Am Fam Physician. 2016 Jan 15;93(2):144-154.
Key Points for Practice
• Serologic screening for HCV should be performed in all persons with HIV infection on initial assessment.
• Any of the HPV vaccines should be given to girls at 11 to 12 years of age, but boys 11 to 12 years of age should receive either the quadrivalent or the 9-valent vaccine.
• If point-of-care diagnostic tests for urethritis are unavailable, NAAT should be done and treatment given to cover gonorrhea and chlamydia.
• The recommended treatment for uncomplicated N. gonorrhoeae infection is a single 250-mg dose of intramuscular ceftriaxone plus a single 1-g dose of oral azithromycin.
• M. genitalium infection is one cause of urethritis, and the treatment is a single 1-g dose of azithromycin.
From the AFP Editors
The Centers for Disease Control and Prevention (CDC) has updated its 2010 recommendations to help guide physicians in preventing and treating sexually transmitted diseases (STDs). This summary practice guideline will focus on the updates, which include yearly screening for hepatitis C virus (HCV) in persons with human immunodeficiency virus (HIV) infection; vaccine recommendations and counseling for persons with human papillomavirus (HPV); diagnostic assessment of urethritis; nucleic acid amplification tests (NAATs) for diagnosing trichomoniasis; alternative treatments for Neisseria gonorrhoeae and genital herpes simplex virus (HSV); the role of Mycoplasma genitalium in urethritis and cervicitis and implications of treatment; STD management in persons who are transgendered; and retesting for repeat STDs.
New and Updated Recommendations
HCV SCREENING IN PERSONS WITH HIV INFECTION
Although HCV is most commonly transmitted through exposure to infected blood, it can also be transmitted through sexual contact, especially in persons with HIV infection. Serologic screening for HCV should be performed in all persons with HIV infection on initial assessment, and should be considered periodically thereafter, and at least annually in persons at high risk of HCV infection. Measurement of alanine transaminase is not recommended for testing; however, if a patient whose alanine transaminase levels are being monitored has increased levels, he or she should be tested for acute HCV infection. Additionally, because some persons with HIV infection do not have HCV antibodies, persons with liver disease of unknown etiology and who are anti-HCV negative should be evaluated for HCV infection using RNA testing.
VACCINES AND COUNSELING IN PERSONS WITH HPV
Vaccines. The bivalent vaccine (Cervarix) protects against HPV types 16 and 18, which are responsible for more than 65% of cervical cancers; the quadrivalent vaccine (Gardasil) protects against HPV types 6 and 11, which are responsible for 90% of genital warts, as well as types 16 and 18; and the 9-valent vaccine protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, which include the strains responsible for an additional 15% of cervical cancers. The vaccine is given in three doses over six months, with the second dose given one to two months after the first dose, and the third dose given six months after the first dose.
For girls, it is recommended that any of the vaccines be given at 11 to 12 years of age, but boys 11 to 12 years of age should receive the quadrivalent or the 9-valent vaccine. In both groups, the vaccine can be given as early as nine years of age. Females 13 to 26 years of age and males 13 to 21 years of age in whom the vaccine series was not
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.
Copyright © 2016 by the American Academy of Family Physicians.
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