Sexual Health in Adolescents Progress in Prevention of STIs: Beyond the Latex Barrier
|
|
- Stephanie Lamb
- 6 years ago
- Views:
Transcription
1 Sexual Health in Adolescents Progress in Prevention of STIs: Beyond the Latex Barrier Katherine Hsu, MD, MPH* Medical Director, Division of STD Prevention Director, Ratelle STD/HIV Prevention Training Center Massachusetts Department of Public Health August 2012 *No commercial disclosures or conflicts of interest
2 Acknowledgements New England Alliance for Public Health Workforce Development Boston University School of Public Health Massachusetts Association of Public Health Nurses (MAPHN)
3 Accrediting Statements The MAPHN is an approved educational provider by the American Nurses Credentialing Center (ANCC) and the Massachusetts Association of Registered Nurses (MARN). MAPHN will issue 1.0 nursing contact hour for this program which will expire 30 days following the live session.
4 How to Obtain Nursing Continuing Education Credit Please visit: Click on the "Evaluation Forms" link which will take you to the evaluation form in Survey Monkey Fill out your evaluation in Survey Monkey and at the end there will be instructions to click here to get your CE Certificate. Click to open up your certificate first and then submit your evaluation. Thank you! Questions please
5 Continuing Education Disclaimer In compliance with continuing education requirements, all presenters must disclose any financial or other relationships (a) with the manufacturer(s) of commercial product(s) and/or of provider(s) of commercial services discussed in the educational presentation and (b) with any commercial supporters of the activity. The presenter wishes to disclose he/she has no financial interest or other relationship with the manufacturer(s) of commercial products, suppliers of commercial services, or commercial supporters. There is no commercial support.
6 Sexual Health in Adolescents Progress in Prevention of STIs: Beyond the Latex Barrier Katherine Hsu, MD, MPH* Medical Director, Division of STD Prevention Director, Ratelle STD/HIV Prevention Training Center Massachusetts Department of Public Health August 2012 *No commercial disclosures or conflicts of interest
7 Outline Relevance to adolescents Are current methods of prevention working? Discuss STI prevention in context of socialecological model of influences on health Individual level Institutional level Systems level Mention prevention & complexity science Provide resources for STD treatment and prevention
8 Estimated Youth STI Incidence, 2000 ~25% Years Account for: ~48% New Infections 5% Gonorrhea 7% Genital herpes 16% Chlamydia 21% Trichomoniasis ~75% Years Sexually Experienced Population ~52% New Infections Incident STIs* 51% HPV *Also included <1% each HIV, Syphilis, Hepatitis B Weinstock et al., Persp Sex Reprod Health, 2004
9 Chlamydia Rates: United States, Culture Era DFA/EIA Era NAAT Era pre post-1994
10 How many cases of infectious syphilis have you seen in the past 2 years ( )? 30% % 23% 22% >10 BIDMC HIV Update
11 How many cases of infectious syphilis did you see in the 2 years before 2010 ( )? >10 47% 30% 11% 12% BIDMC HIV Update
12 HIV and Syphilis Diagnoses Have Increased in Young MSM Survey of trends in HIV and syphilis diagnoses in 73 large metro areas, 2004/05 and 2007/08 (Torrone et al., JAIDS 2011) 70% of areas had increases in primary+secondary syphilis rates Average increases in young black men HIV: 68% Syphilis: 203% Syphilis/HIV co-infection is common 30-50% of MSM diagnosed with primary and secondary syphilis in urban STD clinics are coinfected with HIV (CDC, STD Surveillance 2010)
13 Influences on Health: The Social Ecological Model Local, state, federal policies Social networks, norms, or Social Structure, Policy, and laws and Systems that regulate or standards (e.g., public support healthy actions agenda, media agenda) Rules, regulations, policies, Community and informal structures (worksites, schools, clinics, religious groups) Interpersonal processes and Institutional/Organizational primary groups (family, peers, social networks, associations) Individual characteristics that that provide social identity and influence behavior such Interpersonal as role definition knowledge, attitudes, beliefs, and personality traits Individual
14 Influences on Health: The Social Ecological Model Social Structure, Policy, and Systems Community Institutional/Organizational Condoms Interpersonal Individual
15 Condom Effectiveness Back in 2001 Consistent condom use results in REDUCTION in HIV transmission from men to women and vice versa in heterosexual couples where one is infected with HIV ( 87%, range 60-96%) REDUCTION in gonorrhea transmission from women to men ( %, range %) Insufficient evidence to determine condom efficacy for Prevention of gonorrhea and chlamydia infection in women Prevention of syphilis, chancroid, trichomonas, genital herpes, genital HPV in men and women Hitchcock P. NIH Consensus Panel Report, 2001
16 Holmes KK et al. Bull World Health Organ 82(6):454-61, 2004
17 Why Are Estimates of Condom Efficacy Disappointing? Difficulties assessing partner infection status If not exposed to an STD carrier, no way to prove risk reduction with condom use! Difficulties assessing condom use Over-reporting of condom use (social desirability bias) Improper use (breakage or bad timing) May be better to use number of unprotected sex acts versus the percentage of times a condom is used, since the latter doesn t account for frequency of intercourse Until they invent the full-body condom Holmes KK et al. Bull World Health Organ 82(6):454-61, 2004
18 Figure 1 No randomised trials have shown a survival advantage for the use of parachutes when leaving airplanes at altitude. Smith GCS, Pell JP. BMJ 2003; 327:
19 Condoms: They work, but can we convince patients to use them?
20 Influences on Health: The Social Ecological Model Social Structure, Policy, and Systems Community STD Screening Guidelines Institutional/Organizational Interpersonal Individual
21 Screening Guideline Sources American Cancer Society (ACS) American College of Obstetrics and Gynecology (ACOG) American Society for Colposcopy and Cervical Pathology (ASCCP) Centers for Disease Control and Prevention (CDC) United States Preventive Services Task Force (USPSTF) American College of Physicians (ACP) HIV Medicine Association (HIVMA) American Academy of Pediatrics (AAP)
22 Why Bother Screening? Percent of Persons with STI Who Are Asymptomatic Men Women Urethra Rectum Pharynx Cervix Rectum Urethra Any Gonorrhea Chlamydia Genital herpes
23 Chlamydial and Gonococcal Infections Identified From Urine/urethral Screening Only: Gay/bisexual men, San Francisco % 53% 54% 56% 47% 44% Chlamydia n = 655 Gonorrhea n = 892 Identified Not Identified (Kent et al. CID 2005 updated)
24 Tests Recommended for Chlamydia & Gonorrhea Screening STD WHO WHAT TEST HOW OFTEN Chlamydia Gonorrhea All women <25 years old Women >=25 years old at increased risk (prior STI, new or multiple sex partners, inconsistent condom use, sex for money or drugs) MSM All women at increased risk of infection (females <25 at greatest risk; prior STI, new or multiple sex partners, inconsistent condom use, sex for money or drugs OR residence in communities with high prevalence) MSM NAAT on cervical or vaginal swab or firstcatch urine NAAT on urethral swab or first-catch urine NAAT on rectal swab if lab will do it, culture if not NAAT on cervical or urethral swab or firstcatch urine NAAT on rectal or pharyngeal swab if lab will do it, culture if not Annually Test of reinfection 3 mos postinfection Annually CDC or USPSTF Recommendations
25 Adolescent Screening: What about the boys?! Insufficient evidence to recommend routine chlamydia screening in young men feasibility efficacy cost Consider screening adolescent/young adult males in clinical settings associated with high chlamydia prevalence adolescent clinics, correctional facilities, STD clinics, MSM defined by the CDC those known to have a 1% or greater prevalence of infection among patient population served
26 Chlamydia and Gonorrhea Nucleic Acid Amplification Testing not FDA-cleared for rectal or pharyngeal specimens but now the preferred testing method over culture
27 CDC GC/CT Screening Highlights Urine in men and vaginal swab in women are the best NAAT specimens to collect for screening Self-collected vaginal swab versus clinician-collected vaginal swab?! Increased emphasis on repeat screening of all infected with chlamydia and gonorrhea -- recommended at 3 months after treatment test of re-infection, not test of cure
28 Effective Practice Changes to Increase Uptake of Re-Screening Implementation of pop-up reminders at six large family planning clinics in California retesting rates for chlamydia and gonorrhea among those patients who returned to the clinic increased by 23% (from 70 to 86%) Western New York, University at Buffalo student health clinic implemented a three-step Treatment- Letter-Reminder ( , phone calls) in those with chlamydia infection re-testing rates went from 16 to 89% Howard et al., Burstein et al., 2012 National STD Prevention Conference Abstracts
29 Tests Recommended for Syphilis, Trichomonas, & Herpes Screening STD WHO WHAT TEST HOW OFTEN Syphilis Persons at increased risk (MSM, sex for money or drugs, correctional settings) Pregnant women Serum nontreponemal test (RPR or VDRL) or treponemal EIA Confirm positive result with serum treponemal test (FTA- ABS, TPPA) Trichomonas HIV-infected women Saline microscopy of vaginal fluid, culture, antigen detection test, NAAT Optimal frequency unknown Genital Herpes Not recommended for everyone Type-specific serology USPSTF Recommendations
30 What have you seen used most as a 1. RPR screening test for syphilis? 2. Syphilis EIA (or other specific treponemal test ) 3. Not sure
31 Marrazzo, CDC-NNPTC Webinar: Sexual Health in MSM, June 7, 2012
32 Low tech vs high tech 180 tests per hour, no manual pipetting
33 Marrazzo, CDC-NNPTC Webinar: Sexual Health in MSM, June 7, 2012
34 CDC-Recommended Algorithm for Reverse Sequence Syphilis Screening 3% Radolf JD et al. MMWR, 2011 Probable false positive EIA If high risk: repeat RPR in several weeks 57% Assess for hx of treated syphilis, sx/signs If treated, no further action If untreated, consider tx for latent syphilis 32%
35 Uses of Herpes Serology Definite Indications: Diagnosis of genital ulcers or lesions, especially when lesions cannot be sampled or are unlikely to yield virus Management of sex partners of persons w/ herpes Implications for counseling, antiviral therapy in infected partner Consider screening persons at risk for HIV transmission (HIV+) Other Uses: Pregnant women and partners (select vs. all) Patient request? Not clear whether all sexually active persons should be screened (cost vs. benefit) Guerry et al. CID 2005, Strick CID 2006
36 Screening asymptomatic populations for STIs: Assuming 1% prevalence of gonorrhea GC test + GC test - GC Infected Not GC Infected ,307 1,000 99,000 Sensitivity = 97.6% = Positivity in Disease 97.6% x 1,000 = 976 Specificity = 99.3% = Negativity in Health 99.3% x 99,000 = 95,832 PPV = 976 / ( ) = 58.5% False Alarm Rate = 41.5% NPV = 98,307 / ( ,307) = 100.0% False Reassurance Rate = 0.0%
37 Screening: A form of secondary prevention
38 CDC Definition of Sexual Health Sexual health is a state of wellbeing in relation to sexuality across the lifespan that involves physical, emotional, mental, social, and spiritual dimensions. Sexual health is an inextricable element of human health and is based upon a positive, equitable, and respectful approach to sexuality, relationships, and reproduction, that is free of coercion, fear, discrimination, stigma, shame, and violence. It includes the ability to understand the benefits, risks, and responsibility of sexual behavior; the prevention of disease and other adverse outcomes, and the possibility of fulfilling sexual relationships. Sexual health is impacted by socioeconomic and cultural contexts including policies, practices, and services that support healthy outcomes for individuals and their communities. Developed by the Sexual Health Workgroup of the CDC-HRSA Advisory Committee, 2011
39 Sexual Exploration We don't teach infants to crawl or walk by moving their limbs for them although they are inefficient at first, this is something they have to do for themselves Of course, we want to minimize risk "if crawling is unsafe because the floor is dirty or littered with broken glass, the appropriate response is not to confine and restrict the child Bay-Cheng L et al., "Not from Always a crawling, Clear Path": Making Space but for Peers, to Adults, clean and Complexity up the in Adolescent mess." Girls' Sexual Development, from Sexualization of Girls and Girlhood, Zurbriggen EL and Roberts T-A, eds. in press, Oxford University Press.
40 Adolescent Brain Development Work-in-progress being replaced by adaptive-adolescence theories» Love of novelty leads directly to useful experience; hunt for sensation provides the inspiration needed to "get you out of the house" and into new terrain» Risk-taking occurs because more weight is given to payoff, particularly new social rewards and relationships, not because less weight is given to risk (risk-taking is necessary to move out of the home into less secure situations)» "They didn't take more chances because they suddenly downgraded the risk," says Steinberg. "They did so because they gave more weight to the payoff."
41 Influences on Health: The Social Ecological Model Expedited Partner Therapy Social Structure, Policy, and Systems Community Institutional/Organizational Interpersonal Individual
42 What is Expedited Partner Therapy (EPT)? A partner management strategy to tx sex partners of patients diagnosed w/ Ct Clinician provides medication or prescription to patient, who brings it to his/her partner(s) Partner tx given without the health care provider first examining the sex partner
43 Percent Infection During Follow-up Among Patients Completing The EPT Trial Standard care Expedited care P= P= P= Gonorrhea Chlamydia Gonorrhea or Chlamydia N=358 N=1595 Golden MR, NEJM 2005 N=1860
44 Chlamydia Infection and EPT EPT is supported by the CDC and permissible in at least 30 states Standard treatment for chlamydia infection is one oral dose of 1g of the antibiotic azithromycin EPT has been shown to be safe and effective in the treatment of sex partners Most states with long-standing EPT programs also have had no reports of adverse events
45 CDC EPT guidelines PDPT can prevent reinfection of index case and has been associated with a higher likelihood of partner notification
46 What state are you from? 1. Massachusetts 2. New York 3. Other
47 Clinical Provider Notification CLINICAL ADVISORY: UTILIZING EXPEDITED PARTNER THERAPY (EPT) FOR CHLAMYDIA INFECTION IN MASSACHUSETTS August 2011 Advisory is posted on MDPH website Advisory will be distributed through licensing Boards and Division of STD Prevention provider network Will collaborate to provide link on MMS website as well as other professional organizations
48 Partner/Patient Information A Message for Partners about Chlamydia Infection Expedited Partner Therapy (EPT) August 2011 Information sheet provided by the Massachusetts DPH (or comparable to that provided by the DPH) will be given out whenever possible with each dose of azithromycin and be available online Question/Answer format easy-to-read language, translated into 4 additional languages Encouragement to follow-up with clinical provider
49 Pharmacy Information Utilizing Expedited Partner Therapy (EPT) for Chlamydia Infection September 2011 Information sheet provided by the Massachusetts Board of Registration in Pharmacy Although every prescription in the Commonwealth is normally required to contain name and address of patient, EPT (or E.P.T. or Expedited Partner Therapy") may be used in place of the name, and the address may be left blank
50 Massachusetts: How to Provide EPT for Chlamydia Provision of EPT by clinicians is voluntary, not required MDPH recommends three options for clinicians implementing EPT for chlamydia: 1. Written prescription for named sex partner(s) of infected patient 2. Written prescription using, in place of the partner s name and address, Expedited Partner Therapy, E.P.T. or EPT, which partner can have filled at any Massachusetts pharmacy 3. Direct dispensation of medication, one dose to be taken immediately by patient, additional dose or doses to be delivered by patient to the sex partner(s) (separate, properly labeled container(s) should be used for dose(s) for each sex partner) If an EMR or e-prescribing system does not permit prescription for Expedited Partner Therapy, E.P.T. or EPT, an information sheet listing fields required is available online to assist prescribers with generating a written prescription Providers may also wish to consider contacting a prescription form vendor to obtain blank prescription forms
51 Summary of NYS EPT Law* Permissible for Chlamydia (Ct) only Ct may be lab-confirmed or presumptive/clinical dx HCP may dispense medication, or prescription HCP protected from liability Regulations specify how to practice EPT * NB Repealed January 1, 2014
52 Summary of NYS EPT Regulations Do not use EPT if index co-infected w/ GC or syphilis Requires EPT informational materials be provided for patient to give partner HCP must counsel patient to tell partner that it is important to read said materials before taking medication Specifies content of informational materials Specifies prescription format Specifies Ct reporting requirements
53 NY EPT Resources NYC DOHMH EPT Webpage: Key materials available: Law Regulations Dear colleague letter from Commissioners of Health Provider guidelines Pharmacist FAQ Patient information Partner information EPT brochure for HCP Links to other sites, including CDC, White paper
54 NYS EPT Regulations: Reporting requirements (1) EPT law and regulations do not affect obligation to report Ct to local DOH (requirement remains) (2) Reports of cases of Ct provided with EPT shall include the designation EPT plus the no. of sex partners for whom a prescription or medication provided
55 Expedited Partner Therapy: It works, but can we convince providers to use it?
56 Thinking Beyond the Latex Barrier Expedited Partner Therapy Social Structure, Policy, and Systems Community STD Screening Guidelines Institutional/Organizational Condoms Interpersonal Individual
57 Bolan, National STD Prevention Conference 2012
58 RCT evidence for preventing sexual HIV transmission Study Effect size (CI) Treatment for prevention (HPTN 052) 96% (73; 99) PrEP for discordant couples (Partners PrEP with FTC/TDF) 73% (49; 85) PrEP for heterosexuals (Botswana TDF2 with FTC/TDF) Medical male circumcision* (Orange Farm, Rakai, Kisumu) STD treatment* (Mwanza) Microbicide* (CAPRISA 004 tenofovir gel) HIV Vaccine (Thai RV144) 0% % 63% (21; 48) 54% (38; 66) PrEP for MSMs (iprex with FTC/TDF) 44% (15; 63) 42% (21; 58) 39% (6; 60) 31% (1; 51) Abdool Karim SS & Q. Antiretroviral Efficacy prophylaxis...lancet 2011;378:e23-5 Slide courtesy of Ken Mayer, 2012
59 Bolan, National STD Prevention Conference 2012
60 Bolan, National STD Prevention Conference 2012
61 Misnomer! Prevention Screening Counseling Management AND Treatment Guidelines
62 California PTC Seattle PTC Denver PTC St. Louis PTC AL-NC STD/HIV PTC Region II (New York) PTC STD/HIV PTC at Johns Hopkins Sylvie Ratelle (Boston) PTC of New England Part I - Clinical and Laboratory Training
63 How to Obtain Nursing Continuing Education Credit Please visit: Click on the "Evaluation Forms" link which will take you to the evaluation form in Survey Monkey Fill out your evaluation in Survey Monkey and at the end there will be instructions to click here to get your CE Certificate. Click to open up your certificate first and then submit your evaluation. Thank you! Questions please
64 Links to PHN Webinar Archives The link to the archives and the PP slides are available at To view the archive select the session you wish to view, click on the right facing arrow below the large black viewing box and the video will play. You can also access the archive link and the PP slides on the MAPHN website at 64
Screening & Treating Chlamydia in Primary Care. Wednesday, September 21, 2016
Screening & Treating Chlamydia in Primary Care Wednesday, September 21, 2016 We Want To Hear From You! Type questions into the Questions Pane at any time during this presentation Patient-Centered Primary
More informationClinical Education Initiative TITLE: UPDATE ON MSM SEXUAL HEALTH. Speaker: Maureen Scahill, MS NP
Clinical Education Initiative Support@ceitraining.org TITLE: UPDATE ON MSM SEXUAL HEALTH Speaker: Maureen Scahill, MS NP 1/25/2017 2/10/2017 Update on MSM Sexual Health [video transcript] 00:00:08 - [Maureen]
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 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 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 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 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 informationScreening, Vaccinations, and Expedited Partner Therapy
Screening, Vaccinations, and Expedited Partner Therapy Will Make a Difference on HIV/STIs Katherine Hsu, MD, MPH, FAAP* Director, Ratelle STD/HIV Prevention Training Center of New England Massachusetts
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 informationExtragenital Gonorrhea and Chlamydia among MSM
Extragenital Gonorrhea and Chlamydia among MSM Laura Quilter, MD Infectious Disease and STD PTC Fellow University of Washington Division of Allergy and Infectious Diseases 3/28/2016 uwptc@uw.edu uwptc.org
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 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 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 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 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 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 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 informationWhat s new in sexually-transmitted infections?
What s new in sexually-transmitted infections? Kevin L. Ard, MD, MPH National LGBT Health Education Center, Fenway Institute Infectious Disease Division, Massachusetts General Hospital Director, Genitourinary
More informationHIV: Pregnancy in Serodiscordant Couple. Dr Chow TS ID Clinic HPP
HIV: Pregnancy in Serodiscordant Couple Dr Chow TS ID Clinic HPP Sexual Reproductive Health and Rights The recognition of the sexual and reproductive health and rights (SRHR) of all individuals and couples
More information3/28/2016. Why you should care? Dana W. Dunne, MD, FACP Associate Professor of Medicine Yale University School of Medicine New Haven, Connecticut
Sexually Transmitted Diseases (STDs) and HIV: Top Ten Highlights for Clinicians Dana W. Dunne, MD, FACP Associate Professor of Medicine Yale University School of Medicine New Haven, Connecticut FINAL:
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 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 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 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 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 informationGAY MEN/MSM AND STD S IN NJ: TAKE BETTER CARE OF YOUR PATIENTS! STEVEN DUNAGAN SPECIAL PROJECTS COORDINATOR NJ DOH STD PROGRAM SEPTEMBER 27, 2016
GAY MEN/MSM AND STD S IN NJ: TAKE BETTER CARE OF YOUR PATIENTS! STEVEN DUNAGAN SPECIAL PROJECTS COORDINATOR NJ DOH STD PROGRAM SEPTEMBER 27, 2016 TOPICS FOR DISCUSSION What medical providers should know
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 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 informationSTI Prevention and Screening. Molly McHenry Fenway Health May 2016
STI Prevention and Screening Molly McHenry Fenway Health May 2016 Presentation Overview CDC Surveillance data Risk Assessment Special Populations and Barriers to Care STI Prevention STI Screening Treatment
More informationPre-exposure Prophylaxis and Primary Care
Pre-exposure Prophylaxis and Primary Care National Latino HIV and Hepatitis C Conference June 7 th, 2016 Allison Finkenbinder, MSN, WHNP-BC Denver Prevention Training Center Who s in the audience? Disclosures
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 informationPractice Steps for Implementation of Guidelines Recommendations The guideline recommendations are shown schematically -
ASK SCREEN Test for HIV and STI Practice Steps for Implementation of Guidelines Recommendations The guideline recommendations are shown schematically - Routinely obtain a thorough sexual history from all
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 informationGetting Prepped for PrEP. Ken Ho, MD, MPH World AIDS Day
Getting Prepped for PrEP Ken Ho, MD, MPH World AIDS Day Objectives HIV epidemiology What is PrEP? Does it Work? Who gets PrEP? How do I prescribe PrEP What to do at the first visit? What to do at follow
More informationMSM&TGpopulations. Management in. Sex. Sex. Outline. STIs/HIV. Sex. Sexual fluidity and HIV. Risk behavior. Recreational drugs
Outline MSM = (at least) 9 patients /day Management in MSM&TGpopulations OPASSPUTCHAROEN M.D. CHULALONGKORNUNIVERSITY BANGKOK, TH /HIV Recreational drugs ual fluidity and HIV Risk behavior AIDS Patient
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 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 informationExtragenital Chlamydia and Gonorrhea. Angel Stachnik, MPH Sr. Epidemiologist Office of Epidemiology and Disease Surveillance
Extragenital Chlamydia and Gonorrhea Angel Stachnik, MPH Sr. Epidemiologist Office of Epidemiology and Disease Surveillance Rate of Chlamydia (CT) and Gonorrhea (GC), Clark County, 2012-2016 600 Rate per
More informationPART 3: HOW TO PROVIDE STI TEST RESULTS
PART 3: HOW TO PROVIDE STI TEST RESULTS HOW TO PROVIDE STI TEST RESULTS When an individual receives a positive result, providers are required by law to provide treatment or refer the patient to treatment
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 informationSyphilis among MSM: Clinical Care and Public Health Reporting
Massachusetts Department of Public Health Bureau of Infectious Disease and Laboratory Sciences Syphilis among MSM: Clinical Care and Public Health Reporting Kevin Ard, MD, MPH, Medical Director, National
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 informationSTRATEGIES TO REDUCE HIV INFECTION AMONG HBCU COLLEGE STUDENTS
STRATEGIES TO REDUCE HIV INFECTION AMONG HBCU COLLEGE STUDENTS ORLANDO O. HARRIS, PhD, RN, FNP, MPH FELLOW CENTER FOR AIDS PREVENTION STUDIES (CAPS) DEPARTMENT OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN
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 informationSTDs in HIV Clinical Care: New Guidelines on Treatment and Prevention
STDs in HIV Clinical Care: New Guidelines on Treatment and Prevention Palliative Care Conference Faculty Development Conference August 13, 2015 Steven C. Johnson M.D. Director, University of Colorado HIV/AIDS
More informationLooking at NY: Our rate of chlamydia is higher than the US as a whole; we rank 13th among all states.
1 In this presentation, we will discuss: What are the most common STDs in NYS What are the most common STDs Can I get gonorrhea from oral sex How do you know if you/or your partner has an STD? Does getting
More informationPrEP for HIV Prevention. Adult Clinical Guideline from the New York State Department of Health AIDS Institute
PrEP for HIV Prevention Adult Clinical Guideline from the New York State Department of Health AIDS Institute www.hivguidelines.org Purpose of the PrEP Guideline Raise awareness of PrEP among healthcare
More informationWelcome to: Coding Scenarios for STD Clinic Visits. We will begin in a few minutes. There will be no sound until the webinar starts.
Welcome to: Coding Scenarios for STD Clinic Visits We will begin in a few minutes. There will be no sound until the webinar starts. Welcome to: Coding Scenarios for STD Clinic Visits You are using audio
More informationNational Network of STD/HIV Prevention Training Centers. Promoting CDC Revised HIV Testing Recommendations Chris Hall, MD, MS
National Network of STD/HIV Prevention Training Centers Promoting CDC Revised HIV Testing Recommendations Chris Hall, MD, MS NNPTC: Who We are Network of 18 regional training centers funded by CDC Each
More informationPresentation to the Worcester Board of Health Matilde Castiel MD June 9, 2016
Presentation to the Worcester Board of Health Matilde Castiel MD June 9, 2016 Sexually Transmitted Infections According to the CDC, there are more than 20 million new STI infections in the United States
More informationThe Synergy between HIV and other STIs
Training Course in Sexual and Reproductive Health Research 2017 Module: Sexually transmitted infections, HIV/AIDS The Synergy between HIV and other STIs Alberto Matteelli Brescia University Sexual Transmission
More informationToday s Webinar will be approximately 1 hour long including breaks for Q and A one in the middle, and one at the end. In order to receive Continuing
1 Today s Webinar will be approximately 1 hour long including breaks for Q and A one in the middle, and one at the end. In order to receive Continuing Nursing Education, participants must attend the entire
More informationLearning Objectives. STI Update. Case 1 6/1/2016
Learning Objectives STI Update June 16 th, 2016 Madhu Choudhary, MD. FIDSA Assoc. Prof of Medicine Albany Medical College Review screening recommendations for STI in different patient populations Describe
More informationCoding for Preventive Services A Guide for HIV Providers
Coding for Preventive Services A Guide for HIV Providers Jessie Murphy, MPH and Michelle Cataldo, LCSW, April 2016 Implementation of the Patient Protection and Affordable Care Act and other regulatory
More informationPrEP: Pre Exposure Prophylaxis
PrEP: Pre Exposure Prophylaxis Lyn Stevens, NP, MS, ACRN Deputy Director Office of the Medical Director NYS Department of Health, AIDS Institute Faculty Disclosure Lyn Stevens No relationships to disclose
More informationOutline. HIV and Other Sexually Transmitted Infections. Gonorrhea Epidemiology. Epidemiology 11/2/2012
HIV and Other Sexually Transmitted Infections Tanya Kowalczyk Mullins, MD, MS Division of Adolescent Medicine Cincinnati Children s Hospital Medical Center Outline Epidemiology of select STIs and HIV STIs
More informationA Sex-informed Framework for HIV Prevention. Robert M. Grant, M.D., M.P.H. Betty Jean and Hiro Ogawa Endowed Investigator
A Sex-informed Framework for HIV Prevention Robert M. Grant, M.D., M.P.H. Betty Jean and Hiro Ogawa Endowed Investigator Disclosures Gilead Sciences donated study medication to US NIH for trials that I
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 informationDidactic Series. STD Screening & Management: Syphilis. Christian B. Ramers, MD, MPH
Didactic Series STD Screening & Management: Syphilis Christian B. Ramers, MD, MPH Assistant Medical Director Family Health Centers of San Diego Ciaccio Memorial Clinic 3/26/15 ACCREDITATION STATEMENT:
More informationIntroduction Define sexual health brainstorm STI symptoms group work (quiz) Time Activity Resource 5 min Introduction
Topic: Sexual health and STIs Level: Foundation Length of session: 1 hour Pre-requisite Keeping safe Foundation lesson Lesson: 8.6 Objectives: Increase awareness of sexual health Discuss ways to maintain
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 informationTrends in STDs among Young People in New York State
Trends in STDs among Young People in New York State Kris Mesler, Bureau of Child and Adolescent Health Alison Muse, Bureau of Sexually Transmitted Disease Control New York State Department of Health Figure
More informationUse of Treponemal Immunoassays for Screening and Diagnosis of Syphilis
Use of Treponemal Immunoassays for Screening and Diagnosis of Syphilis Guidance for Medical Providers and Laboratories in California These guidelines were developed by the California Department of Public
More informationSexually Transmitted Infections in Vulnerable Groups. Kevin Rebe
Sexually Transmitted Infections in Vulnerable Groups Kevin Rebe Definition: Key Populations Key populations are: Defined groups who, due to specific higher-risk behaviours, are at increased Men risk who
More informationOverview of CDC Recommendations for Expedited Partner Therapy (EPT)
Overview of CDC Recommendations for Expedited Partner Therapy (EPT) Catherine Satterwhite, PhD, MSPH, MPH Epidemiologist Expedited Partner Therapy: Challenges & Opportunities for Effective Implementation
More informationSTI Prevention: Housekeeping and How We Use Public Health. M. Terry Hogan, MPH 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 informationRefocussing on STI management to impact HIV prevention
Refocussing on STI management to impact HIV prevention Koleka Mlisana Head: Medical Microbiology (UKZN & NHLS) 14 June 2017: SA AIDS Conference NSP 2017 2022 Objectives Goal 1:Accelerate preventioninorder
More informationWhat's the problem? - click where appropriate.
STI Tool v 1.9 @ 16/11/2017 What's the problem? - click where appropriate. Male problems: screening urethral symptoms proctitis in gay men lumps or swellings ulcers or sores skin rash and/or itch Female
More informationPre-exposure prophylaxis : Systemic and topical. Linda-Gail Bekker The Desmond Tutu HIV Centre UCT SA HIV ClniciansSociety Conference 2012
New biomedical technologies. Pre-exposure prophylaxis : Systemic and topical. Linda-Gail Bekker The Desmond Tutu HIV Centre UCT SA HIV ClniciansSociety Conference 2012 And the last parachute goes to..
More informationSuccessful interventions to increase use of Self Obtained Vaginal Swabs (SOVs) for chlamydia/gonorrhea testing in WA State
Successful interventions to increase use of Self Obtained Vaginal Swabs (SOVs) for chlamydia/gonorrhea testing in WA State Goldenkranz S 1, Fine D 1, Knutson C 2, Loza, R 2. Infertility Prevention Project
More informationManagement of Syphilis in Patients with HIV
Management of Syphilis in Patients with HIV Adult Clinical Guideline from the New York State Department of Health AIDS Institute www.hivguidelines.org Purpose of the Guideline Increase the numbers of NYS
More informationSTDs Update: Prevention, Special Populations, HIV and Syphilis
STDs Update: Prevention, Special Populations, HIV and Syphilis Sexually Transmitted Diseases Treatment Guidelines, 2015 Prepared by Kimberly A. Workowski, MD 1,2 Gail A. Bolan, MD 1 1 Division of STD Prevention
More informationSTDs and Hepatitis C
STDs and Hepatitis C Catherine S. O Neal, MD Assistant Professor of Clinical Medicine, Infectious Diseases Louisiana State University Health Sciences Center March 3, 2018 Objectives Review patient risk
More informationPrEP 201: Beyond the Basics
NORTHWEST AIDS EDUCATION AND TRAINING CENTER PrEP 201: Beyond the Basics Joanne Stekler, MD MPH Associate Professor of Medicine University of Washington February 19, 2015 Disclosures and Disclaimers I
More informationWhat You Need to Know. Sexually Transmitted Infections (STIs)
What You Need to Know Sexually Transmitted Infections (STIs) What You Need to Know About STIs What are STIs? Sexually transmitted infections (STIs) are diseases that spread through sexual contact. If you
More informationGuidelines for Implementing Pre-Exposure Prophylaxis For The Prevention of HIV in Youth Peter Havens, MD MS Draft:
Guidelines for Implementing Pre-Exposure Prophylaxis For The Prevention of HIV in Youth Peter Havens, MD MS Draft: 10-2-2015 Clinical studies demonstrate that when a person without HIV infection takes
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 informationRecent Breakthroughs in HIV Prevention for Men who Have Sex with Men and Transgender Populations
Recent Breakthroughs in HIV Prevention for Men who Have Sex with Men and Transgender Populations Kevin Ard, MD, MPH Brigham and Women s Hospital The Fenway Institute Boston, MA Funding: The New England
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 informationClinical Guidelines Update (aka Know Your NAATs)
Clinical Guidelines Update (aka Know Your NAATs) WARNING: contains adult themes, sexual references and pictures that may be disturbing! Dr Heather Young Christchurch Sexual Health Centre heather.young@cdhb.health.nz
More informationHIV & THE MEDICAL HOME A NEW FRONT FOR GETTING TO ZERO. Brent K. Sugimoto, MD, MPH Kaiser Permanente. 29th Annual East Bay HIV Update June 3, 2016
HIV & THE MEDICAL HOME A NEW FRONT FOR GETTING TO ZERO 29th Annual East Bay HIV Update June 3, 2016 Brent K. Sugimoto, MD, MPH Kaiser Permanente Photo Credit: C. GoldsmithContent Providers: CDC/ C. Goldsmith,
More informationSYNDROMIC CASE MANAGEMENT OF STD
SYNDROMIC CASE MANAGEMENT OF STD Sexually Transmitted Diseases A Guide for Decision-makers, Health Care Workers, and Communicators WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC MANILA
More informationCAN MONEY REDUCE HIV RISK?? Audrey Pettifor, PhD MPH Department of Epidemiology, University of North Carolina
CAN MONEY REDUCE HIV RISK?? Audrey Pettifor, PhD MPH Department of Epidemiology, University of North Carolina Overview Epidemiology of HIV in young people Rationale behind cash transfers Review completed
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 informationBarriers, Concerns, and Recommended Course of Action for Expedited Partner Therapy for the Treatment of Gonorrhea and Chlamydia
Barriers, Concerns, and Recommended Course of Action for Expedited Partner Therapy for the Treatment of Gonorrhea and Chlamydia 15 March 2012 MALPH EPT 2 Introduction What is expedited partner therapy?
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 informationProfessor Adrian Mindel
Causes of genital ulceration viruses and others Professor Adrian Mindel University of Sydney VIM 16 th August 2012 Outline Definition Causes Epidemiology Diagnosis Definition of genital ulcer A defect
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 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 informationIf you are a man that ONLY has sex with women this may not be the brochure for you.
If you are a man that ONLY has sex with women this may not be the brochure for you. To find resources that best meet your needs check out the following website: http://www.cdc.gov/men Whether you are gay,
More informationPEP and PrEP: AWAAC 2014
Acknowledgements: HIVCS PEP guidelines group, Helen Rees, Slim Abdool Karim, Quarraisha Abdool Karim, Clinical Care Options, Edwina Wright, Jared Baeton, AETC PEP and PrEP: AWAAC 2014 Francois Venter Wits
More informationPrEP and Behavioral Strategies for HIV Prevention. Douglas Krakower, MD January 30, 2014
PrEP and Behavioral Strategies for HIV Prevention Douglas Krakower, MD January 30, 2014 Potential Competing Interests Dr. Krakower: investigator-initiated research regarding HIV prevention National Institutes
More informationSex Talk for Self-Advocates #3 Safe Sex Practices - Sexually Transmitted Infections (STIs)
Sex Talk for Self-Advocates #3 Safe Sex Practices - Sexually Transmitted Infections (STIs) Self-Advocacy Educator - Max Barrows Sex Educator - Katherine McLaughlin www.elevatustraining.com Sex Educator
More informationHIV Prevention. Recent Advances and Implications for the Caribbean
HIV Prevention Recent Advances and Implications for the Caribbean Chris Behrens, MD CCAS/CHART Conference Barbados, August 2010 Cases 200 180 160 140 120 100 80 60 40 20 0 Year HIV Cases AIDS Cases HIV
More informationCDC Laboratory Update
CDC Laboratory Update Chlamydia and Gonorrhea Laboratory Guidelines Overview of the APHL / CDC STD Steering Committee Laboratory Recommendations for the Detection of Chlamydia trachomatis, Neisseria gonorrhoeae
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 informationSTI Indicators by STI
STI Indicators by STI Table of Contents pg. 2 Sexual History pg. 3-4 Syphilis pg. 5-6 Gonorrhea pg. 7-9 Chlamydia pg. 10 HIV/PrEP 1 Sexual History Comprehensive Sexual History Elements Percentage of patients
More informationLABORATORY DIAGNOSIS SEXUALLY TRANSMITTED DISEASES
LABORATORY DIAGNOSIS SEXUALLY TRANSMITTED DISEASES LABORATORY MEDICINE COURSE 2004 CLINICAL MICROBIOLOGY SERVICE STD EPIDEMIC- USA TIP OF THE ICEBERG INCIDENCE DISCHARGE Chlamydia - 4 million Gonorrhea
More informationSexual Health reproduction in reference to treatment as/for prevention
Sexual Health reproduction in reference to treatment as/for prevention The reasons for sexual reproductive health for PLHIV The number of people living with HIV (PLWH) continues to rise in the UK The increase
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 information