Target Audience (click to view)
This activity is designed to meet the needs of physicians.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Review the 2015 update to the CDC’s sexually transmitted disease treatment guidelines.
- Discuss the importance of risk assessment, as well as the prevention and control, of sexually transmitted disease.
Method of Participation(click to view)
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwFeb2. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Commercial Support(click to view)
There is no commercial support for this activity.
Disclosures(click to view)
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer(click to view)
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Complete the Post Test(click to view)
The CDC recently published an update to its 2010 sexually transmitted disease (STD) treatment guidelines in order to address key questions regarding the treatment and clinical management of these diseases. Published in the Morbidity and Mortality Weekly Report (MMWR), the guideline addresses several key updates, including:
- Alternative treatment regimens for Neisseria gonorrhoeae.
- The use of nucleic acid amplification tests for the diagnosis of trichomoniasis.
- Alternative treatment options for genital warts.
- The role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications.
- Updated HPV vaccine recommendations and counseling messages.
- The management persons who are transgender.
- Annual testing for hepatitis C in individuals with HIV infection.
- Updated recommendations for diagnosing urethritis.
- Retesting for chlamydia, gonorrhea, and trichomoniasis to detect repeat infections.
A Focus on Risk Assessment
As the guideline indicates, primary prevention of STDs should include behavioral and biologic risk assessment. As part of the clinical encounter, the CDC recommends that clinicians routinely obtain sexual histories and address risk reduction using the “Five Ps” approach (Table).
“Regarding partners, clinicians should ask patients if they have sex with men, women, or both,” explains Kimberly A. Workowski, MD, FACP, FIDSA, lead author of the guideline update. “They should also ask about how many partners they’ve had in the last 2 and 12 months and whether it’s possible that their partners have other partners.”
In terms of practices, Dr. Workowski says it is important to know if patients are engaging in vaginal, oral, or anal sex because certain infections can reside in certain anatomic sites of exposure and, in many instances, may infect patients without symptoms. Additional questions pertain to past history of sexually transmitted infections and whether any sexual partners have ever had a sexually transmitted infection. Clinicians should also address the methods that patients are using to prevent pregnancy.
According to Dr. Workowski, performing a behavioral risk assessment should be accompanied by screening tests, because sexually transmitted infections are biologic markers of risk. Identification of risk behaviors may also encourage clinicians to provide risk reduction by providing prevention counseling. Clinicians can use resources from the CDC’s Division of STD Prevention and review the curriculum provided by the division’s training centers for additional guidance when obtaining sexual history.
“Many STDs affect patients without noticeable symptoms, which may come as a surprise to patients and lead them to be unaware of an infection” explains Dr. Workowski. “For this reason, it’s important for clinicians to ask the right questions regarding sexual activity and behaviors. We must then provide the appropriate screening tests in patients suspected to be at risk. It’s also important for clinicians to educate sexually active patients that many STDs don’t have symptoms. Empowering patients with this information can help them think about how they can practice safer sexual practices and ensure that they are aware of methods to prevent the transmission of STDs to sexual partners.”
The prevention and control of STDs are important themes in the guideline. Dr. Workowski and colleagues note that this should be based on five major strategies:
- Accurate risk assessment and education and counseling of at-risk people on ways to avoid STDs through changes in sexual behaviors and use of recommended prevention services.
- Pre-exposure vaccination of people at risk for vaccine-preventable STDs.
- Identification of both asymptomatic and symptomatic STDs.
- Effective diagnosis, treatment, counseling, and follow-up of infected people.
- Evaluation, treatment, and counseling of sex partners of people infected with STDs.
A Multimedia Experience
Multiple formats of the CDC’s guideline are available to meet clinicians’ preferences, according to Dr. Workowski. “Aside from the print version that was published in MMWR, there are wall charts that can be displayed in clinics, pocket guides for quick referencing, a smartphone and tablet app, and a bound guideline that can all be ordered through the CDC website,” she says. A webinar is also available on the CDC website that discusses the revised guidance and STD prevention; epidemiologic trends related to STD prevention; and key screening, treatment, and emerging antimicrobial resistance recommendations.
“If clinicians still have questions regarding the prevention and management of STDs, they can access the National Network of STD Clinical Prevention Training Centers for access to experts in the management and treatment of sexually transmitted infections,” says Dr. Workowski. “Clinicians can get answers to consultation requests quickly if they have difficulty obtaining information on the evaluation and management of a particular infection or syndrome.”
Readings & Resources (click to view)
Workowski K, Bolan. Sexually transmitted disease treatment guidelines, 2015. MMWR. 2015;64:1-137. Available at www.cdc.gov/std/tg2015/tg-2015-print.pdf.
O’Connor E, Lin J, Burda B, et al. USPSTF: behavioral sexual risk-reduction counseling in primary care to prevent sexually transmitted infections. Ann Intern Med. 2014;161:874-883.
LeFevre ML. USPSTF: behavioral counseling interventions to prevent sexually transmitted infections. Ann Intern Med. 2014;161:894-901.
Metsch L, Feaster D, Gooden L, et al. Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial. JAMA. 2013;310:1701-1710.