Beyond Didactic Presentations in Clinical Training: Thinking Outside the Powerpoint Box

1. Beyond Didactic Presentations in Clinical Training:Thinking Outside the Powerpoint Box Presented by the National Network of Prevention Training Centers (NNPTC) Parts I (Clinical), II (Behavioral) and III (Partner Services) March 11, 2008 Featuring … Cornelis Rietmeijer, MD, PhD Laura Bachman, MD, MPH Linda Creegan, MS, FNP M. Terry Hogan, MPH Katherine Hsu, MD, MPH Patricia Jennings, DrPH, PA-C Patricia Coury-Doniger, NP, MSN Anne Rompalo, MD, ScM

2. Laboratory Procedure CoursesNational Network of Prevention Training Centers Linda Creegan, MS, FNP California STD/HIV Prevention Training Center Oakland, CA National STD Prevention Conference Chicago, March 2008

3. CLINICIANS….. Are you new to the STD clinic? Is your clinic starting to use a new test? Trichomoniasis? Herpes? Bacterial Vaginosis? Syphilis? Rapid HIV test? Darkfield microscopy?

4. NNPTC Laboratory Procedure Courses Participants learn to perform..... • Tests for STD specialty clinics • Syphilis tests • Rapid RPR test • Darkfield microscopy • Gram stains • Saline and KOH wet mounts • Other Point-of-Care (POC) tests for STD and HIV

5. Tests for STD Specialty Clinics

6. Serologic Tests for Syphilis • Utility of rapid RPR test • Evaluate patients withsymptoms of primary or secondary syphilis • Assess contacts to syphilis infection • Facilitate immediate diagnosis, treatment, and initiation of partner management activities • Learn to perform and interpret qualitative and quantitated RPR tests

7. Darkfield Microscopy • Evaluate patients with ulcers typical of primary syphilis • Learn to • Obtain the specimen • Use the darkfield microscope • Identify T. pallidum by morphology and motility Photo credit: Dr. Joseph Engelman, San Francisco City Clinic

8. Morphology Rigid, uniform, tightly-coiled spirals Length: 6-20 micrometers Width: VERY thin 0.10-0.18 micrometers, below the resolution of the light microscope Motility Exhibits three types of movement Translation: slow, forward or backwards movement Rotation: turning around the longitudinal axis Flexion: stiff bending, usually in the middle, and returning to original position Identifying T. pallidum by DF

9. Gram Stains • Evaluate male urethral specimens • Learn to • Obtain the specimen • Identify polymorphonuclear leukocytes (PMNs) and Gram-negative intracellular diplococci (GNID) • Diagnose gonococcal vs non-gonococcal urethritis STD Atlas, 1997

10. Saline and KOH Wet Mounts Vaginal Specimens • Differentiate the causes of vaginal discharge • Learn to • Obtain the specimen • Use the light microscope • Identify findings (clue cells, yeast forms, trichomonads) • Diagnose bacterial vaginosis, yeast, trichomoniasis Photo credit: Seattle STD/HIV Prevention Training Center http://depts.washington.edu/nnptc/online_training/wet_preps_video.html

11. Other Rapid Point-of-Care Tests for STD

12. What are Point-of-Care tests? • Run in clinic or field setting • Provide results at same clinic visit • Very easy to perform • Usually require only microscope or simple lab equipment • Often CLIA waived

13. Point-of-Care STD Tests:A Paradox • Generally not as sensitive/specific as delayed lab tests • Not intended to replace traditional STD tests, where these are available HOWEVER… • In populations of patients less likely to return for results or when F/U is difficult, higher treatment levels can be achieved with POC than with delayed tests • Homeless clinics • Emergency rooms • Correctional facilities

14. POC tests for common STD HSV 2 Bacterial vaginosis Trichomoniasis Chlamydia Gonorrhea Learn about Lab regulatory issues (CLIA) Obtaining specimens Using test kits Interpreting results Maintaining quality assurance Point-of-Care STD Tests

15. Rapid HIV Tests Learn about….. • Performing oral fluid and fingerstick tests • Giving positive and negative test results

16. Enroll in a Lab Procedure Courseoffered by your regional Prevention Training Center!