WA Endemic Regions STI/HIV Control Supplement

Transcription

1 WA Endemic Regions STI/HIV Control Supplement MAY 2013

2 Contents INTRODUCTION... 2 HEALTH UNITS CONTACTS... 3 RATES OF CHLAMYDIA, GONORRHOEA AND SYPHILIS NOTIFICATIONS IN THE GOLDFIELDS, KIMBERLEY, MIDWEST AND PILBARA REGIONS... 4 Figure 1: Age-standardised rates of chlamydia notifications in WA by endemic region and year, Figure 2: Age-standardised rates of gonorrhea notifications in WA by endemic region and year, Figure 3: Age-standardised rates of infectious syphilis notifications in WA by endemic region and year, ROLES AND RESPONSIBILITIES OF HEALTH CARE WORKERS IN THE REGIONAL STI/HIV CONTROL PROGRAM... 7 Primary Health Care Services (Aboriginal Health Services, Community Health Services and General Practitioners)... 8 ENDEMIC REGIONS APPLICATION OF STI/HIV CONTROL PRINCIPLES... 9 Trained Workforce and Accessible Health Services... 9 Prevention and Education Case Detection Clinical Management Information and Evaluation REFERENCES Further reading and resources ACKNOWLEDGEMENTS APPENDIX Sample: GOLDFIELDS FEMALE AND MALE SEXUAL HEALTH CLINICAL MANAGEMENT FORMS Sample: KIMBERLEY STI CLINICAL MANAGEMENT FORM Sample: PILBARA STI CLINICAL MANAGEMENT FORM Sample: PILBARA SEXUAL CONTACT INTERVIEW AND TRACING FORM APPENDIX Management of Sexually Transmitted Infections - Treatment Guidelines

3 INTRODUCTION This supplement to the Guidelines for Managing Sexually Transmitted Infections (2010) is to guide practitioners working in regions of Western Australia (WA) where sexually transmitted infections (STIs) are endemic. Different approaches to prevention education, testing, treatment and management of STIs and HIV are often required in these areas. The WA Endemic Regions STI/HIV Control Supplement has been developed in partnership with WA Country Health Service (WACHS), Regional Population Health Units (PHU) and the Communicable Disease Control Directorate s Sexual Health and Blood-borne Virus Program. The supplement is for regions of WA where rates of infection for syphilis, gonorrhoea and chlamydia are well above the State average (Figures 1, 2 and 3), particularly in the 15 to 30 year old age group. Prevention and control of these treatable diseases are important in their own right, and also in reducing the spread of HIV. This supplement describes useful STI/HIV control strategies for public health and primary health care settings. The WA Endemic Regions STI/HIV Control Supplement does not replace the Guidelines for Managing Sexually Transmitted Infections (2010) but provides supplementary information, which is important in areas of endemic disease. If you require further information please contact your local Population Health Unit (PHU) or direct your inquiries to Disease Control Staff (see local regional contact details below). 2

4 HEALTH UNITS CONTACTS GOLDFIELDS POPULATION HEALTH UNIT (GPHU) Goldfields Population Health Unit Tel: Fax: Public Health Medical Officer/Public Health Physician Tel: Senior Public Health Nurse Tel: Regional Sexual Health Team Tel: KIMBERLEY POPULATION HEALTH UNIT (KPHU) Kimberley Population Health Unit Tel: Public Health Medical Officer/Public Health Physician Tel: Senior Public Health Nurse, STI Tel: Public Health Nurse Tel: Regional Sexual Health Team Tel: MIDWEST POPULATION HEALTH UNIT (MPHU) Midwest Population Health Unit Tel: Public Health Physician Tel: Mob: Public Health Nurse Tel: Mob: PILBARA POPULATION HEALTH UNIT (PPHU) Pilbara Population Health Unit Tel: Public Health Medical Officer/Public Health Physician Tel: Public Health Coordinator (CDC) Tel: Confidential Fax Regional Sexual Health Team Tel:

5 RATES OF CHLAMYDIA, GONORRHOEA AND SYPHILIS NOTIFICATIONS IN THE GOLDFIELDS, KIMBERLEY, MIDWEST AND PILBARA REGIONS Figure 1: Age-standardised rates of chlamydia notifications in WA by endemic region and year, Age-standardised rate per 100,000 population 2,000 1,800 1,600 1,400 1,200 1, Year Goldfields Kimberley Midwest Pilbara WA (Total) 4

6 Figure 2: Age-standardised rates of gonorrhea notifications in WA by endemic region and year, Age-standardised rate per 100,000 population 2,000 1,800 1,600 1,400 1,200 1, Year Goldfields Kimberley Midwest Pilbara WA (Total) 5

7 Figure 3: Age-standardised rates of infectious syphilis notifications in WA by endemic region and year, Age-standardised rate per 100,000 population Year Goldfields Kimberley Midwest Pilbara WA (Total) 1 Definition of terms used Endemic: The constant presence of a disease or infectious agent within a given geographic area or population group; may also refer to the usual prevalence of a given disease within such area or group. Empirical treatment: Treatment given before laboratory results are available. Refer to sections and 4.1.2, STI Guidelines 2010, Outbreak: An epidemic limited to localised increase in the incidence of a disease. Opportunistic screening: Offering an STI check to patients who have no symptoms or signs of STIs but are in a high-risk group. Refer to section 1.4.1, STI Guidelines Last, JM A dictionary of epidemiology, 4 th edition. Oxford University Press. 6

8 ROLES AND RESPONSIBILITIES OF HEALTH CARE WORKERS IN THE REGIONAL STI/HIV CONTROL PROGRAM Within each region, a variety of health care providers and services are involved with the STI/HIV control program. Communicable disease control is the responsibility of the Public Health Unit, which is part of each region s Population Health Unit (PHU). Regular review and evaluation of the STI/HIV control program is required to ensure quality control. The PHU is responsible for provision of information, training and ongoing support to regional health practitioners in regard to the unique features of the region; however, in the Kimberley, the PHU and the Kimberley Aboriginal Medical Services Council share this role. In each region, the PHU s Public Health Medical Officer/Public Health Physician (PHMO/PHP) is responsible for providing standing orders for Department of Health staff if there is no local Medical Officer (MO) in the town or servicing the community. It is preferred to integrate the local MO servicing the town/community into the sexual health program by allowing WACHS staff who have undergone appropriate training to use a particular MO s provider number when ordering STI tests. If this is not possible, it is possible to arrange to use the PHMO/PHP s provider number. The PHMO/PHP provides advice on testing, treatment and management of STIs. All syphilis serology results received by the PHU should be reviewed by the PHMO/PHP who makes recommendations regarding follow-up and treatment. Senior Public Health Nurse (Goldfields) - Based in the Goldfields PHU, this position is responsible for provision of advice, following up notifications, and coordinating contact tracing as requested. The Senior Public Health Nurse also coordinates the notification process of STIs in minors. This position also assists in the provision of Sexual Health Clinic Services at Population Health in Kalgoorlie. Sexual Health Coordinator (Goldfields) Also based in the Goldfields PHU this position coordinates the support, training and ongoing assistance to staff providing sexual health services across the region. The position also coordinates the Sexual Health Clinic Services at Population Health in Kalgoorlie. Senior Public Health Nurse - STI (Kimberley) - This is a regional position that provides sexual health program support, guidance and expertise to health professionals working in the field. This position works in partnership with the Sexual and Reproductive Health Officer, based in the East Kimberley to ensure that there is an effective sexual health program in place at all key sites across the Kimberley Region and to facilitate the process for new staff to be orientated to the sexual health program. Public Health Nurse (Kimberley) - Based in the Kimberley PHU, this position is responsible for phoning out of positive STI results to practitioners, attending to notifications, maintenance of the Syphilis database, providing advice to health professionals, coordination of treatment where indicated and assistance with contact tracing as requested. The Public Health Nurse also coordinates the referral and notification process of STIs in minors. 7

9 Public Health Nurse - Communicable Disease Coordinator (Pilbara) - Based in the Pilbara PHU, this position is responsible for provision of advice, support and training to staff, phoning out of positive STI results to practitioners, attending to notifications, maintenance of the Syphilis Register, and coordinating contact tracing as requested. Sexual Health Nurse (Midwest) - Based in Geraldton in the Midwest PHU, this position is responsible for provision of advice, support and training to staff, following up notifications, and coordinating contact tracing as requested. The Sexual Health Nurse also coordinates the notification process of STIs in minors. This position is also responsible for the provision of Sexual Health Clinic Services at Population Health in Geraldton. Sexual Health Team - Based in each endemic region s PHU, the Sexual Health Team is available to assist, support and where possible initiate promotion of sexual health throughout the region. Primary Health Care Services (Aboriginal Health Services, Community Health Services and General Practitioners) Primary health care services within an endemic region can assist with STI/HIV control through the implementation of a comprehensive sexual health program. This can be supported by the PHU. Each service should: nominate a Sexual Health Program or STI Coordinator whose responsibility is to monitor, maintain and support other staff to provide education, testing, treatment and effective management of STIs/HIV. This person should maintain close contact with the Public Health team. promote and encourage staff and members (e.g. doctors, registered nurses, Aboriginal Health Workers) to attend sexual health orientation and professional development work in partnership with other service providers to increase availability of quality sexual health service delivery for the regional population participate in evaluation and monitoring of the regional STI/HIV control program. 8

10 ENDEMIC REGIONS APPLICATION OF STI/HIV CONTROL PRINCIPLES The following information lists the key elements, which may be different when working in an endemic area. All points are referenced to sections in the Guidelines for Managing Sexually Transmitted Infections The points are grouped under the five principles of STI/HIV control: 1. Trained workforce and accessible health services 2. Prevention and education 3. Case detection 4. Clinical management 5. Information and evaluation. Trained Workforce and Accessible Health Services Orientation to the Sexual Health Program is available for staff through the PHU (see contact details on page 3 of the supplement). Cross-cultural training is an essential part of orientation and is available from the PHU and/or the regional health service. Be aware of the many different perceptions in regard to the clinical environment, privacy, confidentiality and gender issues, which can create barriers to patients accessing health services for STI/HIV services. Seek cultural advice from an Aboriginal Health Worker (AHW) from the PHU or a primary health care service. Refer to sections and 1.1.3, STI Guidelines Regional sexual health updates are provided several times a year by the PHU with or without Community Health Management. In addition, the Sexual Health and Blood-borne Virus Program coordinates STI and blood-borne virus (BBV) quarterly forums (via videoconference), and FPWA Sexual Health Services coordinates an annual face-to-face STI forum. Primary health care staff should seek support from their line-manager to participate in these opportunities for professional development and collegial support. 9

11 Prevention and Education Every STI/HIV consultation is an opportunity for preventive education. Mutual respect and trust between both parties enables risk behaviours to be clarified and appropriate information to be delivered. Encouraging people to return for test results allows a further opportunity for education and information exchange. Some discussion points return for results, abstinence following treatment, regular STI checks, risky behaviours, and notification requirements. Various resources are available to assist with education. Refer to the local orientation pack for more details. For more information about these points, refer to section 1.1.7, STI Guidelines Case Detection Opportunistic testing. Offer STI checks with Well Person Checks, Pap tests, and at any other appropriate opportunity. This will assist with normalising regular STI/HIV testing and promote early detection of asymptomatic cases. Refer to section 1.4.1, STI Guidelines Be suspicious. Consider STIs as an underlying cause for a variety of clinical presentations. In endemic areas, STIs are an important cause of urethral (male) or vaginal (female) discharge, with or without dysuria, abdominal/pelvic pain, generalised sepsis, pelvic inflammatory disease (PID), epididymo-orchitis, Bartholin s abscess, endocarditis, alopecia and rashes/skin lesions. When in doubt, ring your medical officer, or public health doctor for advice. Suspect one STI then test for all. Co-infection with more than one STI is common. A standard STI investigation should include gonorrhoea, chlamydia, syphilis, hepatitis B and HIV. Refer to sections , STI Guidelines The Kimberley PHU also recommends trichomonas testing of females. Contact tracing. Sex partners of patients with an STI should be offered a full STI/HIV assessment and empirical treatment. This is the primary health care provider s responsibility; assistance is available from the PHU. Refer to sections , STI Guidelines Antenatal STI screening should be offered to all pregnant women. STIs can be asymptomatic in pregnancy and have serious consequences for the infant. The following screening tests are recommended: 10

12 first trimester - HIV, syphilis, hepatitis B and C serology, gonorrhoea and chlamydia NAAT between 28 and 36 weeks HIV, syphilis serology 36 weeks - gonorrhoea and chlamydia NAAT. Refer to sections 1.1.4, and , STI Guidelines The Kimberley PHU also recommends: testing for trichomonas in the first trimester and at 36 weeks. However, it is not known whether detection and treatment of trichomonas in pregnancy has any effect on pregnancy outcomes. syphilis testing of neonatal cord blood as this ensures that neonatal syphilis is not missed. Contact the Kimberley PHU for information and advice on cord blood serology Tel: (08) or refer to section , STI Guidelines Syphilis is often diagnosed by serology alone and is part of a routine STI screen. Interpretation of serology depends on past serological history, past treatment history as well as current clinical assessment. Refer to the PHU for assistance in obtaining past history, management and treatment of syphilis. Refer to section 2.7, STI Guidelines Normalise HIV testing Having an STI or being a contact of an STI is a risk factor for HIV infection. HIV testing is recommended as an integral part of any STI assessment, after obtaining informed consent. Refer to sections and 2.5, STI Guidelines 2010 and National HIV Testing Policy HIV transmission in Aboriginal populations is predominantly heterosexual. From 2003 to 2012, the age-standardised rate (ASR) of HIV notifications was higher among Aboriginal people (5.7 per 100,000 population) compared to non-aboriginal people (3.7 per 100,000 population). The ASR of HIV notifications was also higher among Aboriginal females (5.3 per 100,000 population) compared to non-aboriginal females (1.9 per 100,000 population). Within this period, heterosexual exposure to HIV was also more commonly reported among Aboriginal people (68%) compared to non-aboriginal people (50%). [1] [1] Epidemiology and Surveillance Program, Department of Health, Western Australia

13 Gonococcal conjunctivitis is considered a public health emergency. Notify the PHMO/PHP (Goldfields, Kimberley, Midwest and Pilbara) with all suspected cases. Refer to section 2.4.4, STI Guidelines Gonococcal conjunctivitis is usually NOT spread sexually. Clinical Management Use the form. STI clinical management forms (CMFs) are available from the PHU, freeof-charge, to all primary health care providers to assist with obtaining a complete sexual history, identifying risky behaviours and STI case management. Community Health staff are required to use the STI CMF. Refer to section 1.2.6, STI Guidelines See Appendix 1 for sample CMFs from each region. Midwest clinicians use Kimberley CMF. History taking includes sexual history, contacts, where a person may have acquired the infection (i.e. interstate, overseas) as this can influence choice of empirical treatment. Refer to sections , STI Guidelines Under 14 years. There are special state-wide protocols for the notification and reporting of an STI in children under 14 years. Refer to the Regional PHU for details of process and standard referral forms. Refer to sections 1.1.8, and , STI Guidelines EXAMINATION and TESTING Male and female STI/HIV pathology packs are available from PathWest for specimen collection. The flow chart in the packs reminds practitioners what specimens to take. Refer to sections , STI Guidelines An STI pathology stamp is available for using on the laboratory request form. Cross out tests not required. Stamps are available from the PHU. Body and genital examination is recommended best practice in the clinical management of a patient presenting with STI symptoms or as an STI contact because STIs can present with painless genital ulcers and body rashes, e.g. syphilis, donovanosis. Refer to sections and 1.2.5, STI Guidelines Penicillin resistance is monitored. Swab and culture all purulent discharge to ensure that gonorrhoea is still sensitive to penicillin. Refer to section 2.4, STI Guidelines NAAT (PCR) testing for gonorrhoea and chlamydia is available in all regions. Genital Ulcer Disease PCR (NAAT). Obtain a dry PCR swab from genital ulcers and order a GUD (genital ulcer disease) PCR (NAAT), which will test for syphilis, donovanosis and herpes. See the STI pathology stamp. Refer to section 1.5.4, STI Guidelines

14 Self Obtained Low Vaginal Swabs (SOLVS) are recommended for gonorrhoea and chlamydia NAAT testing if a female has no genital symptoms and is not due for a Pap smear. Refer to section 1.3.8, STI Guidelines For a patient handout on how to collect SOLVS (STI Self Testing Card), refer to section 4.7, STI Guidelines The Kimberley PHU also recommends trichomonas testing of females. TREATMENT ISSUES Empirical treatment (before results are available) is recommended for symptomatic cases of gonorrhoea and chlamydia and for all sex partners of people with gonorrhoea and chlamydia regardless of whether they have symptoms. Refer to the Treatment Guidelines at the end of this supplement (Appendix 2). Copies are also available from the PHU s PHMO/PHP. Empirical treatment (before results are available) is recommended for symptomatic cases of syphilis and named sex partners of people with syphilis. Refer to section 2.7.6, STI Guidelines Non-infectious syphilis. Clinicians are advised to consult with the relevant PHU s PHMO/PHP who has access to the patient s previous syphilis serology results and treatment history before initiating treatment for non-infectious syphilis. A LAC pack contains ceftriaxone 500 mg, 2 ml of 1% lignocaine and azithromycin 1 g. Check with the regional standing orders in regard to use of a LAC pack. Refer to Appendix 2. A ZAP pack contains 1 g azithromycin, 3 g amoxycillin, 1 g probenecid and a patient advice sheet. Check with the regional standing orders in regard to use of a ZAP pack. Refer to Appendix 2. Syphilis treatment must be ordered by a Medical Officer. Re-testing for syphilis on the day treatment commences, and at three month follow-up, is essential in syphilis cases to detect a two-titre or four-fold (e.g. 1:16 to 1:4) fall in RPR (rapid plasma reagin test), indicating a therapeutic response to treatment. For further information contact the PHU (see page 3 of the supplement) or refer to sections and 2.7.7, STI Guidelines Treatment of STIs in children is only to be given after consultation with the local Medical Officer, Paediatrician or PHMO/PHP as drug dosage may vary. Refer to sections and 2.4.4, STI Guidelines

15 CONTACT TRACING Contact time frames are recommended on the STI CMF. Refer to the Australasian Contact Tracing Manual 2010 and STI Guidelines 2010, under each notifiable infection, for information about how far back to trace. Contact tracing should be undertaken urgently for gonorrhoea and chlamydia and infectious syphilis or syphilis of unknown duration. Refer to section 1.6.7, STI Guidelines Contact tracing should be initiated prior to laboratory confirmation of an STI under the following circumstances: male presenting with discharge/dysuria female presenting with acute PID symptoms and/or purulent cervical discharge patient presenting with symptoms of infectious syphilis. Penicillin resistant gonorrhoea contact tracing should be undertaken with particular urgency. Refer to section 2.4.8, STI Guidelines Assistance with contact tracing can be obtained from the PHU (see page 3 of the supplement). Partner notification. When a patient chooses to notify their sexual partners instead of providing their names for contact tracing, it is the treating clinician s responsibility to follow-up that this has occurred. This can be done during the case review. CASE REVIEW / EVALUATION A desktop case review should be conducted for all cases of STI by the treating clinician or Sexual Health Program/STI Coordinator (if the service has one). Case review is recommended 10 days after the initial consultation for gonorrhoea and chlamydia and at appropriate intervals for syphilis and donovanosis. Information to consider in a case review - resolution of presenting complaint, test results, outcome of contact tracing and the patient has been informed of their results. The case either can be closed or requires follow up. Follow up screening all positive STI cases should have a three month follow up STI/BBV screen to check for re-infection and to cover window periods. A clinical case review, i.e. a repeat patient consultation is required if: the index patient was diagnosed with infectious syphilis or HIV the patient continues to have symptoms. 14

16 A clinical case review, i.e. a repeat patient consultation may be required if: the index patient did not name any sex partners and/or their regular sex partner none of the sex partners named by the index patient were identified as having the same infection (this is essential for HIV and infectious syphilis cases and should be considered for gonorrhoea and chlamydia cases on a case-by-case basis) the index patient has gonorrhoea where there is no culture test, i.e. antibiotic sensitivities are unknown. Refer to sections 2.2.7, 2.3.7, 2.4.7, and 2.7.7, STI Guidelines Information and Evaluation A completed STI CMF provides health services staff with a record of an STI assessment and information necessary for contact tracing and case review. This information is also useful for completing notification forms. Assistance with evaluation of all aspects of a clinical consultation through to sexual health program delivery is available from the PHU. Medical Officers are required by law to notify STIs to the WA Department of Health. Syphilis cases (Goldfields). Practitioners receiving a positive syphilis result can contact the Regional PHU for more information, support, advice and management assistance. The PHMO/PHP reviews all syphilis serology results, interprets them in light of the reason for the test and past serology/treatment history, and makes a recommendation regarding treatment and/or follow-up syphilis testing. Syphilis database (Kimberley). The PHU maintains the Kimberley Syphilis database. The PHMO/PHP reviews all syphilis serology results, interprets them in light of the reason for the test and past serology/treatment history, and makes a recommendation regarding treatment and/or follow-up syphilis testing. This is a confidential, named database. Clinicians are encouraged to use the patient s full name (not coded) for syphilis serology, and to avoid marking the request form CONFIDENTIAL. Marking the request form CONFIDENTIAL will prevent the Kimberley PHMO/PHP from receiving the result from PathWest. Syphilis Register (Pilbara). The PHU maintains the Pilbara Syphilis Register. All clinicians ordering syphilis serology are encouraged to mark copy to Pilbara PHU on the pathology request form. This promotes completeness of data at a central point, particularly for mobile clients, and ensures correct interpretation of test results. The 15

17 PHMO/PHP reviews all syphilis serology results, to interpret them in light of the reason for the test and past serology/treatment history, and to discuss with clinicians recommendations regarding treatment and/or follow-up syphilis testing. This is a confidential, named register. Clinicians are encouraged to use the patient s full name (not coded) for syphilis serology. Rapid results service (Kimberley). The PHU has an agreement with all government and non-government practitioners that a copy of all STI NAAT test results are sent to the PHU. Results are downloaded daily and positive results are phoned through to clinicians. This provides enhanced surveillance to ensure clinicians can initiate contact tracing for cases of gonorrhoea, chlamydia and trichomonas in a timely (rapid) manner. This service is particularly important for remote locations. Rapid results service (Pilbara). The PHU receives results of all STI tests which use the PHMO/PHP s provider number, along with results from other regional clinicians who request a copy of STI test results to be sent to the Regional PHU or PHP (i.e. mark copy to Pilbara PHU on the pathology request form). Results are downloaded daily and positive results are phoned through to clinicians. This provides enhanced surveillance to ensure clinicians can initiate contact tracing for cases of gonorrhoea and chlamydia in a timely (rapid) manner. This service is particularly important for remote locations. 16

18 REFERENCES 1. Department of Health, Guidelines for Managing Sexually Transmitted Infections. A guide for clinical care. Communicable Disease Control Directorate, Department of Health, 2. National HIV Testing Policy (November 2011) 3. Department of Health WA Endemic Regions STI/HIV Control Supplement: Goldfields Region. 4. Department of Health WA Endemic Regions STI/HIV Control Supplement: Kimberley Region. 5. Department of Health WA Endemic Regions STI/HIV Control Supplement: Pilbara Region. Further reading and resources The Second Western Australian Sexual Health and Blood-borne Virus Strategy and Implementation Plan Template ; February STI/HIV Flipchart Male and Female versions. A client educational resource. Available from the Sexual Health and Blood-borne Virus Program, tel: (08) Office of Aboriginal and Torres Strait Islander Health 1999, STD control in remote Aboriginal communities, a manual for clinic workers. Commonwealth Department of Health and Aged Care, Canberra. < 22B /$File/std.pdf> Australasian Society for HIV Medicine 2010, Australasian Contact Tracing Manual, 4th ed, Australian Government Department of Health and Ageing, Canberra. Australian Department of Health and Ageing. Third National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy Commonwealth of Australia, Canberra. atsi-bbv/$file/atsi.pdf Each health region produces local resources which assist in this program. Contact the local PHU for details (see page 3 of the supplement). 17

19 ACKNOWLEDGEMENTS In 1997, Kimberley health staffs were involved in the statewide consultation for the development of the Guidelines for managing sexually transmitted diseases. One of the results of this consultation was the production of the first Kimberley STI/HIV Control supplement. This edition of the supplement has been adapted from the WA Endemic Regions STI/HIV Control Supplement May 2007, and has been updated by the Sexual Health and Blood-borne Virus Program, with assistance from the dedicated staff from the Goldfields, Kimberley, Midwest and Pilbara Population Health Units and other sexual health experts. 18

20 APPENDIX 1 Sample: GOLDFIELDS FEMALE AND MALE SEXUAL HEALTH CLINICAL MANAGEMENT FORMS Copies can be obtained from the PHU 19

21 20

22 21

23 22

24 Sample: KIMBERLEY STI CLINICAL MANAGEMENT FORM 23

25 24

26 Sample: PILBARA STI CLINICAL MANAGEMENT FORM Copies can be obtained from the PHU STI CLINICAL MANAGEMENT FORM DATE PRESENTED REASON ID Number PATIENT S DETAILS (please print) Name / /201_ Self referral Address Contact Post Code Positive lab result Tel: H M Referred Opportunistic Date of birth / / Country of birth: Sex Male Female Race Indigenous Other SEXUAL HISTORY Does the patient have any regular sexual partners? Y N Does the patient have casual sexual partners? Y N Sexual preference Previous STI Previous STI testing M F M/F Y N Unknown Y N Unknown SIGNS OR SYMPTOMS - DURATION & DESCRIPTION Asymptomatic Discharge Dysuria Genital lesion Rash Hair loss Other Pregnant Y N Unknown Sexual activities Vaginal Oral Anal Condom use Always Sometimes Never Sexual contact in last 12 months Interstate Overseas Country. Injecting drug use Currently Past Never Sex worker Currently Past Never ESSENTIAL TESTS Urethra Cervix Vagina Rectum Throat NAAT swab (gono & chlam +/- trich) NAAT not validated in rectum & throat Charcoal MC&S swab + slide (if discharge present or gono contact) First void urine NAAT (gono & chlam +/- trich) Blood tests Syphilis HIV HepB Tests refused (specify) ADDITIONAL TESTS Hep A Hep C B-HCG SOLVS-NAAT Pap Smear Vag ph. NAAT HSV NAAT Donovanosis NAAT Syphilis Other Tests SAFE SEX EDUCATION Condom education Issued condoms Advised where to access condoms 3 month follow up testing PROVISIONAL DIAGNOSIS Allergies TREATMENT Treatment given Further treatment required (drug, dose, date) Review appt date / /201_ Where screening took place Clinician s name..signature Date / /201_ Send back page of completed form in sealed envelope to the STI co-ordinator at your health service unit STI CO-ORDINATOR USE ONLY Lab confirmed Dx Gono Chlam Syph HIV Hep B Other No STI All sexual contacts contacted, examined and treated Y N Date form received / /201_ If patient had STI/s, at least one contact found with same STI/s Y N Case review date / /201_ 25

27 Sample: PILBARA SEXUAL CONTACT INTERVIEW AND TRACING FORM Same DOB/Age Partner Address Date of last sexual contact & location Regular Casual Sex worker Regular Casual Sex worker Regular Casual Sex worker Regular Casual Sex worker Regular Casual Sex worker Regular Casual Sex worker Attempts to locate (dates, details) & date last seen in clinic Epidemiological Rx given ZAP Y N LA Bicillin Y N Date ZAP Y N LA Bicillin Y N Date ZAP Y N LA Bicillin Y N Date ZAP Y N LA Bicillin Y N Date ZAP Y N LA Bicillin Y N Date ZAP Y N LA Bicillin Y N Date Results of lab tests Gono Chlam Syph pos pos new neg neg old Other neg pos pos new neg neg old Other neg pos pos new neg neg old Other neg pos pos new neg neg old Other neg pos pos new neg neg old Other neg pos pos new neg neg old Other neg Tips for interviewing Time frames (months) To jog patient s memory Other tips for better contact tracing Inform the patient Take your time Be non-judgemental Use plain English Ask direct questions, e.g. Who did you have sex with? Who did you go with? DO NOT use ambiguous Disease M F Gonorrhoea 1 3 Chlamydia 1 3 M & F Primary syph 3 Link sexual encounters with events significant to the patient, e.g. rodeos, Easter, X mas, visits to relatives Start with the most recent sexual encounter and work backwards Stress the importance of an accurate contact history (prevents re-infection of the patient, female infertility, congenital STI in babies, STI spreading in their community) Get a description of the contact Where does s/he live? What does s/he look like? Who does s/he associate All information re sexual history and lab tests is confidential Lab test results will go to their doctor and Pilbara Population Health Unit (if copy to PPHU printed on lab form) terms, e.g. sleep with Secondary syph 6 to 24 Donovanosis 3 with? Ask patient (if literate) to write names of contacts on paper Following consult, FAX FORM to Pilbara Population Health Unit Communicable Disease Coordinator, confidential fax: (08)

28 APPENDIX 2 Management of Sexually Transmitted Infections - Treatment Guidelines The Regional Population Health Unit s (PHU s) Public Health Medical Officer (PHMO)/ Public Health Physician (PHP), WA Country Health Service (WACHS), authorises Community Health Nurses currently employed by this WACHS region, who have a working knowledge of the Department of Health s Guidelines for Managing Sexually Transmitted Infections (2010) to administer medications under the following guidelines for the treatment of uncomplicated STIs in adults (16 years and over). Where these specific criteria are not met, further advice from the PHMO/PHP or local Medical Officer is to be sought prior to treatment: staff must have undertaken orientation by the PHU and completed the on-line STI e-learning module, Special Module for Nurses, at in line with the Nurse Initiated STI Treatment Code each case must be assessed for drug sensitivities and medication allergies a history of pregnancy should be sought from all females all information is to be recorded on a Clinical Management Form or on the patient s notes all treatment is carried out according to the Guidelines for Managing Sexually Transmitted Infections (2010) any other treatment will be given under the advice of the PHMO/PHP PRESENTATION TREATMENT NOTE Signs and symptoms of chlamydia and/or gonorrhoea, acquired locally or in an endemic region Signs and symptoms of chlamydia and/or gonorrhoea, acquired outside an endemic region Sexual partners of clients symptomatic of chlamydia and/or gonorrhoea, acquired locally or in an endemic region Sexual partners of clients symptomatic of chlamydia and/or gonorrhoea, acquired outside an endemic region or if place of acquisition not known Clients with a positive result of chlamydia and negative gonorrhoea result (if not already treated) ZAP pack (Amoxycillin 3 g, Probenecid 1 g and Azithromycin 1 g) prior to obtaining results LAC pack (Ceftriaxone 500 mg IMI in 2 ml of 1% lignocaine plus Azithromycin 1 g oral) prior to obtaining results ZAP pack (Amoxycillin 3 g, Probenecid 1 g and Azithromycin 1 g) prior to obtaining results LAC pack (Ceftriaxone 500 mg IMI in 2 ml of 1% lignocaine plus Azithromycin 1 g oral) prior to obtaining results Azithromycin 1 g Single dose Directly observed therapy Do not wait for results before treating Single dose Directly observed therapy Do not wait for results before treating Single dose Directly observed therapy Do not wait for results before treating Single dose Directly observed therapy Do not wait for results before treating Single dose Directly observed therapy Sexual partners of a confirmed case of chlamydia Azithromycin 1 g prior to obtaining results Single dose Directly observed therapy Do not wait for results before treating Clients with a positive result of genital gonorrhoea and negative chlamydia result, acquired locally or in an endemic region (if not already treated) Sexual partners of a confirmed case of gonorrhoea, acquired locally or in an endemic region Sexual partners of a confirmed case of gonorrhoea, acquired outside an endemic region or if place of acquisition not known Gonorrhoea infection in anorectal or oral sites Genital ulcers (presumptive clinical diagnosis of syphilis, donovanosis or chancroid)* Sexual partners of a confirmed case of syphilis and reverse contact trace positive* ZAP pack (Amoxycillin 3 g, Probenecid 1 g and Azithromycin 1 g ZAP pack (Amoxycillin 3 g, Probenecid 1 g and Azithromycin 1 g) prior to obtaining results LAC pack (Ceftriaxone 500 mg IMI in 2 ml of 1% lignocaine plus Azithromycin 1 g oral) prior to obtaining results LAC pack (Ceftriaxone 500 mg IMI in 2 ml of 1% lignocaine plus Azithromycin 1 g oral) prior to obtaining results Benzathine penicillin 1.8 g IMI and azithromycin 1 g orally prior to obtaining results Benzathine penicillin 1.8 g IMI Single dose Directly observed therapy Single dose Directly observed therapy Do not wait for results before treating Single dose Directly observed therapy Do not wait for results before treating Single dose Directly observed therapy Ensure NAAT and MC&S swab Do not wait for results before treating If penicillin allergy or swab positive for herpes, syphilis, donovanosis or chancroid, discuss with PHMO/PHP Ensure syphilis serology blood test If penicillin allergy discuss with PHMO/PHP Do not wait for results before treating * It is strongly recommended that nurses discuss syphilis cases and contacts with a Public Health Medical Officer prior to commencing treatment. For further advice or information please contact PHU staff (see page 3 of the supplement). 27

29 This document can be made available in alternative formats on request for a person with a disability. Department of Health 2013