Appendix F Recommended Interventions During the Periodic Health Examination for the Prevention of STDs, U.S. Preventive Services Task Force, 1996



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--> Appendix F Recommended Interventions During the Periodic Health Examination for the Prevention of STDs, U.S. Preventive Services Task Force, 1996

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--> RECOMMENDED INTERVENTIONS DURING THE PERIODIC HEALTH EXAMINATION FOR THE PREVENTION OF STDs, U.S. PREVENTIVE SERVICES TASK FORCE, 1996 Age Group (in years) Interventions for General Population Strength of Recommendationa Interventions for Populations with High-Risk Sexual Behavior Strength of Recommendationa Birth-10 • Immunize for hepatitis B (birth, 1 month, 6 months; or 0-2 months, 1-2 months later, and 6-18 months; if not done in infancy, current visit and 1 and 6 months later). A • HIV testing (for infants of mothers at high risk for HIV)b B   • Give ocular prophylaxis to prevent gonococcal ophthalmia neonatorum (for newborns).       11-24 • Screen with Papanicolaou (Pap) test (for females who are sexually active at present or in the past, at least every 3 years. If sexual history is unreliable, begin Pap tests at age 18 years). A • RPR/VDRL (serological test for syphilis)c; • Screen for gonorrhea (for females)d; • HIVe; • Chlamydial (for females)g A; B; A; B   • Screen for chlamydial (for sexually active females < 20 years old). B • Hepatitis A vaccineh B

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-->   • Counsel for abstinence.f B       • Counsel to avoid high-risk sexual behavior.f B       • Counsel to use condoms/female barrier with spermicide.f B       • Counsel to use contraception. B       • Immunize for hepatitis B (if not previously immunized: current visits, 1 and 6 months later). A     25-64 • Screen with Papanicolaou (PAP) test (for women) who are or have been sexually active, at least every 3 years). A • RPR/VDRLc A     • Screen for gonorrhea (for females)i B   • Counsel to avoid high-risk sexual behaviorf B • HIVe A   • Counsel to use condoms/female barrier with spermicide.f B • Chlamydial (for females)j B   • Counsel to use contraception. B • BHepatitis B vaccinek; A       • Hepatitis A vaccinel B

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--> Age Group (in years) Interventions for General Population Strength of Recommendationa Interventions for Populations with High-Risk Sexual Behavior Strength of Recommendationa >64 • Screen with Papanicolaou (Pap) test (for all women who are sexually active and who have a cervix. Consider discontinuation of testing after age 65 yrs. if previous regular screening showed consistently normal results). A • Hepatitis A vaccinem; B • HIV screene; A • Hepatitis B vaccinek; A • RPR/VDRLc A • Counsel to avoid high-risk sexual behavior.f B     • Counsel to use condoms.f B     Pregnant women During first visit:   • Screen for chlamydial (1st visit)n B • Screen for hepatitis B surface antigen (HBsAg). B • Gonorrhea (1st visit)o; B   • HIV (1st visit)p (see note) A • RPR/VDRL A • HbAg (3rd trimister)q A • Chlamydial (<25-year-olds) B • RPR/VDRL (3rd trimester)r A • Offer to screen for HIV (universal screening is recommended for states, counties, or cities with an increased prevalence of      

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-->   HIV infection among pregnant woman. In low-prevalence areas, the choice between universal and targeted screening may depend on other considerations).     • Counsel to avoid high-risk sexual behavior.f B   • Counsel to use condoms.f B NOTE: The recommendations of the task force regarding the screening of pregnant women and newborns for HIV differ from those of the U.S. Public Health Service and some professional medical organizations. As examples, the U.S. Public Health Service recommends voluntary HIV testing for all pregnant women (Centers for Disease Control and Prevention, U.S. Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women, MMWR 1995;44(No. RR-7). The American Academy of Pediatrics recommends routine screening with consent of all pregnant women and HIV testing for infants whose mother's serostatus is unknown (American Academy of Pediatrics, Provisional Committee on Pediatric AIDS, Pediatr 1995;95:303-6). Determination of the appropriateness of these recommendations is beyond the charge of this committee. The following footnotes are direct quotations from the primary source. a The letter ''A" indicates that there is good evidence to support the recommendation that the condition be specifically considered in a period health examination. "B" indicates that there is fair evidence to support the recommendation that the condition be specifically considered in a period health examination. b Infants born to high-risk mothers whose HIV status is unknown. Women at high risk include past or present injection drug users; persons who exchange sex for money or drugs and their sex partners; injection drug using, bisexual, or HIV-positive sex partners currently or in past; persons seeking treatment for STDs; blood transfusion during 1978-1985. c Persons who exchange sex for money or drugs, and their sex partners; persons with other STDs (including HIV); and sexual contacts of persons with active syphilis. Clinicians should also consider local epidemiology.

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--> d Females who have two or more sex partners in the last year; a sex partner with multiple sexual contacts; exchanged sex for money or drugs; or a history of repeated episodes of gonorrhea. Clinicians should also consider local epidemiology. e Males who had sex with males after 1975; past or present injection drug use; persons who exchange sex for money or drugs and their sex partners; injection-drug using, bisexual, or HIV-positive sex partner currently or in the past; blood transfusion during 1978-1985; persons seeking treatment for STDs. Clinicians should also consider local epidemiology. f The ability of clinician counseling to influence this behavior is unproven. g Sexually active females with multiple risk factors including history of STD; new or multiple sex partners; age under 25; nonuse or inconsistent use of barrier contraceptives; cervical ectopy. Clinicians should also consider local epidemiology of the disease in identifying other high-risk groups. h Persons living in, traveling to, or working in areas where the disease is endemic and where periodic outbreaks occur (e.g., countries with high or intermediate endemicity; certain Alaska Native, Pacific Island, Native American, and religious communities); men who have sex with men; injection or street drug users. Vaccine may be considered for institutionalized persons and workers in these institutions, military personnel, and day care, hospital, and laboratory workers. Clinicians should also consider local epidemiology. i Women who exchange sex for money or drugs or who have had repeated episodes of gonorrhea. Clinicians should also consider local epidemiology. j Sexually active women with multiple risk factors including history of STD; new or multiple sex partners; nonuse or inconsistent use of barrier contraceptives; cervical ectopy. Clinicians should also consider local epidemiology. k Blood product recipients (including hemodialysis patients), persons with frequent occupational exposure to blood or blood products, men who have sex with men, injection drug users and their sex partners, persons with multiple recent sex partners, persons with other STDs (including HIV), travelers to countries with endemic hepatitis B. l Persons living in, traveling to, or working in areas where the disease is endemic and where periodic outbreaks occur (e.g., countries with high or intermediate endemicity; certain Alaska Native, Pacific Island, Native American, and religious communities); men who have sex with men; injection or street drug users. Consider for institutionalized persons and workers in these institutions, military personnel, and day-care, hospital, and laboratory workers. Clinicians should also consider local epidemiology. m Persons living in, traveling to, or working in areas where the disease is endemic and where periodic outbreaks occur (e.g., countries with high or intermediate endemicity; certain Alaska Native, Pacific Island, Native American, and religious communities); men who have sex with men; injection or street drug users. Consider for institutionalized persons and workers in these institutions, and day-care, hospital, and laboratory workers. Clinicians should also consider local epidemiology.

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--> n Women with history of STD or new or multiple sex partners. Clinicians should also consider local epidemiology. Chlamydial screen should be repeated in 3rd trimester if at continued risk. o Women under age 25 with two or more sex partners in the last year, or whose sex partner has multiple sexual contacts; women who exchange sex for money or drugs; and women with history of repeated episodes of gonorrhea. Clinicians should also consider local epidemiology. Gonorrhea screen should be repeated in the 3rd trimester if at continued risk. p In areas where universal screening is not performed due to low prevalence of HIV infection, pregnant women with the following individual risk factors should be screened: past or present injection drug use; women who exchange sex for money or drugs; injection drug-using, bisexual, or HIV-positive sex partner currently or in the past; blood transfusions during 1978-1985; persons seeking treatment for STDs. q Women who are initially HBsAg negative who are at high risk due to injection drug use, suspected exposure to hepatitis B during pregnancy, multiple sex partners. r Women who exchange sex for money or drugs, women with other STDs (including HIV), and sexual contacts of persons with active syphilis. Clinicians should also consider local epidemiology. SOURCE: U.S. Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Washington, D.C.: U.S. Department of Health and Human Services, 1996.