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révention
en pratique médicale
MALADIES INFECTIEUSES
We thought we had won the battle
Bacterial STIs make a comeback!
After decreasing progressively for years, STIs are making a strong comeback. This worrisome rebound requires an energetic and coordinated response:
promote the adoption of safe sexual behaviours,
recognise the presence of risk factors and perform appropriate screening tests,
treat infected people without delay,
evaluate and treat all their sexual partners without delay.
Chlamydia
Young women aged 15 to 19 years are
still the most affected
In Montreal, from 1990 to 1996, the number of
reported cases of chlamydia decreased by 65%; from
1996 to 2001, there was a 75% increase in the number of cases reported every year. (Outside Montreal,
in the rest of the province, there was a 45% increase
STIs: the globalisation of STDs
STIs are sexually transmitted diseases,
renamed to match international nomenclature. STI stands for Sexually Transmitted
Infections. It is more accurate to use the
word “infection” rather than “disease” since
not all people who are infected are sick.
during the latter period.) Women continue to be the
most affected (70% of all cases), especially women
aged 15 to 24 years: the rate of incidence was 1488
cases per 100 000 among 15 to 19-year-old women
and 1228 cases per 100 000 among those aged 20 to
24-year-old. These rates are 2 to 3 times higher than
the targets set in Canada for the year 2000 for women
in these age groups.
Recent studies conducted by the Montreal Public
Health Department have shown that the prevalence
rate among street youth is 6.6% (prevalence is significantly higher among women with a history of
pregnancy than in those without such a history:
10.4% versus 3.6%), and 3.8% among people consulting in various types of clinics (CLSCs, private
clinics, etc.) (prevalence is significantly higher
among women with a history of abortion than in
those without such a history: 5.1% versus 2.7%).
continued on page 4 “STIs make a comeback”
Number of cases of STI, Montreal region, 1990-2001
Diseases
4544
2495
1718 1832 2066
2598 2990
Chlamydia
1209
306 350 308
Gonorrhea
381 443 559
32
6
Infectious syphilis
1990
August 2002
4
1
3
6
11
1996 1997 1998 1999 2000 2001
1
Infections with
severe consequences
The probability of developing pelvic inflammatory disease (PID) following C. trachomatis or
N. gonorrhoeae endocervical infection is about
20% to 25%, whereas the probability of having
chronic pelvic pain, an ectopic pregnancy, or
tubal infertility after untreated PID is 15%, 5%,
and 15% respectively (the probability of tubal
infertility could be as high as 60%, depending on
the number of episodes of PID). For syphilis, it
is estimated that 30% of those untreated will
develop latent syphilis (cardiovascular, neurological or ophthalmic lesions, or gumma which
can affect any organ).
It was already known that the human papilloma
virus (HPV) contributes to the development
of squamous cell cancer of the cervix. Recent
studies have demonstrated that infection from
C. trachomatis can act as a co-factor, increasing
the risk of cancer associated with HPV infection.
Interaction with HIV infection
Ulcerative (e.g.: syphilis, chancroid, herpes) and
inflammatory STIs (e.g.: gonorrhea, chlamydia)
are factors of HIV transmission. The presence of
these STIs may enhance infectiousness in people
with HIV and increase susceptibility to HIV infection in those who are HIV negative. Moreover,
having HIV infection alters the evolution of
syphilis, and can result in atypical presentation
and early signs of neurological disease.
Screening
Currently we do not know enough to define, for each STI, all the specific contexts
in which systematic screening is appropriate.
However, we believe that people in the following risk groups should be
offered screening tests. People who have had unprotected sex with someone
in one of these groups should also undergo the same tests as the person in
the group itself. A pregnant women who has a risk factor or whose partner
has a risk factor should have the three tests listed in the table below. Of course,
sexual partners of known cases of STI should be evaluated and tested (including
newborns with a parent who has an STI or who is at risk).
Openly discuss the presence of risk factors with each patient
Bacterial STIs to test for, based on identified risk factors (for guidance)
PEOPLE AT RISK AND THEIR SEXUAL PARTNERS
STI TO TEST FOR
Chlamydia
Someone < 25 years who has had a new sexual partner in the last two months
Someone < 25 years who has had more than 2 sexual partners in the last year
Someone < 25 years who has contracted an STI in the last year
Street youth
Woman asking for an abortion
Someone with multiple sex partners
Man who has sex with men
Hard drug user, whether injection drug or not
Someone who has had sexual relations with a new partner who has recently been to
✔
a country where STI and HIV are highly endemic
Gonorrhea
Syphilis
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
STI and HIV are highly endemic
✔
✔
✔
Sex worker
Someone who asks to be tested, even if he or she has no risk factors
✔
✔
✔
✔
✔
✔
Someone who has had sexual relations with a partner from a country where
Source: Adapted from: “Canadian STD Guidelines”, 1998 Edition, Health Canada, “Sexually Transmitted Diseases Treatment Guidelines ”, 2002 edition, Centers
for Disease Control, USA, and “Recommandations de dépistage des MTS”, Comité MTS, MSSS, 2000.
Chlamydia and gonorrhea
Note that systematic testing for chlamydia among
all sexually active youth under the age of 25 is not
recommended (it could be recommended in particular clinical contexts, for example in a youth
clinic where prevalence of the infection is unusually high). The same recommentation applies to
gonorrhea.
We recommend that you wait for 3 weeks after the end
of any antibiotic treatment before taking a sample.
In men, it is important to wait one hour between
last urination and taking a urethral specimen. In
women, a sample taken from the endocervix can
be done even when the woman is menstruating, if
bleeding is not too abundant.
When testing for gonorrhea, it is important to
obtain pharyngeal and rectal specimens, if these
sites might have been exposed, even if the person
is asymptomatic.
Waiting a few days between the time of sexual contact at risk and the time when the specimen is taken
increases the probability of detecting a germ, thus
avoiding a false-negative result. Few data are available on this subject. It is not necessary to adhere to
this time frame if the person is symptomatic or if he
or she may be exposed to an STI regularly.
Syphilis
Since transmission can occur by simple oral-genital
contact without penis-rectum or penis-vagina penetration, and since a person often develops atypical
and transitory symptoms, you may not readily suspect syphilis. It is important to offer the test to all
individuals who have a risk factor.
During recent outbreaks, a high proportion of
men who have sex with men (MSM) who had
infectious syphilis also had HIV infection.
Therefore, we recommend offering an HIV test to
MSM who have infectious syphilis.
2
In some people with HIV infection, a syphilis
serology is difficult to interpret because of
abnormally high, low, or fluctuating titres, or a
false “non reactive” test.
Frequency of tests
The frequency for repeating screening tests
has not been established. People with repeated STI or who have multiple sex partners
could be evaluated regularly, every 3 to 6
months, for example.
Prévention en pratique médicale, August 2002
Tests
Nucleic Acid Amplification Testing (NAAT)
Screening for C. trachomatis
Over the last few years, most laboratories in Montreal hospitals have been offering
Chlamydia trachomatis (CT) screening by nucleic acid amplication test using the
PCR (polymerase chain reaction) method. Other NAAT methods are also available,
such as LCR (ligase chain reaction) or TMA (transcript mediated assay).
best choice. A urinary sample test should only be considered when taking a
genital specimen is not praticable or unacceptable to the patient and could be
an obstacle to testing. The urine test is especially pertinent for men, who are
more reluctant to being tested.
The anus and throat cannot be tested using the NAAT; the only appropriate test is
a cell culture.
Increased sensitivity and specificity
The sensitivity (proportion of infected people identified through testing) and
specificity (proportion of uninfected people identified through testing as noninfected) of NAAT in detecting CT are higher than for antigen detection tests such
as direct immunofluorescence (DIF) and enzyme immunoassay (EIA).
Test
Chlamydia
Genital EIA
Genital PCR
Urinary PCR
Sensitivity %
Men
Women
60.0
65.1
99.1
96.5
94.4
95.1
Procedures for obtaining a urine specimen
The patient must not have urinated for 2 hours before obtaining a urine specimen. The patient collects the first 10 mL of urine. The urine is refrigerated
(between 2oC and 8oC); if need be, the specimen can remain at room temperature
for a maximum of 24 hours.
Specificity %
Men
Women
75-95
95.9
98.5
99.4
100.0
99.8
Screening for N. gonorrhoeae
Gonorrhea may also be detected by a genital or urine specimen using NAAT. When
using NAAT instead of a culture (with sensitivities), it is impossible to establish
an antibiotic resistance profile for the strain of N. gonorrhoeae. Testing a urine
sample for N. gonorrhoeae using NAAT is especially advantageous when screening
people at risk of infection who are reached outside usual clinical settings (sauna
or bath houses, prisons...).
Possibility of analysing a urine sample
NAAT can be used not only to test genital secretions (cervix in women, urethra
in both men and women) but also urinary specimens. However, for complete
evaluation, a genital and pelvic examination and genital specimen are still the
Treatment
Treatment of choice
Alternatives
Doxycycline 100 mg PO BID X 7 days
Azithromycin 1g PO in 1 dose
or
Ofloxacin 300 mg PO BID X 7 days
Azithromycin 1g PO in 1 dose
Ceftriaxone 125 mg IM in 1 dose
Cefixime 400 mg PO in 1 dose
or
or
Ciprofloxacin 500 mg PO in 1 dose
Plus chlamydia treatment
Ceftriaxone 125 mg IM in 1 dose
Plus chlamydia treatment
Primary, secondary, and latent syphilis (less than a year)(2) – adolescents and adults
Benzathine penicillin G
2.4 million UI IM in 1 dose
Amoxicillin 500 mg PO TID X 7 days
or
Gonorrhea – adolescents and adults - Urethral, endocervical, pharyngeal, rectal infection
Cefixime 400 mg PO in 1 dose (1)
Plus chlamydia treatment
Pregnant or breastfeeding woman
Chlamydia – adolescents and adults - Urethral, endocervical, rectal infection
If allergic to penicillin:
Doxycycline 100 mg PO BID X 14 days
Benzathine penicillin G
If allergy to penicillin: desensitization
Latent syphilis of more than a year(2) – adolescents and adults
Benzathine penicillin G
2.4 million UI IM/week X 3 doses
If allergic to penicillin:
Doxycycline 100 mg PO BID X 28 days
Benzathine penicillin G
If allergy to penicillin: desensitization
(1) Cefixime and ceftriaxone should not be administered to people allergic to cephalosporin or who have ever had an immediate or anaphylactic reaction to penicillin.
(2) People with HIV may require treatment for a longer period of time and/or higher doses of medication.
Source: Adapted from: “Canadian STD Guidelines”, 1998 edition, Health Canada, and “Sexually Transmitted Diseases Treatment Guidelines”, 2002 edition, Centers for Disease Control, USA.
Up to 25% of cases of gonorrhea reported in
Montreal in 2001-2002 were treated with fluoroquinolone (ciprofloxacin or ofloxacin)
although the treatment of choice is cefixime.
Post-treatment follow-up test
Usually, a test is not repeated when following-up on
treatment for urethral or endocervical CT or NG infection. However, we recommend repeating the test
when compliance with treatment is difficult to verify or when the prescribed treatment is not optimal
Prévention en pratique médicale, August 2002
3
(e.g.: if cefixime or ceftriaxone is not used, or when
treating a gonococcal infection) and if the patient is
a child or a pregnant woman, or if there is a history
of treatment failure.
However, all cases of syphilis must be closely followed after treatment, especially people with HIV.
“STIs make a comeback” continued from page 1
Gonorrhea
Back after a 20-year decline
In Montreal, the annual number of cases of gonorrhea among men has increased by 120% since the
lowest levels were attained in 1996. (In the rest of
the province, the number rose by 65% during the
same period.) Although a large increase has also
been observed among women, men continue to
make up the majority of cases by far; in fact among
reported cases, the proportion of men has grown
from 75% in 1996 to 85% in 2001. Among men, the
proportion of men having sex with men (MSM)
has climbed from 53% in 1996 to 66% in 2001.
Of the cases reported in 2001, most of the men were
25 to 39-year-old whereas most women were aged
20 to 24-year-old; almost 80% are French-Canadian;
just over 5% reported using hard drugs; and 7% had
given or received money in exchange for sex.
Strains of fluoroquinolone-resistant
N. gonorrhoeae
In Montreal in 1994, a strain showing reduced sensitivity to ciprofloxacine was isolated for the first
time. Subsequently, 1 to 4 strains were identified
every year. In 2001, 15 were discovered. The continuous activity of floroquinolone-resistant gonococcal
infections highlights the importance of prescribing
cefixime as the treatment of choice for gonococcal
disease.
Infectious syphilis
Outbreak in the gay community
The annual number of reported cases of infectious
syphilis (SPC) in Montreal had been decreasing over
the last several years; the rate declined from 32 in
1990 to 1 in 1998. However, between 11 September
2000 and 31 July 2001, a total of 15 cases of infectious syphilis, 14 men and 1 woman, were reported.
Among the men, 12 (85.7%) were men who have sex
with men (MSM); the average age of these MSM was
39 years, 8 (66.6%) were French-Canadians, 6
(50.0%) said they had had sex with partners living
outside Québec, and 6 (50.0%) had had sex in
saunas with anonymous partners. None reported
having taken hard drugs or having given or received
money in exchange for sex. As of 2 July 2002, there
were 9 cases of infectious syphilis in 2002, all in
MSM, an indication that the trend is continuing.
In Québec, outside Montreal, 4 cases of infectious
syphilis were reported in 2001 and 4 in 2002 (as of
2 July). From 2000 to 2001 in New York City, the
number of cases more than doubled, and 50% of
cases were among MSM.
Regional service for the supply Vaccination against hepatitis
of benzathine penicillin G
Hepatitis B vaccination should be offered to
for the treatment of syphilis
people presenting an STI and those at risk of
At this time, benzathine penicillin G is available only
through the Special Access Programme (SAP) at Health
Canada’s Therapeutic Products Directorate. To make it
easier to have access to benzathine penicillin G through
the SAP, the Montreal Health Department has set up
a regional service to supply the medication.
To order doses from the Public Health Department,
contact (514) 528-2400, extension 3887 during
regular working hours. Delivery takes 2 to 24 hours,
depending on the time at which the Public Health
Department receives the order. Medication and
delivery are free. When placing your order, you
should have the following information on hand: indication for the medication, and the patient’s initials, date of birth and sex.
being exposed to an STI.
Free vaccination in Montreal
In Montreal, hepatitis B vaccination is free for
people who have contracted gonorrhea or infectious syphilis and their sexual partners, and for all
people aged 18 years and under.
Moreover, hepatitis A and B vaccination is free for
specific populations including MSM, people who
use injection drugs, and street youth.
Partner Notification Service,
Public Health Department
For doctors who wish to refer a patient:
528-2400, extension 3840
For Patients and their partners: 528-2464
(direct, confidential telephone line)
Prescribe condoms!
A person usually goes through different stages
before adopting new behaviours and condom
use is no exception. Physicians can help their
patients by developing a helping relationship
and a one of trust:
create or strengthen the need for your
patient to use condoms,
discuss the patient’s risk factors that support or obstruct this behaviour,
encourage the patient to start changing gradually, using solutions that suit him or her,
support and monitor the efforts required
to maintain this behaviour.
Condoms are not effective if they are not
used properly!
The spermicide nonoxynol-9 can increase the risk
of HIV transmission through mucosal irritation.
If condoms are used for HIV and STI prevention,
they should be those without nonoxynol-9
www.santepub-mtl.qc.ca
révention
en pratique médicale
a twice-monthly column
on the Web
4
The #9-STI fact sheets (August 2002) included with
this bulletin are an up-date of the #9-STD fact
sheets (February 2000) from the "Prévention en
pratique médicale" binder.
révention
en pratique médicale
A publication of the Direction de santé publique
de Montréal-Centre in collaboration with the
Association des médecins omnipraticiens de Montréal,
as part of the Prévention en pratique médicale programme coordinated by Doctor Jean Cloutier.
This issue is produced by the
Infectious Disease Unit
Head of the unit: Dr. John Carsley
Editor-in-chief: Dr. Monique Letellier
Editor: Blaise Lefebvre
Graphic designer: Paul Cloutier
Translator: Sylvie Gauthier
Texts by: Dr. Gilles Lambert
Dr. Marc Steben
Contributors:
Dr. Jean-Pierre Villeneuve
Dr. Mark A. Miller
Dr. Jean Vincelette
1301 Sherbrooke East, Montreal, Québec H2L 1M3
Telephone: (514) 528-2400, fax: (514) 528-2452
http://www.santepub-mtl.qc.ca
email: [email protected]
Legal deposit – 3rd trimester 2002
Bibliothèque nationale du Québec
National Library of Canada
ISSN: 1481-3734
Agreement number: 40005583
Association
des Médecins
Omnipraticiens
de Montréal
Prévention en pratique médicale, August 2002
STIs
révention
Sexually Transmitted Infections
en pratique médicale
Notification of partners
The infection rate is high among the partners (men or women) of individuals suffering from a sexually transmitted infection.
Many of these partners remain asymptomatic.
At least 30% to 35% of all sexual partners are unaware that they have been exposed to the infection:
• 5% of regular partners,
• 30% of occasional partners,
• up to 60% of casual partners.
The notification of sexual partners is the process through which all sexual partners, not just the regular partner, are promptly identified,
located, assessed, treated and advised on prevention measures in order to reduce the risk of sequellae among the partners and avoid
spreading the infection in the community.
The medical treatment of an STI includes the notification of the partners.
Notification must be discussed at the time of the first medical evaluation
1. Provide the patient with complete information on the STI and explain that it is relevant and necessary to inform the partners.
2. Establish with the patient a list of all sexual partners to be contacted,
bearing in mind the STI’s incubation and contagious periods.
3. Discuss ways of notifying the partners.
• If the patient wishes to personally notify the partners, discuss how he will do so. Present possible problems and solutions.
Suggest to the patient that a third party such as a friend, a physician or a public health professional be present when a partner is informed.
If
• the patient does not wish to personally notify the partners, suggest that a third party such as a physician, a nurse or
a public health professional notify the partners without revealing the patient’s identity. Collect the information needed to
retrace the partners that the patient refuses to contact and in respect of whom he agrees to have a third party intervene:
name, sex, address, telephone numbers (home and work), date and type of exposure, age or date of birth, place of work or study.
4. Ensure follow-up.
Set a deadline within which the patient promises to notify his partners. Notification should take place promptly, ideally
within 48 hours. Plan a follow-up telephone call or visit. It is useful to make note of at least the partners’ first names
in order to ascertain whether the patient has indeed taken the necessary steps to notify each one of them.
Provide special assistance when notification occurs in the following situations
When the index case:
•
•
•
•
•
•
•
had two or more partners during
the infection period
is reluctant to personally inform certain
of his partners
fears violence or reprisals
is suffering from pelvic inflammatory disease
has suffered from STIs repeatedly
or has undergone several abortions
has been exposed through sexual abuse
is under 20 years of age and suffering
from a chlamydial infection.
When the partner:
•
•
•
•
•
•
is a casual or occasional partner
appears to play a key role in the transmission
process or appears to be the source
of the patient’s infection
also has several partners
is hard to locate
is likely to be unaware of the exposure
is pregnant.
When the infection is:
•
•
•
•
•
•
•
a contagious syphilis
a gonococcal infection (especially
if the strain is resistant to quinolone)
a chancroid
a venereal lymphogranuloma
an inguinal granuloma
an HIV infection
a chlamydial infection in someone less
than 20 years old.
Notification is recommended even in the case of a clinical syndrome that is compatible with an STI:
a clinical diagnosis of pelvic inflammatory disease, urethritis, mucopurulent cervicitis or proctitis made
when samples cannot be taken or test results are negative.
Direction de santé publique de Montréal-Centre August 2002 ISSN: 1481-3742
9
STIs
Dealing with sexual partners*
Partners to be contacted **
STI
Chlamydial
infections or
compatible
syndromes,
including pelvic
inflammatory
disease
Gonococcal
infections or
compatible
syndromes,
including pelvic
inflammatory
disease
Hepatitis A
Fecal-oral transmission
frequent among men
who have sexual
relations with men
Hepatitis B
• All sexual partners :
•
•
- during the 60 previous days prior to the
appearance of symptoms or, if the patient
is asymptomatic, before the diagnosis was
made
- up to the seventh day after adequate
treatment was effected.
In the absence of a partner during this
period, go back to the most recent partner.
In the case of an infected newborn, assess
the mother and her sexual partners.
• All sexual partners :
•
•
- during the 60 previous days prior to the
appearance of symptoms or, if the patient
is asymptomatic, before the diagnosis was
made
- up to the seventh day after adequate
treatment was effected.
In the absence of a partner during this
period, go back to the most recent partner.
In the case of an infected newborn,
assess the mother and her sexual partners.
• All sexual partners during the two weeks
preceding and the week following either
jaundice or the acute phase of the illness.
Clinical procedures ***
Preventive measures
• Clinical evaluation including samples.
• Treatment even if the analysis
• Patient and partners should abstain
• Clinical evaluation including samples.
• Treatment for gonococcal infection and
• Patient and partners should abstain
• Clinical evaluation.
• Serology if necessary (AntiHAV-IgM).
• Immunization as quickly as possible with:
• Wash hands frequently.
• Monitor the appearance of symptoms
• Depending on whether the cases are acute
• Never share syringes, needles, razors
or toothbrushes.
• During the six months following
of the samples is negative.
for chlamydial infection even if the analysis
of the samples is negative.
from sexual relations or use a condom
until seven days after the end of
the treatment.
from sexual relations or use a condom
until seven days after the end of
the treatment.
among food handlers or day-care workers.
- Hepatitis A vaccine within 7 days of the
last infectious contact (add immunoglobulin (IG) if immunodeficient).
- IG only if between 7 and 14 days of
last infectious contact.
•
•
Acute cases:
- All sexual partners during the six months
preceding the appearance of symptoms.
Chronic cases:
- All regular or current sexual partners
- All sexual partners since the likely time
of infection.
or chronic and the partners regular or new:
- serology (HBsAg and anti-HBs)
at 0 and six months
- vaccination against hepatitis B
- administration of specific hepatitis B
immune globulin (HBIG) if contact
less than 14 days.
the last exposure:
- abstain from sex or use a condom
- do not breast feed or donate blood,
sperm or organs
- discuss risks if pregnancy is considered.
Herpes simplex
• All current or regular sexual partners.
from sex during symptomatic
• Risk of transmission especially to newborn • Abstain
periods of index case.
if primary infection occurred during pregnancy.
• Use a condom between symptomatic phases.
• Explanation of possible contagiosity
Syphilis
• All sexual partners during the period
• Clinical and serological assessment:
(VDRL and TP-PA).
• Preventive treatment of all partners
during asymptomatic phase.
specific to each stage of development:
- Primary syphilis: 3 months ➤
- Secondary syphilis: 6 months Contagious
phase
- Early latent syphilis: 1 year
➤
- Late latent syphilis:
assess spouse or longstanding
partners and children
- Congenital syphilis: examine the mother
and sexual partners.
Both parents of infected newborns.
Trichomoniasis
•
• All sexual partners during
HIV
•
• Abstain from sex or use a condom
until cured.
of contagious syphilis cases:
- during the past 90 days even if
the serology is negative
- over 90 days if follow-up is uncertain or
the results are not available quickly.
• Abstain from sex or use a condom
• Clinical microscopy.
• Treatment of symptomatic or asymptomatic until cured.
the 60 previous days.
sexual partners even if results are negative.
All current and previous sexual partners
since the likely time of infection determined
according to the history of exposure
and the clinical evaluation.
• Clinical and serological evaluation (anti-HIV)
•
Human
papilloma
virus (HPV)
• All current or regular sexual partners.
at time 0, then at three, and if need be,
six months after the last exposure because
of variable delays in seroconversion
(diagnostic window).
Pre-and post-test counselling.
• Simple visual examination.
• Cytology of the cervix for women
when it goes back more than one year.
• Treatment solely of macroscopic lesions.
• Never share syringes, needles, razors
or toothbrushes.
• During the six months following
the last exposure:
- abstain from sex or use a condom
- do not breast feed or donate blood,
sperm or organs
- discuss risks if pregnancy is considered.
• Use of condom recommended with new
or occasional partners (variable protection
depending on location of lesions).
***Depending on the history, sampling for STIs other than that of the index case may be recommended.
* Only factors concerning sexual partners have been incorporated into this table.The physician
may have to take into account other exposed individuals, e.g. the newborn child of a mother
- Vaccination against hepatitis B is recommended for anyone with an STI and all of the individual’s sexual
infected by HBV.
partners. It is free of charge for cases of gonorrhea and syphilis in the contagious stage and for their partners,
regardless of age.
** Depending on the exposure history of the index case, the reference period could be broadened
in respect of the inclusion of partners to be contacted.
- Vaccination against hepatitis A and B is recommended and is free of charge for all men who have sexual
relations with other men, injection drug users, street youths and chronic carriers of HCV.
Association
des Médecins
Omnipraticiens
de Montréal
STIs
esources
Sexually Transmitted Infections
Direction de santé publique de Montréal-Centre: (514) 528-2400
1. Notification of partners - NoPa STIs/HIV
Specialized regional support service pertaining to the notification of the partners of individuals suffering from STIs or HIV infection.
Confidentiality is assured.
(514) 528-2400, ext. 3840
• Service for physicians wishing to refer patients
(514) 528-2464 (direct, confidential line)
• Direct service for patients and their partners
2. Reporting of STIs by the physician (compulsory reportable diseases)
STIs should be reported promptly by telephone at (514) 528-2400, ext. 3840, by mail,
or through the fax line devoted to reportable diseases at (514) 528-2461. Confidentiality is assured.
Use the appropriate form or a copy of the laboratory report, as the case may be, for the following infections:
• gonococcal infection
• inguinal granuloma
syphilis
•
• venereal lymphogranuloma
• chancroid
• Chlamydia trachomatis infection
viral
hepatitis
A
and
B
•
• HIV (The Laboratoire de santé publique du Québec
will directly contact the physician)
3. Epidemiological data
The Epidemiological Surveillance Bureau (Bureau de surveillance épidémiologique) is responsible for receiving, verifying, compiling,
analysing and archiving reports on reportable diseases. To obtain epidemiological data, call (514) 528-2400, ext. 3858
or visit the Web site of the Direction de santé publique: http://www.santepub-mtl.qc.ca, infectious diseases section.
For physicians who prefer to refer their patients
Clinics - Adapted from a list distributed by the Centre québécois de coordination sur le sida
Name
Address
Clinique 30 St-Joseph
Clinique médicale des Jeunes St-Denis
Clinique médicale l’Alternative
Clinique médicale 1851
Clinique médicale GLR
Clinique médicale l’Actuel
Clinique médicale La Cité
Clinique médicale de l’Ouest
Clinique médicale du Quartier Latin
Head and Hands Inc.
Telephone (514)
30, boul. St-Joseph Est, local 100, Montréal (Québec) H2T 1G9
CLSC des Faubourgs, 1250, rue Sanguinet, 3e étage, Montréal (Québec) H2X 3E7
2034, rue St-Hubert, Montréal (Québec) H2L 3Z5
1851, rue Sherbrooke Est, bureau 101, Montréal (Québec) H2K 4L5
3545, chemin de la Côte-des-Neiges, bureau 023, Montréal (Québec) H3H 1V1
1001, boul. de Maisonneuve Est, bureau 1130, Montréal (Québec) H2L 4P9
300, rue Léo Pariseau, bureau 900, case postale 933, Place du Parc, Montréal (Québec) H2W 2N1
4647, rue Verdun,Verdun (Québec) H4G 1M7
905, boul. René-Lévesque Est, Montréal (Québec) H2L 5B1
2304, avenue Old Orchard, Montréal (Québec) H4A 3A8
845-4240
844-9333
281-9848
524-7564
935-1197
524-1001
281-1722
765-3600
285-5500
481-0277
CLSC - Refer patients to youth or family medicine clinics
EAST
(514)
Montréal-Est/PAT
642-4050
Rivière des Prairies 494-4924
Montréal-Nord
327-0400
Mercier-Est/Anjou
356-2572
Olivier-Guimond
255-2365
Saint-Léonard
328-3460
Saint-Michel
374-8223
De Rosemont
524-3541
Hochelaga-Maisonneuve 253-2181
CENTRE
Plateau Mont-Royal
Saint-Louis du Parc
Des Faubourgs
Métro
Côte-des-Neiges
René-Cassin
NDG/Mtl-Ouest
(514)
521-7663
286-9657
527-2361
934-0354
731-8531
488-9163
485-1670
Hospitals - Refer patients to family medicine clinics
Direction de santé publique de Montréal-Centre August 2002 ISSN: 1481-3742
WEST
Pierrefonds
Lac Saint-Louis
du Vieux La Chine
(514)
626-2572
697-4110
639-0650
SOUTHWEST
Saint-Henri
Pointe Saint-Charles
Verdun/Côte St-Paul
LaSalle
933-7541
937-9251
766-0546
364-2572
NORTH
Ahuntsic
Parc Extension
La Petite Patrie
Villeray
Bordeaux-Cartierville
Saint-Laurent
(514)
381-4221
273-9591
273-4508
376-4141
331-2572
748-6381
9
STIs
Community services
ACTION
SÉRO-ZÉRO
•
Prevention and intervention aimed at men who have sexual relations with other men
STELLA
•
•
•
•
•
•
Prevention and intervention aimed at women working in the sex industry:moral support,referrals,and so on (514) 285-8889
GAP-VIES
CRISS
RUBAN EN
ROUTE
(514) 521-7665
Prevention, support and intervention aimed at the Caribbean and African Communities (non restrictive) (514) 722-5655
Centre de Ressources et Intervention en Santé et Sexualité :
Prevention, support and intervention for women living with HIV
Prevention and management of STIs
Individual, couple, and group counselling (condylomas and herpes)
(514) 855-8991
(514) 725-6425
Telephone support lines
STI
•
Support and information line dealing with condylomas, herpes and other STIs
GAI-ÉCOUTE
•
Free telephone service offering information and resources for gays, lesbians and bisexuals
INFO-SIDA
•
•
Service of CPAVIH (Comité des Personnes Atteintes du VIH - People living with HIV)
Referral line, help line and info
(514) 855-8995
1-888-505-1010
(no charge)
(514) 521-7432
1-866-521-7432
(regions)
Documentation
•
•
Canadian STD Guidelines, 1998, Health Canada, Health Protection Branch, Laboratory Centre for Disease Control (LCDC).
Highlights of the Canadian STD Guidelines, 1998, Health Canada, Health Protection Branch, Laboratory Centre
for Disease Control (LCDC). Summary of Canadian guidelines concerning the most frequent STIs.
Both documents are available free of charge to physicians. To obtain a copy, call (514) 528-2400, ext. 3953
(Direction de santé publique de Montréal-Centre). Both publications are also available at the following Web address:
http://www.hc-sc.gc.ca/hpb/lcdc/bah
•
•
Sexually Transmitted Diseases, Holmes K.K., Mardh P.E. et al. McGraw Hill, 3rd ed., 1999.
•
Canadian Immunization Guide, 6th ed., 2002, Health Canada, Population and Public Health Branch,
Centre for Infectious Disease Prevention and Control. Publication: Canadian Medical Association, (613) 731-8610, ext. 2307.
Protocole d’immunisation du Québec, 1999 and updates, MSSS, Direction générale de santé publique.
Distribution: Direction de santé publique de Montréal-Centre, (514) 528-2400, ext. 3863.
Québec program, administered by RAMQ, to provide free drugs
to treat sexually transmitted infections
Under this program, anyone covered by the Québec health insurance plan and suffering from a bacterial STI (chlamydial infections,
gonococcal infections, syphilis, inguinal granuloma, chancroid and venereal lymphogranuloma) and the individual’s partners can obtain
drugs free of charge from private pharmacies.
The physician must write out a prescription for each patient, using his own prescription form (it is not necessary to use a special form).
In addition to the usual information, the physician must note one of two codes used in the free-drug program, depending on the situation:
•
•
Code K : Treatment of individuals suffering from STIs
Code L : Treatment of the partners of individuals suffering from STIs
Association
des Médecins
Omnipraticiens
de Montréal