDY Sexually Transmitted Infection Testing of Adult Film Performers: Is Disease Being Missed? Cristina Rodriguez-Hart, MPH,* Rohit A. Chitale, PhD, MPH,Þ Robert Rigg, MD,þ Binh Y. Goldstein,
More informationCOMMUNICABLE DISEASE
Public Health Activities & Services Inventory Technical Notes COMMUNICABLE DISEASE CLINICAL SERVICES, SURVEILLANCE AND CONTROL In 2014, decision was made to adopt number of national public health activities
More informationENHANCING ADOLESCENT SEXUAL HEALTH
ENHANCING ADOLESCENT SEXUAL HEALTH SERVICES BY CREATING AN ADOLESCENT MEDICAL HOME Gale R. Burstein, MD, MPH, FAAP, FSAHM Commissioner, Erie County Department of Health, Associate Clinical Professor, SUNY
More informationHigh quality follow up support and care
High quality follow up support and care How do you think the benefits of high quality follow up care? Client satisfaction Safe and effective continuation of the method What are the tasks involved in routine
More informationPalm Beach Obstetrics & Gynecology, PA
Palm Beach Obstetrics & Gynecology, PA 4671 S. Congress Avenue, Lake Worth, FL 33461 561.434.0111 4631 N. Congress Avenue, Suite 102, West Palm Beach, FL 33407 Urinary Tract Infection About one of every
More informationU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention Division of Tuberculosis Elimination Public
More informationIOWA DEPARTMENT OF JUSTICE ATTORNEY GENERAL'S OFFICE CRIME VICTIM ASSISTANCE DIVISION SEXUAL ABUSE EXAMINATION PAYMENT PROGRAM
IOWA DEPARTMENT OF JUSTICE ATTORNEY GENERAL'S OFFICE CRIME VICTIM ASSISTANCE DIVISION SEXUAL ABUSE EXAMINATION PAYMENT PROGRAM The Attorney General's Crime Victim Assistance Division administers the Sexual
More informationPSA Screening for Prostate Cancer Information for Care Providers
All men should know they are having a PSA test and be informed of the implications prior to testing. This booklet was created to help primary care providers offer men information about the risks and benefits
More informationBalanitis (change on the helmet of the penis) This is a change in the skin on the glans (helmet) of the penis. It is often caused by either:-
INFECTIONS Bacterial Vaginosis Women with Bacterial Vaginosis (BV) often complain of an increase in vaginal discharge that is "smelly" or they feel "unclean" despite regular washing. This is more noticeable
More informationwww.hepinfo.ie Are you Hep C aware? awareness information support prevention To find out more visit
Are you Hep C aware? awareness information support prevention To find out more visit www.hepinfo.ie What is Hepatitis C? Hepatitis C is a viral infection that affects the liver, causing it to become inflamed
More informationPrevention and Recognition of Obstetric Fistula Training Package. Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula
Prevention and Recognition of Obstetric Fistula Training Package Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula Early detection and treatment If a woman has recently survived a
More informationTUBERCULOSIS (TB) SCREENING GUIDELINES FOR RESIDENTIAL FACILITIES AND DRUG
TUBERCULOSIS (TB) SCREENING GUIDELINES FOR RESIDENTIAL FACILITIES AND DRUG Tx CENTERS Tuberculosis Control Program Health and Human Services Agency San Diego County INTRODUCTION Reducing TB disease requires
More informationCopper-Bearing Intrauterine Device
CHAPTER 9 Copper-Bearing Intrauterine Device This chapter describes primarily the TCu-380A intrauterine device (for the Levonorgestrel Intrauterine Device, see p. 157). Key Points for Providers and Clients
More informationGenital warts. Looking after your sexual health
Genital warts Looking after your sexual health 2 Genital warts Genital warts are the most common viral sexually transmitted infection (STI). They are caused by the human papilloma virus (HPV) which can
More informationClinical Aspects of Diagnosis of Gonorrhea and Chlamydia Infection in an Acute Care Setting
BRIEF REPORT Clinical Aspects of Diagnosis of Gonorrhea and Chlamydia Infection in an Acute Care Setting Supriya D. Mehta, 1 Richard E. Rothman, 2 Gabor D. Kelen, 2 Thomas C. Quinn, 3,4 and Jonathan M.
More information