Recommendations for STD Clinical Preventive Services for Persons Living with HIV/AIDS

MMWR 2003;52(No.RR-12): Incorporating HIV Prevention Into The Medical Care Of Persons Living With HIV. HRSA, CDC, NIH, IDSA MMWR 2003;52 (No. 15): Advancing HIV Prevention: New Strategies For A Changing Epidemic, USA MMWR 2002;51(No. RR-6): Sexually Transmitted Treatment Guidelines MMWR 2002;51(No. RR-15): Screening Tests To Detect Chlamydia trachomatis and Neisseria gonorrhoeae Infections

A. Risk Assessment At the initial visit or if not previously done while in ongoing care Repeat at subsequent visits, and at least every 3 months  Sexual and substance use risk assessment  STD History  STD symptoms STD Clinical Preventive Services

When taking a sexual/substance use history, remember :  Use open-ended questions which paint a “big” picture” to understand client’s influencing factors such as - Tell me about your current partner situation - If steady, what’s that relationship like for you? - When is the last time you had sex with that person? How about with someone other than that person? - What’s your experience been with condom use? - With disclosing to sexual partner(s)? - What’s your experience been with substance use? Etc..

When taking a sexual/substance use history, remember (con) :  Once you have gathered “big picture” information, move to more closed-ended questions to narrow and define the situation: - Do you have vaginal, rectal, oral sex? With males, females, both, or, with same sex partners? - How many different partners have you had in the last 3 months? In the last year? - Do your current partners know your HIV status? - How often are you using? Have you ever been in treatment? - Have you ever been in a situation where you had sex in order to use?

STD Clinical Preventive Services B. Clinical Preventive Services Screening  Visual inspection of the skin, mouth, genitals and anal area  Syphilis serology (RPR, VDRL)  Urethral/cervical/urine test for Chlamydia trachomatis  Urethral/cervical/urine test for Neisseria gonorrhoeae (GC)  Rectal/pharyngeal test for GC if history of exposure  Hepatitis B and C serology  For women: pelvic examination, wet prep and pH for Trichomonas vaginalis and bacterial vaginosis Cervical cytology  Consider HSV by glycoprotein G-specific serology

STD Clinical Preventive Services For chlamydia testing : For gonorrhea testing:  Nucleic Acid Amplification tests (NAAT) are preferred - Urine should be used if a urethral or cervical swab is refused  NAAT or culture is preferred for the urethral/cervical sites. Use a urine NAAT if a urethral or cervical swab is refused  Only cultures should be used for the rectum/pharynx

STD Clinical Preventive Services B. Clinical Preventive Services Vaccination  Hepatitis B vaccine if no serologic evidence of immunity  Hepatitis A vaccine:  Illegal drug users  MSM  Chronic liver disease (including HBV, HCV)  Anal/oral or insertive anal intercourse