STI/HIV Update 6/7/2018. Objectives. Chlamydia

Transcription

1 STI/HIV Update 2018 Kansas Immunization Conference June 12 th 2018, Salina, KS Stephanie Green STI/HIV Section Chief Jennifer VandeVelde Director, Bureau of Disease Control & Prevention Objectives 1. Participants will be able to identify testing, treatment, and follow-up of STIs, including HIV. 2. Participants will be able to identify trends in STIs, including HIV, over time. Chlamydia The Clam, Silent Epidemic Most common bacterial STI Usually asymptomatic Frequently diagnosed in age group Graham and Comanche counties 1

2 Chlamydia: Signs & Symptoms Usually asymptomatic Watery/milky discharge from the penis/vagina, dysuria Bleeding between menstrual cycles Lower abdominal pain Rectal pain, itching, and/or discharge Testing for Chlamydia CDC Recommendations: Annual screening of all sexually active women <25, as well as older women with risk factors All pregnant women <25, as well as older pregnant women with risk factors Young men in high prevalence settings or in populations with high burden of infection (e.g.msm) At least annually for sexually active MSM at sites of contact (urethra, throat, rectum) regardless of condom use Treatment for Chlamydia CDC Recommendations: Azithromycin 1g orally in a single dose OR Doxycycline 100mg orally BID X 7 days 2

3 Follow-Up for Chlamydia Treat all sex partners in the last 60 days Retest 3 months after completion of treatment Educate the client on risk reduction Chlamydia by the Numbers Chlamydia by the Numbers 3

4 Gonorrhea Dose, Clap, Drip Frequently co-infected with chlamydia Usually asymptomatic Frequently diagnosed in the age group Gonorrhea: Signs & Symptoms Usually asymptomatic Milky or yellow/green discharge from the penis/vagina, dysuria Bleeding between menstrual cycles Lower abdominal pain Rectal pain, itching, and/or discharge Testing for Gonorrhea CDC Recommendations: Annual screening of all sexually active women <25, as well as older women with risk factors All pregnant women <25, as well as older pregnant women with risk factors Young men in high prevalence settings or in populations with high burden of infection (e.g.msm) At least annually for sexually active MSM at sites of contact (urethra, throat, rectum) regardless of condom use 4

5 Treatment for Gonorrhea Ceftriaxone 250mg IM PLUS Azithromycin 1g orally Follow-Up for Gonorrhea Treat all sex partners in the last 30 days Retest 3 months after completion of treatment Educate the client on risk reduction Gonorrhea by the Numbers 5

6 Gonorrhea by the Numbers Syphilis The Great Imitator, The Pox Defined stages of infection, primary, secondary, early nonprimary / nonsecondary, unknown duration, late More frequently involves neurological system Syphilis: Signs & Symptoms Primary lesion: chancre Highly infectious At the site of inoculation Painless 6

7 Syphilis: Signs & Symptoms Secondary Symptoms: Rashes Alopecia Testing for Syphilis CDC Recommendations: All pregnant women at the first prenatal visit Retest early in 3 rd trimester and at delivery if high risk All sexually active MSM at least annually, every 3-6 months if at increased risk KDHE Recommendations: Screen all sexually active individuals Submitting Specimens for Syphilis Screening All syphilis specimens must be received as cold (2-8 C) poured-off serum within 5 days of collection. Specimen kits are available to order from KHEL, Requisition for Specimen Kits by ordering the Mailing Cooler (Cold shipper). This kit includes: an insulated mailer, screw-cap serum tubes, ice packs and specimen transport bags. Alternatively, these items may be ordered separately in the Other Health Supplies section. Please follow the Serum Cold Shipper guidelines for collection and handling requirements. 7

8 Specimen Collection Instructions Collect a blood specimen in serum separator tube (SST). Gently invert 5 times. Allow blood to clot for at least 30 minutes. Centrifugation must be performed within 2 hours of collection for 10 minutes at RCF (g) in a swinging bucket centrifuge, or 15 minutes in a fixed-angle centrifuge. Remove cap and pour serum into provided pour-off tube. Required serum volume is 2 to 5 ml. Label pour-off tube with patient identifiers (2) and form barcode on the specimen tube for verification. Refrigerate specimen at 2-8 C prior to shipping. Ship on cold packs for overnight delivery. Treatment for Syphilis 2.4mu Benzathine penicillin G IM Follow-Up for Syphilis Call your KDHE-assigned Disease Intervention Specialist for assistance. 8

9 HIV Human Immunodeficiency Virus Stages 0,1,2,3 More frequently involves neurological system Transmitted: Oral, anal, or vaginal sex Sharing needles/syringes Babies born to infected mother Breastmilk HIV: Signs & Symptoms May have flu-like symptoms during acute (Stage 0) infection Testing for HIV CDC Recommendations: Everyone between the ages of 13 and 64 at least once. Annual testing for those with specific risk factors: MSM Sex w/an HIV+ partner More than 1 sex partner since your last HIV test Injected drugs and shared needles or works Exchanged sex for drugs/money/something needed Been diagnosed w/an STI Had sex w/someone who could answer yes to above questions or whose sexual history you don t know 9

10 Follow-Up for HIV Call your KDHE-assigned Disease Intervention Specialist for assistance. DIS and Linkage to Care work hand in hand to ensure appropriate care is identified, engaged, and maintained. 10

11 Syphilis Outbreak Southeast Kansas 8/14/ /06/ cases of early (infectious) syphilis identified (19 ID) 356 contacts (contact index 4.19) cluster index (12.76) $13, Estimated travel costs 1,049 total staff hours (incl. 148 OT hours) Counties: Allen, Cherokee, Crawford, Labette, Montgomery, Neosho, Wilson, and Woodson Meth use Our Hereos 11

12 HIV Outbreak Southwest Kansas 01/03/ /26/ cases of HIV (3 ID) 90 contacts (contact index 5.4) cluster index (3.6) $2, Estimated travel costs total staff hours Counties: Butler, Edwards, Ellis, Finney, Ford, Hodgeman, Kearny, Marion, Pawnee, Pratt, Reno, Rice, Riley, Sedgwick, Seward, Wichita 5 MSM, Heterosexual transmission, pregnant women, 12