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Updated or Reaffirmed 2019/2020 and New 2020 CPS > Updated or Reaffirmed 2019/2020 or New 2020 CPS > Flashcards

Updated or Reaffirmed 2019/2020 or New 2020 CPS Flashcards

1
Q

On what measures of health do Indigenous children lag behind their non-indigenous peers? (4+2)

A
  • Infant mortality
  • Early childhood development
  • Acute healthcare needs
  • Mental health

They also have:

  • Increased rates of substance abuse (tobacco, prescription drugs, alcohol)
  • Increased rates of suicice
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2
Q

What are some additional social determinants of health that help to understand the root causes of inequality affecting Indigenous children and youth? (3)

A
  • Kinship and support networks
  • Racism
  • Loss of traditional language, land and social identity
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3
Q

As per the core principles of the TCPS 2, what must take priority over every other research consideration?

A

‘Respect for persons’, or the welfare and integrity of individuals - it is unacceptable to treat individuals as a means to an end.

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4
Q

What are some possible negative impacts of a research project on Indigenous communities? (3)

A
  • Discrimination
  • Stigmatization
  • Loss of control over research outcomes
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5
Q

In developing countries, what are the benefits of Kangaroo Care for low birthweight infants? (4)

A

Reduction in:

  • Mortality
  • Severe illness
  • Infection (includinig nosocomial)
  • Length of hospital stay
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6
Q

In high income countries, what are the benefits of Kangaroo Care for preterm infants? (5)

A
  • Cardiorespiratory and temperature stability
  • Sleep organization and duration of quiet sleep
  • Neurodevelopmental outcomes
  • Breastfeeding
  • Modulation of pain responses
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7
Q

What are the benefits of breast milk for preterm infants?

A
  • Decreased incidence of infections
  • Decreased incidence of NEC
  • Improved growth
  • Improved neurodevelopmental outcomes
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8
Q

What infectious diseases does human milk feeding decrease the incidence of in infancy? (6)

A
  • Bacterial meningitis
  • Bacteremia
  • Diarrhea
  • Respiratory tract infections
  • Otitis media
  • Urinary tract infections
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9
Q

What are some additional benefits of breastfeeding? (2)

A
  • Enhanced performance on neurocognitive testing

- Economical (no need to purchase bottles and formula)

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10
Q

What are some health benefits for mothers who breastfeed?

A
  • Decreased incidence of breast and ovarian cancer
  • Delay in return of ovulation
  • Greater post-partum weight loss
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11
Q

Contraindication to breastfeeding in Canada? (4)

A
  • HIV positive mother
  • Mother receiving cytotoxic chemotherapy for duration of treatment
  • Mothers receiving radioactive isotopes or radiation therapy during treatment
  • Classic galactosemia
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12
Q

What important pathogens must be considered in situations of needle stick injuries? (3)

A
  • Hepatitis B virus
  • Hepatitis C virus
  • HIV
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13
Q

How can needle stick injuries be prevented? (4)

A
  • Education of children, parents, educators, health care providers about the dangers of handling used needles, syringes, and other objects contaminated with blood, including sharps containers
  • Children should be made aware of these rules at an early age
  • Communities should be responsible for providing adequate cleanup of parks and schoolyards
  • Communities must commit to and support addiction treatment and infection prevention programs for injection drug users
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14
Q

The risk of infection from exposure to a blood by a needle stick injury depends on? (3)

A
  • The size of the needle
  • The depth of penetration
  • Whether blood was injected, and then amount of blood introduced and concentration of virus in that blood
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15
Q

Which is the most stable of the blood-borne viruses, and can be transmitted by a minute amount of blood?

A

Hepatitis B virus

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16
Q

How long can HBV survive for under optimal conditions, in discarded needles?

A

Up to 1 week

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17
Q

What to do with respect to HBV prophylaxis if child is known to be anti-HBsAg antibody positive OR HbsAg positive?

A

No action required.

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18
Q

What to do if child with needle stick injury has not been fully vaccinated against HBV? (1)

A

Test for anti-HbsAg antibody and HBsAg immediately. Await results if available within 48h.

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19
Q

What to do if child who has not been fully vaccinated with needle stick injury is anti-HBs-Ag antibody AND HBsAg negative?

A

-Give HBIG immediately (ideally within 48h of injury; efficacy unknown if >7 days after injury)
Dose 0.06ml/kg, administered IM
-Give HBV vaccine (as soon as possible, and at latest within 7 days of injury). Arrange to complete vaccine series.

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20
Q

What to do if child who has not been fully vaccinated with needle stick injury is anti-HBsAg positive (but HBsAg negative)?

A

Complete HBV vaccine series according to schedule.

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21
Q

What to do if child who has not been fully vaccinated with needle stick injury is HBsAg-positive (anti-HBsAg negative)?

A

Discontinue vaccine series. Arrange appropriate follow-up.

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22
Q

What to do for child with needle stick injury who is not fully vaccinated if results of anti-HBsAg antibody and HBsAg not available within 48h?

A
  • Give HBIG immediately
  • Give a dose of HBV vaccine (as soon as possible, and at latest within 7 days of injury)
  • When results are available, proceed with vaccine and follow-up.
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23
Q

What to do for child who has been fully vaccinated with needle stick injury?

A

Test for anti-HBsAg antibody. If results not available in 48h, give one dose of HBV vaccine.

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24
Q

What to do for child who has been fully vaccinated with needle stick injury if anti-HbsAg antibody positive?

A

No further action required.

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25
Q

What to do for child who has been fully vaccinated if anti-HbsAg antibody negative? (3)

A
  • Test for HBsAg.
  • If HBsAg-negative, give HBIG and dose of HBV vaccine
  • If HBsAg positive, arrange appropriate follow-up.
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26
Q

What is the risk of acquiring HCV from an occupational needle stick injury when the source was infected?

A

3-10%

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27
Q

What is the risk of acquiring HIV from a hollow-bore needle with blood from a known HIV-seropositive source as a result of occupational needle stick injury?

A

0.2-0.5%

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28
Q

Steps to take following a needle stick injury? (9)

A
  • Clean the wound thoroughly with soap and water as soon as possible after the needle stick injury.
  • Do not squeeze the area to induce bleeding.
  • Assess the extent of the wound and probability of exposure to blood through open skin lesions or mucous membranes.
  • Determine the child’s immunization status for tetanus and HBV
  • Administer tetanus vaccine +/- tetanus Ig, when indicated
  • Document the circumstances of the injury - date and time of injury or exposure, where needle was found, how injury happened, description of the needle, whether or a syringe was attached, whether blood was visible in or on the needle or syringe, whether the injury caused bleeding, whether the previous user of the needle is known
  • Obtain a blood sample for:
  • Baseline HBV, HIV and HCV status
  • In the rare instance where antiretrovirals are being started, CBC + differential, AST, ALT, alk phos, BUN, creatinine
  • Testing needles or syringes for viruses is NOT indicated - results are likely to be negative, but a negative result does not rule out the possibility of infection
  • When the user of the needle is known, attempts should be made to assess for risk factors for blood-borne viruses and, if possible, to test for these viruses. Pending results, proceed as for an unknown source.
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29
Q

When is ART prophylaxis recommended? (2)

A
  • Only in cases of high risk, when the source is considered likely to have HIV
  • Incident involved a needle or syringe wth visible blood, and blood may have been injected
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30
Q

When is the source of a needle considered to be high risk for HIV transmission? (2)

A
  • Source known to have HIV

- Source unknown but presumed or known high prevalence (>15%) of HIV in local injection drug user population

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31
Q

What factors to consider about the device when assessing risk for HIV transmission after needle stick injury? (4) What would be highest risk?

A
  • Size of needle
  • Whether it is hollow bore
  • Presence of visible blood in needle or syringe
  • Probability of exposure to drying, head and freezing since use
  • Large lumen devices with visible blood = highest risk
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32
Q

What factors to consider about the injury when assessing risk for HIV transmission after needle stick injury? (2) Which injuries are high vs. low risk? (5)

A
  • Depth and extent of trauma (scratch vs deep cut, injection of blood, bleeding at site)
  • Injuries with actual blood injection are high risk
  • Other high risk exposures: child put syringe with visible blood into mouth and possibly injected blood, splashes involving large volume of blood coming into contact with extensive areas of non-intact skin
  • Superficial scratches are low risk
  • Other low risk: suspected but unobserved splash into eyes or lips
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33
Q

What is the optimal time frame for starting antiretrovirals after a needle stick injury? After what timeframe is it no longer indicated as it is of no benefit?

A
  • 1-4 hours

- 72 hours

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34
Q

What ART agents are recommended for young children (<12 y o)? (3)

A

Zidovudine PLUS lamivudine PLUS lopinavir/ritonavir

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35
Q

What ART agents are recommended for children who are at least 12 y o and at least 35kg?

A

Emtricitabine PLUS tenofovir PLUS raltegravir or dolutegravir (latter three better tolerated than those recommended for younger children)

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36
Q

What antiretroviral to use if renal function abnormal?

A

Tenofovir

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37
Q

What is the duration of HIV ppx?

A

28 days

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38
Q

What do you need to advise parents re: needle stick injuries? (3)

A
  • Need to test for acquisition of infection
  • Need to complete HBV vaccinatio schedule
  • Need to monitor side-effects if on ART ppx
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39
Q

How to perform follow-up with respect to HIV?

A
  • If on ART ppx:
  • Reassess at 2-3 days by phone or visit
  • Follow-up at 2 AND 4 weeks for assessment of adherence, drug tolerance, CBC + diff, AST, ALT and creatinine
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40
Q

Follow-up schedule for needle stick injury management?

A
  • At 4 weeks: second HBV vaccine dose if only one previous doese received and if no antibody or antigen was detected on initial testing
  • At 4-6 weeks: test for anti-HIV antibody
  • At 3 months: Test for anti-HIV antibody (unless previously positive) and anti-HCV antibody
  • At 6 months: anti-HIV, anti-HCV and anti-HBsAg antibody (unless previously positive). HIV test may be omitted if negative at 3 months using fourth-ggen combo HIV p24 Ag-HIVI Ab test and chilid doesn’t have HCV infection (HCV delays HIV seroconversion). Give third HBV vaccine dose if only two previous doses received
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41
Q

What if anti-HBsAg antibody test negative at 6 months (after 3rd dose of vaccine)?

A
  • Test again at 1-2 months after 3rd dose of vaccine
  • If still negative, test for HBsAg.
  • If HBsAg negative, give fourth dose of HBV vaccine, and test again 1-2 months later.
  • If anti-HbSAg antibody still negative, refer to specialist.
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42
Q

What is the leading cause of death in Canadian Indigenous children and youth?

A

Unintentional injuries

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43
Q

What factors increase the risk and impact of injury in Indigenous communities?

A
  • Far more likely to:
  • be poor (lower incomes, higher unemployment)
  • Have less education
  • Be younger
  • have substandard housing
  • Live in a rural area
  • have difficulty accessing health care - local shortages in health care personnel and resources
  • Higher rates of depression, alcohol and substance abuse have associated risk-taking behaviours and inadequate parenting skills for some
  • Alcohol is a significant contributor to MVCs, lack of seat-beltt use and drowning
  • Lack of culturally appropriate or targeted injury prevention programs
  • Rural indigenous children and youth have not benefitted to the same degree as otther Canadians from vehicle safety programs, campaigns against impaired driving, swimming lessons, firs aid/CPR training, or enforcement of existiing safety laws
44
Q

What percentage of the Canadian population self-identifies as being Indigenous (or Aboriginal)?

A

5%

45
Q

What is the unintentional death rate in Indigenous children and teens in Canada compared to the rate for other children?

A

Three to four times higher. Some specific rates of injury in certain populations are as high as 22 times the Canadian average.

46
Q

What are the most common causes of death due to injury in children younger than 10 years of age? In children 10-19 years of age?

A
  • Fires and motor vehicle collisions

- MVCs and drownings

47
Q

Potential adverse impacts of more severe injuries on youth?(6)

A
  • Disability
  • Education
  • Growth and development
  • Future employability
  • Depression
  • Substance abuse
48
Q

Why are Indigenous peoples generally at a higher risk of MVCs? (4)

A
  • Communities are isolated
  • Health care facilities are harder to get too
  • Road conditions are generally poor
  • Hazardous machines such as all-terrain vehicles (ATVs) and snowmobiles are used frequently or in unsafe conditions, often by necessity
49
Q

Why are Indigenous people at increased risk of death from fire? (5)

A
  • Higher proportion of smokers at home
  • Wood-framed, substandard housing
  • Underuse of working smoke detectors
  • Longer travel times for fire rescue equipment and personnel
  • Shortage of trained firefighters
50
Q

What factors increase the risk of drowning in Indigenous communities? (4)

A
  • Proximity to water
  • Risk of hypothermia (e.g. in northern regions)
  • Snowmobiling on thin ice
  • Underuse of personal flotation devices
51
Q

What are the 6 Es in successful injury prevention?

A
  • Education
  • identify community champions to help disseminate safety messages over local media and in school-based programs
  • use anticipatory guidance with families on personal safety measures, such as using helmets, PFDs and seat belts
  • Develop IP programs such as First aid and CPR training, swimming lessons, water safety fire prevention, emergency preparedness
  • Empowerment
  • incorporate Indigenous culture, language and beliefs into IP planning
  • ensure local participation in the design and implementation of IP strategies
  • Enabling
  • provide easier access and affordability to IP education and devices through combined community purchasing, installation or subsidies (e.g. smoke detectors, bicycle helmets and PFDs)
  • Engineering
  • design safer products and environments (e.g. safer, well-lit roads and sidewalks, fencing around domestic animals, or designing winter clothing with built-in inflatable devices
  • Enforcement
  • involve band council members and community leaders in policy implementation and reinforcement
  • Employment
  • build capacity while designing and implementing IP programs, to enhance community participation and create revenue
52
Q

Etiologies for absent or defective spleen function in children?

A
  • Congenital anatomical absence of a spleen
  • Surgical removal of the spleen
  • Medical conditions that result in poor or absent spleen function (e.g. SCD)
53
Q

Which patients with asplenia are at greater risk of overwhelming sepsis than those who have undergone a splenectomy for trauma?

A

-Individuals with underlying blood disorders, such as hemoglobinopathies (SCD, thal major), or HS

54
Q

When are asplenic patients at risk of overwhelming sepsis? When is the highest frequency of sepsis reported?

A
  • Throughout their life span
  • Highest frequency of sepsis in first three years post-splenectomy, or first three years of life, if congenitally asplenic
55
Q

What is the mortality rate for asplenic patients with sepsis from encapsulated organisms? What age group has the highest mortality rate?

A
  • 50-70%

- Children younger than 2 years of age

56
Q

What is the most common organism causing sepsis in asplenic patients? In how many cases is it isolated?

A
  • Streptococcus pneumoniae

- Isolated in 50% of cases

57
Q

What are some other encapsulated bacteria that can cause overwhelming sepsis in asplenic patients? (3)

A
  • Haemophilus influenzae type b (Hib)
  • Neisseria meningitidis
  • Salmonella species

Less commonly e.coli and more recently bordatella holmesii infection have been described

Pneumonic for encapsulated bacteria: YES Some Nasty Killers Have Pretty Big Capsules)

  • Yersinia pestis
  • Escherichia coli (meningeal strains only)
  • Salmonella typhi
  • Streptococcus pneumoniae and streptococcus pyogenes
  • Neisseria meningitidis
  • Klebsiella pneumoniae
  • Haemophiilus influenzae type B
  • Pseudomonas aeruginosa
  • Bordatella pertussis and Bacillus anthracis
  • Cryptococcus neoformans (only encapsulated fungal pathogen)
58
Q

What organism causes sepsis associated with cat and dog bites and high morbidity in asplenic patients? What is the appropriate antibiotic if bitten?

A
  • Capnocytophaga species

- Amox-clav

59
Q

What other serious infections are asplenic patients at risk for?

A
  • Severe or fatal malaria

- Infection by protozoan Babesia

60
Q

Broadly, what preventative strategies should health care providers ensure when caring for children with asplenia?

A
  • Parent and patient education
  • Immunization
  • Antibiotic prophylaxis
  • Aggressive management of suspected infection
61
Q

What information to include in parent and patient education re: asplenia?

A
  • Emphasize importance of immunization and prophylactic antibiotics
  • Emphasize that the above do not provide complete protection
  • Educate about risk of sepsis
  • Instruct t seek medical attention promptly when child is ill or has a fever
  • Heightened infection risk continues into adulthood
  • Advise to wear a Medic Alert bracelet
  • When travelling, should carry a note from physician stating diagnosis, associated risks, and suggested medical management plan should they become ill
  • Discuss increased risk of infection with animal bites, especially capnocytophages caminorsus from dog bites, and need for antibiotics if bitten (amox-clav)
62
Q

What are the supplementary immunizations (in addition to standard) that asplenic children should receive, possibly on an earlier schedule than routine?

A
  • For pneuomococcus - Pnemoococcal polysaccharide vaccine (PPV23/Pneumovax) - 8 weeks after receipt of appropriate number of PCV13 doses + booster dose 5 years after first dose
  • If have previously received only PPV23, should receive one dose of PCV13 one year after receiving PPV23

-For meningococcus:
4CMenB

-For haemophilus influenzae type b (Hib)

  • Other: Influenza yearly
  • All asplenic patients travelling to countries with less stringent food safety and water supply standards than Canada should be immunized for S.typhi
63
Q

What is the most frequently reported STI in Canada?

A

Chlamydia trachomatis (non-lymphogranuloma venereum serological variants)

64
Q

What population does chlamydia trachomatis predominantly affect?

A

Women 15-29 years of age and Men 20-29 years of age

65
Q

Which STI is more prevalent in men 20-29, particularly among MSM, and has declining rates among adolescents <20 years of age, but increasing rates in older age groups? Why is the number of female cases likely to be underestimated?

A
  • Neisseria gonorrhoeae

- Unlike males, females are often asymptomatic

66
Q

Why is management with combination antimicrobial therapy and repeat testing post-treatment increasingly necessary for N. Gonorhoaea?

A

Increasing gonococcal antimicrobial resistance in Canada and globally

67
Q

What populations of patients does T. pallidum (syphillis) most commonly affect?

A
  • MSM 25-29 years of age
  • Sex workers and their clients
  • Individuals who have acquired infection in endemic regions of the world
68
Q

What groups are affected most by HIV? In what groups have the largest increases in rates been seen?

A
  • MSM
  • Individuals who have acquired infection via heterosexual contact
  • People who inject drugs
  • Males, especially age 30-39
  • First Nations
69
Q

Which STIs are not reportable?

A

Trichomonas vaginalis, HSV, HPV

70
Q

Which is the most common STI causing vaginitis, affecting estimated 2% of sexually active females 14-19 years of age in the US?

A

Trichomonas vaginalis

71
Q

In what percentage of patents is T. vaginialis asymptomatic?

A

> 70%

72
Q

Most common cause of genital ulcer disease?

A

HSV

73
Q

What is the most common reported STI among males and females?

A

HPV

74
Q

What is the lifetime risk of infection with HPV?

A

75%

75
Q

What are the ‘high risk’ types of HPV that cause cervical and other genital cancers?

A

16, 18

76
Q

What are the ‘low-risk’ type of HPV that cause anogenital warts?

A

6,11

77
Q

In what groups of patients is the prevalence of high-risk HPV higher?

A

Females younger than 25 years of age
Lower SES
Indigenous women

78
Q

What impact has the introduction of HPV immunization programs for girls had?

A
  • Lower rates of:
  • HPV infection
  • Precancerous cervical abnormalities
  • Anogenital warts
79
Q

6 Risk factors for STIs?

A

*Any sexually active youth < 25 years old

  • Inconsistent or n condom use
  • Contact with someone known to have an STI
  • New partner
  • > 2 partners in past year
  • Serial monogamy
  • No contraception or only non-barrier contraception (e.g. oral contraceptive, IUD, Depo)
  • Injection drug use
  • Any drug use (e.g. alcohol, marijauna, others - especially if associated with sex)
  • Previous STI
  • Any unsafe sexual practices (e.g. involving exchange of blood or sharing sex toys)
  • Sex workers and ther clients
  • Survival sex (e.g. exchange of sex for food, shelter, or drugs)
  • Street involvement/precarious housing
  • Anonymous sex (sex with a stranger after meeting online or elsewhere)
  • Experience of sexual assault or abuse
80
Q

Screening recommendation for chlamydia and gonorrhea?

A
  • All sexually active youth under 25 years of age should be offered screening at least annually, with more frequent screening offered to individuals with additional STI risk factors
  • After treatment, screening should be repeated every six months if risk of re-infection persists
81
Q

What is the most sensitive and specific lab test for chlamydia screening? How to obtain sample?

A

Nucleic acid amplification test (NAAT)

-First-catch void, vaginal (including self-collected), endocervical or urethral specimens are all suitable for NAAT testing

82
Q

What type of lab testing should NOT be used for Chlamydia diagnosis? Why?

A

Serological testing due to cross-reactivity and associated difficulty of interpreting results

83
Q

When and for what patients is test of cure for chlamydia recommended?

A

Three to four weeks after completion of therapy in adolescents when compliance is uncertain, an alternative treatment was used, re-exposure is likely, or the adolescent is pregnant

84
Q

What samples recommended for screening asymptomatic individuals for gonorrhea?

A

First-catch urine or self-collected vaginal swab

85
Q

When should culture with susceptibility testing for gonorrhea always be performed? Why is culture preferred?

A
  • Sexual assault cases
  • When treatment failure is presumed
  • Evaluating PID
  • Symptomatic or asymptomatic MSM
  • Infection believed to have been acquired overseas or in an area of recognized antimicrobial resistance
  • Preferred for pharyngeal and rectal specimens
  • For medical legal purposes, positive result from NAAT should be confirmed using culture OR different sent of primers OR by DNA sequencing techniques

-Preferred because provide the best opportunity for determining resistance pattern of an isolate, particularly given emerging antimicrobial resistance of N gonorrhoeae

86
Q

What is the most sensitive testing method for gonorrhea? For what samples is it validated for?

A
  • NAAT

- Validated for urine, vaginal, urethral and cervical samples

87
Q

Why is combination therapy recommended for gonorrhea?

A

-Rising rates of gonococcal resistance to cephalosporins and azithromycin and resulting treatment failures

88
Q

When is test of cure recommended for gonorrhea? What is the preferred test of cure?

A
  • A second-line or alternative treatment is used
  • Antimicrobial resistance is suspected
  • High re-exposure risk exists
  • Pregnant adolescent
  • Failure of previous treatment
  • Pharyngeal, rectal or disseminated infection
  • Signs or symptoms persist following treatment
  • COmpliance uncertain

-Culture performed three to seven days post-treatment. If culture can not be obtained, may performed NAAT two to three weeks post-treatment (remains positive for longer than a culture following adequate therapy)

89
Q

For whom is repeat screening using NAAT six months after therapy recommended?

A

-Individuals at risk for reinfection

90
Q

For whom is co-treatment for chlamydia indicated?

A

-All patients with proven gonorrhea, even if chlamydia not detected

91
Q

Who should be offered screening for syphillis?

A

All sexually active adolescents

92
Q

When should screening for syphilis in pregnancy be performed? For individuals at high risk of syphilis? For individuals at very high risk? Who is at very high risk?

A
  • At first prenatal visit and ideally again at delivery
  • Also at 28-32 weeks for high risk
  • At more regular intervals (e.g. monthly) when at very high risk
  • Very high risk: engaged in sex trade work in an area experiencing an outbreak of infectious syphilis
93
Q

Which test may yield false-negative results in early cases of primary syphillis?

A

Non-treponemal tests (such as rapid plasma reagin/RPR)

94
Q

Follow-up for syphilis?

A
  • Follow-up RPR is recommended after treatment of all stages of syphilis with a reactive RPR.
  • Should be referred to an STI or infectious disease clinic for treatment and follow-up
95
Q

Who should be offered screening for HIV?

A

All sexually active adolescents

96
Q

When to screen for HIV in pregnancy? For those at ongoing risk?

A
  • First pre-natal visit

- For those at ongoing risk, retest during pregnancy and at point of delivery

97
Q

What to do for newly diagnosed adolescent with HIV?

A

Urgent referral to HIV specialist for initiation of treatment

98
Q

For which STIs is routine screening NOT recommended?

A

Trichomonas and HSV

, HPV before 21 years of age

99
Q

Who to consider screening for hepatitis A, B, and C/?

A

Hepatitis A: Asymptomatic males and femaleswith RFs - particularly with oral-anal contact,
Hepatitis B - asymptomatic males and females with risk factors if no history of vaccine
Hepatitis C - asymptomatic males and females with risk factors, particularly in people who inject drugs

100
Q

What STI screening tests/samples for asymptomatic males with risk factors?

A
  • First-catch urine for Chlamydia trachomais, Neisseria gonorrhoeae
  • Pharyngeal and/or rectal swabs for C. trachomais, N. gonorrhoeae (history of unprotected receptive oral or anal exposure)
  • Serology for: Syphilis, HIV
  • Consider Hep A (particularly with oral-anal contact), Hep B (if no history of vaccine), Hep C (particularly in PWIDs)
101
Q

What STI screening/samples for asymptomatic females with risk factors?

A
  • First-catch urine OR vaginal swab for C. trachomatis, N. gonorrhoeae-Pharyngeal and/or rectal swabs for C. trachomais, N. gonorrhoeae (history of unprotected receptive oral or anal exposure)
  • Serology for: Syphilis, HIV
  • Consider Hep A (particularly with oral-anal contact), Hep B (if no history of vaccine), Hep C (particularly in PWIDs)
102
Q

What STI screening/samples for males with symptoms of urethritis?

A

-Urethral swab for gram stain and culture for gonorrhea (NAAT may also be used, when available) AND first-catch urine for C. trachomatis (NAAT)

103
Q

What STI screening/samples for females with symptoms of cervicitis?

A
  • Vaginal or cervical swab for gram stain, N. gonorrhoeae (culture or NAAT if culture unavailable) and C. trachomatis (NAAT or culture)
  • Swab of cervical lesions (if present) for HSV
  • Vaginal swab for wet-mount
104
Q

What STI screening/samples for suspected pharyngeal gonococcal infection?

A
  • Swab posterior pharynx and tonsillar cryptts

- Use the swab to directly inoculate the appropriate culture medium, or place it in a transport medium

105
Q

What STI screening/samples for genital ulcer disease?

A

-Swab if ulcerative, erosive, pustular, or vesicular lesions for HSV culture OR HSV PCR. Unroof vesicular lesions to collect fluid and place swab in viral transport medium
AND
-Serology for syphilis. If suspected (e.g. painless ulcer), send swab from ulcer for dark-field examination, direct/indirect fluorescent antibody, or NAAT test if available
-Referral to an infectious diseases or STI clinic is recommended for patients with HIV, immunosuppression, systemic symptoms, history of travel (to assess need to test for other pathogens), MSM, atypical, and/or non-healing lesions

106
Q

What STI screening/samples for symptoms of vaginitis?

A
  • Collect pooled vaginal secretions if present
  • If no vaginal secretions present, swab the vaginal wall in the posterior fornix to prepare a smear, or place the swab in a transport medium
  • Wet-mount and Gram stain smears are useful in the diagnosis of trichomonas as well as non-STI causes of vaginitis (e.g. candidiasis, bacterial vaginosis). Because of the low sensitivity of direct microscopy, culture or commercial NAATs for T vaginalis should be used, when available

-If individual at high risk for STIs, collect vaginal or cervical swab for N. gonorrhoaeae culture and C. trachomatis (NAAT or culture)

Updated or Reaffirmed 2019/2020 and New 2020 CPS (1 decks)

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