In almost all cases, partners of patients with STDs should be examined. If the diagnosis of a curable STD is likely, appropriate antibiotics should be prescribed even in the absence of clinical signs of infection and until laboratory results are obtained. In many states, local or federal health departments can help identify partners of patients with certain STDs, especially HIV, syphilis, gonorrhea and chlamydia.
Healthcare workers should convince patients with STDs that they should notify their sex partners of a possible infection, including those who do not have symptoms, and advise these partners to go to the clinic for examination. This type of partner identification is known as "partner notification by the patient." In situations where notification by the patient may not be effective or impossible, the clinical services staff should notify the patient's sexual partners either by "notification by agreement" or by notification through the service. " Notification by agreement "is a way of identifying partners, in which the patient agrees to notify his partners within a certain period of time. Th time period, use care service, ie. E. Partners named infected patients are identified and consulted the staff of health care institutions.
The transmission chain gap is crucial for STD control. Further transmission and reinfection of curable STDs can be prevented if it is possible to identify sexual partners for diagnosis, treatment, vaccination and counseling. When a doctor sends infected patients to local or federal health departments, trained staff can interview them to find out the names and locations of all sexual partners. Each department of public health secrets the involvement of patients in identifying partners. Therefore, given the confidentiality of the information provided by them, many patients prefer that notification of partners should be made by health officials. However, health officials can not always provide appropriate prevention to contact persons of all patients with STDs. In situations where the number of partners whose names may not be known to patients is significant, for example, among those who offer sexual services in exchange for drugs, active detection of STD in high-risk individuals may be more effective in interrupting further transmission of infection than the activities conducted by doctors to identify partners. Recommendations for managing sexual partners and recommendations for identifying partners for specific STDs are included in the relevant sections of this manual.
STD Registration and Confidentiality
Accurate identification and timely reporting of STD cases are part of the successful control of morbidity. Reporting is important for assessing trends in morbidity, allocating the necessary funds, and helping local health authorities identify sexual partners who may be infected. About STDs / HIV, as well as cases of AIDS, must be reported in accordance with local requirements.
Syphilis, gonorrhea and AIDS are registered diseases in every state. Chlamydia infection is registered in most states. The list of other STDs that are subject to registration, including asymptomatic HIV infection, varies from state to state and physicians should be aware of local reporting requirements. Reporting can be based on clinical and / or laboratory data. Health professionals who are not familiar with local regulations on disease registration should seek advice from local health departments or check with the STD control program in that state.
Reports of cases of STDs and HIV infection are conducted in strict confidentiality and in most cases patients are protected by law from being forced to summon a summons. In the future, before commencing an STD case, the program's commissioners should consult a medical worker observing the patient to verify the diagnosis and treat the patient.
Intrauterine or perinatal transmission of STDs can lead to death or severe fetal pathology. It is necessary to ask a pregnant woman and her sexual partners about STDs and advise them about the possibility of developing an infection in a newborn.
Recommended Screening Tests
- Serologic test for syphilis should be given to all pregnant women at their first visit during pregnancy. In populations where there is no possibility for full prenatal observation, rapid plasma-sea-test (RPR) and treatment of women (if the test results are positive) should be performed at the time of pregnancy detection. For patients from high-risk groups, screening should be repeated in the third trimester and before delivery. In some states, all women are required to be screened before delivery. No newborn can be discharged from the hospital if a serological test for syphilis has not been carried out at the mother at least once during pregnancy and, preferably, once more at the time of delivery. All women who have had births with a dead fetus must be examined for syphilis.
- A serological test for the surface antigen (HBsAg) of the hepatitis B virus (HBV) should be given to all pregnant women on their first visit during pregnancy. Women with a negative result on HBsAg who are at high risk of HBV infection (ie, UNV drug users, STD patients) should be re-examined for HBsAg at late gestation.
- The test for Neisseria gonorrfioeae should be performed at the first visit during pregnancy to women at risk, or to women living in areas with high prevalence of N. Gonorrhoeae. A repeat test should be performed in the third trimester of pregnancy for those women who continue to be at risk.
- The Chlamydia trachomatis test should be performed in the third trimester of pregnancy for women at increased risk (younger than 25 years old with a new or more than one partner) in order to prevent postpartum complications in the mother and chlamydia infection in the infant. Screening in the first trimester of pregnancy can prevent the development of adverse effects of Chlamydia infection during pregnancy. However, evidence of adverse effects of Chlamydia infection during pregnancy is minimal. If screening is carried out only in the first trimester of pregnancy, there is a long period of time before delivery, during which time infection may occur.
- Testing for HIV infection should be offered to all pregnant women on their first visit.
- A test for bacterial vaginosis (BV) at the beginning of the second trimester can be performed in asymptomatic women with a high risk of premature birth (having a history of premature birth).
- A smear for Pap smear (Pap) should be performed on the first visit, if there is no corresponding record in the history of the disease for the last year.
Other STD-related issues that need to be considered:
- In the management of pregnant women with primary genital herpes, hepatitis B, primary cytomegalovirus infection (CMV), group B Streptococcal infection and women with syphilis who have an allergy to penicillin, it may be necessary to refer them to a counselor for the management of such patients.
- Information should be provided on pregnant women with HBsAg identified to the local health authorities and / or public health authorities in order to be sure that these cases are documented in the hepatitis case management system and that their newborns will receive appropriate preventive measures. In addition, people who had been in close contact with an HBsAg-positive woman should be vaccinated.
- In the absence of lesions during the third trimester of pregnancy, routine culture tests for the detection of herpes simplex virus (HSV) are not indicated in women with recurrent genital herpes in the anamnesis. However, the isolation of HSV from such women during childbirth may indicate a tactic of management of the newborn. "Preventive" cesarean section is not indicated for women without active genital lesions during labor.
- The presence of genital warts is not an indication for caesarean section.
For a more detailed discussion of these issues, as well as questions relating to infections that are not sexually transmitted, see the Manual on Perinatal Surveillance .
NOTE: Guidelines for screening pregnant women include: Guide to Clinical Preventive Services, Guidelines for Perinatal Care, American College of Obstetricians and Gynecologists (ACOG) Technical Bulletin: Gonorrhoeae and Chlamydia Infections, Recomendations for the Prevention and Management of Chlamydia trachomatis Infections and Hepatitis In the Virus: A Comprehensive Strategy for the Eliminating Transmission in the Unified States through Universal Childhood Vaccinations: Recommendation of the Immunization Practices Advisory Commitee (ACIP). These sources do not always give the same recommendations. Guide to Clinical Preventive Services recommends conducting a screening survey of patients at risk for chlamydia, but it is indicated that the optimal time intervals through which these examinations should be performed are not determined. Thus, the Guidelines for Perinatal Care recommends a screening for chlamydia for high-risk women at the first appearance and repeat testing in the third trimester of pregnancy. Screening of pregnant women for STDs is recommended based on the severity of these diseases and the potential for complications, prevalence in the population, cost, medical / legal considerations (including state laws), and other factors. Screening recommendations in this guide are more extensive (for example, it is recommended that more women be screened for more STDs than in other guidelines) and are comparable to other guidelines issued by the CDC. Physicians should choose a screening strategy in accordance with the characteristics of this population and its environment, guided by the stated goals of identifying STD cases and their treatment.
Medical workers who provide assistance to adolescents with STDs need to keep in mind some of the characteristics of these individuals.
The incidence rate of most STDs among adolescents is the highest in the population; for example, the incidence of gonorrhea is highest among girls aged 15-19. Clinical studies have shown that the prevalence of chlamydial infections and, possibly, infection caused by the human papillomavirus (HPV) virus is also the highest among adolescents. In addition, epidemiological surveillance data show that 9% of adolescents with hepatitis B, or have sex with people who have a chronic infection, or had multiple sexual partners, or had mostly homosexual contacts. Implementing a national strategy to stop the spread of HBV in the US, ACIP recommends vaccinating all adolescents with hepatitis B vaccine.
Adolescents with the highest risk of contracting STDs include gay men, sexually active heterosexuals, clients of STD clinics and drug users-UNV. The youngest (under 15), sexually active adolescents, are particularly at risk of infection. The high risk of STD infection in adolescents is due to the fact that they often have unprotected sex, are biologically more susceptible to infection and find many obstacles to seeking medical help.
Health professionals should consider these risk factors and the general lack of knowledge and understanding of the consequences of STDs in adolescents and offer a guide to primary prevention in order to generate healthy sexual behavior in young people and prevent the installation of patterns of behavior that could undermine sexual health. With few exceptions, all teenagers in the United States have the right to consent to confidential diagnosis and treatment of STDs. Medical assistance in these conditions can be provided without the consent of the parents or even without their notification. Moreover, in most states, adolescents can agree to counseling and testing for HIV. The right to consent of adolescents to vaccination varies depending on the state. Some states believe that for the vaccination, as well as for the treatment of STDs, parental consent is not required. Health workers need to understand the importance of confidentiality for adolescents and make every effort to provide it in the treatment of STDs in adolescents.
The style and content of counseling, as well as health education should be adapted for adolescents. Discussion should be consistent with the level of the patient's development and be aimed at identifying risk behavior, such as drug use or promiscuous sexual intercourse. The tactful behavior of the physician and the detailed history of the anamnesis are especially important for adolescents who may not realize that their behavior includes risk factors. Medical assistance and counseling should be provided with benevolence and without condemnation.
Treatment of children with STDs requires close interaction between clinicians, laboratories and child protection organizations. Studies, if they are necessary, should be carried out without delay. Some diseases, such as gonorrhea, syphilis and chlamydia, if they are acquired after the neonatal period, in almost 100% of cases indicate sexual contact. For other diseases, such as HPV infection and vaginitis, the association with sexual contact is not so obvious (see Sexual Violence and STDs).
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