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STD/AIDS Prevention Branch
Information for Medical Providers

| HIV/AIDS | STDs | Viral Hepatitis |

HIV/AIDS

STDs

Viral Hepatitis

HIV Treatment Guidelines

The U .S. Department of Health and Human Services (DHHS) issues guidance documents for the medical management of HIV infection, including guidelines on antiretroviral treatment, prevention and treatment of opportunistic infections, post-exposure prophylaxis, and preventing perinatal transmission. Treatment guidelines are posted on DHHS's AIDSinfo website

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The National HIV Telephone Consultation Service

The National HIV Telephone Consultation Service (Warmline) offers physicians and other health care providers up-to-the-minute HIV clinical information, and individualized expert case consultation across the broad range of clinical HIV/AIDS problems

Phone: 1-800-933-3413
Hours: 6am-5pm (PST), M-F

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The National Clinicians' Post-Exposure Prophylaxis Hotline

Phone: 1-888-448-4911
Hours: 24 hours / 7 days a week

Exposure to blood-borne pathogens can present serious risks to health care providers. Prompt post-exposure treatment for HIV and hepatitis B virus can be effective, but because each exposure case is unique, determining who should receive prophylaxis and which drugs are most appropriate is not always easy.

The National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline) offers treating clinicians up-to-the-minute advice on managing occupational exposures (i. e., needlesticks, splashes, etc.) to HIV, hepatitis and other blood-borne pathogens.

 

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HIV/AIDS Reporting Rules, Policy & Confidentiality

Health providers are required to report AIDS cases by name upon diagnosis within 3 days to Department of Health (DOH) according to Hawai‘i Statue Chapter 325, Section 2 and Hawai‘i DOH Administrative Rules 11-156-3, and report HIV cases by unnamed test code (UTC) upon diagnosis within 7 days to DOH according to Hawai‘i DOH Administrative Rules 11-156-8.8, respectively. Laboratories are required to report any confirmatory HIV positive result by UTC to DOH according to Hawai‘i Department of Health Administrative Rules Statue 11-156-8.9, and report a test result of CD4+ T-lymphocyte count <200 per microliter or CD4 cell percent of lymphocytes of <14% to DOH according to Hawai‘i Department of Health Administrative Rules Statue 11-156-3. All patients' information reported to DOH are maintained confidential. Confidentiality of case records is protected by state law in Chapter 325, section 101. The department may conduct investigation when requested by an authorized representative of the Director (Stature 321-29). If you want to report cases or have any other questions in regards to reporting, please contact the "Hawai‘i HIV/AIDS Surveillance Program", 3627 Kilauea Avenue, Suite 306, Honolulu, HI 96816, Tel: (808) 733-9010. Report forms are available to download here.

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MMWR-HIV

The Morbidity and Mortality Weekly Report (MMWR) series is published by the Centers for Disease Control and Prevention (CDC).

CDC's Divisions of HIV/AIDS Prevention (DHAP) post recent HIV-related articles here


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Screening Population at-risk of STD:

STD screening is recommended for patients with one or more of the following risk factors:

  • Are sexually active with more than one sex partner.
  • Have new or multiple sex partners.
  • Had an STD infection in the past.
  • Are sexually active and less than 25 years of age.
  • Are male and have sex with men and not in a mutually monogamous relationship
  • Are bi-sexual and not in a mutually monogamous relationship.
  • Do not use condoms correctly and consistently.
  • Have shared syringes or injection equipment.
  • Are pregnant or considering pregnancy.

Prevent re-exposure or re-infection by getting sex partners also tested for STD and HIV.

Assessment of patient’s sexual behaviors to better determine the patient’s risk of STD include asking about:

  • The gender of the patient’s sexual partners.
  • Whether the patient is in a sexually monogamous relationship. If not, the number of different sexual partners in the last six months.
  • Whether the patient is having sex with a partner who is infected with HIV or other STDs or of unknown HIV status.
  • Travel history of the patient and their partners; Pacific and Asian countries endemic with resistant-strain gonorrhea or States with recent outbreaks of STD.

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Frequency of STD screening

Men who have sex with men or bi-sexual men who are not in a mutually monogamous relationship should be screened for HIV, syphilis and other sexually transmitted diseases (STDs) every six months. Screening may be more frequent for those who use illicit drugs, engage in commercial sex, or have high rates of sexual partner exchange.

For more information on syphilis screening and patient assessment, visit the California STD/HIV Prevention Training Center for primary and secondary syphilis algorithms, diagnostic tools, and clinical courses on syphilis:

CDC Sexually Transmitted Disease Treatment Guideline

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Laboratory Tests and Services

Collection of Specimen

The type of specimen collected for gonorrhea should be based on the type of sexual exposure because infection site determines treatment regimen. Pharyngeal and rectal specimens can only be performed using culture.

Interpretation of positive tests

It is imperative to interpret a positive STD test in the context of sexual history by assessing STD risk of the patient and their partner. The possibility that positive test results may be false should be considered when patients have unanticipated positive test results.

For more information on screening tests for Chlamydia trachomatis and Neisseria gonorrhoea, click here

Reference

“False-Positive Gonorrhea Test Results with a Nucleic Acid Amplification Test: The Impact of Low Prevalence on Positive Predictive Value.”
Alan R Katz, Paul V Effler, Roy G Ohye, Barbara Brouillet, Maria Veneranda Lee, Peter M Whiticar. CID. 38: 814-819. March 15, 2004.

The Hawai‘i State Laboratory performs:

  • Chlamydia and gonorrhea tests submitted by the Chlamydia and Gonorrhea Screening Providers
  • Confirmatory testing for serology test for syphilis
  • HIV-1 EIA and western blot tests and HIV-2 EIA tests submitted through the Hawai‘i HIV Counseling and Testing Program
  • Antibiotic susceptibility tests for N. gonorrhoeae isolates

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Partner Management of Patients infected with STD/HIV

Referral of partners of syphilis patients for medical management and treatment are key components in STD prevention and control activities. Partner referral provides an opportunity to break the chain of infection by preventing re-infection of the patient and by preventing the spread of infection to sex- or needle-sharing partners. Timely referral of partners for examination and treatment will decrease the disease burden of STDs in the community.

The STD Prevention Program will continue to provide case management services to all early syphilis and antibiotic-resistant N. gonorrhea cases. Contact the STD Prevention Program at 808-733-9281.

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Treatment Guidelines

The Hawai‘i STD Prevention Program has modified the CDC Sexually Transmitted Diseases Treatment Guidelines, 2006 to address the differences in the epidemiology of STDs in Hawai‘i as compared to mainland US. The Hawai‘i STD Treatment Guideline reflects the 2002 CDC STD Treatment Guidelines and the Region IX Infertility Clinical Guidelines to focus primarily on STDs encountered in an office practice. These guidelines are intended as a source of clinical guidance and are not a comprehensive list of all effective regimens.

Special note on the treatment of gonococcal infections

Ciprofloxacin-resistant N. gonorrhoeae is endemic in Hawai‘i. Patients diagnosed with gonorrhea in Hawai‘i should not be treated with fluroquinolones. Clinicians who suspects or identifies treatment failure should submit a gonococcal culture specimen for antibiotic susceptibility testing. When a patient is diagnosed with an antibiotic-resistant gonorrhea, it is strongly recommended to identify sex partners so that they may be examined and appropriately treated. Contact the STD Prevention Program for assistance in case management of patients diagnosed with resistant-strain gonococcal infections at 808-733-9281.

Special note on the Treatment of Syphilis

Long-acting benzathine penicillin is the drug of choice for treating most stages of syphilis. The alternative regimens listed in the treatment guideline may be used; however, close follow-up is essential because data on non-penicillin regimens for the treatment of syphilis are limited – particularly for treating patients co-infected with HIV. There may be a higher risk of treatment failure when using alternative regimens.

Treatment and Laboratory Test Results
It is imperative to obtain a sexual history for both assessing STD risk and interpreting STD test results. The possibility that positive test results may be false should be considered when patients have unanticipated positive test results.

Hawai‘i Sexually Transmitted Diseases Treatment Guidelines, 2007
CDC Sexually Transmitted Diseases Treatment Guidelines, 2006
HIV Treatment Guidelines

Additional information:

  • “False-Positive Gonorrhea Test Results with a Nucleic Acid Amplification Test: The Impact of Low Prevalence on Positive Predictive Value.” Alan R Katz, Paul V Effler, Roy G Ohye, Barbara Brouillet, Maria Veneranda Lee, Peter M Whiticar. CID 2004:38 (15 March) 814-819.
  • “Azithromycin Treatment Failures in Syphilis Infections- San Francisco, California, 2002-2003.” MMWR 53(9) 197-198. March 12, 2004.
  • “Increases in Fluoroquinolone-Resistant Neisseria gonorrhoeae Among Men Who Have Sex with Men --- United States, 2003, and Revised Recommendations for Gonorrhea Treatment, 2004.” MMWR 53(16):335-338. April 30, 2004.
  • “Oral Alternatives to Cefixime for the Treatment of Uncomplicated Neiserria Gonorrhoeae Urogenital Infections.” MMWR 51(46):1052. November 22, 2002.

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Medical Alert

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Publication and Reports

Gonorrhea:

Epidemiology:

Laboratory Test Results:

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Toolkits

  • The online Practitioner's Handbook for the Management of Sexually Transmitted Disease, updated December 2004.
  • Self Study STD Module
    This site offers seven web-based educational modules, each based on a specific STD topic.  Each module is considered to be an individual course.  The target audience is clinicians in primary care settings who desire a basic introduction to STD diagnosis and management.
  • NNPTC Online Case Series
    This web-based case series is designed for practicing clinicians who diagnose, treat and manage patients with, or at risk for, STDs.  The series includes case presentations of common STD-related syndromes with a guided, interactive process to evaluate each case, arrive at a diagnosis and provide recommended treatment.
  • STD 101 In-A-Box: Ready-To-Use Presentations.
    This product includes nine ready-to-use STD presentations, a user's guide with suggested agendas, discussion questions, and a script for an interactive group exercise (with a demonstration animation). STD 101 In-A-Box may be used by state/local health departments, health educators, conference organizers, trainers, clinicians, or anyone needing to conduct a basic presentation on sexually transmitted disease prevention.  The presentations may be used together or separately and can be customized to the user's needs.  For a full description of how this product may be used, please refer to the user's guide that can be located on the home page.
  • Prevention and Management of STDs in Men Who Have Sex with Men:  A Toolkit for Clinicians is designed to assist clinicians in supporting STD prevention efforts among men who have sex with men.  To order a copy of the toolkit, contact the STD/HIV Prevention Training Center of New England at 617-983-6945.
  • Diagnostics tools, clinical courses on syphilis, and primary and secondary syphilis algorithms, visit the California STD/HIV Prevention Training Center:

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Other resources

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Viral Hepatitis Treatment Guidelines

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MMWR-Hepatitis

The Morbidity and Mortality Weekly Report (MMWR) series is published by the Centers for Disease Control and Prevention (CDC).

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Viral Hepatitis Online Trainings

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Additional Viral Hepatitis Resources

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Last update: 04/17/2008

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