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

2. 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-2003. MMWR 2002;51(No. RR-6): Sexually Transmitted Treatment Guidelines 2002. MMWR 2002;51(No. RR-15): Screening Tests To Detect Chlamydia trachomatis and Neisseria gonorrhoeae Infections - 2002

3. 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

4. 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..

5. 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?

6. 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

7. 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

8. 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