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The International AIDS Society USA

STD Screening: First Visit. All patientsAsk about STD symptomsSyphilis serology, chlamydia, gonorrheaHepatitis A/B/C status Men should be screened for urethral infectionPatients who report receptive anal sexRectal gonorrheaRectal chlamydiaPatients who report receptive oral sexPharyngeal g

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The International AIDS Society USA

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    2. STD Screening: First Visit All patients Ask about STD symptoms Syphilis serology, chlamydia, gonorrhea Hepatitis A/B/C status Men should be screened for urethral infection Patients who report receptive anal sex Rectal gonorrhea Rectal chlamydia Patients who report receptive oral sex Pharyngeal gonorrhea *Check with local laboratory/program regarding availability of approved tests for pharynx/rectum* KEY SLIDEKEY SLIDE

    3. Periodic retesting for all sexually active patients Annually for all, more frequent (every 3-6 months) depending on risk: Multiple or anonymous sex partners Unprotected vaginal or anal intercourse with partner with negative or unknown HIV status Sex or needle-sharing partner with above risks “Life changes” associated with increased risk KEY SLIDEKEY SLIDE

    4. Syphilis Serology Nontreponemal: VDRL & RPR Antibody to cardiolipin-lecithin-cholesterol antigen; not specific to T. pallidum Quantitative: titer measured Used to follow treatment response (always use same test) Treponemal tests: TP-PA, FTA-ABS, EIA/CLIA Qualitative Confirmatory (needs to be done only once) KEY SLIDEKEY SLIDE

    5. Syphilis EIA/CLIA Treponemal tests FDA cleared for clinical use Captia, Trep-Chek, Trep-Sure,* BioPlex 2200, Enzy-Well, Liaison* (CLIA) Both IgG and IgM* tests available No clinical value of IgM in adult early syphilis diagnosis Highly automated, occupational advantages (no pipette), less costly, no prozone KEY SLIDEKEY SLIDE

    6. Challenges and limitations of EIA/CLIA Cannot distinguish between active disease and old disease (treated/untreated) Cannot use to monitor therapy (no titers) Studies to compare test performance with other serologic tests are lacking, however False positive results may not be uncommon in low prevalence populations Confirm positives with standard nontreponemal test titer (RPR/VDRL) to guide management If this is negative, perform a different treponemal test (TPPA) Patients with discrepant serology (e.g., positive EIA/CLIA and negative RPR) Early untreated, false+ EIA, OR previously treated syphilis KEY SLIDEKEY SLIDE

    7. Major Conclusions: Lab Testing for GC/CT KEY SLIDEKEY SLIDE

    8. KEY SLIDEKEY SLIDE

    9. Summary of HIV/HSV Intervention Trials Suppressive regimens (ACV 400 mg bid) do not resolve persistent inflammation due to herpes; likely why did not prevent HIV acquisition Acyclovir 400 mg bid did not prevent HIV transmission in spite of significantly reduced GUD & plasma HIV levels Acyclovir 400 mg bid modestly slowed progression of HIV disease in HIV/HSV-2 dually-infected persons with CD4>250 KEY SLIDEKEY SLIDE

    10. HSV Serology: Bottom Line Routine serologic screening may be relevant Discordant couples: counseling re transmission risk and value of suppressive therapy to reduce transmission (heterosexual data) If ART not standard or desired Diagnostic testing When lesions are atypical or cannot be cultured KEY SLIDEKEY SLIDE

    11. New Testing Options for Trich Microscopy is inferior to new options, including Rapid antigen testing TMA Trichomonas Vaginalis Analyte Specific Reagent Nucleic Acid Amplification Test Utilizes same technology as assay for CT/GC May use same specimen type as used with assay for CT/GC (i.e.vaginal swab, endocervical swab, urine) Huppert CID 2007 Test Sens Spec TMA 98.2% 98% OSOM 90% 100% Culture 83% 100% Wet prep 56% 100% KEY SLIDEKEY SLIDE

    12. Clinical Indications for HPV DNA Testing: HIV-Uninfected Proven to be clinically useful for: Triage of ASCUS Pap smears in women >20 years of age Adjunct screening in women age 30 and over NO proven benefit for: To decide whether or not to vaccinate STD screening Triage of LSIL in adults or higher grade lesions Testing of adolescents <21 years of age Evaluation of sex partners Evaluation of genital warts KEY SLIDEKEY SLIDE

    13. Take-Home Messages Screen, screen, screen Baseline then annually for all; at 3- 6 month intervals if at ? risk Recognize extent of genital herpes and variable clinical manifestations; value of screening with serology depends on context Be aware of pharyngeal GC, and alert for antibiotic-resistance Syphilis: it’s not going away. Screening is cheap, so don’t hesitate; recognize myriad clinical manifestations & how to interpret, follow up on EIA+ Sexual health Vaccinate for HPV (but continue Pap smear screening) Recognize and treat trichomoniasis, probably with a longer course in HIV+ Most importantly… KEY SLIDEKEY SLIDE

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