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STI Prophylaxis and Care
38
Transcript
Sexually Transmitted Infections (STIs)
Sexual Assault Exam
STI Prophylaxis and Care
Sexually Transmitted Infections
STI Prophylaxis and Care
TESTING
Testing
Acute Testing:
Why Not?
- Only detects infections from at least 1-2 weeks prior to visit.
- Unlikely exposures from SA will be detectable at time of exam.
Why?
- A pre-existing STI at the time of assault may increase the risk of HIV acquisition
- May require additional treatment, education, or follow-up care.
Acute Testing
Follow up Testing
Follow-up Testing
Regardless of initial acute testing, follow-up testing for STIs is typically recommended.
- Testing within 2-3 weeks of the assault may detect infectious organisms that might not have reached sufficient concentrations to produce positive test results at the initial exam.
- Additional testing is part of necessary care for HIV nPEP, re-evaluate positive findings, etc.
Treatment
Treatment
Treatment
- Chlamydia
- Gonorrhea
- Trichomoniasis
Chlamydia,
Gonorrhea
Trichomoniasis
Prior CDC Guidelines
- Ceftriaxone 250 mg IM X 1
- Azithromycin 1 g PO X 1
- Flagyl 2 g PO X 1
Prior CDC Guidelines
Considerations
+/-
- "One and done"
- No prescriptions necessary
- Covered by SAVE Fund
- Not consistent with current CDC best-practice recommendations
Current (2021) CDC Guidelines
- Ceftriaxone 500 mg IM X 1
- Doxycycline 100 mg BID X 7 days
- Flagyl 500 mg PO BID X 7 days
Current (2021) CDC Guidelines
Considerations
+/-
- Requires multiple prescriptions
- Concern for barriers to adherence
- Not covered by SAVE Fund
- Psychological, financial, and logistical barriers.
- Consistent with current best-practice CDC regimen
- Potentially more effective for anal/rectal infections
- Antibiotic stewardship: reduces resistant variants and strains
HIV
Non-occupational Post Exposure Prophylaxis (HIV nPEP)
HIV
Vaccines
- Hepatitis
- If pt unvaccinated> initiate vaccine and treat with HBIG
- If pt vaccinated> without record of confirmed antibody response, give single vaccine booster dose
- HPV
- If unvaccined/partially vaccinated age 9-26 years
Education & Follow up
- Initial
- Discharge
- Instructions
Education + Follow-up
Initial Education
- Risk factors for infection
- Options for testing
- Options for treatment
Initial
Discharge Education
- Review care provided
- Local community resources
- Next steps
Discharge
Instructional education
- Verbal and written
- Include prescriptions
- Risk reduction
Instructions
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