Alberta Treatment Guidelines for Sexually Transmitted Infections (STI) in Adolescents and Adults 2008 General for STI Given the current rise in all STI in Alberta, it is appropriate to assess for risk of and screen for STI at routine medical appointments. This is particularly important in individuals at higher risk for STI* or in individuals where the risk of consequences of STI are high (e.g. adolescents, pregnant women). All insertive sexual practices (oral, vaginal and anal) put individuals at risk for STI. Treatment of curable STI is necessary to mitigate sequelae of infection and to prevent further transmission. Drugs for treatment of notifiable STI are provided free of charge and are replaced following submission of a STI Notification Form. STI are under the Alberta Public Health Act (for copies of Notification of Sexually Transmitted Infections forms, see STI Resources on back page). Partner notification is a critical component of STI control and important in preventing further spread and re infection. Assistance with partner notification (PN) is available from regional public health staff (see section on Partner Notification on back page). Counselling about safer sex practices is important and effective in inducing behaviour change in individuals with or at risk for STI. This can in turn prevent re infection and acquisition of new infections. Safer sex options include use of barrier contraceptives, reducing numbers of sexual partners, delaying onset of sexual debut and abstinence. Patients and contacts should abstain from unprotected sexual intercourse until treatment in both is completed or 7 days after single dose therapy. Hepatitis B immunization should be offered to all individuals with a STI. Having one STI puts one at risk for other STI, including HIV. Therefore, all individuals with a STI should be screened for other STI, particularly syphilis, HIV, gonorrhea and chlamydia. *Individuals at higher risk for STI include but are not limited to those having sexual contact with person(s) with a known STI, sexually active under 25 years of age, a new sexual partner or > 2 sexual partners in the past year, use of non barrier contraception, injection drug or other substance use, sex trade workers and their clients, street involved/homeless, Aboriginal ethnicity, anonymous sexual partnering, previous STI, victims of sexual assault/abuse, men who have sex with men.
The Alberta Treatment Guidelines for Sexually Transmitted Infections (STI) in Adolescents and Adults 2008 has been adapted from the Canadian Guidelines on Sexually Transmitted Infections for provincial use with permission from the Public Health Agency of Canada. The Canadian Guidelines are available on line at: www.phac-aspc.gc.ca. Recommendations regarding treatment of pediatric infection are excluded from these guidelines. In general, children diagnosed with a STI should be managed in conjunction with a specialist at a referral centre and be reported to Alberta Children and Youth Services for investigation of possible sexual abuse (see section on back page on in Persons Under 18 Years of Age). This guideline includes the level of recommendation and quality of evidence indicators for the treatment recommendations. The indicators reflect a combination of the methodologies from the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care and have been modified and simplified for use as outlined below (re printed with permission from the Canadian Guidelines on Sexually Transmitted Infections, 2006 Edition). Levels of recommendation Quality of evidence A Strongly recommends that clinicians routinely provide the treatment to eligible patients. Good evidence that the treatment improves important health outcomes and concludes that benefits substantially outweigh harms. B Recommends that clinicians routinely provide the treatment to eligible patients. At least fair evidence that the treatment improves important health outcomes and concludes that benefits outweigh harms. C No recommendation for or against routine provision of the treatment. At least fair evidence that the treatment can improve health outcomes but concludes that the balance of the benefits and harms is too close to justify a general recommendation. D Recommends against routinely providing the treatment to asymptomatic patients. At least fair evidence that the treatment is ineffective or that harms outweigh benefits. I Evidence is insufficient to recommend for or against routinely providing the treatment. Evidence that the treatment is effective is lacking, of poor quality or conflicting, and the balance of benefits and harms cannot be determined. I Evidence from at least one properly randomized, controlled trial. II Evidence from at least one well designed clinical trial without randomization, from cohort or case control analytic studies (preferably from more than one centre), from multiple time series studies or from dramatic results in uncontrolled experiments. III Evidence from opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees. CHLAMYDIA Non Pregnant/ Non Lactating Adults Urethral, cervical, rectal infection azithromycin 1 gm po as a single dose (A I) doxycycline 100 mg po BID for Pregnant/Breastfeeding Mothers Urethral, cervical, rectal infection amoxicillin 500 mg po TID for azithromycin 1 gm po as a single dose (B I)* or erythromycin 500 mg po QID for 7 days (B I) *Limited data is available on the long term safety of azithromycin in pregnancy but the benefits of single dose treatment for selected patients (e.g. if poor compliance is expected) may outweigh this risk. If vomiting occurs > 1 hour post administration of azithromycin, a repeat dose is not required. Doxycycline is contraindicated in pregnant women. Erythromycin dosage refers to the use of erythromycin base. Estolate preparations of erythromycin are contraindicated as they may cause drug related hepatoxicity. Chlamydia Infection of the Eye doxycycline 100 mg po BID for 14 days (B III) All patients should be followed to ensure resolution of infection; test of cure (TOC) using chlamydia culture should be performed in all cases. Patients should also have genitourinary specimens submitted for C. trachomatis. (all chlamydia cases) Follow Up (all chlamydia cases) Test of cure is not routinely indicated if recommended treatment agent is taken, symptoms and signs disappear and there is no re exposure to an untreated partner unless: compliance is sub optimal an alternate treatment agent is used child (< 14 years) pregnant woman non genital site involved (e.g. eye, rectum) Test of cure should be done 3 4 weeks after completion of treatment if a nucleic acid amplification test is performed or 5 7 days after completion of treatment if culture is used. Re screening of all individuals diagnosed with chlamydia is recommended after 6 months. Infants born to untreated mothers must be tested for C. trachomatis. Newborns must be treated if test results are positive. They should also be closely monitored for signs of chlamydial infection (e.g. conjunctivitis, pneumonitis). Oral antibiotic prophylaxis is not routinely recommended unless follow up cannot be guaranteed (e.g. if samples obtained for chlamydia testing but compliance with follow up uncertain).
SYPHILIS Non-HIV Infected/ Non Pregnant Adults Primary, Secondary, Early Latent (< 1 year duration) benzathine penicillin 2.4 mu IM as a single dose (only available through regional or provincial STI services) (A II) (penicillin allergic patients) doxycycline 100 mg po BID for 14 days (B II) Latent (> 1 year duration or unknown duration and cardiovascular) benzathine penicillin 2.4 mu IM weekly for 3 consecutive weeks (only available through regional or provincial STI services) (A II) (penicillin allergic patients) doxycycline 100 mg po BID for 28 days (B II) Non-HIV Infected/ Pregnant Adults Primary, Secondary, Early Latent (< 1 year duration) benzathine penicillin 2.4 mu IM weekly for 2 doses (only available through regional or provincial STI services) (C III) Latent (> 1 year duration or unknown duration and cardiovascular) benzathine penicillin 2.4 mu IM weekly for 3 consecutive weeks (only available through regional or provincial STI services) (A II) All pregnant women should be screened for syphilis during pregnancy. Screening should be performed in the first trimester for all pregnant women, repeated at 28 32 weeks and again at the time of delivery in women at high risk of acquiring syphilis. This includes women: who have had contact with a known case of syphilis who are sex trade workers who are street involved/homeless who are injection drug users of Aboriginal ethnicity with multiple sexual partners with a history of syphilis with HIV and other STI originating from or having sex with an individual from a country with a high prevalence of syphilis living in areas experiencing outbreaks of heterosexual syphilis with sexual partners with any of the preceding characteristics. All pregnant women with infectious syphilis should be managed in conjunction with a STI specialist. If the mother is > 20 weeks gestation, a detailed fetal ultrasound should be performed and she should be managed together with a materno fetal specialist. Treatment of infectious syphilis in pregnancy may precipitate a Jarisch Herxheimer reaction which may cause fetal distress or premature labour; all patients > 20 weeks gestation should undergo fetal monitoring for 12 24 hours after administration of benzathine penicillin. There is no satisfactory alternative to penicillin in pregnancy. Penicillin allergic pregnant women should be considered for desensitization followed by treatment with benzathine penicillin. Doxycycline is not recommended for use during pregnancy. All Adults Neurosyphilis crystalline penicillin G 4 mu IV q4h for 10 14 days (A II) CSF examination for cell count and differential, protein, glucose and VDRL is recommended to establish a diagnosis of neurosyphilis and is indicated in all patients with neurologic or eye/ear symptoms or signs, and patients meeting other criteria (refer to syphilis chapter in Canadian Guidelines on Sexually Transmitted Infections). HIV Co-Infection Patients with HIV co infection should be managed with a HIV specialist. It is generally recommended that all HIV infected patients without evidence of neurologic involvement receive 3 weekly doses of benzathine penicillin 2.4 mu IM. (all syphilis cases) With documentation of adequate treatment in the past, patients need not be re-treated, unless there is clinical or serological evidence of re infection or treatment failure. Past history of treatment for syphilis may be available from STI Services, Alberta Health and Wellness and may help to guide current management. (all syphilis cases) All sexual and perinatal contacts in the last year of early syphilis (primary, secondary and early latent) must be located, examined, tested and treated. Follow Up (all syphilis cases) For early syphilis, repeat serology should be obtained at 1, 3, 6, 12 and 24 months following therapy. For late latent syphilis, serology generally need not be repeated until 12 months post therapy. For babies born to mothers with infectious syphilis or with congenital syphilis, expert consultation regarding management and follow up is strongly recommended.
GONORRHEA All Adults Urethral, cervical, rectal, pharyngeal infection cefixime 400 mg po as a single dose (A I) or ceftriaxone 125 mg IM as a single dose (A I) spectinomycin 2 gm IM as a single dose (only available through regional or provincial STI services) (A I)* *Not effective for pharyngeal infection Overall resistance to ciprofloxacin among gonoccocal isolates in Alberta in 2006 was 10%. As such, ciprofloxacin and other quinolone antibiotics are no longer recommended as preferred treatment agents. They may be used as an alternate treatment agent if antimicrobial susceptibility testing is available and quinolone susceptibility is demonstrated. If quinolones are utilized and antimicrobial resistance testing is not available, a test of cure must be obtained. Ciprofloxacin is contraindicated during pregnancy. All patients treated for gonorrhea should also be treated for chlamydia infection unless a chlamydia test is available and negative. Cultures for N. gonorrhoeae should be performed in all cases with sexual contact outside of Canada, failure of treatment, sexual assault/abuse cases and infection in a non genital site (e.g. eye, rectum, pharynx). Disseminated infections and infections involving the eye require expert consultation and systemic antibiotics. Follow Up Test of cure for gonorrhea is not routinely indicated if recommended treatment agent has been taken, symptoms and signs disappear and there is no re exposure to an untreated partner unless: compliance is sub optimal or uncertain an alternate treatment agent is used child (< 14 years) pregnant woman antimicrobial resistance is documented PID or disseminated gonococcal infection non-genital site involved (e.g. eye, rectum, pharynx) Test of cure should be done 3 4 weeks after completion of treatment if a nucleic acid amplification test is performed and 5 7 days after completion of treatment if a culture test is used. Infants born to untreated infected mothers must be tested and treated. Re screening of all individuals diagnosed with gonorrhea is recommended after 6 months. GENITAL HERPES SIMPLEX First Episode* acyclovir 200 mg po five times per day for 5 10 days (A I) or acyclovir 400 mg po TID for 7 10 days (A III) or famciclovir 250 mg po TID for 5 days (A I) or valacyclovir 1 gm po BID for 10 days (A I) * Note that duration of therapy depends on severity of outbreak Recurrent Lesions Episodic Therapy acyclovir 200 mg po 5 times per day for 5 days (C I) or famciclovir 125 mg po BID for 5 days (B I) or famciclovir 1 gm po BID x 2 doses (B II) or valacyclovir 500 mg po BID for 3 days (B I) or valacyclovir 1 gm po QD for 3 days (B I) Suppressive Therapy (non-pregnant) acyclovir 200 mg po TID to 5 times daily (A I) or acyclovir 400 mg po BID (A I) or famciclovir 250 mg po BID (A I) or valacyclovir 500 mg po QD (A I) [for patients with 9 recurrences per year] or valacyclovir 1 gm po QD (A I) [for patients with > 9 recurrences per year] Suppressive Therapy (pregnant) acyclovir 400 mg po TID at 36 weeks with termination at parturition (A I) or valacyclovir 500 mg po BID at 36 weeks with termination at parturition (B I) There is no role for topical acyclovir. Choice of treatment depends on dosing frequency and cost. For episodic therapy, treatment should be started as soon as possible during the development of a recurrent lesion preferably less than 6 hours (famciclovir) (B I) to 12 hours (valacyclovir) (B I) after the first symptoms appear. Antiviral therapy is not necessary in all cases, particularly when recurrences are both mild and infrequent. Episodic therapy may be an option for patients with infrequent (less than 6 outbreaks per year) but significant symptomatic outbreaks. Suppressive therapy may be an option for patients with more than 6 symptomatic outbreaks a year or in addition to barrier contraception in those who are concerned with disease transmission. Suppressive therapy reduces the frequency and severity of recurrences and reduces asymptomatic viral shedding. Counselling is an essential part of management. Expert consultation may be of value, particularly in the management of pregnant patients and discordant couples.
NON-GONOCOCCAL URETHRITIS (NGU) Case Definition: Inflammation of the urethra with or without a mucoid, muco purulent or purulent urethral discharge and/or 5 polymorphonuclear leukocytes per oil immersion field (x1000) in 5 non adjacent, randomly selected fields in a smear of urethral secretions (if available) and absent gram negative intracellular diplococci on gram stain of urethral secretions (if available) and negative tests or no tests performed for gonorrhea and chlamydia. All patients should be tested for gonorrhea and chlamydia. If urethritis is diagnosed clinically, immediate treatment is recommended. Treat presumptively for gonorrhea and chlamydia pending laboratory results (see treatment for chlamydia and gonorrhea). In the absence of a positive gonorrhea test, treat as for chlamydia. Patients who remain persistently symptomatic 3 4 weeks after treatment for gonorrhea and chlamydia and in whom a diagnosis of NGU has been made and persistent or repeat infection with gonorrhea has been ruled out should be treated with doxycycline 100 mg po BID x 7 days. Follow Up Patients should return for re evaluation if symptoms persist or recur. MUCO-PURULENT CERVICITIS (MPC) Case Definition: Inflammation of the cervix with a muco purulent or purulent cervical discharge or cervical bleeding on insertion of a swab and negative tests from genitourinary specimens for chlamydia and gonorrhea.* * Not all patients with vaginal discharge have MPC; vaginal speculum examination is required to make this clinical diagnosis. * Diagnosis of MPC should not be made in pregnancy due to poor positive predictive value of any criteria for defining MPC in pregnant women. EPIDIDYMO ORCHITIS Epididymo orchitis (If likely due to gonorrhea and/or chlamydia infections)* ceftriaxone 250 mg IM as a single dose PLUS doxycycline 100 mg po BID for 14 days (A I) ** ciprofloxacin 500 mg po as a single dose PLUS doxycycline 100 mg po BID for 14 days (A I) ** Quinolone antibiotics may continue to be used as an alternate treatment agent if antimicrobial susceptibility testing for gonorrhea is available and quinolone susceptibility is demonstrated. If quinolones are utilized and antimicrobial resistance All patients should be tested for gonorrhea and chlamydia. If cervicitis is diagnosed clinically, immediate treatment is recommended. Treat presumptively for gonorrhea and chlamydia pending laboratory results (see treatment for chlamydia and gonorrhea). In the absence of a positive gonorrhea test, treat as for chlamydia. Patients who remain persistently symptomatic 3 4 weeks after treatment for gonorrhea and chlamydia and in whom a diagnosis of MPC has been made and persistent or repeat infection with testing is not available, a test of cure must be obtained. The timing of test of cure is 3 4 weeks after completion of antibiotics when a nucleic acid amplification test is used and 7 days if a culture test is used. Epididymo orchitis (If likely due to non sexually transmitted organisms)* ofloxacin 300 mg po BID for 14 days (A I) *Depending on sexual history, gonococcal and/or chlamydial infections should be considered as the etiology of acute epididymo orchitis in all sexually active men especially those under age 35 years. Non-sexually transmitted epididymo orchitis occurs more gonorrhea has been ruled out should be treated with doxycycline 100 mg po BID x 7 days. Follow Up Patients should return for re evaluation if symptoms persist or recur. frequently in men > 35 years, those who have recently undergone urinary tract instrumentation or surgery and those with abnormalities of the urinary tract. Bed rest, scrotal elevation and support and analgesics are also recommended. (sexually acquired epididymo orchitis) a sexual contact is identified. Follow Up (all epididymo orchitis) All patients who fail to improve after 48 72 hours should undergo re evaluation and reassessment for alternate diagnosis.
PELVIC INFLAMMATORY DISEASE (PID) Outpatients (non-pregnant/non-lactating adults) ceftriaxone 250 mg IM as a single dose PLUS doxycycline 100 mg po BID for 14 days (A II) WITH or WITHOUT metronidazole 500 mg po BID for 14 days* (B III) ** ofloxacin 400 mg po BID for 14 days WITH or WITHOUT metronidazole 500 mg po BID for 14 days* (A II) *Addition of metronidazole is recommended when concurrent anaerobic infection is a concern (i.e. bacterial vaginosis, presence of tubo ovarian abscess and/or HIV co infection). be advised not to take alcohol for the duration of treatment and for 24 hours after because of possible disulfiram like (Antabuse) reaction. **Quinolone antibiotics may continue to be used as an alternate treatment agent if antimicrobial susceptibility testing for gonorrhea is available and quinolone susceptibility is demonstrated. If quinolones are utilized and antimicrobial resistance testing is not available, a test of cure must be obtained. The timing of test of cure is 3 4 weeks after completion of antibiotics when a nucleic acid amplification test is used and 7 days if a culture test is used. If an IUD is in place, consideration should be given to removal after therapy has been initiated and at least 2 doses of antibiotics have been given. HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) Follow Up All women should be re evaluated in 48 72 hours. Referral to a specialist for consideration of hospitalization if individual is: not responding to treatment unable to tolerate oral medication pregnant/breastfeeding immunocompromised a child (< 14 years) and/or there is: atypical presentation moderate to severe illness adnexal mass or tubo ovarian abscess and/or: surgical emergency (e.g. acute appendicitis cannot be excluded) All individuals having unprotected sexual intercourse (oral, vaginal or anal), injecting drugs, sharing needles and other injection drug use equipment, and/or infected with other STI are at risk of HIV infection. The presence of a STI increases the risk of acquisition and transmission of HIV. Testing HIV antibody testing should be offered to all at risk individuals, including those diagnosed with another STI. Testing should only be done with the patient s consent after a full discussion of the implications and limitations of the test. Providing the patient with a copy of the pamphlet, HIV, Could you be Infected? is suggested (see STI Resources on back page). HIV results, both positive and negative, should be given in person whenever possible. Those who test negative should be re tested at intervals up to 6 months after their last potential exposure and encouraged to modify their risk behaviour. Individuals testing positive must be counselled regarding their obligation to reduce/prevent transmission. HIV Testing In Pregnancy HIV testing in pregnancy is strongly recommended as part of routine prenatal care. Testing should be accompanied by informed consent. Print resources on prenatal HIV testing are available from Alberta Health and Wellness (see STI Resources on back page). Referral Newly diagnosed HIV positive individuals require medical, emotional and psychological support. Patients should be referred to a HIV specialist. Patients should be informed of local HIV/ AIDS support groups (see STI Resources on back page). All confirmed and probable cases of HIV should be reported to the Regional Medical Officer of Health and Alberta Health and Wellness using the HIV/AIDS Case Report Form. Identification and contact tracing of all known sexual and needle-sharing partners of HIV infected patients should be undertaken. It may be necessary to go back several years. Knowledge of a previous negative test can assist in determining the time frame for contact identification. Upon request, the Regional Medical Officer of Health or regional public health staff can assist in eliciting a list of contacts as well as locating and counselling these individuals.
VAGINITIS Bacterial Vaginosis Non-Pregnant/ Non Lactating Adults metronidazole 500 mg po BID for or metronidazole gel 0.75% gel, one applicator (5 gm) intravaginally qhs for 5 days (A I) or clindamycin cream 2%, one applicator (5 gm) intravaginally qhs for metronidazole 2 gm po as a single dose (A I) (higher relapse rate with this treatment) or clindamycin 300 mg po BID for Routine treatment of asymptomatic non pregnant women is not indicated except prior to IUD insertion, gynecologic surgery or upper tract instrumentation. Routine treatment of partners is not indicated. be advised not to take alcohol for the duration of treatment and for 24 hours after because of possible disulfiram like (Antabuse) reaction. Clindamycin cream is oil based and may weaken latex condoms. Pregnant/Breastfeeding Mothers metronidazole 500 mg po BID for clindamycin 300 mg po BID for Indications for screening and treatment of bacterial vaginosis in pregnancy include: presence of symptoms asymptomatic women who are a high risk pregnancy (e.g. history of pre term labour or delivery, pre-term premature rupture of membranes) prior to termination of pregnancy Treatment with vaginal cream/gel has not been shown to decrease the risk of adverse pregnancy outcomes. Clindamycin cream has been associated with adverse outcomes in the newborn when used in pregnancy. Based on multiple studies, data supports the safety and lack of teratogenicity of systemic metronidazole use in pregnancy. be advised not to take alcohol for the duration of treatment and for 24 hours after because of possible disulfiram like (Antabuse) reaction. Vulvovaginal Candidiasis Non Pregnant/ Lactating Adults Topical Agents intravaginal butoconazole, clotrimazole, miconazole, nystatin, tioconazole or terconazole preparations (A I) Oral Agents fluconazole 150 mg po as a single dose (A I) Treatment is unnecessary for asymptomatic infection. Many topical/intravaginal agents are oil based and might weaken latex condoms and diaphragms. Treatment of sexual partners is not routinely recommended unless male partner has candida balanitis. In males, use a topical azole cream twice a day for 7 days. Pregnant Mothers topical azole for Some effective topical azole agents are: butoconazole, clotrimazole, miconazole, terconazole and nystatin. Fluconazole is contraindicated in pregnancy but considered safe in breastfeeding. Trichomoniasis Non Pregnant/ Non Lactating Adults metronidazole 2 gm po as a single dose (A I) or metronidazole 500 mg po BID for Intravaginal metronidazole gel is not effective. Sexual partners should be treated simultaneously. be advised not to take alcohol for the duration of treatment and for 24 hours after because of possible disulfiram like (Antabuse) reaction. Pregnant/Breastfeeding Mothers metronidazole 2 gm po as a single dose (A I) Based on multiple studies, data supports the safety and lack of teratogenicity of systemic metronidazole use in pregnancy. be advised not to take alcohol for the duration of treatment and for 24 hours after because of possible disulfiramlike (Antabuse) reaction.
Partner Notification for STI Partner notification will identify those at risk, reduce disease transmission/ re infection and ultimately prevent disease sequelae. It is mandated under the Public Health Act that every attempt is made to identify, locate, examine and treat partners/contacts of all cases. Physician/case manager are required to provide partner names and locating information on the Notification of Sexually Transmitted Infections form and forward to STI Services, Alberta Health and Wellness. If testing and/or treatment of partners is not confirmed on the STI Notification Form, STI Services will initiate follow up by a Regional Partner Notification Nurse. Partner Notification Nurses (PNN) are specially trained to conduct notification of partners and contacts in a confidential manner that protects the identity of the index case. The phone number for your designated PNN is available by calling STI Services at: 780-427 2830. STI Services initiates follow up on all out of province/country referrals of cases and partner(s). STI Resources Medical and case consultation for STI/HIV is available through STI Services, Alberta Health and Wellness by calling: 780-427 2830 or through your regional STD clinic or Partner Notification Nurse. To obtain copies of the Notification of Sexually Transmitted Infections form contact STI Services, Alberta Health and Wellness by calling: 780-427-2830 or faxing: 780-422-5149. Alberta Health and Wellness, STI/HIV publications available at: www.health.alberta.ca. To order a supply, fax: 780-422 1695 with complete mailing address, contact name and phone number. STI/HIV toll free, province wide, 24 hour information line for general public: 1 800 772 2437. The Alberta Community Council on HIV (ACCH) for information on community based HIV organizations: 780-633 0388. Public Health Agency of Canada, Canadian Guidelines on Sexually Transmitted Infections available at: www.phac aspc.gc.ca in Persons Under 18 Years of Age In any person under 18 years of age, where there is concern about the child s safety or welfare (e.g. suspected sexual assault/abuse), contact Alberta Children and Youth Services. For contact numbers see: www.child.gov.ab.ca/home/local_offices.cfm or call the Child Abuse Hot Line 1 800 387 5437. It is recommended that all children under 14 years of age (except for congenitally acquired infections) be managed in consultation with a referral centre in either: Edmonton: Child and Adolescent Protection Centre Stollery Children s Hospital, 1C4.24 Mackenzie Health Sciences Centre 8440 112 Street, Edmonton, AB T6G 2B7 Tel: 780-407 1240 Calgary: Child Abuse Service Child Development Centre Suite 200, 3820 24 Avenue NW Calgary, AB T2N IN4 Tel: 403-955-5959 STI Services Alberta Health and Wellness 23 rd Floor, 10025 Jasper Avenue Edmonton, Alberta T5J 1S6 Tel: 780-427-2830 Fax: 780-422-5149 STD Clinics Calgary Health Region STD Clinic #404, 906 8 th Avenue SW Calgary, Alberta T2P 1H9 Tel: 403-944-7575 Fax: 403-297-2946 Moving Late Summer of 2008 to: 5 th Floor, Sheldon M. Chumir Health Centre 1213 4 th Street SW, Calgary, AB T2R 0X7 Tel: 403-955-6700 Fax: 403-955-6722 Capital Health STD Centre Edmonton General Hospital Site 11111 Jasper Avenue, Room 3B20 Edmonton, Alberta T5K 0L4 Tel: 780-413-5156 Fax: 780-425-2194 Fort McMurray STD Clinic Northern Lights Regional Health Authority 113 Thickwood Blvd Fort McMurray, Alberta T9H 5E5 Tel: 780-791-6263 Fax: 780-791-6282 Free Replacement Drugs The following drugs are supplied and replaced following submission of a STI Notification Form: Amoxicillin 500 mg po TID for 7 days Azithromycin 1 gm po as a single dose *Benzathine Penicillin (Bicillin) 2.4 mu injection Cefixime 400 mg po as a single dose Ceftriaxone 250 mg injection Ciprofloxacin 500 mg po as a single dose Doxycycline 100 mg po BID for 7, 14 or 28 days Erythromycin 500 mg po QID for 7 days Ofloxacin 300 mg and 400 mg po BID for 14 days Metronidazole 500 mg po BID for 14 days (for treatment of PID only) *Spectinomycin 2 gm injection *These are Special Access drugs that are available by request through STI Services, Alberta Health and Wellness for treatment of STI as per these guidelines. Regional STD clinics or Partner Notification Nurses can provide assistance in acquiring these medications. SX18 Printed in Alberta, Canada April 2008