Evaluate all patients for risks of sexually transmitted infections (STIs), including AIDS.
Don’t make assumptions
Assessing STI Risk www.joannwoodward.com “ Have you ever had a sexually transmitted infection?” “ What steps or precautions do you take during sexual activity to prevent transmission of diseases?”
Assessing Abuse www.joannwoodward.com “ Have you ever been forced to have sex against your will?” “ Did anyone ever touch you, or make you touch them, in a way that made you feel uncomfortable?” “ Has anyone ever battered you or hit you?” “ Do you live with anyone who verbally abuses you?”
The PLISSIT Model www.joannwoodward.com Annon JS. J Sex Ed & Ther. 1976. L imited I nformation S pecific S uggestions I ntensive T herapy P ermission
PLISSIT Level Two: Limited Information www.joannwoodward.com “… It is not at all uncommon for men and women in their 60s and 70s to have sexual intercourse on a regular basis.” Annon JS. J Sex Ed & Ther. 1976. Annon JS J Sex Ed & Ther. 1976
Chlamydia -The Current Problem An Introduction of this issue
The Reported Year 2007
The reported occurrence - 1.1 million cases of Chlamydia : reported to the Centers for Disease Control and Prevention.(CDC )
The ages at risk :females aged 16-25 years of age.
A brief description of the policy and its development
Expedited Partner therapy allows a patient to receive treatment for Chlamydia.
Expedited Partner Therapy (EPT) is the clinical service of treating the partners of patients diagnosed with Chlamydia by providing prescriptions or medications to the patient to take to their partner without the health care provider first examining the partner.
When One STI is present- Look and Ask for More www.joannwoodward.com
In spot provides electronic assistance to patients interested in using technology to notify their partners. This program allows infected patients to notify their partners of the need for testing and treatment by sending them a text message or an e-mail. This can be signed or anonymous. These cards vary from cordial to rude .In spot messages can also be very sensitive depending on the viewer’s choice of card. A sample is provided above.
Zithromax Gram 1 ,given as a suspension in water or as four capsules by mouth (p.o.) each with 250 mg.to be taken at once.
EPT should be accompanied by information to advise recipients to seek personal health care in addition to EPT. This is particularly important when EPT is provided to male patients for their female partners, and for male partners with symptoms.
Recommended Regimens Azithromycin 1 g orally in a single dose OR Doxycycline 100 mg orally twice a day for 7 days
Alternative Regimens Erythromycin base 500 mg orally four times a day for 7 days OR Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days OR Ofloxacin 300 mg orally twice a day for 7 days OR Levofloxacin 500 mg orally once daily for 7 days
Pregnancy. Doxycycline, ofloxacin, and levofloxacin are contraindicated in pregnant women. However, clinical experience and studies suggest that azithromycin is safe and effective .
Repeat testing (preferably by NAAT) 3 weeks after completion of therapy with the following regimens is recommended for all pregnant women to ensure therapeutic cure, considering the sequelae that might occur in the mother and neonate if the infection persists. The frequent gastrointestinal side effects associated with erythromycin might discourage patient compliance with the alternative regimens.
Azithromycin 1 g orally in a single dose OR Amoxicillin 500 mg orally three times a day for 7 days
Alternative Regimens Erythromycin base 500 mg orally four times a day for 7 days OR Erythromycin base 250 mg orally four times a day for 14 days OR Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days OR Erythromycin ethylsuccinate 400 mg orally four times a day for 14 days
Ongoing evaluation is needed to define when and how EPT can be best utilized for patients.
EPT represents an additional strategy to embrace the lateral resource pool for partner management that does not replace other strategies, such as standard patient referral or provider-assisted referral, when available.
EPT may replace conventional strategies in the adolescent population if notification can be significantly improved.
Sources: Golden, MR. (2001).
Check From Top to Bottom www.joannwoodward.com
A Nurse Practitioner, Nurse Midwife and Physician Collaboration www.joannwoodward.com
Let’s Work Together to Avoid Painful Neonatal Herpes www.joannwoodward.com
www.joannwoodward.com LOS ANGELES – By SHAYA TAYEFE MOHAJER, Associated Press Writer Los Angeles county health officials are offering a free, at-home program to test for sexually transmitted diseases. All women in the county can request free test kits that detect Chlamydia or gonorrhea infection by visiting a Web site or calling a toll-free number. The kits are then mailed to the women's homes. The program is intended to eliminate clinic waits or costs and targets young women of color. There will be 10,000 kits available immediately. According to the Centers for Disease Control and Prevention, Los Angeles County ranks first in the nation in the number of Chlamydia cases, and second in gonorrhea cases. LA County says it will pass out mail-in STD tests
www.joannwoodward.com Teenage girls are now a text message away from finding out whether they have sexually transmitted diseases (STD). Health officials in Los Angeles County unveiled a program that will target young women by offering home delivery of STD testing kits and a text message to alert them when the results are ready online. Health officials hope their program can curb the alarming spread of gonorrhea and Chlamydia. Offers Home Delivery Of Chlamydia, Gonorrhea Test Kits L.A. County, Calif.
If you are a woman age 12 to 25 and you live in Los Angeles County, you can get a free home test kit for Chlamydia and gonorrhea. Just fill out the form below to get a test kit sent to you. It will arrive in a plain white envelope in 3 to 5 days. Take the test and mail it back in the pre-paid envelope. Then pick up your results at this website or by phone in one week. The kit and the test are free – including postage!
This test is for women who don't have any signs or symptoms of an STD. Most women with Chlamydia or gonorrhea have no signs or symptoms and don’t know they are infected. If you think you are having signs or symptoms of an STD, don’t order the kit -- please go to a clinic right away to get checked.
Arizona Department of Health Services. (n.d.). Retrieved March 17, 2009, from http://www.azdhs.gov/phs/oids/std/pdf/Expedited%20Partner%20Therapy%20Chlamydia%20-%20English.pdf
CDC. Sexually transmitted disease surveillance, 2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2009.(n.d.) Retrieved April 10,2009, from http://www.cdc.gov/std/stats07/toc.htm .
Golden, MR, Whittington, WLH, Handsfield, HH, et al. (2005). Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or Chlamydia infection. New England Journal of Medicine; 352, 676-685.
Golden, MR, Whittington WLM, Handsfield HH, et al. (2001). Partner management for gonococcal and chlamydial infection: Expansion of public health services to the private sector and expedited sex partner treatment through a partnership with commercial pharmacies. Sexually Transmitted Diseases, 26:658-665.