STIs in Women. *Top 10* STI Highlights. Karen. External genitalia
|
|
- Debra Fields
- 6 years ago
- Views:
Transcription
1 Artist: Kathryn Love STIs in Women Heidi M. Bauer, MD MPH California Dept of Public Health STD Control California STD/HIV Prevention Training Center UCSF Primary Care Medicine October 3, 28 *Top 1* STI Highlights 1. Socio-cultural context and women s STI risk 9. Low rates of chlamydia screening 8. Fewer antibiotics for gonorrhea 7. Expedited partner treatment 6. CT/GC re-testing at 3 months 5. New trich treatment option 4. Herpes serology testing 3. Herpes suppressive treatment 2. HPV testing 1. HPV vaccine Karen 19 y.o. African American woman from Alabama recently moved to SF to start school Presents with vaginal discharge, itching and bumps Sexual debut 1 year prior, one lifetime sex partner male, age 27 no longer together Didn t use condoms because I thought I was in love LMP 1 days prior External genitalia STD Atlas,
2 HIV (-) Syphilis (-) Chlamydia (+) Gonorrhea (+) STI Test Results What does this case illustrate? 19 y.o. African American woman from Alabama recently moved to SF to start school presents with vaginal discharge, itching and bumps Sexual debut 1 year prior, reports one lifetime sex partner male age 27 no longer together Didn t use condoms because she thought I was in love Why are Young Women at Higher Risk for STIs? Female anatomy Large mucosal surface area Prolonged exposure to secretions Young age Cervical ectopy Immunologically naïve Thinner cervical mucus Infections asymptomatic Delay in seeking care Increase risk of complications 2
3 Cervical Ectopy STD Atlas, 1997 Why are Young Women at Higher Risk for STIs? Social influences Power differentials relationships Differential behavioral norms for partners Limited female-controlled barrier methods Shame and stigma Access to sexuality information Healthcare access Greater screening opportunities Financial barriers Challenges to partner treatment World War II public health poster National Library of Medicine World War II public health poster National Library of Medicine 3
4 Overview of Complications of STIs in Women Infertility Ectopic Pregnancy Chronic Pelvic Pain Upper Tract Infection STIs Systemic Infection Chronic Disease HIV Infection Cancer Pregnancy Complications & Neonatal Infections STI Screening for Women Sexually Active adolescents & up to age 25 Routine chlamydia and gonorrhea screening Pap 3 years after sexual debut Others STDs and HIV based on risk Women over 25 years of age STD/HIV testing based on risk factors Pregnant women (first trimester) HIV, Syphilis serology, Hep B sag, Chlamydia Gonorrhea (<25 years of age) Hep C based on risk Consider BV if high risk pregnancy Pap as indicated Chlamydia & Gonorrhea 4
5 CT & GC Highlights Chlamydia and Gonorrhea Rates: Total and by sex: United States, CT screening unacceptably low despite non-invasive tests Antibiotic resistant GC Expedited partner treatment (EPT) Re-testing after treatment Rate (per 1, population) 6 Men Women 48 Total Rate (per 1, population) 4 Male Female 32 Total 21 Target 24 Chlamydia Gonorrhea Chlamydia and Gonorrhea Age- and sex-specific rates: United States, 26 Men Rate (per 1, population) Women 3 6 Age Chlamydia and Gonorrhea Rates by race/ethnicity and sex: United States, 26 Men Rate (per 1, population) Women 2 4 Race AI/AN Chlamydia 59.2 Asian/PI Black Chlamydia Hispanic White Total Total Men Rate (per 1, population) Women Age Gonorrhea Race AI/AN Gonorrhea Asian/PI Black Hispanic White Total Total
6 Who Needs Chlamydia Screening? ALL sexually active adolescent and young women <26 years Pregnant women MSM Others according to risk: new/multiple partners, partner with other partners, history of CT, other STDs, high prevalence settings Chlamydia Prevalence Monitoring, Percent Positive for Females Ages and 2 24 by Health Care Setting, California, 26 Percent Positive Managed Care Organization Family Planning Clinics * These two venues target adolescents primarily. 4.4 College Sites Teen Clinics School-Based Sites* 13.1 Juvenile Detention* STD Clinics Source: California Department of Public Health, STD Control Branch; Los Angeles Infertility Prevention Project; and San Francisco Infertility Prevention Project CA DPH STD Control Branch (rev 7/27) Chlamydia Positivity among 15- to 24-year-old women tested in family planning clinics by state: United States and outlying areas, Positivity (%) < >=1. Puerto Rico 6.4 Virgin Is Note: Includes states and outlying areas that reported chlamydia positivity data on at least 5 women aged years screened during SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention VT 3.9 NH 4.1 MA 4.7 RI 6.7 CT 5.7 NJ 7.5 DE 7.7 MD 5.7 DC 7.2 (n= 8) (n= 38) (n= 7) Estimated Chlamydia Screening Coverage (HEDIS), Females 16 26, USA and California, Percent Screened Natl MCO Natl Medicaid MediCal MC Cal HMO FPACT National California 1 4 Source: National Committee on Quality Assurance; California DHS Division of Medi-Cal Managed Care; Kaiser Permanente Northern CA; California DHS Office of Family Planning CA DPH STD Control Branch (rev 7/26) 6
7 Nucleic Acid Amplification Tests Highest sensitivity Able to detect up to 4% more infections Less dependent on specimen collection and handling Noninvasive Urine and self-collected vaginal swabs Pelvic exams not necessary Who Needs Gonorrhea Screening? Sexually active women (including pregnant women) under age 25 MSM Others according to risk: previous GC infection, other STD, new/multiple partners, partner with other partners commercial sex, drug use for CA GC screening guidelines What is your primary treatment for uncomplicated gonorrhea? Gonococcal Isolate Surveillance Project (GISP) Percent of Neisseria gonorrhoeae isolates with resistance or intermediate resistance to ciprofloxacin, U.S., A. Ceftriaxone IM injection B. Oral cephalosporin (e.g., cefixime or cefpodoxime) C. Ciprofloxacin or other fluoroquinolone D. Azithromycin 2 g E. Other Percent Resistant Intermediate resistance Note: Resistant isolates have ciprofloxacin MICs 1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in
8 Gonorrhea Treatment Uncomplicated Genital/Rectal Infections AVOID fluoroquinolones Recommended regimens: Ceftriaxone 125 mg intramuscularly in a single dose OR Cefixime 4 mg orally in a single dose * Co-treat for chlamydia unless ruled out What method do you use most often to get sex partners treated? A. I ask the health department to contact partners B. I ask patients to notify their partners C. I ask patients to bring their partners to clinic for testing and treatment D. I give patients medication/prescriptions for their partners E. I don t discuss sex partner treatment (UPDATED April 27) Percent Infection During Follow-up Among Patients Completing The EPT Trial Standard care Expedited care 1.6 P= P= Gonorrhea Chlamydia Gonorrhea or N=358 N=1595 Chlamydia Golden NEJM P= N=186 Expedited Partner Treatment Expedited partner treatment for CT and GC safe and effective First line management is clinical evaluation Concern regarding co-morbidities (e.g., PID in women, HIV in MSM) for CA EPT guidelines 8
9 Legal Status of EPT in the U.S. Reinfection of Women with Chlamydia Within 12 Months of Initial Infection 4 Reinfection (%) Months Follow-up as of 28 Hosenfeld, unpublished review of 17 active cohort studies Our New Motto for CT/GC: Screen Treat Treat Screen Trichomoniasis Highlights New point-of-care tests New treatment regimen: Tinidazole 9
10 POC Tests for Trichomonas Trichomoniasis Treatment Detects Type of test Manufacturer Time to results Sensitivity Specificity DNA hybridization, colorimetric test Becton Dickinson 45 min Affirm TM VP III T. vaginalis, G. vaginalis, and C. albicans Gardnerella: 84% Trich: 92% Candida: 78% 96-98% OSOM Trichomonas Rapid Test T. vaginalis Color immunochromatographic capillary flow test; dipstick Genzyme 1 min Vaginal swab: 83% Saline wet mount: 75% >97% Recommended regimen: Metronidazole 2 g PO x 1 ADDED: Tinidazole 2 g po x 1 Alternative regimen: Metronidazole 5 mg PO BID x 7d Recommended regimen in pregnancy: Metronidazole 2 g PO x 1 * Metronidazole category B and Tinidazole is category C in pregnancy Genital Herpes Highlights Genital Herpes Uses for type-specific serologic tests When to use suppression therapy to prevent transmission 1
11 Percent Genital herpes simplex virus type 2 - Seroprevalence according to age in NHANES* II ( ) and NHANES III ( ) Age Group NHANES II NHANES III Note: Bars indicate 95% confidence intervals. *National Health and Nutrition Examination Survey Rationale for HSV-2 Serologic Screening Up to 8% of people with HSV-2 unaware of their infection Patients can be taught to recognize symptoms; treat as needed Awareness may reduce risky behavior, increase disclosure, and protect partners Suppression therapy reduces HSV-2 transmission CA Guidelines at Type-Specific HSV Serology Tests HSV-1 and HSV-2 Immunoblot IgG (Focus Technologies) Sensitivity 97-1%, Specificity 96-97% HSV-1 and HSV-2 ELISA IgG (Focus Technologies) Sensitivity 96-1%, Specificity 94-98% Captia ELISA HSV-2 (Trinity Biotech) Sensitivity 9-92%, Specificity 91-98% Biokit HSV-2 & Sureview HSV-2 (Biokit & Fisher Scientific) Point of care tests Sensitivity 93-96%, Specificity 95-98% Who Should Be Tested for HSV-2 Antibodies? Type-specific HSV serologic assays might be useful for: Recurrent genital symptoms or atypical symptoms with negative HSV cultures Clinical diagnosis of genital herpes without lab confirmation A partner with genital herpes Some specialists believe HSV serologic testing should be included in a comprehensive STD evaluation among: Persons with multiple sex partners HIV infection MSM at increased risk for HIV acquisition 11
12 How do you prescribe HSV-2 suppressive treatment? A. Only sporadically for special purposes (e.g., wedding, vacation, midterms) B. Only with demonstrated frequent severe outbreaks C. Anyone who wants to reduce transmission to partners D. Pregnant women prior to term E. All of the above Genital Herpes Prevention of Sexual Transmission Suppressive therapy is safe and effective Suppression should be encouraged among discordant heterosexual couples Suppressive therapy probably reduces transmission when used by persons who have multiple partners (including MSM) and by those who are HSV-2 seropositive without a history of genital herpes Counsel regarding condoms, disclosure, abstinence during recurrences Rates of Transmission of HSV-2 to Susceptible Partners is Reduced with Once-Daily Suppressive Therapy 1484 heterosexual couples randomly assigned to take 5 mg of valacyclovir or placebo once daily for 8 months Serum samples collected monthly from susceptible partners for HSV analysis The valacyclovir group showed decreased transmission lower frequency of shedding fewer copies of HSV-2 DNA when shedding occurred Percent Transmission % Valacyclovir Group (N=743) 3.6% Control Group (N=741) Corey et al, NEJM 24; 35:11-2 Genital HPV 12
13 HPV Highlights The HPV Family Best uses for HPV tests HPV vaccine who and when Dermal HPVs Common skin warts (~6 types) Mucosal HPVs (~4 types) Low-risk wart types High-risk cancer types Incidence of Cervical HPV Detection in Women From the Time of Sexual Debut 7% 6% 5% 4% 3% 2% 1% % Cervical HPV Detection Time since first intercourse (mo) Collins S et al. Br J Obstet Gynecol. 22;19(1): Clearance of Cervical HPV Infections in Young Women Within 2 Years Percentage HPV Infected Time from HPV infection (mo) Brown DR et al. J Infect Dis. 25;191(2):
14 Stages of Cancer Progression Natural History of HPV and Cervical Cancer Over the Lifespan Wright TC Jr, Schiffman M. N Engl J Med. 23;348(6): Reprinted with permission from Massachusetts Medical Society. Schiffman M, Castle PE. N Engl J Med. 25;353(2): Reprinted with permission from Massachusetts Medical Society. The HPV DNA Test Only test FDA-cleared: Digene (Qiagen) Hybrid Capture II RNA probe cocktail to 13 high risk types*: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, & 68 Provides positive or negative result Which patient are you most likely to test for HPV? A. 21-year-old woman in a new relationship who wants to get the HPV vaccine B. 28-year-old woman with ASC-US Pap result C. 34-year-old woman with LSIL Pap D. 45-year-old woman previously treated for cervical dysplasia E. None of the above * High risk HPV test 14
15 How Should Get an HPV Test? FDA-cleared for: Triage of ASC-US Adjunct screening in women age 3 and over Supported by research for F/U of: No CIN on colpo (ASC-H, LSIL, ASC-US/HPV+) mo CIN 1 on colpo mo Initial w/u of AGC; subsequent w/u of AGC w/ neg colpo - -6& 12 mo Post treatment CIN 2/ mo NO ROLE for HPV DNA Testing Screening in women under 3 Diagnosis of genital warts Testing in males Triage of ASC-H, LSIL or higher grade lesions Before or after vaccination Screening STD patients or their partners HPV Virus-Like Particles (VLPs) Current HPV Vaccines L1 major capsid protein synthesized in yeast or insect cells assembles into structures resembling whole virus Manufacturer Product VLP types Antigen source Adjuvant Timing Target groups FDA clearance Quadrivalent Merck Gardasil 6, 11, 16, 18 Yeast Alum, 2, 6 mo Females 9-26 y (Males) June 26 Bivalent GSK Cervarix 16, 18 Baculovirus ASO4, 1, 6 mo Females 1-55 y Expected 28 Image: Shi L et al. Clin Pharmacol Ther 27; 81(2): Gardasil PI. GlaxoSmithKline press release. March 29,
16 Percentage of Worldwide Cervical Cancers Attributed to Different HPV Types Cumulative % Quadrivalent HPV Vaccine Efficacy Clinical End Point CIN 2/3 or AIS Condyloma VIN 2/3 or VaIN 2/3 Per Protocol 98% 1% 1% ITT HPV 16/18- Related 44% 76% 62% ITT All HPV- Related 17% 51% 26% Roden R, Wu TC. Nat Rev Cancer. 26;6(1): Reprinted with permission from Nature Publishing Group. Future II Study Group. N Engl J Med. 27;356(19): Garland SM et al. N Engl J Med. 27;356(19): Anti-HPV 16 cria Geometric Mean Titer (mmu/ml) Anti-HPV 16 Titers Through 3.5 Years Postdose Vaccination HPV 16 L1 VLP vaccine Placebo recipients previously infected with HPV Month Since Enrollment Fever Nausea Vaccine-Related Experiences Injection Site 1-5 d Post-dose Pain Swelling Erythema Pruritus Systemic 1-15 d Post-dose Vaccine 83.9% 25.4% 24.6% 3.1% Vaccine 1.3% 4.2% Dizziness* 2.8% * Recommend observation 15 minutes Placebo (Alum) 75.4% 15.8% 18.4% 2.8% Placebo 8.6% 4.1% 2.6% Placebo (Saline) 48.6% 7.3% 12.1%.6% Mao C et al. Obstet Gynecol. 26;17(1): Gardasil Package Insert. 16
17 HPV Vaccines: Other Key Findings Duration of protection >5 years 1,2 No therapeutic value 3 Safe and immunogenic in males 4 Evidence for cross-protection against non-vaccine types 5,6 No role for HPV testing in vaccine program 1. Villa LL et al. Br J Cancer. 26;95(11): Olsson SE et al. Vaccine. 27;25(26): Hildesheim A et al. JAMA. 27;298(7): Reisinger KS et al. Pediatr Infect Dis J. 27;26(3): Harper DM et al. Lancet 26; 367: Brown D. 47th Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL. Sept 17-2, 27. Which patient would you most strongly recommend the HPV vaccine? A. 18-year-old sexually active female college student B. 12-year-old female prior to sexual debut C. 15-year-old male prior to sexual debut D. 24-year-old female with history of cervical dysplasia E. None of the above Who Should Get an HPV Vaccine? Routine vaccination of females ages years (as young as age 9 years) Catch-up vaccination for females years Can by given despite history of abnormal Pap, HPV, genital warts Not recommended in pregnancy Contraindications: allergy to yeast or other vaccine component, severe illness Thank You! No change in cervical cancer screening recommendations VAERS: or Merck Pregnancy registry: MMWR. 27;56(RR-2):
Genital Chlamydia and Gonorrhea Epidemiology, Diagnosis, and Management. William M. Geisler M.D., M.P.H. University of Alabama at Birmingham
Genital Chlamydia and Gonorrhea Epidemiology, Diagnosis, and Management William M. Geisler M.D., M.P.H. University of Alabama at Birmingham Chlamydia and Gonorrhea Current Epidemiology Chlamydia Epidemiology
More informationAnswers to those burning questions -
Answers to those burning questions - Ann Avery MD Infectious Diseases Physician-MetroHealth Medical Center Assistant Professor- Case Western Reserve University SOM Medical Director -Cleveland Department
More informationThe Impact of Sexually Transmitted Diseases(STD) on Women
The Impact of Sexually Transmitted Diseases(STD) on Women GAL Community Symposium AUM September 2, 2011 Agnes Oberkor, MPH, MSN, CRNP, Nurse Practitioner Senior Alabama Department of Public Health STD
More informationTrends in STDs: US Perspective. Michael Towns, M.D. WW Vice President, Medical Affairs BD Diagnostic Systems
Trends in STDs: US Perspective Michael Towns, M.D. WW Vice President, Medical Affairs BD Diagnostic Systems Outline Overview of STD Epidemiology and Current Situation in US Overview of Chlamydia infections
More informationDisclosures. STD Screening for Women. Chlamydia & Gonorrhea. I have no disclosures or conflicts of interest to report.
Disclosures Management of STIs: Challenges in Practice I have no disclosures or conflicts of interest to report. Alison O. Marshall, MSN, FNP-C Associate Professor of Practice & Director of the Family
More informationStephanie. STD Diagnosis and Treatment. STD Screening for Women. Physical Exam. Cervix with discharge from os
STD Diagnosis and Treatment Ina Park, MD, MS STD Control Branch, California Department of Public Health California STD/HIV Prevention Training Center Stephanie 23 year-old female presents for contraception,
More informationDisclosures. What s New in the 2015 CDC STD Treatment Guidelines. Outline. None
Disclosures None What s New in the 2015 CDC STD Treatment Guidelines Ina Park, MD, MS California STD/HIV Prevention Training Center UCSF Dept of Family and Community Medicine STD Control Branch California
More informationSexually Transmitted Diseases
Sexually Transmitted Diseases Ina Park, MD, MS California Prevention Training Center University of California San Francisco Dept of Family and Community Medicine Disclosures/Disclaimers No disclosures
More informationSexually Transmitted Infections in the Adolescent Population. Abraham Lichtmacher MD FACOG Chief of Women s Services Lovelace Health System
Sexually Transmitted Infections in the Adolescent Population Abraham Lichtmacher MD FACOG Chief of Women s Services Lovelace Health System STI in the Adolescent High school students nationwide, 34.2% were
More informationNew Guidelines for Detection and Treatment of Sexually Transmitted Infections
UCSF Controversies in Women s health December 8, 2016 San Francisco, CA New Guidelines for Detection and Treatment of Sexually Transmitted Infections Disclosure I am a litigation consultant to a law firm
More informationNothing to disclose.
Update on Diagnosis and Treatment Lisa Winston, MD University of California, San Francisco/ Zuckerberg San Francisco General Nothing to disclose. 1 This talk will be a little depressing Rising incidence
More informationSexually Transmitted Infection Treatment and HIV Prevention
Sexually Transmitted Infection Treatment and HIV Prevention Toye Brewer, MD Co-Director, Fogarty International Training Program University of Miami Miller School of Medicine STI Treatment and HIV Prevention.
More informationThe promise of HPV vaccines for Cervical (and other genital cancer) prevention
The promise of HPV vaccines for Cervical (and other genital cancer) prevention CONTROVERSIES IN OBSTETRICS GYNECOLOGY & INFERTILITY Barcelona March 27 F. Xavier Bosch Catalan Institute of Oncology CURRENT
More informationSTD Prevention Among Youth
STD Prevention Among Youth Jody Pierce Glover New Beginnings Emer S. Smith, MPH Maine Center for Disease Control & Prevention In Today s Talk... Maine Learning Results: Education Content Areas Health Behaviors
More informationIndex. Infect Dis Clin N Am 19 (2005) Note: Page numbers of article titles are in boldface type.
Infect Dis Clin N Am 19 (2005) 563 568 Index Note: Page numbers of article titles are in boldface type. A Abstinence in genital herpes management, 436 Abuse sexual childhood sexual behavior effects of,
More information1 Cervical Cancer Prevention and Screening: Update 2010 Michael S. Policar, MD, MPH Clinical Professor of Ob, Gyn, and RS UCSF School of Medicine policarm@obgyn.ucsf.edu No commercial disclosures for this
More information6/11/15. BACTERIAL STDs IN A POST- HIV WORLD. Learning Objectives. How big a problem are STIs in the U.S.?
BACTERIAL STDs IN A POST- HIV WORLD Tracey Graney, PhD, MT(ASCP) Monroe Community College Learning Objectives Describe the epidemiology and incidence of bacterial STDs in the U.S. Describe current detection
More informationCategories of STI Screening and Testing Routine screening Population based risk factors Targeted screening Personal behavioral risk factors Contact te
Sexually Transmitted Infections: New Tests, New Guidelines Michael S. Policar, MD, MPH UCSF Ob, Gyn, and Reproductive Sciences No disclosures for this lecture Value of STI Screening and Testing Benefits
More informationHPV Vaccine Ina Park, MD, MS
HPV Vaccine Ina Park, MD, MS California Department of Public Health STD Control Branch Alameda County Immunization Update 2014 Over 170 types of HPV classified Updated incidence/prevalence estimates (CDC):
More informationFocus. A case. I have no conflicts of interest. HPV Vaccination: Science and Practice. Collaborative effort with Karen Smith-McCune, MD, PhD 2/19/2010
HPV Vaccination: Science and Practice George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics Director, Colposcopy Clinic,
More informationSTD Essentials for the Busy Clinician. Stephanie E. Cohen, MD, MPH
STD Essentials for the Busy Clinician Stephanie E. Cohen, MD, MPH Assistant Professor, Division of Infectious Diseases, UCSF Medical Director, City Clinic San Francisco Department of Public Health Disclosures
More informationSTI 2016: Where We Need to Go
STI 2016: Where We Need to Go Gail Bolan, M.D. Director, Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention Sexually
More informationFamily Planning Title X Chlamydia Screening Quality Improvement Project
Family Planning Title X Chlamydia Screening Quality Improvement Project Illinois Department of Public Health STD Section Staff March 22, 2017 Objectives Discuss current STD trends and epidemiology of chlamydia
More informationClinical Practice Objectives
STD Essentials for the Busy Clinician Susan S. Philip, MD, MPH Assistant Professor, Division of Infectious Diseases, UCSF Director, STD Prevention and Control Services San Francisco Department of Public
More informationSexually Transmitted Infections: New Tests, New Guidelines
Sexually Transmitted Infections: New Tests, New Guidelines Michael S. Policar, MD, MPH UCSF Ob, Gyn, and Reproductive Sciences No disclosures for this lecture Value of STI Screening and Testing Benefits
More informationSay Ahhh!, STDs in Maine. Emer Smith, Maine CDC,
Say Ahhh!, STDs in Maine Emer Smith, Maine CDC, emer.smith@maine.gov Say AHHH! : STDs in Maine Emer S. Smith, MPH Maine Center for Disease Control & Prevention HIV, STD, & Viral Hepatitis Program April
More informationDisclosure Information Julie Stoltey, MD MPH
Courtesy CDC Public Health Image Library The New Yorker 2012 2016 Update on Testing, Treatment, and Gonorrhea Resistance Julie Stoltey, MD, MPH STD Control Branch-California Dept. of Public Health Assistant
More informationEmerging Issues in STDs and Resistance
Emerging Issues in STDs and Resistance Toye H. Brewer, MD Asst. Professor of Clinical Medicine University of Miami School of Medicine Co-Director- Fogarty International Training Program Outline Syphilis-
More informationWomen s Sexual Health: STI and HIV Screening. Barbara E. Wilgus, MSN, CRNP STD/HIV Prevention Training Center at Johns Hopkins
Women s Sexual Health: STI and HIV Screening Barbara E. Wilgus, MSN, CRNP STD/HIV Prevention Training Center at Johns Hopkins I have no disclosures! Review most recent rates of STIs and HIV across the
More informationSexually Transmi/ed Diseases
Sexually Transmi/ed Diseases Chapter Fourteen 2013 McGraw-Hill Higher Education. All rights reserved. Also known as sexually transmitted infections The Major STDs (STIs) HIV/AIDS Chlamydia Gonorrhea Human
More informationKhalil G. Ghanem, MD, PhD Associate Professor of Medicine Johns Hopkins University School of Medicine. April 2, 2014
Khalil G. Ghanem, MD, PhD Associate Professor of Medicine Johns Hopkins University School of Medicine April 2, 2014 E-mail your questions for the presenter to: maphtc@jhsph.edu DISCLOSURES OFF- LABEL USES
More informationSummary Guidelines for the Use of Herpes Simplex Virus (HSV) Type 2 Serologies
Summary Guidelines for the Use of Herpes Simplex Virus (HSV) Type 2 Serologies Genital herpes is one of the most prevalent sexually transmitted diseases, affecting more than one in five sexually active
More informationUpdate on Sexually Transmitted Infections among Persons Living with HIV
Update on Sexually Transmitted Infections among Persons Living with HIV Stephen A. Berry, MD PhD Assistant Professor of Medicine Johns Hopkins University Division of Infectious Diseases Abbreviations and
More informationEradicating Mortality from Cervical Cancer
Eradicating Mortality from Cervical Cancer Michelle Berlin, MD, MPH Vice Chair, Obstetrics & Gynecology Associate Director, Center for Women s Health June 2, 2009 Overview Prevention Human Papilloma Virus
More informationBest Practices in STD Partner Management
Best Practices in STD Partner Management An Overview of Patient-Delivered Partner Therapy (PDPT) and Counseling for Partner Notification and Treatment Amber Eisenmann, MS Director of Learning Exchange
More informationS403- Update on STIs for the Generalists
S403- Update on STIs for the Generalists Mobeen H. Rathore, MD Professor and Director University of Florida Center for HIV/AIDS Research Education and Service (UF CARES) Chief, Pediatric Infectious Diseases
More informationAn update on the Human Papillomavirus Vaccines. I have no financial conflicts of interest. Case 1. Objectives 10/26/2016
An update on the Human Papillomavirus Vaccines Karen Smith-McCune Professor, UCSF Department of Obstetrics, Gynecology and Reproductive Sciences John Kerner Endowed Chair I have no financial conflicts
More informationSTD UPDATE Patrick Loose, Chief HIV, STD & Hepatitis Branch February 15, 2018
Patrick Loose, Chief HIV, STD & Hepatitis Branch February 15, 2018 MISSION Improve health outcomes in communities disproportionately impacted by HIV and STDs Collect, study and publish data Diagnose and
More information2012 California Clinical Laboratory Survey: STD/HIV/Hepatitis Testing
2012 California Clinical Laboratory Survey: STD/HIV/Hepatitis Testing Joan M. Chow, MPH, DrPH Surveillance, Epidemiology, Assessment & Evaluation Section Sexually Transmitted Disease Control Branch Division
More informationX-Treme Primary Care: HPV and STIs. Arti Barnes MD MPH Clinical Director South Central AIDS Education and Training Centers
X-Treme Primary Care: HPV and STIs Arti Barnes MD MPH Clinical Director South Central AIDS Education and Training Centers Learning Objectives Review recommendations for HPV related cancer screening in
More informationSexually Transmitted Infections in HSV-2 Seropositive women in Sub- Saharan Africa HPTN 039
Sexually Transmitted Infections in HSV-2 Seropositive women in Sub- Saharan Africa HPTN 039 Ulrika Makuraj, MBBCH University of Witwatersrand Mentor : Sinead Delany-Moretlwe South Africa 17 May 2018 Introduction
More informationChlamydia Trachomatis and Neisseria Gonorrhoeae. Khalil G. Ghanem, MD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationOverview. Disclosures. Sexually Transmitted Diseases: What s New in the Guidelines and Beyond?
Sexually Transmitted Diseases: What s New in the Guidelines and Beyond? Susan S. Philip, MD, MPH Director, Disease Prevention and Control Branch Population Health Division San Francisco Department of Public
More informationSexually transmitted infections (in women)
Sexually transmitted infections (in women) Timothy Kremer, MD Assistant Professor, Department of Obstetrics and Gynecology University of North Texas Health Science Center Last official CDC guidelines:
More informationUpdate on Sexually Transmitted Infections Jeanne Marrazzo, MD, MPH
Update on Sexually Transmitted Infections Jeanne Marrazzo, MD, MPH Division of Infectious Diseases University of Alabama at Birmingham School of Medicine Birmingham, Alabama Outline Syphilis in all its
More informationTrends in Sexually Transmitted Infections (STIs) C. Junda Woo, MD, MPH, Medical Director San Antonio Metropolitan Health District June 3, 2017
Trends in Sexually Transmitted Infections (STIs) C. Junda Woo, MD, MPH, Medical Director San Antonio Metropolitan Health District June 3, 2017 1 Speaker Disclosure Dr. Woo has disclosed that she has no
More informationSexually transmitted infections (in women)
Sexually transmitted infections (in women) Timothy Kremer, MD Assistant Professor, Department of Obstetrics and Gynecology University of North Texas Health Science Center Last official CDC guidelines:
More informationSTD UPDATE 2017 FSACOFP CONVENTION
STD UPDATE 2017 FSACOFP CONVENTION L. Michael Waters, Jr, DO Adjunct Clinical Assistant Professor of Family Medicine LECOM-Bradenton Clinical Assistant Professor of Family Medicine PCOM- Georgia DISCLOSURES
More informationComplex Vaginitis Cases: Applying New Diagnostic Methods to Enhance Patient Outcomes ReachMD Page 1 of 5
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationSexually Transmitted Infections Angela Farrell MD Dept of Family Medicine University of Iowa
Sexually Transmitted Infections Angela Farrell MD Dept of Family Medicine University of Iowa Objectives Review taking a sexual history Discuss screening, diagnosis, and management of chlamydia, gonorrhea,
More informationSESSION J4. What's Next? Managing Abnormal PAPs in 2014
37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, 2014 2:45 SESSION J4 What's Next? Managing Abnormal PAPs in 2014 Session Description: Linda Eckert, MD Review current guidelines
More informationSTIs- REVISION. Prof A A Hoosen
STIs- REVISION Prof A A Hoosen Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria and the NHLS Microbiology Tertiary Laboratory at the Pretoria Academic Hospital Complex
More informationGenital Herpes in the STD Clinic
Genital Herpes in the STD Clinic Christine Johnston, MD, MPH Last Updated: 5/23/2016 uwptc@uw.edu uwptc.org 206-685-9850 Importance of HSV HSV is the leading cause of GUD - HSV is very common HSV-2: 16%
More informationCLINICAL MANAGEMENT OF STDS
CLINICAL MANAGEMENT OF STDS Diana Torres-Burgos MD, MPH NYC STD/HIV Prevention Training Center STD/HIV Update Conference Grand Rapids, MI 3/11/2014 Outline Essential components of STD care management Sexual
More informationTrends in Reportable Sexually Transmitted Diseases in the United States, 2007
Trends in Reportable Sexually Transmitted Diseases in the United States, 2007 National Surveillance Data for Chlamydia, Gonorrhea, and Syphilis Sexually transmitted diseases (STDs) remain a major public
More informationSTD Epidemiology. Jonathan Zenilman, MD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationChapter 11. Sexually Transmitted Diseases
Chapter 11. Sexually Transmitted Diseases General Guidelines Persons identified as having one sexually transmitted disease (STD) are at risk for others and should be screened as appropriate. Partners of
More informationGenital Tract Infections in Women. Michael S. Policar, MD, MPH UCSF School of Medicine
Genital Tract Infections in Women Michael S. Policar, MD, MPH UCSF School of Medicine www.policarlectures.com Value of STI Screening and Testing Benefits Detect infection Patient treatment Partner treatment
More informationSexually Transmitted Diseases This publication was made possible by Grant Number TP1AH from the Department of Health and Human Services,
Sexually Transmitted Diseases This publication was made possible by Grant Number TP1AH000081-01-01 from the Department of Health and Human Services, Office of Adolescent Health; its contents are solely
More informationThe (likely) New 2010 CDC STD Treatment Guidelines Guideline Development Process. Overview
The (likely) New 2010 CDC STD Treatment Guidelines http://www.cdc.gov/std/treatment Deborah Cohan, MD, MPH University of California, San Francisco San Francisco General Hospital cohand@obgyn.ucsf.edu I
More informationServices for GLBTQ Youth
Sexual Health Care Services for GLBTQ Youth Gale R Burstein, MD, MPH, FAAP, FSAHM Erie County Commissioner of Health Buffalo, NY Agenda Introduction Epidemiology Sexual health care services for YMSM Sexual
More informationTO DECREASE THE CHANCE OF GETTING
POST ASSAULT MEDICATIONS Terri Stewart RN Naomi Sugar MD TO DECREASE THE CHANCE OF GETTING Pregnant STDs Chlamydia Gonorrhea Trichomonas Hep B HIV EMERGENCY CONTRACEPTION Plan B Levonorgestrel PLAN B Plan
More informationEdward W. Hook, III, M.D.
Challenging Cases Edward W. Hook III M.D. Professor and Director Division of Infectious Diseases University of Alabama at Birmingham And PI, Alabama/North Carolina STD PTC Edward W. Hook, III, M.D. Grant/Research
More information5/1/2017. Sexually Transmitted Diseases Burning Questions
Sexually Transmitted Diseases Burning Questions Jeffrey D. Klausner, MD, MPH Professor of Medicine and Public Health University of California Los Angeles Los Angeles, California FORMATTED: 04-03-17 Financial
More informationPerfecting the Prevention of Cervical cancer. I have no financial interests in any product I will discuss today. Preview
Perfecting the Prevention of Cervical cancer Rebecca Jackson, MD Associate Professor Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics I have no financial interests in any
More informationSexually Transmitted Infection surveillance in Northern Ireland An analysis of data for the calendar year 2011
Sexually Transmitted Infection surveillance in Northern Ireland 2012 An analysis of data for the calendar year 2011 Contents Page Summary points. 3 Surveillance arrangements and sources of data.. 4 1:
More informationWhat is the Safety and Efficacy of Vaccinating the Male Gender to Prevent HPV Related Neoplastic Disorders in Both the Male and Female Genders
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2011 What is the Safety and Efficacy of Vaccinating
More informationPathology of the Cervix
Pathology of the Cervix Thomas C. Wright Pathology of the Cervix Topics to Consider Burden of cervical cancer 1 Invasive Cervical Cancer Cervical cancer in world Second cause of cancer death in women Leading
More informationHPV/Cervical Cancer Resource Guide for patients and providers
DHS: PUBLIC HEALTH DIVISION IMMUNIZATION PROGRAM HPV/Cervical Cancer Resource Guide for patients and providers Independent. Healthy. Safe. Oregon HPV Provider Resource Kit: Table of Contents Provider Information
More information4/6/17 UNPRECEDENTED HIGH. Shelagh Larson, RNC, WHNP, NCMP
Shelagh Larson, RNC, WHNP, NCMP UNPRECEDENTED HIGH Total combined cases of chlamydia, gonorrhea, and syphilis reported in 2015 reached the highest number ever, according to the annualmore than 1.5 million
More informationChapter 20: Risks of Adolescent Sexual Activity
Unit 7 Lesson 7.1 Notes Introductory Video Video STIs: Running the Risk Chapter 20: Risks of Adolescent Sexual Activity Section 1: What Are the Risks? Key Terms: Sexually Transmitted Disease (STD) an infectious
More informationALASKA NATIVE MEDICAL CENTER SEXUALLY TRANSMITTED DISEASE SCREENING AND TREATMENT GUIDELINES
ALASKA NATIVE MEDICAL CENTER SEXUALLY TRANSMITTED DISEASE SCREENING AND TREATMENT GUIDELINES A. Screening Page Chlamydia and Gonorrhea 1 HIV 1 Syphilis 1 Genital Herpes 2 Hepatitis A 2 Hepatitis B 2 Hepatitis
More informationUpdated Guidelines for Post-Assault Testing and Treatment
Updated Guidelines for Post-Assault Testing and Treatment Ann S. Botash, MD Professor of Pediatrics October 5, 2016!" Disclosure Statement Ann S. Botash, MD, has no financial relationships with any commercial
More informationClinical Cases from the STD Clinical Consultation Network
Clinical Cases from the STD Clinical Consultation Network Christine Johnston STD TCG April 24, 2017 Last Updated: uwptc@uw.edu uwptc.org 206-685-9850 STD Clinical Consultation Network (STDCCN) Developed
More informationSEXUALLY TRANSMITTED INFECTIONS IN ST LOUIS
SEXUALLY TRANSMITTED INFECTIONS IN ST LOUIS Sarah Garwood MD, Assistant Professor of Pediatrics, Washington University Elizabeth Fox MD, Pediatric Resident, St Louis Children s Hospital STDS IN ADOLESCENTS
More informationSexually Transmitted Diseases:
Sexually Transmitted Diseases: Diagnosis and Management Department of Internal Medicine, Division of Infectious Diseases University of New Mexico A 21 year old woman comes to your clinic asking to be checked
More informationSeveral of the most common STDs are often asymptomatic. Asymptomatic
What Are STDs? Several of the most common STDs are often asymptomatic. Asymptomatic Individuals show no symptoms, or the symptoms are mild and disappear after the onset of the infection Common STDs There
More informationRon Gray, MBBS, MFCM, MSc Johns Hopkins University. STIs in an International Setting
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationSTIs: Practical Aspects of Management
STIs: Practical Aspects of Management Dr Heather Young FAChSHM DipPH Christchurch Sexual Health heathery@xtra.co.nz 027 343 4963 Sexually Transmitted Infections BACTERIAL STIs: CHLAMYDIA GONORRHOEA SYPHILIS
More informationOutline. Trichomoniasis: Testing and Treatment Update. What s in a name? From the Greek: trichos, hair monas, unit, single
Trichomoniasis: Testing and Treatment Update Arlene C. Sena, MD, MPH Medical Director, Durham County Health Department Associate Professor, University of North Carolina Infectious Diseases Outline Epidemiology
More informationHOT OFF THE PRESS! R.
STI Update 2016: New CDC Treatment Guidelines Focus on the Female HOT OFF THE PRESS! R. Mimi Secor, DNP, FNP-BC, FAANP Onset, Massachusetts Mimi Secor, DNP, FNP-BC, FAANP Nurse Practitioner for 40 years
More informationGonorrhea, Chlamydia, and Syphilis in Alaska
Department of Health and Social Services Division of Public Health Section of Epidemiology Karen Perdue, Commissioner Karen Pearson, Director John Middaugh, MD, Editor 361 C Street, Suite 54, P.O. Box
More informationChlamydia Curriculum. Chlamydia. Chlamydia trachomatis
Chlamydia Chlamydia trachomatis 1 Learning Objectives Upon completion of this content, the learner will be able to: 1. Describe the epidemiology of chlamydial infection in the U.S. 2. Describe the pathogenesis
More informationManagement of Gonorrhea in Adolescents and Adults in the United States
SUPPLEMENT ARTICLE Management of Gonorrhea in Adolescents and Adults in the United States Sarah Kidd 1 and Kimberly A. Workowski 1,2 1 Division of STD Prevention, Centers for Disease Control and Prevention,
More informationBiology 3201 Unit 2 Reproduction: Sexually Transmitted Infections (STD s/sti s)
Biology 3201 Unit 2 Reproduction: Sexually Transmitted Infections (STD s/sti s) STI s once called venereal diseases More than 20 STIs have now been identified most prevalent among teenagers and young adults.
More information9/11/2018. HPV Yoga. Human Papillomavirus. Human Papillomavirus (HPV) Disease. Most common sexually transmitted infection in the U.S.
Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases Human Papillomavirus September 2018 Chapter 11 Photographs and images included in this presentation
More informationBuve, A., H. A. Weiss, et al. (2001). The epidemiology of trichomoniasis in women in four African cities. Aids 15 Suppl 4: S89-96.
Behets, F., J. Andriamiadana, et al. (2001). Sexually transmitted infections and associated socio-demographic and behavioural factors in women seeking primary care suggest Madagascar's vulnerability to
More informationSexually Transmitted Infections. Kim Dawson October 2010
Sexually Transmitted Infections Kim Dawson October 2010 Objectives: You will learn about: Sexually Transmitted Infections (STI s). How they are transferred. High risk behavior. The most common STI s. How
More informationI have no financial interests in any product I will discuss today.
Cervical Cancer Prevention: 2012 and Beyond George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics University of California,
More informationProphylactic HPV Vaccines. Margaret Stanley Department of Pathology Cambridge
Prophylactic HPV Vaccines Margaret Stanley Department of Pathology Cambridge 8kb double stranded DNA viruses, absolutely host and tissue specific, Can t grow virus in tissue culture Classified by genotype
More informationSexually Transmitted Diseases
Table of content Sexually Transmitted Diseases Judith A. Lightfoot DO, FACOI Update on the prevalence of STD s in the US Which populations are greatly affected? Should we be alarmed? How does this affect
More informationLove Bugs and Drugs Managing Sexually Transmitted Infections in Teens. Renée R. Jenkins, M.D., F.A.A.P. Howard University College of Medicine
Love Bugs and Drugs Managing Sexually Transmitted Infections in Teens Renée R. Jenkins, M.D., F.A.A.P. Howard University College of Medicine 37 th Annual Sanford Black Hills Pediatric Symposium June 26,
More informationThe objectives of this presentation are; to increase awareness of the issue of antimicrobial resistant gonorrhea, and to inform primary care and
1 Antimicrobial resistant gonorrhea is an emerging public health threat that needs to be addressed. Neisseria gonorrhoeae is able to develop resistance to antimicrobials quickly. Effective antibiotic stewardship
More informationBest practices in chlamydia (CT) and gonorrhea (GC) screening in a changing healthcare environment:
Best practices in chlamydia (CT) and gonorrhea (GC) screening in a changing healthcare environment: Lessons from the Infertility Prevention Project (IPP) Goldenkranz Salomon S., Fine D., Curtiss J., Nakatsukasa-Ono
More informationThe Global Burden of HPV Related Cancers and Their Prevention
The Global Burden of HPV Related Cancers and Their Prevention What Every Doctor Should Know! Dr. Adrian Lear, MD Conflict of Interest Disclosure I have no financial relations with any commercial entity
More informationUniversity Health Services at CMU STI Awareness Month specials for students:
University Health Services at CMU STI Awareness Month specials for students: -Free condoms during April (10 per student) -Free walk-in rapid HIV testing April 22-27 (no appointment needed) -STI Screening
More informationEmerging Laboratory Diagnostic Options for Sexually-transmitted Infections
Emerging Laboratory Diagnostic Options for Sexually-transmitted Infections Erik Munson Wheaton Franciscan Laboratory Marquette University Milwaukee, Wisconsin 1 OBJECTIVES I. Appreciate the changing epidemiology
More informationPopulation attributable fraction of genital inflammation and ulceration in HIV risk among discordant couples, Zambia,
Population attributable fraction of genital inflammation and ulceration in HIV risk among discordant couples, Zambia, 1994-2012 10 th International Workshop on HIV Transmission Kristin M. Wall, PhD kmwall@emory.edu
More informationGenital Herpes Infections
Genital Herpes Infections Clinical Guidelines and Consultation Linda Creegan, MS, FNP California STD/HIV Prevention Training Center Linda.creegan@ucsf.edu www.cdc.gov/std/treatment/ www.std.ca.gov Clinician
More informationCervical Cancer Screening - Improving PAP Rates. Objectives
Cervical Cancer Screening - Improving PAP Rates Dineo Khabele, MD, FACOG, FACS Assistant Professor Division of Gynecologic Oncology Vanderbilt University Medical Center Objectives 1. Review the current
More information