Sexually Transmitted Infections: Difference between revisions

From Guide to YKHC Medical Practices

No edit summary
Line 1: Line 1:
We have a lot of STI’s in the Delta region and Alaska typically ranks number one or two in the nation for Chlamydia infections.  Due to high levels of STIs, it is recommended that we aggressively screen all females and males over the age of 12.
We have a lot of Sexually Transmitted Infections (STIs) in the Delta region and Alaska typically ranks number one or two in the nation for Chlamydia infections (CT) and Gonorrhea (G).  Due to high levels of STIs, it is recommended that we aggressively screen all females and males over the age of 12.


When someone asks for a STI check, please do urine, self-vaginal or cervical swab, an anal swab, RPR, and HIV tests. Ask if they are interested in Hep B, C and Herpes (HSV1/HSV2) testing as well. When doing the urine STI test, it needs to be done with dirty urine without wiping beforehand. Use the '''AMB STI''' PowerPlan which has all testing, treatments, etc.
When someone asks for a STI check, please do urine, self-vaginal or cervical swab, anal and Oral GC/CT swab, RPR, and HIV tests. If a person specifically requests STI screening, inquire if they have gotten a social media notice or text from a partner notifying them of being a STI contact.  Let them know most have NO symptoms with Chlamydia.  Ask if they are interested in Hep B, C and Herpes (HSV1/HSV2) testing as well (''FYI: HSV testing generally not offered unless specifically requested or herpetic lesion concern''). When doing the urine STI test, it needs to be done with dirty urine without wiping beforehand. Use the '''AMB STI''' or the '''Village Reproductive''' PowerPlan which has all testing, treatments, etc. ''(Vaginal self swab preferred for any female  over age 14, and not heavily menstruating).''


All positive STI tests will go to the Community Case Manager (CCM) to fill out the required Partner Information forms and follow-up with the patient regarding treatment. The provider should order any required medications and send a message to the CCM.
Daily report generated of any +CT or +GC sent to the Infectious Disease Advanced Practice Provide (IDAPP) who will complete the required Partner IAK State Epidemiology report form and follow-up with the patient regarding treatment. The provider should order any required medications and send a message to the IDAPP.


We use '''Expedited Partner Therapy''' for anyone who is positive for GC or CT screening.  The EPT kits can be given out at the hospital or the village clinic.  Ideally, a Partner Notification Sheet is filled out so public health knows who was treated, but the patient does not need to provide the names of her/his partners.  The Community Case Manager is usually able to elicit the partner’s names, even if you are not.
We use '''Expedited Partner Therapy''' for anyone who is positive for GC or CT screening.  The EPT kits can be given out at the hospital or the village clinic.  Any person who has a Reactive Syphilis, HIV test will have a State of AK Epidemiology report form filled out by the IDAPP, to be sure a person is tracked and Confirmatory testing is completed.  If a person is truly +Syphilis or HIV, the IDAPP will coordinate needed f/u care with ID specialist at ANMC and initiation of medications.  Ideally, a Partner Notification Sheet is filled out so public health knows who was treated, but the patient does not need to provide the names of her/his partners.  The IDAPP is usually able to elicit the partner’s names, even if you are not.


===Treatment Recommendations===
===Treatment Recommendations===
Line 13: Line 13:


'''Comments:'''
'''Comments:'''
#While the CDC recommends Doxycycline if chlamydia cannot be ruled out, the STI team believes there is high risk for treatment failure with a 7-day course of medication and that one dose of azithromycin is a better choice.
#While the CDC recommends Doxycycline if chlamydia cannot be ruled out, the STI team believes there is high risk for treatment failure with a 7-day course of medication and that one dose of azithromycin is a better choice.  If a person has a +Anal/+Oral GC/CT result, they should be retested in 1month to be sure it is cleared, and appropriate medications to clear infection in Anal/Oral area should be prescribed.
#There is no effective therapy for pharyngeal gonorrhea beside ceftriaxone, thus we recommend you contact HROB, the STI case manager or an ID specialist.  Contacting the experts in Seattle for a recommendation for therapy is highly recommended.
#There is no effective therapy for pharyngeal gonorrhea beside ceftriaxone, thus we recommend you contact HROB, the STI case manager or an ID specialist.  Contacting the experts in Seattle for a recommendation for therapy is highly recommended.
#The recommended medications are on formulary at all of the village clinics and SRCs.  They are also in the Pyxis in the ED, Outpatient Clinic, Inpatient and OB.
#The recommended medications are on formulary at all of the village clinics and SRCs.  They are also in the Pyxis in the ED, Outpatient Clinic, Inpatient and OB.


''Please direct any comments or questions to Claire Lewis or David Compton via email or TigerText.''
''Please direct any comments or questions to to IDAPP or  STI designated Provider Claire Lewis or David Compton via email or TigerText.''


===Frequently Asked Questions===
===Frequently Asked Questions===
Line 26: Line 26:
#Has the patient been previously treated? How can I tell?
#Has the patient been previously treated? How can I tell?
#*Please check the MAR, medications and notes for evidence of treatment. Make sure that you set the filter on your medications for All Medications All Statuses. Make sure that you set the MAR dates to include the dates in questions.
#*Please check the MAR, medications and notes for evidence of treatment. Make sure that you set the filter on your medications for All Medications All Statuses. Make sure that you set the MAR dates to include the dates in questions.
#*When looking under lab results, “change search criteria” and back date, to find other +STI results.
#When do you recommend an HIV or RPR?
#When do you recommend an HIV or RPR?
#*If the patient has a negative HIV and RPR within the past 6 months they do not need a repeat. We want to strongly encourage those without a recent test to get tested.
#*If the patient has a negative HIV and RPR within the past 6 months they do not need a repeat. We want to strongly encourage those without a recent test to get tested.
#What if the patient answers yes to anal or oral sex? Do I change the treatment?
#What if the patient answers yes to anal or oral sex? Do I change the treatment?
#*If the patient answers yes to having anal or oral sex, perform the appropriate swabs or find a provider to help. They will need to be state lab tests. Treat with the azithromycin and/or Cefixime. Wait for a positive test to treat with different medications.
#*If the patient answers yes to having anal or oral sex, perform the appropriate swabs or find a provider to help. They will need to be state lab tests. Treat with the azithromycin and/or Cefixime. Wait for a positive test to treat with different medications.  (Anal/Oral +STI results will not clear unless correct RX is prescribed and taken)
#Are you asking the 5 P’s:  Partners (who and how many and gender); Practices (This includes behavior making them at risk for HIV, such as ETOH/Drugs); Protection for STI (Condom use with all routes of sex); Past Hx of +STI; Prevention of Pregnancy.


===Resources/References===
===Resources/References===
* [https://www.std.uw.edu/ University of Washington STD Website]
* Health care providers with STI consultation requests can contact the [https://www.stdccn.org|STD Clinical Consultation Network (STDCCN)], a free service.
* [[media:YK HIV-STD Update 6-25-19.pdf|HIV-STD Update 2019]]
* [[media:YK HIV-STD Update 6-25-19.pdf|HIV-STD Update 2019]]
* [[media:STI_guideline.pdf|Sexually Transmitted Infections, Screening YKHC Clinical Guideline]]
* [[media:STI_guideline.pdf|Sexually Transmitted Infections, Screening YKHC Clinical Guideline]]

Revision as of 20:40, 10 August 2021

We have a lot of Sexually Transmitted Infections (STIs) in the Delta region and Alaska typically ranks number one or two in the nation for Chlamydia infections (CT) and Gonorrhea (G). Due to high levels of STIs, it is recommended that we aggressively screen all females and males over the age of 12.

When someone asks for a STI check, please do urine, self-vaginal or cervical swab, anal and Oral GC/CT swab, RPR, and HIV tests. If a person specifically requests STI screening, inquire if they have gotten a social media notice or text from a partner notifying them of being a STI contact. Let them know most have NO symptoms with Chlamydia. Ask if they are interested in Hep B, C and Herpes (HSV1/HSV2) testing as well (FYI: HSV testing generally not offered unless specifically requested or herpetic lesion concern). When doing the urine STI test, it needs to be done with dirty urine without wiping beforehand. Use the AMB STI or the Village Reproductive PowerPlan which has all testing, treatments, etc. (Vaginal self swab preferred for any female over age 14, and not heavily menstruating).

Daily report generated of any +CT or +GC sent to the Infectious Disease Advanced Practice Provide (IDAPP) who will complete the required Partner IAK State Epidemiology report form and follow-up with the patient regarding treatment. The provider should order any required medications and send a message to the IDAPP.

We use Expedited Partner Therapy for anyone who is positive for GC or CT screening. The EPT kits can be given out at the hospital or the village clinic. Any person who has a Reactive Syphilis, HIV test will have a State of AK Epidemiology report form filled out by the IDAPP, to be sure a person is tracked and Confirmatory testing is completed. If a person is truly +Syphilis or HIV, the IDAPP will coordinate needed f/u care with ID specialist at ANMC and initiation of medications. Ideally, a Partner Notification Sheet is filled out so public health knows who was treated, but the patient does not need to provide the names of her/his partners. The IDAPP is usually able to elicit the partner’s names, even if you are not.

Treatment Recommendations

As of July 15, 2021, STI treatment has been modified (see the table below):

STI treatment.PNG

Comments:

  1. While the CDC recommends Doxycycline if chlamydia cannot be ruled out, the STI team believes there is high risk for treatment failure with a 7-day course of medication and that one dose of azithromycin is a better choice. If a person has a +Anal/+Oral GC/CT result, they should be retested in 1month to be sure it is cleared, and appropriate medications to clear infection in Anal/Oral area should be prescribed.
  2. There is no effective therapy for pharyngeal gonorrhea beside ceftriaxone, thus we recommend you contact HROB, the STI case manager or an ID specialist. Contacting the experts in Seattle for a recommendation for therapy is highly recommended.
  3. The recommended medications are on formulary at all of the village clinics and SRCs. They are also in the Pyxis in the ED, Outpatient Clinic, Inpatient and OB.

Please direct any comments or questions to to IDAPP or STI designated Provider Claire Lewis or David Compton via email or TigerText.

Frequently Asked Questions

  1. What if the patient is allergic to a recommended antibiotic choice?
    • Contact Dr. Compton or an infectious disease specialist at ANMC. Be absolutely sure that the patient is truly allergic. If they are TRULY allergic to all penicillins and cephalosporins, give Azithromycin 2gm orally. It is very important to treat with 2 drugs if possible. If you are not sure, call one of the above for guidance.
  2. What if the patient is only a contact?
    • Get the appropriate testing for STIs. Do a pharyngeal, genital, and anal test as needed. Treat for the appropriate STI as a contact. DO NOT treat their partners.
  3. Has the patient been previously treated? How can I tell?
    • Please check the MAR, medications and notes for evidence of treatment. Make sure that you set the filter on your medications for All Medications All Statuses. Make sure that you set the MAR dates to include the dates in questions.
    • When looking under lab results, “change search criteria” and back date, to find other +STI results.
  4. When do you recommend an HIV or RPR?
    • If the patient has a negative HIV and RPR within the past 6 months they do not need a repeat. We want to strongly encourage those without a recent test to get tested.
  5. What if the patient answers yes to anal or oral sex? Do I change the treatment?
    • If the patient answers yes to having anal or oral sex, perform the appropriate swabs or find a provider to help. They will need to be state lab tests. Treat with the azithromycin and/or Cefixime. Wait for a positive test to treat with different medications. (Anal/Oral +STI results will not clear unless correct RX is prescribed and taken)
  6. Are you asking the 5 P’s: Partners (who and how many and gender); Practices (This includes behavior making them at risk for HIV, such as ETOH/Drugs); Protection for STI (Condom use with all routes of sex); Past Hx of +STI; Prevention of Pregnancy.

Resources/References