WHAT’S NEW IN STIS? Sarah Weninger, HIV.STD.Viral Hepatitis Prevention Coordinator Division of Sexually Transmitted and Bloodborne Diseases January 27, 2021 OBJECTIVES
▪ Describe the updated gonorrhea treatment recommendations ▪ Identify the five goals of STI National Strategic Plan. ▪ Describe three strategies to implement for best practices for the prevention and treatment of STIs.
GONORRHEA TREATMENT ▪ Combination therapy since 1985 ▪ Evidence and Rationale ▪ Antimicrobial Stewardship ▪ Pharmacokinetics ▪ Azithromycin Susceptibility 2020 UPDATE TO TREATMENT FOR GONOCOCCAL INFECTIONS.
Uncomplicated urogenital, rectal or pharyngeal gonorrhea
500 mg IM Ceftriaxone*
*For persons weighing ≥ 300 lbs, 1 g of IM Ceftriaxone should be administered 2020 UPDATE TO TREATMENT FOR GONOCOCCAL INFECTIONS.
Uncomplicated urogenital, rectal or pharyngeal gonorrhea
500 mg IM Ceftriaxone^ + Doxycycline 100 mg orally BID * 7 Days (If Chlamydia is NOT ruled out)
^For persons weighing ≥ 300 lbs, 1 g of IM Ceftriaxone should be administered AZITHROMYCIN IS PREGNANT INDIVIDUALS WITH GONORRHEA AND CHLAMYDIA NOT RULED OUT.
Uncomplicated urogenital, rectal or pharyngeal gonorrhea 500 mg IM Ceftriaxone^ + 1 G Azithromycin 2020 UPDATE TO TREATMENT FOR GONOCOCCAL INFECTIONS.
Uncomplicated urogenital, rectal or pharyngeal gonorrhea - Cephalosporin Allergy 240 mg IM dose of Gentamicin + Single 2 g Oral Dose of Azithromycin EPT CAN STILL BE USED FOR GONORRHEA.
Uncomplicated urogenital, rectal or pharyngeal gonorrhea Single 800 mg Oral Dose of Cefixime + Doxycycline 100 mg orally BID * 7 Days (If Chlamydia is NOT ruled out) RETESTING & TEST-OF-CURE
▪ Test-of-Cure ▪ Only recommended for pharyngeal gonorrhea ▪ 7 to 14 days after initial treatment ▪ Retesting ▪ All patients diagnosed with gonorrhea ▪ 3 months after treatment 2021 STI TREATMENT GUIDELINES….ARE COMING ▪ STD changing to STI ▪ 5Ps – Emphasizing Harm Reduction ▪ Chlamydia Treatment Updated ▪ Syphilis Pregnant Women – 2nd Screen @ 28 Weeks SEXUALLY TRANSMITTED INFECTIONS NATIONAL STRATEGIC PLAN
“The United States will be a place where sexually transmitted infections are prevented and where every person has high-quality STI prevention, care, and treatment while living free from stigma and discrimination. This vision includes all people, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, disability, geographic location, or socioeconomic circumstance.” Primary Prevention.
Increase Awareness.
Increase Vaccine Completion Rates. 1 Prevent New Expand Workforce. Infections. Screening, Care, Treatment.
Extragenital STI testing.
Education and training. Improve Health of People Partner Services. 2 by Reducing Adverse Outcomes of STIs. STI vaccines.
Develop therapeutic agents.
Develop STI point of care testing. Accelerate progress in STI 3 research, technology and innovation. Reduce stigma and discrimination.
Training providers.
Address social Reduce STI – related determinants of 4 health disparities and health. health inequities. Syndemic Focus: STIs, HIV, Viral Hepatitis & Substance Use Disorders
Improve Data
Collection. Achieve integrated, 5 coordinated efforts that address the STI epidemic. ADDITIONAL RESOURCES ▪ STI National Strategic Plan Overview | HHS.gov www.hhs.gov/programs/topic- sites/sexually-transmitted- infections/plan- overview/index.htmlHS.gov Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020 | MMWR (cdc.gov) IMPACTING STI PREVENTION 1)Retesting 2)Prenatal Testing 3)3 Site STI Testing 4)PrEP WHAT STRATEGIES CAN BE USED TO IMPROVE RETESTING? ▪ Set-up retesting appointments at time of treatment ▪ Email/Text reminders ▪ Incentives ▪ Lab only appointments ▪ Self-collection SYPHILIS SCREENING IN PREGNANT WOMEN
▪ In July 2018, the NDDoH issued a recommendation for three-time screening for syphilis during pregnancy for all pregnant females. ▪ First trimester ▪ 28-32 weeks ▪ Delivery EXTRAGENITAL SCREENING
▪ Per the guidelines, the clinical significance of pharyngeal chlamydia infection is unclear and routine pharyngeal screening for chlamydia is not recommended. ▪ The CDC recommends that MSM be screened at least annually for chlamydia infection at sites of sexual contact, including the rectum and urethra; for gonorrhea, the guidelines recommend screening at the urethra, rectum, and pharynx. ▪ Extragenital specimens are collected via a swab of the rectum or pharynx, by either a clinician or a self-collected swab. Self-collected swab as a means of collecting pharyngeal and rectal specimens is supported by the CDC guidelines and has been found to be an acceptable means of obtaining specimens among women and MSM, which may lead to an increase in extragenital diagnoses due to the noninvasive nature of the procedure. Self-collected swabs may also reduce the workload for clinic staff who obtain them and promote screening when clinicians are not available for collection.
Chan, P, et. al. Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. Infectious Diseases in Obstetrics and Gynecology Volume 2016 (2016), Article ID 5758387, 17 pages http://dx.doi.org/10.1155/2016/5758387. STDs PREDICT FUTURE HIV RISK AMONG MSM
Rectal GC or CT 1 in 15 MSM were diagnosed with HIV within 1 year.* Primary or Secondary Syphilis 1 in 18 MSM were diagnosed with HIV within 1 year.** No rectal STD or syphilis infection
1 in 53 MSM were diagnosed with HIV within 1 year.* *STD Clinic Patients, New York City. Pathela, CID 2013:57; **Matched STD/HIV Surveillance Data, New York City. Pathela, CID 2015:61 3 SITE TESTING: SEXUAL HEALTH HISTORY ▪ Implement Universal Screening or Behavior Based ▪ Ask Type of Sex during Sexual Health History ▪ Check with your STD Lab if they offer 3 site testing
GOAL: INCREASE PREP AWARENESS IN N.D. 2019 2020
20% 28%
72% 80%
N: 2,906 HIV Tests N: 5,635 HIV Tests No Yes No Yes HIV PREP
▪ PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed. ▪ Although there is less information about how effective PrEP is among people who inject drugs, we do know that PrEP reduces the risk of getting HIV by at least 74% when taken as prescribed. ▪ Priority Areas: Access, Awareness, Cost ▪ On-Demand PrEP: Not in CDC guidelines National HIV Curriculum Online Curricula with Free CME/CNE
www.std.uw.edu features self-study modules and Question Bank (board-review style) on a variety of STDs.
www.hepatitisc.uw.edu features self-study modules for diagnosis, monitoring, and management of HCV infection; tools and calculators; HCV medications; and a resource library. DIVISION OF SEXUALLY TRANSMITTED AND BLOODBORNE DISEASES ▪Sarah Weninger ▪ HIV.STD.Hepatitis Prevention Coordinator ▪ 701.328.2366 ▪ [email protected]