Catherine M. Bettcher, M.D. CME Director & Assistant Professor, Department of Family Medicine

Apply evidence-based recommendations to the diagnosis and treatment of Trichomoniasis, Chlamydia and gonorrhea Implement strategies to prevent HPV infection Discuss special situations that may arise with screening/treatment of adolescents

NAAT % sensitivity Collect vaginal, endocervical, or urine specimens from women Prefer urethral swabs in men Culture Antigen-detection, point-of-care test Wet prep microscopy 60-70% sensitivity

Retest females 3 months after treatment Routine screening not recommended CDC recommends annual screening in all HIV-infected women AAP recommends consideration of screening in high- risk females

In 2009, ACOG changed guidelines for Pap smears Study compared data from 3,500 females aged before and after the change

NAAT Endocervical or vaginal swabs, or first catch urine in women Urethral swab or first catch urine in men Culture Endocervical swab in women Urethral swab in men

NAAT Endocervical or vaginal swabs, or first catch urine in women Urethral swab or first catch urine in men Culture Endocervical swab in women Urethral swab in men

No routine test of cure 3-4 weeks after treatment Retest patients 3 months after treatment Consider Expedited Partner Therapy (EPT) for sex partners

Consider failure in the following situations No resolution of symptoms in 3-5 days after treatment, and no sex during this period Positive test of cure and no sex following treatment Send culture with simultaneous NAAT Retreat with recommended regimen

Usually resolves spontaneously with no health problems Can lead to genital warts and precancers/cancers of cervix, anus, penis, vulva, vagina, head and neck Cannot determine which infections will resolve and which will progress Does not interfere with pregnancy

That’s 1 case every 20 minutes

CDC, United States Cancer Statistics (USCS), Cancer site Average number of cancers per year probably caused by HPV % per year MaleFemaleBoth Sexes Anus1,4002,6004,00091% Cervix010,400 91% Oropharynx7,2001,8009,00072% Penis % Vagina % Vulva02,200 69% TOTAL9,30017,60026,900

Routinely give at age years Recommended through age 26 for females and through age 21 for males not previously vaccinated

These Genital warts ~66% of ~15% of HPV Types CervicalCervical Cause: CancersCancers

In countries with >50% coverage among year olds Prevalence of HPV 16/18 decreased 68% Anogenital warts decreased by 61% Evidence of herd effects

Your preteen needs three vaccines today to protect against meningitis, HPV cancers, and pertussis.

A parent or legal guardian must provide consent on behalf of a minor (under age 18) before health care services are provided. Exceptions to the parental consent rules: Emergency care Care for emancipated minors By court order, marriage, military active duty Specific healthcare services related to: Sexual health Mental health Substance use treatment

Patients ages 12 and up have a right to the following WITHOUT parental consent or knowledge: Pregnancy testing and prenatal care Birth control information and contraceptives Testing and treatment for sexually transmitted infections

Healthcare providers must breach the minor’s confidentiality and tell the parent if: There is suspicion of abuse by an adult The minor is a risk to themselves or someone else The minor is under age 12 and has been sexually active P rovider may choose (but is not obligated) to tell the parents about any care provided to the minor patient

Discuss the expectation that some time will be spent with the teen alone Inform adolescent patients and their parents about their rights and limitations regarding confidentiality laws and procedures

Explanation of benefit (EOB) or medical bill might disclose tests and treatments for STDs Encourage teens to discuss care with families Teens can pay out of pocket Refer teens to clinics where confidential care is free or based on a sliding scale Consider making STI screening “routine”

Administer HPV vaccine to females and males aged 11 to 12 years Give the hep B vaccine if not previously vaccinated Offer the hep A vaccine if not previously vaccinated Counsel about sexual behaviors and educate about prevention

Use NAAT for diagnosis Rescreen men and women with chlamydia or gonorrhea in 3 months Rescreen women with trichomoniasis in 3 months Promote HPV vaccination Seek opportunities to screen adolescents appropriately

Expedited Partner Therapy (EPT) for Chlamydia and Gonorrhea: Guidance for Health Care Providers. Michigan Department of Health and Human Services. Hauk L. CDC releases 2015 guidelines on the treatment of sexually transmitted diseases. Am Fam Phys. 2016;93(2): Murray PJ. Screening for nonviral sexually transmitted infections in adolescents and young adults. Pediatrics. July 2014;134(1):e302–e311. Ursu A, Sen A, Ruffin M. Impact of cervical cancer screening guidelines on screening for Chlamydia. Ann Fam Med. 2015;13(4): Workowski KA. Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Inf Dis. 2015;61:S759- S762. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, MMWR Recommendations and Reports. 2015;64(3):