CME: Updated Guidance for STDs

CME: Updated Guidance for STDs

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...
Updated Guidance for STDs

Updated Guidance for STDs

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...
The Importance of HIV/STD Prevention Counseling

The Importance of HIV/STD Prevention Counseling

According to recent estimates, approximately 1.1 million people in the United States are living with HIV, and about 50,000 new HIV infections occur each year. “Reducing transmission remains a key part of HIV prevention,” says Yuko Mizuno, PhD. “To further reduce the spread of HIV, an increased emphasis must be placed on preventing transmissions among individuals who already have the infection.” Research shows that those who are aware of their HIV status are more likely to take the necessary steps to protect themselves and their partners. Dr. Mizuno says that healthcare providers play an important role in offering critical health information and services to patients living with HIV. “In fact,” she says, “the CDC recommends that providers offer prevention counseling for HIV and sexually transmitted diseases (STDs) to all patients living with HIV during their routine clinic visits. Few studies, however, have explored what percentage of people in the U.S. who are living with HIV and receiving care are exposed to HIV/STD prevention counseling and whether it is reaching those who need it the most.” Examining New Data To better understand who is being reached with HIV/STD prevention counseling and how well they are being reached, Dr. Mizuno and colleagues published a study in AIDS evaluating data from the CDC’s Medi-cal Monitoring Project (MMP). The MMP provides nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving care in the U.S., including the estimated prevalence of exposure to HIV/STD risk-reduction interventions. According to the findings, only about 44% of people living with HIV in active care reported receiving one-on-one HIV/STD prevention counseling from their healthcare providers (Table)....
Updated Guidelines for HIV Care

Updated Guidelines for HIV Care

According to the CDC, nearly 1.2 million Ameri-cans are living with HIV and about 50,000 people in the United States are infected with the virus each year. Studies have estimated that as many as 80% of patients with HIV have their virus under control and live long, full lives. “With HIV continuing to become a manageable but complex chronic disease, HIV specialists and primary care physicians (PCPs) now need to provide the full spectrum of healthcare to these patients,” says Michael A. Horberg, MD, MAS, FACP, FIDSA. “PCPs and other healthcare providers need a better grasp of the impact that HIV care has on routine healthcare.” A Helpful Update In 2009, an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America (IDSA) released evidence-based guidelines for the management of people infected with HIV. Recently, these guidelines were updated to replace the 2009 recommendations and published in Clinical Infectious Diseases. Since 2009, new antiretroviral drugs and classes have become available, and the prognosis of people with HIV infection continues to improve. The guideline update also incorporates new information based on publications from 2009 to 2013. “The updated IDSA guidelines are intended for use by healthcare providers who care for HIV-infected patients,” says Dr. Horberg, who was on the expert panel that developed the update. “These new recommendations reflect the fact that people with HIV are now living much more normal life spans. As such, there is a greater need to focus on preventive care, including screening for high cholesterol, diabetes, osteoporosis, depression, and substance abuse, among other health conditions.” Although there are better survival rates,...

Chlamydia Retesting Rates Low

Data from the CDC indicate that retesting rates for chlamydia within 3 months after treatment for the infection  appear to be low. The retesting rate was 60.1% for pregnant women from 2008 to 2010, but only 22.0% of these women received a test-of-cure within the recommended 4 weeks. The authors noted that interventions are needed to increase adherence to recommendations for retesting in both men and women who have positive chlamydia test results. Abstract: Clinical Infectious Diseases, January 1,...
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