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September 01, 2016 23:11

Notification and management of sexual partners from STIs

almost all cases, partners of patients with STDs should be screened.If the diagnosis of curable STDs is likely, should be given appropriate antibiotics even in the absence of clinical signs of infection and to obtain laboratory results.In many states, local or federal health departments can help to identify the partn

ers of patients with certain STDs, especially HIV, syphilis, gonorrhea and chlamydia.

Health care providers should urge patients with sexually transmitted diseases, that they should inform their sexual partners about possible infection, including those who do not have symptoms, and advise these partners to the clinic for an examination.This type of detection of partners known as ". Partner notification patient 'In situations where notice the patient may not be effective or not possible, the staff of clinical services should inform sexual partners of the patient or by a" notice by agreement "or notification via patronage service."Notification on an agreement "- a way to identify the partners, in which the patient agrees to itself inform their partners for a certain period of time if the partners fail to appear during this time period, use care service, ie, partners, called the infected patient identified...and consult employees of health care facilities.

break the chain of transmission is crucial for STI control. further transmission and reinfection curable STDs can be prevented, if able to identify sexual partners for diagnosis, treatment, vaccination and counseling. When the doctor sends infected patients in the local or federalhealth departments, specially trained personnel may conduct an interview with them to find out the names and locations of all sexual partners.Each health department shall keep confidential the patients involved in identifying partners.Therefore, given the confidentiality of the information provided by them, many patients prefer to partner notification conducted Officials health authorities.However, public health officials may not always provide adequate prevention contact persons of all patients with STDs.In situations where a number of partners, whose names are not known to the patients, significantly, for example, among those who offer sexual services in exchange for drugs, active detection of STDs in individuals at high risk, it may be more efficient to interrupt further transmissionthan the activities carried out by physicians to identify partners.Recommendations for the management of sexual partners and recommendations for identifying partners for specific STDs included in the relevant sections of this guide.

Register STDs and confidentiality

Accurate identification and timely reporting of cases of STDs are part of successful disease control.Accountability is important to monitor disease trends, allocating the necessary resources, and helps staff the local health authorities to identify sexual partners who may be infected.About STD / HIV and AIDS cases, must be reported in accordance with local requirements.

Syphilis, gonorrhea and AIDS is a notifiable disease in every state.Chlamydia infection is registered in most states.The list of other STDs, subject to registration, in Vol. H. And asymptomatic HIV-infection is different in different states, and doctors should be aware of local reporting requirements.The report may be based on clinical and / or laboratory data.Health care workers who are not familiar with local regulations relating to the registration of diseases, should seek advice from your local health department or see STD control program in the state.

Reported cases of STDs and HIV are held in strict confidence and in most cases, patients are legally protected against forcible summons.In the future, before starting the monitoring of STD cases, authorized for the program should consult with a medical professional, observing the patient for verification of the diagnosis and treatment of the patient.

Pregnant women

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 to advise them about the possibility of infection in the newborn.

Recommended screening tests

  • serologic test for syphilis should be done for all pregnant women at their first visit during pregnancy.In populations where there is no opportunity for a full antenatal care, rapid plasma-moreaginovy ‚Äč‚Äčtest (RPR) and the treatment of women (if test results are positive) should be carried out at the time of detection of pregnancy.For patients at high risk screening should be repeated in the third trimester and before delivery.In some states there is a compulsory screening of all women before delivery.None of the newborn can not be discharged from the hospital, if serological testing for syphilis has not been a mother at least once during pregnancy and preferably again at delivery.All women who took birth stillbirth should be screened for syphilis.
  • serological test for the surface antigen (HBsAg) Hepatitis B virus (HBV) should be performed for all pregnant women at their first visit during pregnancy.Women negative for HBsAg, at high risk for HBV infection (ie, CNF-addicts, patients with sexually transmitted diseases), should be re-study for HBsAg late in pregnancy.
  • Test for Neisseria gonorrfioeae should be performed at the first visit during pregnancy for women at risk, and women living in areas with high prevalence of N. gonorrhoeae.Repeat the test should be performed in the third trimester of pregnancy to women who remain at risk.
  • Test for Chlamydia trachomatis should be performed in the third trimester of pregnancy in women with an increased risk (younger than 25 years with new or more than one partner) to prevent post-partum complications in the mother and chlamydial infection in the infant.Screening in the first trimester of pregnancy can prevent the development of adverse effects of chlamydial infection during pregnancy.However, evidence of adverse effects of chlamydial infection during pregnancy is minimal.If the screening is carried out only in the first trimester of pregnancy until delivery remains a long period during which infection can occur.
  • testing for HIV infection should be offered to all pregnant women at their first visit.
  • Screening for bacterial vaginosis (BV) in the beginning of the second trimester can be carried out in asymptomatic women at high risk of preterm delivery (with a history of premature birth).
  • Smear on cytology Papanicolaou (Pap) should be performed at the first visit, if there is no corresponding record for the last year in the history of the disease.

Other issues

Other related to STD issues that need to be taken into account:

  • When conducting pregnant women with primary genital herpes, hepatitis B, primary cytomegalovirus infection (CMV), a streptococcal infection Group B andwomen with syphilis who are allergic to penicillin, you may need their referral to a consultant to conduct such patients.
  • should submit information about pregnant women who test of HBsAg, local health authorities and / or state public health authorities, in order to ensure that these cases are registered in the system of cases of hepatitis and their newborns appropriate preventive measures will be carried out.It should also be vaccinated individuals who were in close household and sexual contact with a HBsAg-positive woman.
  • In the absence of lesions during the third trimester of pregnancy routine culture studies to identify herpes simplex virus (HSV) is not indicated for women with recurrent genital herpes in history.However, the allocation of HSV by these women during childbirth may point to the tactics of the newborn.'Preventive' 'cesarean section is not indicated for women with no active genital lesions at delivery.
  • presence of genital warts is not an indication for caesarean section.

For a more detailed discussion of these issues as well as issues related to infections that are not transferredsexually see Guide perinatal surveillance [6]

NOTE:.. for guidelines on screening pregnant women include: Guide to Clinical Preventive Services, Guidelines for perinatal Care, American College of Obstetricians and Gynecologists (ACOG) Technical Bulletin: gonorrhoeae and ChlamidialInfections, Recomendations for the Prevention and Management of Chlamydia trachomatis Infections and Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the Unated States through Universal Childhood Vaccinations:. recommendation of the Immunisation Practices Advisory Commitee (ACIP) These sources provide is not always the same recommendations.Guide to Clinical Preventive Services recommends a screening of patients at risk for chlamydia, but indicated that the optimal time intervals, through which these surveys should be carried out - to be determined.So, Guidelines for Perinatal Care recommends screening for chlamydia for women from high-risk groups performed at the first summons and repeat testing in the third trimester of pregnancy.Screening of pregnant women for STDs is recommended based on the severity of the disease and the possibility of complications, the prevalence in the population, cost of medical / legal considerations (including state laws) and other factors.Recommendations for screening contained in this manual are more extensive (for example, it is recommended to explore more women to more STDs than in other manuals) and comparable to other guidelines issued by the CDC.Physicians should select screening strategy in accordance with the characteristics of this population and its environment, guided by the objectives to identify cases of STDs and their treatment.

Teens

Health care workers who provide care to adolescents with STDs should keep in mind some of the features on these individuals.

The incidence of the majority of STDs among teens is the highest in the population;for example, gonorrhea incidence highest among girls aged 15-19 years.Clinical studies have shown that the prevalence of chlamydial infections, and possibly an infection caused by the human papilloma virus (HPV), also the highest among teenagers.In addition, these epidemiological-surveillance shows that 9% of adolescents with hepatitis B or admitted sexual contact with persons with chronic infection or have had multiple sexual partners or have had a predominantly homosexual.By implementing a national strategy for halting the spread of HBV in the United States, the ACIP recommends that all adolescents be vaccinated against hepatitis B. The vaccine

Teenagers with the highest risk of STD infection include homosexual youth, sexually active heterosexuals, customer clinics STI and drug-CNF.Most young (under 15 years), sexually active adolescents are at particular risk of infection.High risk of STDs among adolescents is due to the fact that they often have unprotected sex, are biologically more susceptible to infection and are a lot of barriers to seeking care.

Health care providers should consider these risk factors and a general lack of knowledge and understanding of the consequences of STDs and adolescents offer guidance on primary prevention in order to form in young people a healthy sexual behavior and prevent the installation of patterns of behavior that can undermine sexual health.With rare exceptions, all the teenagers in the US have the right to give consent to the confidential diagnosis and treatment of STDs.Medical care in these conditions can be given without parental consent or even without notice.Moreover, in most states, teenagers can give consent for HIV counseling and testing.The right to consent to vaccination of adolescents varies from state to state.Some states believe that vaccinations, as well as for the treatment of STDs, parental consent is required.Health workers need to understand the importance of privacy for adolescents and to make every effort to ensure the treatment of sexually transmitted diseases in adolescents.

style and content of counseling and health education should be adapted for teenagers.The discussion should correspond to the level of the patient, and be directed to the identification of risk behavior such as drug use or promiscuity.Considerate behavior physician and a detailed elucidation of history is especially important for teenagers who may not realize that their behavior involves risks.Medical care and counseling should be provided friendly and non-judgmental.

Children Treatment of children with STDs requires close collaboration between clinicians, laboratories and child protection organizations.Studies, if any, must be carried out without delay.Some diseases, such as gonorrhea, syphilis and chlamydia, if they are acquired after the neonatal period, virtually 100% of cases point to sexual contact.For other diseases, such as HPV infection and vaginitis, connection with the sexual contact is not so obvious (see. Sexual violence and sexually transmitted diseases).