Sexually Transmitted Diseases Management in HIV.2016hivlifeinfo
In this downloadable slideset, Laura H. Bachmann, MD, MPH, reviews important management issues to consider when treating common sexually transmitted diseases in patients coinfected with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 1.00 MB
Date posted: 6/6/2016
Anal dysplasia: Diagnosis and Management, OR Everything you ever wanted to kn...CBRC
Screening, treatment and prevention of Anal
Intraepithelial Neoplasia (AIN) Presented by Joel Palefsky, UCSF School of Medicine, San Francisco at the 5th Annual Gay Men's Health Summit held in Vancouver, BC on November 9th and 10th, 2009.
Hepatitis C Risk Assessment, Testing and Referral for Treatment in primary Ca...Real Wellness, LLC
Dr. Robert Winn worked with a team to determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity.
Awareness about Stomach Cancer in Biotechnology Students_Crimson PublishersCrimsonpublishersCancer
Stomach cancer is caused by mutation in CDH1 gene which is involved in the normal function of E-cadherin this gene sends signals to other cells thus regulate the function of other genes. To check the awareness of stomach cancer among post graduate students a questionnaire was developed. This was concluded that the post graduate students were somehow aware with this disease.
Seroepidemiology of Toxoplasma gondii infection in drivers involved in road t...Erwin Chiquete, MD, PhD
Background: The prevalence of toxoplasmosis in the general population of Guadalajara, Mexico, is around 32%.
Toxoplasmosis can cause ocular lesions and slowing of reaction reflexes. Latent toxoplasmosis has been related
with traffic accidents. We aimed to assess the prevalence of anti-Toxoplasma gondii antibodies and visual
impairments related with traffic accidents in drivers from the metropolitan Guadalajara.
Methods: We prospectively evaluated the prevalence of IgG and IgM anti-T. gondii antibodies in 159 individuals
involved in traffic accidents, and in 164 control drivers never involved in accidents. Cases of toxoplasmosis
reactivation or acute infection were detected by PCR in a subset of 71 drivers studied for the presence of T. gondii
DNA in blood samples. Ophthalmologic examinations were performed in drivers with IgG anti-T. gondii antibodies
in search of ocular toxoplasmosis.
Results: Fifty-four (34%) traffic accident drivers and 59 (36%) controls were positive to IgG anti-T. gondii antibodies
(p = 0.70). Among the 113 seropositive participants, mean anti-T. gondii IgG antibodies titers were higher in traffic
accident drivers than in controls (237.9 ± 308.5 IU/ml vs. 122.9 ± 112.7 IU/ml, respectively; p = 0.01 by Student’s t
test, p = 0.037 by Mann–Whitney U test). In multivariate analyses, anti-T. gondii IgG antibody titers were consistently
associated with an increased risk of traffic accidents, whereas age showed an inverse association. The presence of
IgM-anti-T. gondii antibodies was found in three (1.9%) subjects among traffic accident drives, and in two (1.2%)
controls. Three (4.2%) samples were positive for the presence of T. gondii DNA, all among seropositive individuals.
No signs of ocular toxoplasmosis were found in the entire cohort. Moreover, no other ocular conditions were found
to be associated with the risk of traffic accidents in a multivariate analysis.
Conclusions: Anti-T. gondii antibody titers are associated with the risk of traffic accidents. We could not determine
any association of ocular toxoplasmosis with traffic accidents. Our results warrant further analyses in order to clarify
the link between toxoplasmosis and traffic accidents.
Sexually Transmitted Diseases Management in HIV.2016hivlifeinfo
In this downloadable slideset, Laura H. Bachmann, MD, MPH, reviews important management issues to consider when treating common sexually transmitted diseases in patients coinfected with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 1.00 MB
Date posted: 6/6/2016
Anal dysplasia: Diagnosis and Management, OR Everything you ever wanted to kn...CBRC
Screening, treatment and prevention of Anal
Intraepithelial Neoplasia (AIN) Presented by Joel Palefsky, UCSF School of Medicine, San Francisco at the 5th Annual Gay Men's Health Summit held in Vancouver, BC on November 9th and 10th, 2009.
Hepatitis C Risk Assessment, Testing and Referral for Treatment in primary Ca...Real Wellness, LLC
Dr. Robert Winn worked with a team to determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity.
Awareness about Stomach Cancer in Biotechnology Students_Crimson PublishersCrimsonpublishersCancer
Stomach cancer is caused by mutation in CDH1 gene which is involved in the normal function of E-cadherin this gene sends signals to other cells thus regulate the function of other genes. To check the awareness of stomach cancer among post graduate students a questionnaire was developed. This was concluded that the post graduate students were somehow aware with this disease.
Seroepidemiology of Toxoplasma gondii infection in drivers involved in road t...Erwin Chiquete, MD, PhD
Background: The prevalence of toxoplasmosis in the general population of Guadalajara, Mexico, is around 32%.
Toxoplasmosis can cause ocular lesions and slowing of reaction reflexes. Latent toxoplasmosis has been related
with traffic accidents. We aimed to assess the prevalence of anti-Toxoplasma gondii antibodies and visual
impairments related with traffic accidents in drivers from the metropolitan Guadalajara.
Methods: We prospectively evaluated the prevalence of IgG and IgM anti-T. gondii antibodies in 159 individuals
involved in traffic accidents, and in 164 control drivers never involved in accidents. Cases of toxoplasmosis
reactivation or acute infection were detected by PCR in a subset of 71 drivers studied for the presence of T. gondii
DNA in blood samples. Ophthalmologic examinations were performed in drivers with IgG anti-T. gondii antibodies
in search of ocular toxoplasmosis.
Results: Fifty-four (34%) traffic accident drivers and 59 (36%) controls were positive to IgG anti-T. gondii antibodies
(p = 0.70). Among the 113 seropositive participants, mean anti-T. gondii IgG antibodies titers were higher in traffic
accident drivers than in controls (237.9 ± 308.5 IU/ml vs. 122.9 ± 112.7 IU/ml, respectively; p = 0.01 by Student’s t
test, p = 0.037 by Mann–Whitney U test). In multivariate analyses, anti-T. gondii IgG antibody titers were consistently
associated with an increased risk of traffic accidents, whereas age showed an inverse association. The presence of
IgM-anti-T. gondii antibodies was found in three (1.9%) subjects among traffic accident drives, and in two (1.2%)
controls. Three (4.2%) samples were positive for the presence of T. gondii DNA, all among seropositive individuals.
No signs of ocular toxoplasmosis were found in the entire cohort. Moreover, no other ocular conditions were found
to be associated with the risk of traffic accidents in a multivariate analysis.
Conclusions: Anti-T. gondii antibody titers are associated with the risk of traffic accidents. We could not determine
any association of ocular toxoplasmosis with traffic accidents. Our results warrant further analyses in order to clarify
the link between toxoplasmosis and traffic accidents.
Awareness Survey about Colorectal Cancer in Students of M. Phil Biotechnology...CrimsonpublishersCancer
Cancer of colon and rectum is collectively called Colorectal Cancer (CRC). It is considered as the second most lethal cancer after lung cancer. One of the symptoms of CRC is rectal bleeding. A survey was conducted to evaluate the level of awareness among M. Phil Biotechnology students. The key idea of this survey was to develop understanding about this deadly disease. A questionnaire consisting of 15 basic questions about CRC was developed. Total 37 students filled the questionnaire; 31 were females while 6 were males. Results clearly demonstrated the unawareness of the students towards this lethal CRC. In the first section about causative agents; 78% of the students answered that CRC is a bacterial disease. Next portion was about the victims of CRC in your surroundings; more than 95% of students never witnessed any case of CRC in their family or vicinity. 3rd category was about transmission route of CRC; according to 38% of students, CRC can be transferred from affected parents to offspring and in the last section which was about possible treatments of CRC; 97% students answered that CRC can be treated with medication only while 68% answered that there is a need of surgical treatment for CRC. Therefore, it is very important to spread awareness among people.
Awareness about Intestinal Cancer in University Student_Crimson PublishersCrimsonpublishersCancer
Cancer is a disease which is caused by the uncontrolled growth of cells. The cancer stem cells suggest that the clones are obtained by the sub population of cells showing diverse cancer cells phenotypically. First possible cancer stem cells are seen in leukemia, brain tumors and breast cancer. The gastrointestinal cancer becoming the major causes of deaths in the world. A questionnaire was developed and it is distributed among the students of class to determine the ideas and awareness of this disease. Questionnaires contain 15 different types of question regarding the disease. 39 students taken from the Bahauddin Zakariya University Multan, Pakistan. All the students are post graduated and the results show that all of them have awareness from this disease.
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
Fluoroquinolone resistant rectal colonization predicts risk of infectious com...TC İÜ İTF Üroloji AD
Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy. Evidence based on journal club by Samed Verep
Kurt Schalper, MD, PhD, and Edward Garon, MD, MS, prepared useful Practice Aids pertaining to immuno-oncology biomarkers for this CME/MOC activity titled "Advances and Challenges in Refining the Use of Cancer Immunotherapies Through Biomarker Testing: Practical Guidance for Pathologists on the Front Lines of the Immuno-Oncology Revolution." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2DE3X9J. CME/MOC credit will be available until December 2, 2019.
Chair & Presenter, Kenneth R. Cooke, MD, Megan Burris, MSN, CPNP-PC/AC, and Megan Burris, MSN, CPNP-PC/AC, prepared useful Practice Aids pertaining to VOD/SOS for this CME/MOC/NCPD/CPE activity titled “Collaborative Strategies for Managing VOD/SOS: Interprofessional Insights on Advances in Diagnosis, Severity Grading, and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/CPE information, and to apply for credit, please visit us at https://bit.ly/2TeQSga. CME/MOC/NCPD/CPE credit will be available until September 23, 2022.
Clinical Impact of New HIV Data From CROI 2019hivlifeinfo
March 4-7, 2019; Seattle, Washington
In this downloadable slideset, expert faculty members summarize key studies from this important annual conference.
Format: Microsoft PowerPoint (.ppt)
File Size: 576 KB
Released: March 22, 2019
Awareness Survey about Colorectal Cancer in Students of M. Phil Biotechnology...CrimsonpublishersCancer
Cancer of colon and rectum is collectively called Colorectal Cancer (CRC). It is considered as the second most lethal cancer after lung cancer. One of the symptoms of CRC is rectal bleeding. A survey was conducted to evaluate the level of awareness among M. Phil Biotechnology students. The key idea of this survey was to develop understanding about this deadly disease. A questionnaire consisting of 15 basic questions about CRC was developed. Total 37 students filled the questionnaire; 31 were females while 6 were males. Results clearly demonstrated the unawareness of the students towards this lethal CRC. In the first section about causative agents; 78% of the students answered that CRC is a bacterial disease. Next portion was about the victims of CRC in your surroundings; more than 95% of students never witnessed any case of CRC in their family or vicinity. 3rd category was about transmission route of CRC; according to 38% of students, CRC can be transferred from affected parents to offspring and in the last section which was about possible treatments of CRC; 97% students answered that CRC can be treated with medication only while 68% answered that there is a need of surgical treatment for CRC. Therefore, it is very important to spread awareness among people.
Awareness about Intestinal Cancer in University Student_Crimson PublishersCrimsonpublishersCancer
Cancer is a disease which is caused by the uncontrolled growth of cells. The cancer stem cells suggest that the clones are obtained by the sub population of cells showing diverse cancer cells phenotypically. First possible cancer stem cells are seen in leukemia, brain tumors and breast cancer. The gastrointestinal cancer becoming the major causes of deaths in the world. A questionnaire was developed and it is distributed among the students of class to determine the ideas and awareness of this disease. Questionnaires contain 15 different types of question regarding the disease. 39 students taken from the Bahauddin Zakariya University Multan, Pakistan. All the students are post graduated and the results show that all of them have awareness from this disease.
Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia
Fluoroquinolone resistant rectal colonization predicts risk of infectious com...TC İÜ İTF Üroloji AD
Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy. Evidence based on journal club by Samed Verep
Kurt Schalper, MD, PhD, and Edward Garon, MD, MS, prepared useful Practice Aids pertaining to immuno-oncology biomarkers for this CME/MOC activity titled "Advances and Challenges in Refining the Use of Cancer Immunotherapies Through Biomarker Testing: Practical Guidance for Pathologists on the Front Lines of the Immuno-Oncology Revolution." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2DE3X9J. CME/MOC credit will be available until December 2, 2019.
Chair & Presenter, Kenneth R. Cooke, MD, Megan Burris, MSN, CPNP-PC/AC, and Megan Burris, MSN, CPNP-PC/AC, prepared useful Practice Aids pertaining to VOD/SOS for this CME/MOC/NCPD/CPE activity titled “Collaborative Strategies for Managing VOD/SOS: Interprofessional Insights on Advances in Diagnosis, Severity Grading, and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/CPE information, and to apply for credit, please visit us at https://bit.ly/2TeQSga. CME/MOC/NCPD/CPE credit will be available until September 23, 2022.
Clinical Impact of New HIV Data From CROI 2019hivlifeinfo
March 4-7, 2019; Seattle, Washington
In this downloadable slideset, expert faculty members summarize key studies from this important annual conference.
Format: Microsoft PowerPoint (.ppt)
File Size: 576 KB
Released: March 22, 2019
Современное лечение ВИЧ : АРТ как профилактика.Contemporary Management of HIV...hivlifeinfo
Contemporary Management of HIV. Antiretroviral Therapy As Prevention.2016
In this downloadable slideset, Kenneth Mayer, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for pre- and post-exposure prophylaxis in patients at risk for HIV infection.
Format: Microsoft PowerPoint (.ppt)
File size: 2.13 MB
This workshop is designed to talk about the impact of STDs on youth under the age of 25. This workshop will discuss the importance of sexual health screenings, partner management, and current data around STD morbidity rates. We will also talk about current STD clinical recommendations for the treatment of gonorrhea, chlamydia, and syphilis. Participants will engage in an interactive activity where they will sharpen their skills on effective partner management strategies.
HIV and Cardiovascular Disease.How Worried Should We Be ? 2015Hivlife Info
In this downloadable slideset, David A. Wohl, MD, reviews the association between HIV and cardiovascular disease, including potential contributing factors and best practices in prevention.
Format: Microsoft PowerPoint (.ppt)
File size: 5.01 MB
Date posted: 6/26/2015
In this downloadable slideset, Joel E. Gallant, MD, MPH, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at upcoming agents currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 3.00 MB
Date posted: 6/15/2015
Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015Hivlife Info
In this downloadable slideset, Priscilla Y. Hsue, MD, and David A. Wohl, MD, discuss data on using traditional and newer markers and modalities to predict and prevent cardiovascular disease in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 3.21 MB
Date posted: 7/16/2015
“Тяжелые” категории пациентов с хроническим гепатитом C- возможности терапии....Hivlife Info
“Тяжелые” категории пациентов с хроническим гепатитом C- возможности терапии.
Бакулин И.Г,д.м.н.2015 Зав. научно-исследовательским отделом гепатологии Московского клинического научно-практического центра ДЗ г. Москва
Integrating Recent Data When Selecting First-line Antiretroviral Therapy.2015...Hivlife Info
Joseph J. Eron Jr., MD
W. David Hardy, MD
Paul E. Sax, MD
How do leading experts select first-line antiretroviral therapy for their HIV-infected patients?
Review these downloadable slides for key clinical trial data and the latest DHHS recommendations for first-line antiretroviral therapy.
HCV Alerts- Rapid Response to Practice-Changing Advances From EASL 2015Hivlife Info
In this downloadable slideset, Mark S. Sulkowski, MD, discusses key practice-changing data from the 2015 liver disease meeting in Vienna.
Format: Microsoft PowerPoint (.ppt)
File size: 751 KB
This downloadable slideset summarizes key studies selected by Andrew J. Muir, MD, David R. Nelson, MD, and Norah Terrault, MD, MPH, regarding the use of investigational agents for treating hepatitis C presented at the 2015 Annual Meeting of the European Association for the Study of the Liver.
Format: Microsoft PowerPoint (.ppt)
File size: 1.99 MB
Grinspoon S.Сердечно-сосудистые заболевания у пациентов с ВИЧ- парадигма и пр...Hivlife Info
Grinspoon S Cardiovascular disease in HIV patients: an emerging paradigm and call to action. 2015 Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, abstract 134, 2015.
Сердечно-сосудистые заболевания у пациентов с ВИЧ- парадигма и призыв к действию.Статины. [CROI 2015]
Fall 2014 HIV Update.Clinical Impact of New Data From ICAAC 2014, IDWeek 2014...Hivlife Info
In this downloadable slideset, Joseph J. Eron, Jr., MD and Jürgen K. Rockstroh, MD, review key HIV studies presented at the 2014 Interscience Conference on Antimicrobial Agents and Chemotherapy, 2014 IDWeek, and 2014 HIV Drug Therapy Glasgow.
Format: Microsoft PowerPoint (.ppt)
File size: 1.70 MB
Should Integrase Inhibitors Be Your First Choice When Starting HIV Therapy- E...Hivlife Info
In this downloadable slideset, Joseph J. Eron, Jr., MD, and Daniel Kuritzkes, MD, review key data on the evolving use of INSTIs in patients beginning HIV therapy.
Format: Microsoft PowerPoint (.ppt)
File size: 2.29 MB
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Preventing and managing sexually transmitted diseases in hiv infected patients.2014
1. Khalil G. Ghanem, MD, PhD
Associate Professor of Medicine
Division of Infectious Diseases
Johns Hopkins University
School of Medicine
Baltimore, Maryland
Preventing and Managing Sexually
Transmitted Diseases in
HIV-Infected Patients
Supported by educational grants from multiple commercial supporters.
2. clinicaloptions.com
24th Annual CCO HIV and Hepatitis C Symposium
About These Slides
Users are encouraged to use these slides in their own
noncommercial presentations, but we ask that content
and attribution not be changed. Users are asked to honor
this intent
These slides may not be published or posted online
without permission from Clinical Care Options
(email permissions@clinicaloptions.com)
Disclaimer
The materials published on the Clinical Care Options Web site reflect the views of the authors of the
CCO material, not those of Clinical Care Options, LLC, the CME providers, or the companies providing
educational grants. The materials may discuss uses and dosages for therapeutic products that have not
been approved by the United States Food and Drug Administration. A qualified healthcare professional
should be consulted before using any therapeutic product discussed. Readers should verify all information
and data before treating patients or using any therapies described in these materials.
4. clinicaloptions.com
24th Annual CCO HIV and Hepatitis C Symposium
Objectives
At the end of this presentation, participants should be
able to:
– Recognize critical components of the history and physical
examination of HIV-infected patients that impact STD
screening and management
– Describe recommended approaches to screen for syphilis,
gonorrhea, chlamydia, trichomoniasis, and herpes
– Identify appropriate antimicrobial treatment regimens for
gonorrhea
– Formulate an approach to preventing HPV infections among
HIV-infected persons
5. clinicaloptions.com
24th Annual CCO HIV and Hepatitis C Symposium
Probability of Asymptomatic STDs
Holmes KK, et al. Sex Transm Dis. 4th ed. New York City: McGraw-Hill. 2008.
100
80
60
40
20
0
Urethra/Cervix
Rectum
Pharynx
Urethra/Cervix
Rectum
Pharynx
Urethra/Vagina
Any
Gonorrhea Chlamydia Trich Herpes
Men
Women
6. clinicaloptions.com
24th Annual CCO HIV and Hepatitis C Symposium
Risk Assessment: History and Physical
Examination
Screening for all STDs is risk based, so accurate information is critical
– Obtain a sexual history in an open, nonjudgmental manner
• Do you have oral sex? Do you use a condom when you have oral sex? vs The last time you
put your mouth on your partner’s penis, did you use a condom? Do you use a condom most
times you do that?
A sexual history should include:
– Current and past sexual practices (number of partners, gender of partners, all
exposure sites, condom and contraceptive use, past STD history, etc)
– Use of drugs (ETOH, poppers, methamphetamines, etc) with sex
– Risks and status of partners
A physical examination should include:
– Pelvic examination in women
– Anogenital examination in both men and women
– Careful skin/mucus membrane examination
Aberg JA, et al. Clin Infect Dis. 2014;58:e1-e34.
8. clinicaloptions.com
24th Annual CCO HIV and Hepatitis C Symposium
Best Specimen Type to Screen for Genital
Gonorrhea and Chlamydia
Women
– A vaginal swab for
NAATs testing is
preferred
– Endocervical swabs and
urine are acceptable
alternate specimen types
for NAATs testing
– Endocervical swabs are
the only acceptable
specimen type for
gonorrhea cultures
Men
– First-catch urine for
NAATs testing is
preferred
– Urethral swabs are
acceptable alternate
specimen types for
NAATs testing
– Urethral swabs are the
only acceptable specimen
type for gonorrhea
cultures
MMWR Recomm Rep. 2010;59:1-116.
9. clinicaloptions.com
24th Annual CCO HIV and Hepatitis C Symposium
Why Screen for Extragenital Gonorrhea
and Chlamydia Infections?
Most cases of pharyngeal and rectal GC and CT are
asymptomatic
Up to 65% of cases of GC[1,2]
and 50% of cases of CT[2]
among MSM may be missed if genital-only testing were
performed
In women, 10% of CT and 31% of GC infections would
have been missed if extragenital testing were not done[3]
Rectal and pharyngeal infections are of public health
significance[4]
1. Gunn RA, et al. Sex Transm Dis. 2008;35:845-848. 2. Kent CK, et al. Clin Infect Dis. 2005;41:67-74.
3. Peters RP, et al. Sex Transm Dis. 2011;38:783-787. 4. Bernstein KT, et al. Clin Infect Dis.
2009;49:1793-1797.
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24th Annual CCO HIV and Hepatitis C Symposium
Extragenital GC and CT Diagnostics
Sensitivity of culture < 50% to detect rectal and
pharyngeal GC vs > 90% sensitivity for NAATs (this can
vary by NAAT type)[1]
The CDC recommends that NAATs be used to detect
these extragenital infections[2]
Although none of the NAATs are FDA cleared to use with
extragenital specimens, most large laboratories have
established performance specifications to satisfy
compliance to Clinical Laboratory Improvement
Amendments
1. Ota KV, et al. Sex Transm Infect. 2009;85:182-186. 2. MMWR Recomm Rep. 2010;59:1-116.
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24th Annual CCO HIV and Hepatitis C Symposium
GC and CT Screening Recommendations
Aberg JA, et al. Clin Infect Dis. 2014;58:e1-e34.
Interval Site-Specific Screening
Chlamydia
Annually for
All women aged ≤ 25 yrs
All sexually active MSM
High-risk women* aged > 25 yrs
Every 3-6 mos for MSM
With multiple or anonymous partners
Use illicit drugs or who have partners who do
Anorectal: On the basis of report of receptive anal intercourse
Pharyngeal: Not recommended due to low prevalence
Gonorrhea
Annually for
All sexually active MSM
Every 3-6 mos for MSM
With multiple or anonymous partners
Use illicit drugs or who have partners who do
Targeted screening
High-risk women*
Anorectal: On the basis of report of receptive anal intercourse
Pharyngeal: If patient reports receptive oral sex
*Includes women with previous CT/GC infection, other STDs, new or multiple sex partners, inconsistent
condom use; those who engage in commercial sex work and drug use; certain demographic groups;
those living in communities with a high prevalence of disease.
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Screening for Trichomoniasis
Indications for HIV+ women[1]
At entry into care
Subsequent screening performed at
least annually based on:
– Reported prevalence of
trichomonas vaginalis
– Effect of treatment at reducing
vaginal HIV shedding
– Potential complications of upper
genital–tract infections among
women who are left untreated
– Partners (among black women)[2]
Diagnostics[2,3]
Wet mount: sensitivity ~ 51% to
65% (time dependent)
Culture: sensitivity 75% to 95%
Rapid antigen test: sensitivity 82%
to 95%
NAAT assay*: sensitivity 100%
– No FDA-approved NAATs for men;
some laboratories have verified the
performance characteristics of
NAATs through a validation
process for male urine specimens
or penile meatal swabs
1. MMWR Recomm Rep. 2010;59 ;1-116. 2. Sutton M, et al. Clin Infect Dis. 2007;45:1319-1326.
3. APHL. Issues in Brief: Laboratory Detection of Trichomonas. August 2013. www.aphl.org.
*FDA approved in 2011 for use with urine, endocervical, and vaginal swabs and Thin Prep Pap.
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Retesting to Detect Repeat Infections
Reinfection with GC, CT, and trichomoniasis is common in
both men and women[1,2]
All persons treated for GC, CT, and all women treated for
trichomoniasis should be retested in 3 mos because of
high reinfection rates regardless of whether their
partner(s) was/were treated[3]
1. Fung M, et al. Sex Transm Inf. 2007;83:304-309. 2. Hosenfeld CB, et al. Sex Transm Dis.
2009;36:478-489. 3. MMWR Recomm Rep. 2010;59:1-116.
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24th Annual CCO HIV and Hepatitis C Symposium
Screening for Syphilis: Serological Tests
1. Peeling RW, et al. Bull World Health Org. 2004;82:439-446. 2. CDC. Reverse sequence syphilis screening.
Common Patterns of Serological
Reactivity in Syphilis Patients[1]
Serological Tests For Syphilis[1,2]
Nontreponemal
Tests
Treponemal
Tests
Complement fixation
tests
Wasserman
reaction
Flocculation tests
RPR
VDRL
TRUST
TPI
FTA-Abs
TPHA
TPPA
EIA
WB and
pseudoblots
Automated chemi-
luminescence
platforms
Chromatographic
POC tests
Microsphere
immunoassay
FTA-Abs
TPHA
VDRL/RPR
IgM
Untreated
Treated
100
80
60
40
20
2 4 6 8 10 12 2 10
20Time of
Reaction
Wks Yrs
Time Postinfection
Primary Secondary Latent
(asymptomatic)
TertiaryClinical Stages
of Syphilis
Primary lesion Secondary lesion
PatientsWhoTestPositive(%)
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24th Annual CCO HIV and Hepatitis C Symposium
Screening for Syphilis: Serological
Algorithms
Traditional Algorithm Reverse Sequence Algorithm
− +
CDC. Reverse sequence syphilis screening.
RPR/VDRL
No further
testing
Treponemal
test
No further
testing
RPR/VDRL
No further
testing
Confirmatory
treponemal test
Treponemal
immunoassay
(EIA/CIA)
+
−
− +
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Screening for Syphilis: Interpretation of
Reverse Sequence Algorithm
Slide courtesy of Barbara Detrick, JHH.
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24th Annual CCO HIV and Hepatitis C Symposium
Screening for Syphilis: Epidemiology
Syphilis and HIV
The estimated proportion of
primary and secondary
syphilis cases attributable to
MSM increased from 7% in
2000 to 75% in 2012[1]
In Maryland, 60% of primary
and secondary cases of
syphilis were among HIV+
MSM, and 30% of MSM
diagnosed with early syphilis
from 2010-2011 had been
diagnosed with syphilis in the
preceding 4 yrs[2,3]
1. www.cdc.gov. STD surveillance. 2012. 2. Data courtesy of Ravikiran Muvva, BCHD. 3. MMWR. 2013; 62:649-650.
25
20
15
10
5
0
16:1
8:1
4:1
2:1
1:1
100
80
60
40
20
0
Rate (per 100,000 Population) Rate Ratio (log scale)
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
61.3
38.7
41.6
58.4
41.9
58.1
39.9
60.1
2009 2010 2011 2012
PrimaryandSecondary
CasesinMen(%)
Male
Female
Total
Male-to-female ratio
Yr
HIV
Negative/Unknown
HIV Positve
Yr
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24th Annual CCO HIV and Hepatitis C Symposium
Screening for Syphilis: Cost and Efficacy
Every 3-mo screening among highly active MSM is very high-
yield and cost-efficient. Contact tracing is high-yield but costly.
Screening in jails also appeared to be cost-efficient[1,2]
Mathematical models suggest that changes in behaviors and
condom use, particularly short-term ones (even long-term ones
if they are modest), would not affect syphilis rates, and that
frequent screening among very high-risk individuals is
probably what would have the most impact[3]
Approximately 30% of high-risk MSM were not rescreened in
the 6 mos following therapy for syphilis[4]
1. Gray RT, et al. Sex Transm Dis. 2010;37:298-305. 2. Lewis FM, et al. J Public Health Manag Pract.
2011;17:513-521. 3. Gray RT, et al. Sex Transm Dis. 2011;38:1151-1158. 4. Marcus JL, et al. Sex
Transm Dis. 2011;38:24-29.
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Syphilis and HIV: Recommendations
Routine serologic screening for syphilis is
recommended AT LEAST annually for sexually active
HIV-infected persons, with more frequent screening
(every 3-6 mos) in those with multiple partners, a
history of unprotected intercourse, a history of sex in
conjunction with illicit drug use, methamphetamine use,
or sexual partners who participate in such activities
Aberg JA, et al. Clin Infect Dis. 2014;58:e1-e34.
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24th Annual CCO HIV and Hepatitis C Symposium
Screening for Herpes Simplex Viruses
Routine screening for HSV is not recommended. Counseling infected
persons and their sex partners may help reduce the risk of HSV
sexual and perinatal transmission[1]
Type-specific HSV serologic assays may be performed in the
following patients[2]
:
– Patients with recurrent genital symptoms or atypical symptoms in whom
HSV cultures/PCR have been negative
– Patients who have been given a clinical diagnosis of genital herpes
without laboratory confirmation
– Patients who have a partner with genital herpes
– Consider screening persons presenting for an STD evaluation, persons
HIV+, and MSM
1. Aberg JA, et al. Clin Infect Dis. 2014;58:e1-e3. 2. MMWR Recomm Rep. 2010;59:1-116.
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Use glycoprotein G-based type-specific assays (gG1 and gG2)
– If gG2 is positive, patient has genital herpes
– If gG1 is positive, patient either has oral herpes or genital herpes
– Do NOT use crude antigen-based serological assays
– Do NOT use IgM serological assays
REMEMBER:
– Antibodies may be negative in early primary infection
– The specificity of these tests is high but not perfect. As such, if the pretest
probability of having herpes is low, a positive test result has a high
likelihood of being a false positive
Screening Tests for Herpes Simplex Virus
Wald A, et al. Clin Infect Dis. 2002;35:S173-S182.
23. clinicaloptions.com
24th Annual CCO HIV and Hepatitis C Symposium
Gonorrhea Drug Resistance Timeline
Unemo M, et al. Ann N Y Acad Sci. 2011;1230:E19-E28.
Protargol
1897
Protargol
no longer
recommended
1938
Sulphonamide
resistance wide
spread
1944-45
1936
Sulphonamides
1943
Penicillin
Erythromycin
1952
Spectinomycin
1961
1962
Tetracycline
1958
Penicillin and
streptomycin
clinical resistance
first reported
1949
Streptomycin
and
chloramphenicol
1977
Erythromycin
resistance wide
spread
β-lactamase
plasmids
first reported
(high-level
penicillin
resistance)
1976
Ceftriaxone
1980
Cefixime
1983
1983
Azithromycin
1987
Spectinomycin
resistance
reported to
rapidly emerge
when widely
used
1989
Penicillin
no longer
recommended
1985
Tetracycline
high-level
resistance
reported
Tetracycline
no longer
recommended
1986
1993
Fluoroquinolones,
cefixime and
ceftriaxone
recommended
Ceftriaxone
recommended
(ciprofloxacin
alternative)
1989
Chromosomal
penicillin
resistance
elucidated
1985
Fluoroquinolone
resistance first
reported in USA
(Hawaii) –
already a
problem in Asia
1991
Cefixime out
of production
2002
Fluoroquinolones
no longer
recommended
2007
Cefixime clinical
failure verified
beyond Japan
(in Europe)
2007
2021?
Untreatable
gonorrhea?
2011
First high-level
ceftriaxone
resistant strain fully
characterized
Super Bug Status!!
2001
Cefixime
decreased
susceptibility in
Hawaii, USA
2007
Azithromycin
no
longer
recommended
2008
Cefixime
available
again
1999
Azithromycin
resistance
first
reported
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Mechanisms of Resistance to
Cephalosporins
Combined effects of several
chromosomal mutations:
– PenA (PBP2)
– Results in 100× increased MIC to
cefixime
– Results in 20× increased MIC to
ceftriaxone
– Acquired via horizontal transfer
from oral commensal bacteria (N
sicca, N perflava, N cinerea, and/or
N flavescens)
– MtrR (MTRCDE-encoded pump
repressor)
– MtrR mutations result in
overexpression of an efflux pump
– PenB (PorB1b)
– Decrease the influx of the antibiotic
into the periplasm
Bolan GA, et al. N Engl J Med. 2012;366:485-487.
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24th Annual CCO HIV and Hepatitis C Symposium
GC Cephalosporin Susceptibility: United
States and the World
Although the MIC
breakpoints for resistance
to cephalosporin have not
been defined, the CLSI
defines susceptibility to
cefixime and ceftriaxone
as MICs of 0.25 μg/mL or
below and 0.125 μg/mL or
below, respectively[1]
1. Bolan GA, et al. N Engl J Med. 2012;366:485-487. 2. Unemo M, et al. Euro Surveill. 2010;15:19721. 3. Unemo M, et al.
Euro Surveill. 2011;16:19792. 4. Unemo M, et al. Antimicrob Agents Chemother. 2012;56:1273-1280.
[2]
[3]
[4]
5
4
3
2
1
0
2005
2006
2009
2010
2011
MSM
West
Midwest
Northeast and
South
Men who report having
sex exclusively with
women
IsolatesWithElevated
MICsofCefixime(%)
Percentage of Isolates in Which MICs of Cefixime
Were ≥ 0.25 µg/mL, 2005-2011[1]
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24th Annual CCO HIV and Hepatitis C Symposium
GC Macrolide Resistance
133 GISP isolates with reduced susceptibility to
azithromycin (at MIC ≥ 2 μg/mL) have been reported in
the United States since 2005, including 7 (0.5% of GISP
isolates) in 2012[1,2]
The first strain with high-level resistance to azithromycin
(MIC ≥ 512 μg/mL) identified in the United States was
detected in Hawaii in 2011, and several additional
strains have now been detected in Hawaii and
California[2]
1. MMWR Recomm Rep. 2010;59:1-116. 2. Katz AR, et al. Clin Infect Dis. 2012;54:841-843.
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24th Annual CCO HIV and Hepatitis C Symposium
Updated CDC GC Treatment
Recommendations
Firstline
– Ceftriaxone 250 mg IM x 1 + azithromycin 1 g PO × 1 or
doxycycline 100 mg PO BID × 7 days
– Azithromycin is preferred over doxycycline, but both are acceptable
– Use dual therapy even if C trachomatis is ruled out
Alternate
– Cefixime 400 mg PO x 1 + azithromycin 1 g PO × 1 or doxycycline
100 mg PO BID × 7 days
– Azithromycin 2 g PO × 1 (single therapy, single dose)
– Azithromycin 2 g PO × 1 is the only regimen currently available to treat
a patient who has an allergy to cephalosporins
CDC. Morb Mortal Wkly Rep. 2012;61:590-594.
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Treatment Failure With Alternate Regimens
Culture relevant clinical sites and perform antimicrobial
susceptibility testing using disk diffusion, E-test, or agar
dilution
Treat with intramuscular ceftriaxone 250 mg +
azithromycin 2 g orally as a single dose
Evaluate sex partners from the preceding 60 days with
culture from all exposed sites and treat with above
enhanced regimen
The laboratory should retain the isolate for possible
further testing
CDC. Morb Mortal Wkly Rep. 2012;61:590-594.
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What About Patients With Penicillin or
Cephalosporin Allergies?
The cross-reactivity between penicillins and
cephalosporins has been found to be low (< 2.5%)
– The risk is highest with first-generation cephalosporins
– The risk of penicillin cross-reactivity between most second-
generation and all third- and fourth-generation
cephalosporins is negligible
If severe allergy to penicillin or cephalosporins, treat with
azithromycin 2 g PO × 1
Oral PID treatment in that setting is more complicated
Park MA, et al. Int Arch Allergy Immunol. 2010;153:268-273. Novalbos A, et al. Clin Exp Allergy.
2001;31:438-443.
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Future Antimicrobial Options
Recent randomized trial of:
– Injectable gentamicin (5 mg/kg) + oral azithromycin (2 g)
– 100% effectiveness
– Oral gemifloxacin (320 mg) + oral azithromycin (2 g)
– 99.5% effectiveness
Many trial participants reported adverse effects from the
drugs, mostly gastrointestinal issues
Kirkcaldy RD. Sex Transm Infect. 2013;89:A14-A15.
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HPV: Anal Pap and HPV Vaccination
Anal Pap screening recommendations
Recommended groups
– MSM
– Women with history of receptive anal
intercourse or abnormal cervical Pap
test results
– All HIV+ persons with genital warts
(weak recommendation, moderate
quality evidence)[1]
If anal cytologic screening (anal Pap
smears) is performed and abnormal:
– High-resolution anoscopy should be
performed with biopsy of abnormal
areas
– Appropriate therapy based on biopsy
results[1]
HPV vaccination recommendations
ACIP recommends vaccination for all
HIV-infected males (quadrivalent
vaccine only) and females in a 3-dose
series at 11 or 12 yrs of age and for
those 13-26 yrs of age if not previously
vaccinated[1]
– Efficacy data in HIV+ patients lacking
– 1 small trial in HIV+ boys and girls found
the vaccine safe and immunogenic as
did a study in HIV-infected men[2,3]
1. Aberg JA, et al. Clin Infect Dis. 2014;58:e1-e34. 2. Levin MJ, et al. J Acquir Immune Defic Syndr. 2010;55:197-204.
3. Wilkin T, et al. J Infect Dis. 2010;202:1246-1253.
Editor's Notes
HPV, human papillomavirus; STD, sexually transmitted disease.
CT, chlamydia; GC, gonorrhea; MSM, men who have sex with men.
CDC, Centers for Disease Control and Prevention; CT, chlamydia; FDA, US Food and Drug Administration; GC, gonorrhea; NAATs, nucleic acid amplification tests.
CT, chlamydia; GC, gonorrhea; MSM, men who have sex with men; STD, sexually transmitted disease.
FDA, US Food and Drug Administration; NAATs, nucleic acid amplification tests.
CT, chlamydia; GC, gonorrhea.
EIA, enzyme immunoassay; FTA-Abs, fluorescent treponemal antibody absorption; IgM, immunoglobulin M; POC, point of care; RPR, rapid plasma reagin; TPHA, treponema pallidum hemaglutination assay; TPI, treponema pallidum immobilization assay; TPPA, treponema pallidum passive particle agglutination assay; TRUST, toluidine red unheated serum test; VDRL, venereal disease research laboratory; WB, Western blot.