Download British Columbia Treatment Guidelines: Sexually Transmitted

655 West 12th Avenue
Vancouver, BC V5Z 4R4
General Inquiries: 604.707.2400
Provincial STI/HIV Clinic Phone: 604.707.5600
Provincial STI/HIV Clinic Fax: 604.707.5604
www.bccdc.ca
British Columbia
Treatment Guidelines
Sexually Transmitted Infections
in Adolescents and Adults 2014
Prepared by:
Richard Lester, MD, FRCP(C), Medical Head, Provincial STI/HIV Clinic, Clinical Prevention Services (CPS)
Carolyn Montgomery, MB, BCh, Provincial STI/HIV Clinic Physician, CPS
Barbra Arnold, MD, CCFP, DTMH, Provincial STI/HIV Clinic Physician, CPS
Sylvia Makaroff, MD, CCFP, Provincial STI/HIV Clinic Physician, CPS
Avril Spencer, BScN, Provincial STI/HIV Clinic Educator, CPS
Gina Ogilvie, MD FCFP DrPH, Medical Director, CPS
These guidelines are based on the Canadian Guidelines on Sexually Transmitted Infections
(STI) 2010 Edition and online updates to 2014
Titling
This document contains treatment guidelines for clinicians and public health professionals regarding care and treatment of STIs in British Columbia and are based on
DIDbest
YOU
KNOW
CAPTIONS:
the
available
scientific
knowledge and medical practices. These guidelines are for information purposes only and are not intended in any manner to replace clinical
judgment or to establish the only approach to all patients. Clinicians and public health professionals must use their independent medical judgment in the context of the
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individual clinical circumstances to determine patient careBody
or treatment.
Clinicians
and public
professionals
are encouraged
to consult other
in order
to
adipiscing
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nonummy
confirm
the information
contained
in thesenibh
guidelines, including,
but
not
limited
to,
individual
product
monograph(s),
and
standards
or
instructions
provided
by
licensed
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manufacturers.
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aliquam erat volutpat.
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These guidelines may be updated as evidence and currentmolestie
practice regarding
the management
of STIs
evolves. eu
Clinicians
and public
professionals
musteros
ensure the
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at vero
guidelines they have are current. Although all efforts are taken by BCCDC to ensure the completeness of the guidelines, BCCDC does not guarantee the completeness or
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accuracy of the information nor is the BCCDC responsibleet
for accumsan
damages resulting
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of the information.
Look
for this mark
PULL QUOTES:
throughout the document to
Loreminfections
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sit
identify
notifiable
to
the medical
health officer
amet,
consectetuer
REPORTABLE
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nonummy nibh euismod
Include routine HIV screening with any
other
STI testing.
certaindolore
sexually
tincidunt
ut With
laoreet
transmitted infections, it is important to
treat
partners
and contacts
at the time of
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erat
testing, before results are available.
volutpat.
Recommendations regarding treatment of
paediatric infections are excluded from these
guidelines. In general, children diagnosed
with a STI should be managed in conjunction
with a specialist and investigation of possible
sexual abuse needs to be considered.
Contact the Provincial STI/HIV Clinic
Physician for further management or
the Child Protection Service Unit (a
multidisciplinary team located at BC
Children’s Hospital) 604.875.2000 or
1.800.300.3088 (toll free in BC only).
Routine STI updates are communicated
via admin circulars on the BCCDC website.
To receive ongoing STI Updates, go to the
BCCDC website: www.bccdc.ca - CDC
Manual- Admin Circulars, enter your Email
address and SUBMIT
delenit augue duis dolore te feugait nulla facilisi. Lorem ipsum dolor sit
The level of evidence and strength of recommendations are graded and summarized below.
amet,
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tincidunt ut laoreet dolore magna aliquam erat volutpat.
Table 1. Levels of Recommendation
Recommendation:
A
Strongly
recommends
clinicians
routinely
provide the treatment
Ut wisi
enim ad minim
veniam,
quis
nostrudthat
exerci
tation
ullamcorper
to eligible individuals. Good evidence that the treatment improves
suscipit lobortis nisl ut aliquip
ex ea
commodo
eu concludes
feugiat nulla
facilisis
at
important
health
outcomes and
that benefits
substantially
outweigh
harms.
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odio
dignissim qui blandit praesent
luptatum zzril delenit augue duis dolore te feugait nulla facilisi.
Recommendation: B
Recommends that clinicians routinely provide the treatment to
eligible individuals. At least fair evidence that the treatment improves
important health outcomes and concludes that benefits outweigh
harms.
Subtitles
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Recommendation: C
No recommendation for or against routine provision of the treatment.
doming id quod mazim placerat
possim
assum.
At leastfacer
fair evidence
that the
treatment can improve health outcomes
but concludes that the balance of the benefits and harms is too close
to justify a general recommendation.
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nonummy
nibh euismod
tincidunt
ut laoreet
doloreproviding
magnathealiquam
erat
Recommendation:
D
Recommends
against routinely
treatment to
asymptomatic individuals. At least fair evidence that the treatment is
volutpat. Duis autem vel eum
iriure
dolor
in
hendrerit
in
vulputate
velit
ineffective or that harms outweigh benefits.
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eros
et accumsanI et iusto odio
dignissim
quitoblandit
praesent
luptatum
Recommendation:
Evidence
is insufficient
recommend
for or against
routinely
providing the treatment. Evidence that the treatment is effective is
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te
feugait
etre
nulla
facilisi.
lacking, of poor quality or conflicting, and the balance of benefits and
harms cannot be determined.
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nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat
volutpat.
Table 2. Quality of Evidence
Ι
Evidence from at least one properly randomized, controlled trial.
Subtitles
П
Evidence from at least one well-designed clinical trial without randomization, from cohort or
case-control
analytic
from more
than one centre),
multiple timeDuis autem
vel eum
iriurestudies
dolor(preferably
in hendrerit
in vulputate
velitfrom
esse
series studies or from dramatic results in uncontrolled experiments.
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Prepared by:
To keep the guidelines concise, references
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nulla
facilisis
at
vero eros et
are not published with the guidelines.
Ш
Evidence from opinions of respected authorities based on clinical experience, descriptive
or reports
accumsanstudies
et iusto
odioof expert committees.
dignissim qui
Name here
References are available on the BCCDC
blandit praesent luptatum
zzril delenit
website, Chapter 5 - CDC Manual
For reportability
of sexually
transmitted
infections
refer
to
the
Public
Health
augue
duis
dolore
te
feugait
etreAct of
Date here
http://www.bccdc.ca/dis-cond/comm-manual/
British Columbia (PHA): Health Act Communicable Disease Regulation
CDManualChap5.htm or the Public Health
nulla facilisi.
Agency of Canada website: http://www.hc-sc.
gc.ca/hc-ps/dc-ma/sti-its-eng.php
See: http://www.health.gov.bc.ca/phact/
Nam
liber tempor
soluta nobis
To consult
with thecum
Provincial STI/HIV Clinic Physician call 604.707.5600
eleifend option congue nihil imperdiet doming id quod mazim placerat
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
1
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
dolore magna aliquam erat volutpat.
Chlamydia - Chlamydia trachomatis
REPORTABLE
If Lymphogranuloma Venereum (LGV) is suspected please contact the Provinicial STI/HIV Clinic Physician and refer to LGV Section.
Recommended Regimen
DID
YOU KNOW
Doxycycline
100CAPTIONS:
mg PO bid for 7 days (A-Ι)
OR
Titling
Considerations - Pregnancy/Lactation
• A test of cure (TOC) should be
performed 3 - 4 weeks after initiation of
Follow Up
A TOC for C. trachomatis
IS NOT
when:tation
Body Copy: Ut wisi enim ad minim veniam,
quisRECOMMENDED
nostrud etre exerci
treatment for all pregnant or lactating
• the standard treatment regimen for
ullamcorper
ea commodo
consequat.
women. suscipit lobortis nisl ut aliquip ex
chlamydia
has been
completed
Duis
autem
vel
eum
iriure
dolor
in
hendrerit
in
vulputate
velit
• Fluoroquinolones, doxycycline and
• signs and symptoms esse
have resolved
Alternate Treatment
estolate
preparations
erythromycin
molestie
consequat,
velof illum
dolore eu feugiat
at vero
eros
• therenulla
is no facilisis
re-exposure
to an untreated
Erythromycin 500 mg PO qid for 7 days (B-Ι)
are contraindicated
pregnant
and qui blandit
partner
et accumsan
et iusto for
odio
dignissim
praesent luptatum zzril
OR
lactating women.
Lorem ipsum dolor sit
Erythromycin 250 mg PO qid for 14 days (B-Ι) delenit augue duis dolore te feugait nullaAfacilisi.
TOC for C. trachomatis
PULL QUOTES:
amet, consectetuer adipiscing elit, sed diam
nonummy
nibhwhen:
euismod
IS RECOMMENDED
Considerations
▫
compliance
is
uncertain
tincidunt
ut laoreet dolore magna aliquam erat volutpat.
Partners/Contacts
Lorem ipsum dolor sit amet, consectetuer
Azithromycin 1 g PO in a single dose (A-Ι)
adipiscing elit, sed diam nonummy nibh
(If vomiting occurs more than one hour postadministration,
a repeat
dose is dolore
not required.)
euismod
tincidunt
ut laoreet
magna
aliquam erat volutpat.
Lorem
dolor sit disease
• Assessipsum
for pelvic inflammatory
(PID) or epididymitis and treat accordingly
amet,
consectetuer
(See PID
or Epididymitis Section)
• Gonorrhea is less common and has a
adipiscing
elit, sed diam
shorter window period than chlamydia,
therefore a negative gonorrhea test
nonummy
nibh euismod
usually rules out a gonorrhea coinfection. ut laoreet dolore
tincidunt
Pregnancy/Lactation
magna
aliquam erat
Recommended Regimen
volutpat.
Amoxicillin 500 mg PO tid for 7 days (A-Ι)
OR
All partners/contacts in the last 60 days,
▫ patient was not initially treated
regardless of symptoms or signs, should
with atation
recommended
regimen
Ut wisi enim ad minim veniam, quis nostrud exerci
ullamcorper
be tested and treated with one of the
▫ patient is pregnant
suscipit
lobortis
nisl ut aliquip
recommended
regimens.
If there isex
noea commodo eu feugiat nulla facilisis at
• Repeat screening is recommended at
vero
erosduring
et accumsan
iusto
odio dignissim qui blandit praesent
partner
this period, et
then
the last
6 months post-treatment as chlamydia
partner
should
be
tested
and
treated.
luptatum zzril delenit augue duis dolore te feugait
nulla
facilisi.
re-infection
risk
is high.
Patients and contacts should abstain from
sexual activity for 7 days after initiation of
treatment and should be advised to avoid
Subtitles
exposure to any untreated partner(s).
Nam liber tempor cum soluta nobis eleifend option congue nihil imperdiet
doming id quod mazim placerat facer possim assum.
Azithromycin 1g PO in a single dose (B-Ι)
Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam
nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat
volutpat. Duis autem vel eum iriure dolor in hendrerit in vulputate velit
esse molestie consequat, vel illum dolore eu feugiat nulla facilisis at vero
eros et accumsan
et iusto odio dignissim qui blandit praesent luptatum
REPORTABLE
Lymphogranuloma Venereum
zzril delenit augue duis dolore te feugait etre nulla facilisi.
(If vomiting occurs more than one hour postadministration, a repeat dose is not required.)
(LGV) C. trachomatis - Serovars L1,2,3
should abstain from sexual activity
Recommended Regimen
Lorem
ipsum dolor sit amet, consectetuerPatients
adipiscing
elit, sed diam
until 3 weeks after initiation of treatment
Doxycycline 100 mg PO bid for 21 days (B-П)
nonummy nibh euismod tincidunt ut laoreet
magna
aliquam
erat
anddolore
should be
advised
to avoid exposure
to
Alternate treatment
volutpat.
any
untreated
partner(s).
The diagnosis of LGV is not always straightforward Azithromycin 1g PO in a single dose, once
*For suspected LGV cases, please contact the
Provincial STI/HIV Clinic Physician for further
management.
and symptoms often overlap with other STIs. A
diagnosis of LGV is often based on history and
clinical presentation which is later confirmed by
laboratory testing.
weekly for 3 weeks (C-Ш)
OR
Contacts should abstain from sexual activity
for 7 days after initiation of treatment.
Erythromycin 500 mg PO qid for 21 days (C-Ш)
Subtitles
Treatment of Contacts to LGV
(Patients are less likely to be compliant with
Duis
autemx 3vel
eum
iriure dolor in hendrerit
in vulputate
esse
Doxycycline
100 mgvelit
PO bid
for 7 days (A-Ι)
Erthromycin
weeks
duration)
OR
molestie consequat, vel
illum dolore eu
Considerations
Prepared by:
Azithromycin 1g PO in a single dose (A-Ι)
Partners/Contacts
LGV strains of C. trachomatis are more
feugiat
nulla facilisis at
vero eros et
All partners/contacts within 60 days prior
invasive, preferentially affecting the lymph
accumsan et iusto odio
dignissim
Treatment of Contacts
to LGVqui
with
to symptom initiation should be tested
and here
Name
tissue. If a patient presents with a painless genital
symptoms
and/or
lab
tests
consistent
blandit
praesent
luptatum
zzril
delenit
treated as a contact. If there is no partner
papule, proctitis (especially hemorrhagic proctitis),
with LGV
duringduis
this period,
augue
dolorethen
te the last partner
feugait etre
painful inguinal/femoral lymphadenopathy AND
Date here
Doxycycline 100 mg PO bid x 21 days
should
be
tested
and
treated.
has had a positive C. trachomatis CT/GC NAAT
nulla facilisi.
(nucleic acid amplification test) swab from a lesion
or the rectum, please arrange for confirmatory
LGV testing by contacting your laboratory or
the Provincial STI/HIV Clinic Physician. Empiric
treatment may be warranted.
Nam liber tempor cum
soluta nobis
eleifend option congue nihil imperdiet doming id quod mazim placerat
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
2
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
Chlamydia & Lymphogranuloma Venereum
dolore magna aliquam erat volutpat.
Gonorrhea - Neisseria gonorrhoeae
REPORTABLE
The treatment regimen recommended by BCCDC differs from the Canadian STI Guidelines treatment guidelines for
Neisseria gonorrhoeae. BC recommendations continue to be updated according to provincial surveillance data.
Uncomplicated Infection
DID
YOU KNOW CAPTIONS:
(Urogenital/Rectal/Pharyngeal
sites)
Titling
Considerations
• Assess for pelvic inflammatory
Partners/Contacts
All partners/contacts in the last 60 days,
All regimens
require
concomitant
empiric
Lorem
ipsum dolor
sit amet,
consectetuer
treatment
for
chlamydial
and
other
adipiscing elit, sed diam nonummy nibh
non-gonoccoccal infections.
euismod tincidunt ut laoreet dolore magna
aliquam
erat volutpat.Regimen
Recommended
or epididymitis
and treat
regardless
of symptoms
signs tation
should
Bodydisease
Copy:(PID)
Ut wisi
enim ad minim
veniam,
quis nostrud
etre or
exerci
accordingly.
be tested and treated with one of the
ullamcorper suscipit lobortis nisl ut aliquiprecommended
ex ea commodo
consequat.
regimens. If there is no
• Obtaining cultures for N. gonorrhoeae
Duis isautem
vel
eum
iriure
dolor
in
hendrerit
in
vulputate
velit
esse
partner during this period,
then the last
important for monitoring antibiotic
partner
should
be
tested
and
treated.
molestie
consequat,
vel
illum
dolore
eu
feugiat
nulla
facilisis
at
vero
eros
resistance.
Clinicians
are
encouraged
to
Cefixime 800 mg PO in a single dose (A-Ι)
perform
a
culture
for
N.
gonorrhoeae,
in
et
accumsan
et
iusto
odio
dignissim
qui
blandit
praesent
luptatum
zzril
OR
Patients and contacts should abstain from
addition to a CT/GC NAAT (nucleic acid
Ceftriaxone 250 mg IM in a single dose (A-Ι) delenit
activity
for 7ipsum
days after
initiation
augue duis dolore te feugait nullasexual
facilisi.
Lorem
dolor
sit of
amplification test) test, for any patient
(The QUOTES:
preferred diluent for this dose of ceftriaxone is
treatment
and
should
be
advised
PULL
amet,with
consectetuer
adipiscing
sed diam nonummy nibh euismodto avoid
obvious cervical,
urethral orelit,
rectal
0.9 mL of 1% lidocaine without epinephrine to reduce
exposure to any untreated partner(s).
discomfort.)
tincidunt
ut laoreet dolore magna aliquam erat volutpat.
discharge.
Lorem
PLUSipsum dolor sit
Azithromycin 1 g PO in a single dose (A-Ι)
amet,
(If vomitingconsectetuer
occurs more than one hour postadministration, a repeat dose is not required.)
adipiscing elit,ORsed diam
Doxycycline 100 mg PO bid for 7 days (A-Ι)
nonummy nibh euismod
Alternate Treatment
Azithromycinut
2 g laoreet
PO in a single
dose (A-Ι)
tincidunt
dolore
(Taking medication with food may minimize adverse
effects.)
magna
aliquam
erat
OR
Spectinomycin 2 g IM in a single dose (A-Ι)
volutpat.
(Consult Provincial STI/HIV Clinic Physician to order
and access this medication. Test of cure (TOC) is
recommended.)
PLUS
Co-treatment for chlamydia
• Cultures for N. gonorrhoeae should be
performed
in all
casesveniam,
of:
wisi
enim ad
minim
Follow Up
• TOC
by culture
recommended for
Ut
quis nostrud
exerci
tation isullamcorper
gonorrhea
positive
patients
3 – 7at
days
▫
suspected
pelvic
inflammatory
suscipit lobortis nisl ut aliquip ex ea commodo eu feugiat nulla
facilisis
after initiation of treatment when:
disease (PID)
vero eros et accumsan et iusto odio dignissim qui blandit praesent
▫ patient is diagnosed with a
▫ treatment failure
luptatum zzril delenit augue duis dolore te feugaitgonococcal
nulla facilisi.
pharyngeal infection
▫ sexual contacts outside of Canada
or from areas with recognized
antimicrobial resistance
▫ patient is treated with a
non-recommended regimen
▫ treatment failure is suspected
▫ sexual assault
Subtitles
▫ antimicrobial
resistance
to therapy
Nam liber tempor cum soluta nobis eleifend option
congue nihil
imperdiet
is documented
Pregnancy/Lactation
doming id quod mazim placerat facer possim assum.
Recommended Regimen
▫ compliance is uncertain
▫ re-exposure to an untreated
Cefixime 800 mg PO as a single dose (A-Ι)
Lorem
ipsum dolor sit amet, consectetuer adipiscing elit, sed diam
partner is suspected
OR
nonummy
euismod
tincidunt
ut laoreet dolore
magna aliquam erat
Ceftriaxonenibh
250 mg
IM in a single
dose (A-Ι)
▫ PID or disseminated gonococcal
volutpat.
Duis autem vel eum iriure dolor in hendrerit
in vulputate
velit
PLUS
infection
is diagnosed
Amoxicillin
500 consequat,
mg PO tid for 7
days
(A-Ι)dolore eu feugiat
esse
molestie
vel
illum
nulla
facilisis
▫ patient is pregnant at vero
OR
eros et accumsan et iusto odio dignissim qui
praesent
luptatum
• If blandit
NAAT is used
for gonorrhea
TOC,
Azithromycin 1 g PO in a single dose (B-Ι)
shouldfacilisi.
be done 2 -3 weeks after
zzril delenit augue duis dolore te feugait etreit nulla
Alternate Treatment
Spectinomycin 2 g IM in a single dose
initiation of treatment.
• Repeat screening is recommended at 6
Lorem
amet,
consectetuer
adipiscing
elit, sed diam
(Consultipsum
Provincialdolor
STI/HIVsit
Clinic
Physician
to access
months for all N. gonorrhoeae positive
this
medication.)
nonummy nibh euismod tincidunt ut laoreet cases.
dolore magna aliquam erat
PLUS
volutpat.
Co-treatment for chlamydia
(See Chlamydia section: Recommended Regimen –
Pregnancy/Lactation)
Subtitles
Considerations - Pregnancy/Lactation
• Aautem
test of vel
cureeum
(TOC)iriure
by culture
Duis
doloris in hendrerit in vulputate velit esse
recommended
for
all
pregnant
and
molestie consequat, vel
illum dolore eu
Prepared by:
lactating patients at 3 - 7 days after
feugiat
nulla
facilisis
at
vero eros et
initiation of treatment.
accumsan et iusto odio
dignissim qui
Name here
blandit praesent luptatum
zzril delenit
augue duis dolore te
feugait etre
Date here
nulla facilisi.
Nam liber tempor cum
soluta nobis
eleifend option congue nihil imperdiet doming id quod mazim placerat
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
3
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
Gonorrhea
dolore magna aliquam erat volutpat.
Bacterial Vaginosis (BV)
Bacterial vaginosis is not usually considered
Recommended Regimen
Titling
Metronidazole 500 mg PO bid for 7 days (A-Ι)
DID
YOU KNOW
CAPTIONS:
a sexually
transmitted
infection.
Symptoms
notedsitbyamet,
either
the clinician
Lorem
ipsum dolor
consectetuer
during aelit,
pelvic
or reported
by
adipiscing
sedexamination,
diam nonummy
nibh
the patient,
mayutinclude
vaginal
euismod
tincidunt
laoreet abnormal
dolore magna
discharge
and/or abnormal vaginal odour
aliquam
erat volutpat.
OR
Considerations - Pregnancy/Lactation
• Systemic rather than intravaginal
treatment is recommended in pregnancy
Body
Copy: Utgelwisi
enim
minim(5veniam,
quis
nostrud treatment
etre exerci
tation
as intravaginal
alone
has not
Metronidazole
0.75%
x onead
applicator
g)
to decrease
the risk of
ullamcorper
suscipit lobortis
nisl(A-Ι)
ut aliquip exbeen
ea shown
commodo
consequat.
once a day intravaginally
for 5 days
pregnancy outcomes.
Duis autem vel eumOR
iriure dolor in hendrerit adverse
in vulputate
velit esse
• Intravaginal clindamycin cream has
Clindamycin cream 2% x one applicator (5 g)
molestie consequat, vel illum dolore eu feugiat
facilisis
vero eros
(i.e., amine odour).
beennulla
associated
withatadverse
outcomes
intravaginally once a day for 7 days (A-Ι)
et
accumsan
et
iusto
odio
dignissim
qui
blandit
praesent
luptatum
zzrilbe used
in the
neonate and
should only
Abnormal vaginal odour may be noticeable
Alternate Treatment
when alternatives
are not
possible.
augue duis dolore te feugait nulla facilisi.
Lorem ipsum
dolor
sit
with or without potassium hydroxide (KOH) delenit
Metronidazole 2 g PO in a single dose (A-Ι)
• Test and treat symptomatic pregnant
PULL
QUOTES:
assessment and vaginal pH is usually
amet, consectetuerOR
adipiscing elit, sed diam nonummy nibh euismod
women.
elevated greater than 4.5. An elevated
tincidunt
ut laoreet
magna
volutpat.
Clindamycin
300 mgdolore
PO bid for
7 daysaliquam
(A-Ι)
•erat
Routine
screening for BV is not
vaginal pH
in peri-menopausal
or post
Lorem
ipsum
dolor sit
recommended during pregnancy unless
menopausal women in the absence of other
Considerations
is a high
risk pregnancy.
Ut wisi enim ad minim veniam, quis nostrud itexerci
tation
ullamcorper
amet,
consectetuer
vaginal symptoms
may not indicate a BV
• Individuals taking metronidazole should
• If considered a high risk pregnancy,
infection.
suscipit
lobortis
nisl
ut
aliquip
ex
ea
commodo
eu
feugiat
nulla facilisis at
not drink alcohol or take alcohol-based
screen at 12 - 16 weeks.
adipiscing elit, sed diam
vero
eros
et
accumsan
et
iusto
odio
dignissim
qui
blandit
praesent
medications
for
12
hours
before
and
When the laboratory report (e.g., Nugent
• BV during pregnancy
is associated
24
–
48
hours
after
treatment
because
Score) is intermediate
positive and the
with premature
rupture of membranes,
luptatum zzril delenit augue duis dolore te feugait
nulla facilisi.
nonummy
nibh oreuismod
of possible disulfiram-like (Antabuse)
client is asymptomatic, treatment would not
chorioamnionitis, preterm labour,
reaction.
be recommended
unless:
preterm birth and post-cesarean
tincidunt
ut laoreet
dolore
• patient is pregnant and at high risk for
• Clindamycin cream is oil-based and may
endometritis.
Subtitles
magna
aliquam
erat
pre-term
delivery
weaken latex condoms or diaphragms.
• Testing should be repeated after one
ensure therapy
was effective.
liber tempor
soluta nobis
eleifend month
optiontocongue
nihil imperdiet
• patient is scheduled to have any upper Nam
• Single
dose oralcum
metronidazole
therapy
volutpat.
reproductive tract instrumentation
hasid
a higher
at one month.
doming
quod relapse
mazimrate
placerat
facer possim assum.
(e.g., gynaecological surgery, D&C or therapeutic
abortion)
There is not enough current evidence to
support routine screening for BV at the time
of IUD insertion in asymptomatic women.
Partners/Contacts
Treatment of male sexual partners is not
Pregnancy/Lactation
Lorem
ipsum dolor sit amet, consectetuerindicated
adipiscing
elit, not
sedprevent
diam recurrence.
and does
Recommended
Regimen
nonummy nibh euismod tincidunt ut laoreet
dolore magna aliquam erat
Offer female partners of women diagnosed with
Metronidazole 500 mg PO bid for 7 days (A-Ι)
volutpat.
Duis autem vel eum iriure dolor BV,
in hendrerit
vulputate
velit treatment
assessment,in
testing,
and possible
Alternate
Treatment
the female
partner(s)
tests are positive.
(D-Ι)
esse
molestie
consequat, vel illum doloreif eu
feugiat
nulla facilisis
at vero
Clindamycin 300 mg PO bid for 7 days (A-Ι)
eros et accumsan et iusto odio dignissim qui blandit praesent luptatum
Follow Up
zzril delenit augue duis dolore te feugait etre
nulla facilisi.
Follow up is not considered necessary
unless symptoms recur.
Trichomoniasis Recommended Regimen
Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam
nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat
Trichomonas
volutpat. vaginalis
Pregnancy/Lactation
Partners/Contacts
Trichomoniasis may be associated with
Partners/contacts should be treated with
Metronidazole 2 g PO in a single dose (A-Ι) Subtitles
premature rupture of membranes, preterm birth
the same therapy recommended for the
Duis
vel eum
dolor
in hendrerit
in vulputate
velit esse
OR
and autem
low birth weight.
It is iriure
not known
whether
patient.
It is not necessary
to screen sexual
Metronidazole 500 mg PO bid for 7 days (A-Ι) molestie
treatmentconsequat,
will improve pregnancy
outcomes.
partners.
The
majority
of men
infected
vel
illum
dolore
eu with
Prepared by:
Trichomonas
vaginalis
are
asymptomatic,
Asymptomatic
pregnantatwomen do not
feugiat
nulla facilisis
vero eros et
although occasionally men will report
need to be et
treated
(D-Ι).
accumsan
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odio
dignissim qui
Considerations
Name here having mild urethritis.
Recommended
praesent Regimen
luptatumzzril delenit
• Individuals taking metronidazole should blandit
Symptomatic
Pregnant
not drink alcohol or take alcohol-based augue
duis dolore
te Women Date here Follow Up
feugait etre
Metronidazole 2 g PO in a single dose for
medications for 12 hours before and
Follow
up
is
not
considered
necessary
nulla
facilisi.
symptom relief (A-Ι)
24 – 48 hours after treatment because
unless recurring symptoms are presumed to
of possible disulfiram-like (i.e., Antabuse)
be due to re-infection.
Alternate Regimen reaction.
Nam liber tempor cum
soluta nobis
Symptomatic Pregnant Women
eleifend
option
congue
nihil
Metronidazole
500
mg PO bid
for imperdiet
7 days (A-Ι) doming id quod mazim placerat
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
4
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
Vaginosis & Trichomoniasis
dolore magna aliquam erat volutpat.
Vulvovaginal Candidiasis - Candida albicans
Vulvovaginal candidiasis is not usually
DID
YOU KNOW
CAPTIONS:
considered
a sexually
transmitted infection
and treatment
is sit
notamet,
necessary
for
Lorem
ipsum dolor
consectetuer
asymptomatic
patients.
(D-Ι)
adipiscing elit, sed diam nonummy nibh
euismod
tincidunt ut laoreet
dolore magna
Recommended
Regimen
aliquam
erat volutpat. (OTC) treatments:
Over-the-counter
Titling
Considerations:
• Oil based ovules and creams may
Partners/Contacts
Routine screening and treatment of male
condoms
diaphragms.
partners
not indicated.
However,
Bodyweaken
Copy:latex
Ut wisi
enimorad
minim veniam,
quis isnostrud
etre(D-Ι)
exerci
tation
if Candida balanitis is present, consider
ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo consequat.
Pregnancy/Lactation
treatment of male sexual partners with a
Duis
autem vel
eum iriure dolor
in hendrerit
in azole
vulputate
velit aesse
Fluconazole
is contraindicated
in pregnancy.
topical
cream twice
day for 7 – 14 days.
molestie
consequat,
vel
illum
dolore
eu
feugiat
nulla
facilisis
at
vero eros
Only
topical
azoles
are
recommended
for
Clotrimazole or miconazole, intravaginal
treatment
of
vulvovaginal
candidiasis
during
Follow
Up
et
accumsan
et
iusto
odio
dignissim
qui
blandit
praesent
luptatum
zzril
azole ovules and/or creams (A-Ι)
pregnancy. Treatment for 7 days may be
No follow up necessary unless symptoms
delenit augue duis dolore te feugait nulla facilisi. Lorem ipsum dolor sit
OR
necessary.
persist or recur in which case repeat
PULL
QUOTES:
Fluconazole
150 mg PO in a single dose. (A-Ι) amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod
assessment is advised.
tincidunt ut laoreet dolore magna aliquam erat volutpat.
Lorem ipsum dolor sit
Pelvic Inflammatory Disease (PID) a polymicrobial infection with multiple etiologies.
Ut wisi enim ad minim veniam, quis nostrud exerci tation ullamcorper
amet,
consectetuer
The BCCDC
recommended regimen differs from the Canadian STI Guidelines treatment guidelines for PID.
suscipit lobortis nisl ut aliquip ex ea commodo eu feugiat nulla facilisis at
adipiscing elit, sed diam
vero
eros
et accumsan et iusto odio dignissim qui blandit praesent
• In
treating mild to moderate PID, it
Outpatient Treatment
Partners/Contacts
luptatum
delenit
auguethe
duis
nulla facilisi.
nonummy
nibh
euismod
is notzzril
necessary
to remove
IUDdolore te
Recommended
Regimen
Allfeugait
partners/contacts
in the last 60 days
during
treatment
unless
there
is
no
Cefixime 800 mg PO in a single dose (A-Ι)
regardless of symptoms or signs should
tincidunt ut laoreet
dolore
clinical improvement after 72 hours of
OR
be tested and treated for gonorrhea and
recommended antibiotic treatment.
Ceftriaxone 250 mg IM in a single dose (A-Ι)
chlamydia. If there is no partner during
Subtitles
magna
aliquam erat
(The preferred diluent for this dose of ceftriaxone is
this period, then the last partner should be
• Consider hospitalization when the
0.9 mL of 1% lidocaine without epinephrine to reduce Nam liber tempor cum soluta nobis eleifend option congue nihil imperdiet
tested, treated and advised to abstain from
patient:
discomfort.)
volutpat.
doming id quod mazim placerat facer possim
sexualassum.
activity for 7 days after initiation of
▫ is pregnant
PLUS
Doxycycline 100 mg PO bid for 10 – 14 days (A-П)
OR
Azithromycin 1g PO in a single dose, once
weekly for 2 weeks
WITH or WITHOUT
treatment.
▫ is severely ill with nausea and
vomiting
and/or
high fever
Lorem ipsum
dolor
sit amet,
consectetuerPatients
adipiscing
sedfrom
diam
shouldelit,
abstain
sexual activity
until
treatment
is
completed
(i.e.,
10 – 14 days)
▫
has
a
suspected
tubo-ovarian
nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat
and should be advised to avoid exposure to
abscess
volutpat. Duis autem vel eum iriure dolor in hendrerit in vulputate velit
any untreated partner(s).
▫ cannot tolerate oral medication
esse molestie consequat, vel illum dolore eu feugiat nulla facilisis at vero
▫ May have a surgical emergency
eros et accumsan et iusto odio dignissimFollow
qui blandit
Up praesent luptatum
such as appendicitis or an ectopic
Alternate Treatment
Patients
treated
for PID as outpatients
zzril
delenit
augue
duis
dolore
te
feugait
etre
nulla
facilisi.
pregnancy
Levofloxacin 500 mg PO bid for 14 days (A-Ι)
need careful follow-up and should be reMetronidazole 500 mg PO bid for 10 – 14 days (B-Ш)
(The alternate antibiotic treatment above will cover
enteric organisms, but may not cover N.gonorrhoeae
or C.trachomatis.)
evaluated 48 – 72 hours after therapy has
Lorem
ipsum dolor sit amet, consectetuerbeen
adipiscing
sed diam
Pregnancy/Lactation
initiated. Ifelit,
no clinical
improvement
Consultation
with
a
obstetrical/gynaecology
has
occurred,
hospital
admission
for
nonummy
nibh
euismod
tincidunt
ut
laoreet
dolore
magna
aliquam
erat
WITH or WITHOUT
specialist is recommended.
parenteral therapy and observation may be
Metronidazole 500 mg PO bid for 14 days (A-Ι) volutpat.
Considerations
• Metronidazole is recommended for
Pregnant patients with suspected PID
should be hospitalized for evaluation and
treatment with parenteral therapy.
required.
Subtitles
Fluroquinolones
(e.g., levofloxacin),
Duis
autem vel eum
iriure dolor in hendrerit in vulputate velit esse
doxycycline and estolate preparations
• Individuals taking metronidazole should molestie consequat, vel
illum dolore eu
of erythromycin are contraindicated for
Prepared by:
not drink alcohol or take alcohol-based feugiat nulla facilisis at
vero eros et
pregnant and lactating women.
medications for 12 hours before and 24
accumsan
et
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odio
dignissim qui
If patient is HIV positive a consultation
withhere
– 48 hours after treatment because of
Name
zzril delenit
an HIVpraesent
specialist isluptatum
advised see:
possible disulfiram-like (i.e., Antabuse) blandit
BC Women’s
Hospital
Centre
reaction.
augue
duis dolore
te& Healthcare Date
feugait etre
here
Oak
Tree
Clinic
Providing
Care
to
Women
&
nulla facilisi.
additional anaerobic coverage and when
bacterial vaginosis is suspected. (B-Ш)
Families Living with HIV/AIDS
www.oaktreeclinic.bc.ca
Nam liber tempor cum
soluta nobis
eleifend option congue nihil imperdiet doming id quod mazim placerat
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
5
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
Vulvovaginal Candidiasis & Pelvic Inflammatory Disease
dolore magna aliquam erat volutpat.
Urethritis
Urethritis is a disgnosis based on
DID
YOU KNOW
CAPTIONS:
presenting
urethral
symptoms in the
absence of microscopic assessment.
Titling
Considerations
• If a male patient presents with urethral
Follow Up
If symptoms persist or recur after therapy
discharge,
has been completed, (i.e. 14 days or more after
Bodysymptoms
Copy: Ut(e.g.,
wisiurethral
enim ad
minim veniam,
quis nostrud etre exerci tation
dysuria, intermittent urethral itching/
the initiation of treatment) the patient should be
ullamcorper
lobortis and
nisl Gram
ut aliquipre-evaluated.
ex ea commodo consequat.
tingling orsuscipit
meatal erythema)
Duis stain
autem
vel
eum
iriure
dolor
in
hendrerit
in vulputate velit esse
results are unavailable, test and
See Persistent or Recurrent Urethritis Section.
treat
empirically
for
both
gonorrhea
and
molestie consequat, vel illum dolore eu feugiat
nulla
facilisis
vero eros
Symptoms
alone
are notat
sufficient
for
Cefixime 800 mg PO as a single dose (A-Ι)
chlamydia.
et
accumsan
et
iusto
odio
dignissim
qui
blandit
praesent
luptatum
zzril
re-treatment in the absence of laboratory
OR
• Full resolution of symptoms can take up
clinical signs.
augue duis dolore te feugait nulla findings
facilisi.orLorem
ipsum dolor sit
Ceftriaxone 250 mg IM in a single dose (A-Ι) delenit
to 14 days or longer after therapy has
PULL
QUOTES:
(The preferred dliuent for this dose of ceftriaxone is amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod
been initiated.
0.9 mL of 1% lidocaine without epinephrine to reduce
tincidunt ut laoreet dolore magna aliquam erat volutpat.
discomfort)
Lorem ipsum dolor sit amet, consectetuer
The recommended regimen covers both
adipiscing elit, sed diam nonummy nibh
N. gonorrhoeae and C. trachomatis.
euismod tincidunt ut laoreet dolore magna
aliquam
erat volutpat.Regimen
Recommended
Lorem
ipsum dolor sit
PLUS
Partners/Contacts
Doxycycline 100 mg PO bid for 7 days (A-Ι)
and contacts
should
abstain
fromnostrud exerci tation ullamcorper
UtPatients
wisi enim
ad minim
veniam,
quis
amet, consectetuer
OR
sexual activity for 7 days after initiation of
lobortis nisl ut aliquip ex ea commodo eu feugiat nulla facilisis at
Azithromycin 1 g PO as a single dose (A-Ι) suscipit
treatment and should be advised to avoid
adipiscing
elit, sed diam
vero
eros
accumsan
iusto odio dignissim qui blandit praesent
exposure et
to any
untreatedet
partner(s).
luptatum zzril delenit augue duis dolore te feugait nulla facilisi.
nonummy nibh euismod
Persistent
or Recurrent
Urethritis
tincidunt
ut laoreet
dolore
Subtitles
magna
Presistentaliquam
or Recurrenterat
Urethritis is
Recommended Regimen
Considerations
Nam
liber tempor
cum
soluta
nobis
eleifend
option
congue
nihil imperdiet
defined as:
• Other
Potential
Causes:
If
Doxycycline
was
the
initial
treatment
consider
volutpat.
• persistent urethral symptoms
doming id quod mazim placerat facer possim assum.
• co-treatment for N. gonorrhoeae and C.
trachomatis was more than 2 weeks ago
• there has been no re-exposure to an
untreated or new sexual partner
Azithromycin 1 g PO in a single dose (A-Ι)
OR
▫ organisms not covered by the
original treatment
(e.g., elit,
Trichomonas
vaginalis)
adipiscing
sed diam
Erythromycin
500 mg
qid forconsectetuer
7 - 14 days
Lorem
ipsum dolor
sitPO
amet,
▫ antimicrobial
resistant erat
organisms
If Azithromycin
the initial treatment
consider
nonummy
nibhwas
euismod
tincidunt
ut laoreet dolore
magna aliquam
▫prostatitis
Doxycycline
100
mg
PO
bid
for
7
days
(A-Ι)
volutpat. Duis autem vel eum iriure dolor in hendrerit in vulputate velit
OR
▫ non-infectious inflammatory syndromes
esseErythromycin
molestie consequat,
vel illum dolore eu feugiat nulla facilisis at vero
500 mg PO qid for 7 - 14 days
• Patients who have been appropriately
eros et accumsan et iusto odio dignissim quitreated
blandit
praesent luptatum
for urethritis and continue to
zzril delenit augue duis dolore te feugait etrehave
nulla
facilisi.
urethral symptoms in the absence
of a known STI infection may benefit
from the anti-inflammatory
Lorem ipsum dolor sit amet, consectetuer adipiscing
elit, sed diamproperties of
either doxycycline or erythromycin.
nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat
• If there is no resolution of symptoms after
volutpat.
treatment, consider referring the patient to
a urologist.
Subtitles
Nongonococcal Urethritis
(NGU)
Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse
NGU is a diagnosis based on immediate
molestie consequat, vel
illum dolore eu
Partners/Contacts
Prepared by:
Recommended Regimen
laboratory microscopy (i.e.,urethral smear)
All partners/contactsvero
in theeros
last 60
feugiat
nulla facilisis at
etdays
showing inflammatory/pus cells as greater than Doxycycline 100 mg PO bid for 7 days (A-Ι)
should be tested and treated to cover for
dignissim qui
OR
or equal to 5 PMNs (i.e., polymorphonuclear accumsan et iusto odio
Name here chlamydia.
blandit
praesent
luptatum
zzril delenit
Azithromycin
1g PO
as a single dose (A-Ι)
leukocytes) in the absence of typical
Patients and their contacts should abstain
intracellular diplococci (i.e., N. gonorrhoeae). augue duis dolore te
feugait etre
Date here
form sexual activity until 7 days after
nulla facilisi.
Causative organisms may include:
initiation of treatment and be advised to
•
Chlamydia trachomatis
avoid exposure to any untreated partner(s).
•
Mycoplasma genitalium
•
•
•
Nam liber tempor cum
soluta nobis
eleifend option congue nihil imperdiet doming id quod mazim placerat
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
6
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
Urethritis & Persistent or Recurrent Urethritis & Nongonococcal Urethritis
dolore magna aliquam erat volutpat.
Ureaplasma urelyticum
Trichomonas vaginalis (occasionally)
Viruses: HSV, VZV, or Adenovirus
Epididymitis
The BCCDC recommended regimen differs from the Canadian STI Guidelines treatment guidelines for Epididymitis.
C. trachomatis and N. gonorrhoeae account
DID
KNOWofCAPTIONS:
forYOU
two-thirds
the epididymitis cases in
men under 35 years of age.
Titling
Alternate treatment
Levofloxacin 500 mg PO once daily for
10-14 days (B-П)
Partners/Contacts
All partners in the last 60 days prior to
symptom
onset or date
diagnosis
should
Body Copy: Ut wisi enim ad minim veniam,
quis nostrud
etreofexerci
tation
OR
be tested and treated for gonorrhea and
ullamcorper
lobortis
nisl ut
aliquip ex ea commodo consequat.
Ciprofloxacinsuscipit
500 mg PO
bid x 10-14
days
chlamydia.
(The autem
alternate antibiotic
treatments
above
will
Duis
vel eum
iriure listed
dolor
in hendrerit
in vulputate velit esse
cover enteric organisms, but may not cover
Patients and contacts should be advised
molestie
consequat,
vel illum dolore eu feugiat nulla facilisis at vero eros
N. gonorrhoeae
or C. trachomatis.)
to not have sexual activity for 7 days after
et accumsan et iusto odio dignissim qui blandit
luptatum zzril
Recommended Regimen
initiationpraesent
of treatment.
Considerations
To cover C. trachomatis and N. gonorrhoeae delenit
augue duis dolore te feugait nulla facilisi. Lorem ipsum dolor sit
• Consider non-infectious causes of
Cefixime
800 mg PO in a single dose (A-Ι)
PULL
QUOTES:
Follow
Up nibh euismod
amet, consectetuer adipiscing elit, sed diam
nonummy
scrotal pain and swelling
OR
Patients should be advised to be
(i.e. trauma,
tumors ordolore
testicularmagna
torsion). aliquam erat volutpat.
tincidunt
ut laoreet
Ceftriaxone 250 mg IM in a single dose (A-Ι)
Lorem ipsum dolor sit amet, consectetuer
adipiscing
sed diam
nonummy
nibh
Coliformelit,
bacteria
account
for many
euismod
tincidunt
ut laoreet
magna
epididymitis
cases
in mendolore
35 years
of age
aliquam
erat volutpat.
or older.
reassessed within 48 to 72 hours after
Lorem
ipsum dolor sit
• Testicular torsion is a surgical emergency
(The preferred diluent for this dose of ceftriaxone is
diagnosis to ensure there has been an
0.9 mL of 1% lidocaine without epinephrine to reduce
and needs to be considered with acute
adequate
response
to treatment. If there
Ut wisi enim ad minim veniam, quis nostrud
exerci
tation ullamcorper
amet,
consectetuer
discomfort)
onset of testicular pain.
has
been
no
clinical
improvement,
PLUS
suscipit lobortis nisl ut aliquip ex ea commodo eu feugiat nulla
facilisisrefer
at to a
urologist.
adipiscing
elit,
sed
diam
Doxycycline 100 mg PO bid for 10 – 14
vero eros et accumsan et iusto odio dignissim qui blandit praesent
days (A-Ι)
luptatum zzril delenit augue duis dolore te feugait nulla facilisi.
nonummy nibh euismod
tincidunt
laoreet dolore
HerpesutSimplex
Virus (Genital)
Subtitles
magna aliquam erat
Recommended Regimen
Nam
liber tempor cum soluta nobis eleifend
option congue nihil imperdiet
Considerations
Pregnancy/Lactation
volutpat.
Primary/First Episode
• Oralidacyclovir,
famciclovir
and
Consultation
with an obstetrician /
doming
quod mazim
placerat
facer possim
assum.
Acyclovir 400 mg PO tid for 7 – 10 days (A-Ι)
gynaecologist experienced in the
management of genital HSV infections is
ipsum dolor sit amet, consectetuerrecommended.
adipiscing elit, sed diam
Famciclovir 250 mg PO tid for 5 – 7 days (A-Ι) Lorem
• Topical acyclovir is not effective for
OR
valacyclovir are comparatively
efficacious.
OR
nonummy
nibh
euismod
systemic
symptoms,
andtincidunt
should notutbelaoreet dolore magna aliquam erat
used Duis
for thatautem
purpose.
volutpat.
vel eum iriure dolor Partners/Contacts
in hendrerit in vulputate velit
Herpes is not a reportable infection.
• Amolestie
shorter course
of acyclovir
800
mgdolore
PO
esse
consequat,
vel
illum
eu feugiat nulla facilisis at vero
Recurrent Episodes (Episodic Therapy)
tid
for
48
hours
appears
as
efficacious
Supportive
counseling
is an
essential part
praesent
luptatum
Acyclovir 400 mg PO tid for 5 days (A-Ι) or eros et accumsan et iusto odio dignissim qui blandit
as the approved 5 day regimen.
of
management
and
patients
will need
Acyclovir 800 mg PO tid for 2 days (C-Ι)
zzril delenit augue duis dolore te feugait etre nulla facilisi.
Valacyclovir 1 g PO bid for 7 – 10 days (A-Ι)
OR
Famciclovir 125 mg PO bid for 5 days or
Famciclovir 1000 mg PO bid x 1 day (B-Ι)
OR
Valacyclovir 500 mg PO bid for 3 days or
Valacyclovir 1 g PO OD for 3 days (B-Ι)
Suppressive Therapy
Recurring outbreaks - 6 to 9 / year
Acyclovir 400 mg PO bid daily for 6 – 12
months (A-Ι)
OR
Famciclovir 250 mg PO bid daily for 6 – 12
months (A-Ι)
OR
Valacyclovir 500 mg PO once daily for
6 – 12 months (A-Ι)
Recurring outbreaks - more than 10 / year
Valacyclovir 1 g PO daily for 6 – 12
months (A-Ι)
• Start famciclovir preferably less than 6
guidance on how they will inform present
and/or future sexual partners.
hours and valacyclovir preferably less
Lorem
ipsum
dolor
sitthe
amet,
consectetuer adipiscing elit, sed diam
than
12 hours
after
first symptoms
Patients should be advised that even
appear.nibh euismod tincidunt ut laoreet dolore magna aliquam erat
nonummy
though transmission can occur in the
• Patient-initiated therapy at the onset of
volutpat.
absence of a lesion (i.e., asymptomatic
prodromal symptoms has been proven
shedding), transmission is more likely to
to be effective.
occur during an active outbreak.
• It is recommended that individuals have
Positive HSV education and public health
Subtitles
medications on hand and be provided
messaging emphasizing genital herpes as
specific
whenin
to hendrerit
Duis with
autem
vel information
eum iriureondolor
in vulputate velit esse
a manageable, albeit a chronic infection,
initiate
treatment.
molestie consequat, vel
illum dolore
eu
is important to help reduce
stigma, lack
Prepared by:
• Having genital herpes simplex (HSV)
feugiat
nulla facilisis at
eros etanxiety
of understanding andvero
subsequent
can increase the risk of acquiring and
experienced by patients
receivingqui
a new
accumsan
et iusto
dignissim
transmitting
HIV. odio
Name here genital herpes diagnosis.
blandit
praesent
zzril delenit
• Physicians
mayluptatum
order HSV-TSS
Please refer to the following
(type
specific
serology)
via LifeLabs
augue
duis
dolore
te
feugaitwebsites
etre for
Date here
genital HSV information:
although
this
is
not
covered
by
BC
nulla facilisi.
• www.bccdc.ca
Medical Services Plan.
CDC Manual, Chapter 5 –
Non-certified STIsoluta
DSTs nobis
Nam liber tempor cum
• www.smartsexresource.com
eleifend option congue nihil imperdiet doming
id quod mazim placerat
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
7
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
Epididymitis & Herpes Simplex Virus
dolore magna aliquam erat volutpat.
Syphilis - Treponema pallidum
REPORTABLE
Contact the Provincial STI/HIV Physician for management, support and to order long acting (Bicillin LA) medication.
Early Syphilis
DID YOU KNOW CAPTIONS:
Primary
Lorem
ipsum dolor
sit amet,
consectetuer
Symptoms
can include
chancre,
and /or
adipiscing
elit,
sed
diam
nonummy
nibh
regional lymphadenopathy.
Titling
Late Latent Syphilis
HIV and Syphilis Co-infections
Syphilis positive patients co-infected with HIV
> 1 year duration or of unknown duration
Body
Copy: Ut wisi enim ad minim veniam,
quissyphilis
nostrud
etre every
exerci
tation
require
serology
3 months.
OR
ullamcorper
lobortis nisl ut aliquip ex ea commodo consequat.
Tertiary suscipit
Syphilis
(cardiovascular and other syphilis not involving the
Neurosyphilis
Duis
autem
vel
eum
iriure dolor in hendrerit
in vulputate velit esse
central nervous system)
• Neurosyphilis symptoms can occur at
molestie consequat, vel illum dolore eu feugiat
vero eros
any nulla
syphilisfacilisis
stage. It at
is usually
seen in
Recommended Regimen
malaise, lymphadenopathy, mucus lesions,
et
accumsan
et
iusto
odio
dignissim
qui
blandit
praesent
luptatum
zzril
the
late
latent
stage
although
recently
Benzathine penicillin G (Bicillin LA)
condylomata lata, and/or alopecia.
some Lorem
cases of ipsum
neurosyphilis
delenit
augue
dolorhave
sit been
2.4 million
unitsduis
givendolore
weekly te
for feugait
3 weeks nulla facilisi.
Early Latent
diagnosed
in
the
secondary
syphilis
PULL
QUOTES:
to a total
of 7.2 millionadipiscing
units
amet,
consectetuer
elit, sed diam nonummy nibh euismod
Asymptomatic and has had a negative
stage.
(Bicillin LA is administered in divided doses of 1.2 million
syphilis test in the last year.
tincidunt
ut laoreet dolore magna aliquam •erat
volutpat.
units given IM into each buttock at the same visit.)
When unexplained neurological
euismod
tincidunt ut laoreet dolore magna
Secondary
aliquam
erat
Symptomsvolutpat.
can include rash, fever,
Lorem ipsum dolor sit
Recommended Regimen
Benzathine
penicillin G (i.e., Bicillin LA)
amet,
consectetuer
2.4 million units in a single dose (A-Ι)
adipiscing
elit,in sed
diam
(Bicillin LA is administered
divided doses
of 1.2 million
units given IM into each buttock at the same visit.)
nonummy nibh euismod
NOTE:
tincidunt
ut laoreet dolore
Long-acting benzathine penicillin G (Bicillin-LA)
is the appropriate treatment for syphilis.
magna
aliquam erat
It achieves detectable serum levels of
penicillin for 2 - 4 weeks and is required to
volutpat.
adequately treat infectious syphilis.
Short-acting benzathine penicillin G or
benzyl penicillin G has a similar name to
the long-acting penicillin (i.e., Bicillin-LA),
but does not provide adequate treatment for
syphilis.
Considerations
Jarisch-Herxheimer Reaction –
(i.e., fever, chills, headache, and myalgia) occurs
2 – 12 hour after treatment of early
infectious syphilis and usually resolves
within 24 hours. Antipyretics may be
needed.
Partners/Contacts to Early Syphilis
All sexual contact/partners within 90 days
of the patient’s diagnosis and/or symptom
onset, should be tested and treated with
Bicillin 2.4 million units IM regardless of test
results to treat incubating syphilis.
Sexual contacts/partners greater than
90 days only need to be tested or as per
instructions from the BCCDC Provincial
STI/HIV Clinic physician or syphilis nurse.
For partner/contact follow up, please
consult Provincial STI/HIV Syphilis Nurse 604.707.5607
symptoms are present (e.g., headaches,
retinitis, auditory
treatment
(if allergic
to Penicillin)
UtAlternate
wisi enim
ad minim
veniam,
quis nostrud vertigo,
exerciataxia,
tationuveitis,
ullamcorper
symptoms such as hearing loss or
Doxycycline
100
mg
PO
BID
for
28
days
(B-П)
suscipit lobortis nisl ut aliquip ex ea commodo
eu feugiat
nulla
facilisis
at
tinnitus,
meningitis,
personality
changes,
vero
eros
et
accumsan
et
iusto
odio
dignissim
qui
blandit
praesent
and dementia), consider syphilis as a
Partners/Contacts to Late Syphilis
differential
diagnosis
luptatum
zzril
delenit
duis
nulla
facilisi.and complete
Test all long
term
sexualaugue
partners
and dolore te feugait
children (i.e., 18 years of age or younger) of
an infected mother.
syphilis serology screening.
• Further testing and possible referral to
an infectious disease specialist may be
Subtitles
warranted.
Pregnancy/Lactation
Nam
liber tempor
cumProvincial
soluta nobis
optionconsult
congue
nihil imperdiet
• Please
consult with
STI/HIVeleifend
• Please
Provincial
STI/HIV
Clinic
at 604.707.5606.
Clinic
Physician at 604.707.5606 for
doming
id Physician
quod mazim
placerat facer possim
assum.
• All pregnant women should be screened
management and treatment.
for syphilis during the first trimester
Lorem
ipsum dolor sit amet, consectetuer adipiscing elit, sed diam
of pregnancy and repeated later in
EIA Syphilis Serology Algorithm
nonummy
nibhforeuismod
tincidunt
dolore
magna
erat
pregnancy
women with
ongoing ut
risklaoreet
• In
July 2014
the BCaliquam
Public Health
volutpat.
Duisexposure.
autem vel eum iriure dolor in hendrerit
vulputate
velit
of syphilis
MicrobiologyinReference
Laboratory,
(BC-PHMRL) switched the preliminary
esse
molestie consequat,
Recommended
Regimen vel illum dolore eu feugiat nulla facilisis at vero
screening test for syphilis from the Rapid
Benzathine
penicillinet
G iusto
(Bicillinodio
LA) dignissim qui blandit praesent luptatum
eros
et accumsan
Plasma Reagin (RPR) antibody test
2.4 delenit
million units
in a single
dose (A-Ι)
zzril
augue
duis dolore
te feugait etretonulla
facilisi.
an Enzyme
Immunoassay (EIA), a
(Bicillin LA is administered in divided doses of 1.2 million
Treponema
pallidum
specific antibody test.
units given IM into each buttock at the same visit.)
In most cases,
Lorem ipsum dolor sit amet, consectetuer •adipiscing
elit,Treponema
sed diampallidum
•
Additional doses may be necessary
antibodies
persist
for the life erat
of a patient
nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam
depending on the duration of the infection.
and therefore the EIA test will detect a
volutpat.
greater number of old syphilis cases.
• If there is a penicillin allergy,
desensitization to penicillin is
recommended as the recommended
alternate treatment with doxycycline is
Subtitles
contraindicated in pregnancy.
• The EIA treponeme-specific test is
similar to the TPPA and FTA-Abs tests
used for confirmatory syphilis testing.
• Confirmatory
no longer need to
Duis autem vel eum iriure dolor in hendrerit
in vulputatetests
velitwillesse
be ordered by a physician as they will be
molestie
vel
illum dolore eu
Followconsequat,
Up
Prepared by: automatically done by the BC-PHMRL
feugiat
nulla
facilisis
at
Syphilis serology should be monitored every 6
as appropriate. vero eros et
months afteret
treatment
until a suitable response
accumsan
iusto odio
dignissim qui
Name here • EIA testing allows for automated, high
is
observed.
A
four
fold
drop
in
the
RPR
titre
volume syphilis screening
for
blandit praesent luptatum
zzril delenit
within 6-12 months and an RPR titire of less
BC residents. feugait etre
augue
duis
dolore
te
Date here
than 1:8 within one to two years after treatment,
• For more information contact the
nulla
facilisi. adequate response to therapy.
is considered
Once adequate response to therapy has been
Nam
liberatempor
cum
achieved,
two-dilution
rise in RPR titre may
indicate re-infection.
eleifend
option congue nihil imperdiet
Provincial STI/HIV Clinic Physician at
604.707.5606
soluta nobis
doming id quod mazim placerat
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
8
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
Syphilis
dolore magna aliquam erat volutpat.
HIV - Human Immunodeficiency Virus
British Columbia guidelines on HIV
DID
YOU are
KNOW
CAPTIONS:
testing
intended
to support healthcare
providers by offering routine HIV testing
REPORTABLE
Titling
Testing and Management of
Potential HIV Exposures
Benefits of HIV Treatment
• Individuals may benefit from initiation of
Probable
lowUt
riskwisi
HIVenim
exposure,
HIV asnostrud
early as etre
possible.
Body
Copy:
ad minim veniam, quis
exerci tation
• test at 6 weeks post exposure
• Benefits include improvement to patient
ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo consequat.
• re-test at 3 months
health and decreased risk of HIV
Duis autem vel eum iriure dolor in hendrerit transmission
in vulputatetovelit
esse
sexual
partners, known
Recent
high
risk
exposures
or
when
HIV
molestie consequat, vel illum dolore eu feugiat
nulla
facilisis as
at Prevention’
vero erosor
in BC
as ‘Treatment
of British Columbia
seroconversion is suspected,
TasP.praesent luptatum zzril
Public Health recommends that healthcare et accumsan et iusto odio dignissim qui blandit
• test soon as the patient presents
providers be aware of the HIV status of all delenit augue duis dolore te feugait nulla facilisi.
• Acute Lorem
HIV infection
is diagnosed
ipsum
dolor sit
• indicate ‘Query Acute HIV’ on
patients
under their care.
by special laboratory testing and is
PULL
QUOTES:
amet,requisition
consectetuer
adipiscing
elit,
sed
diam
nonummy
nibh
euismod
as the laboratory may
supported by the BC Public Health
Specifically it is recommend that providers tincidunt
perform
specific HIV
tests magna
if indicated
ut laoreet
dolore
aliquam erat
volutpat.and Reference Laboratory
Microbiology
Lorem ipsum dolor sit amet, consectetuer
as well as enhanced HIV testing to priority
adipiscing elit, sed diam nonummy nibh
populations.
euismod tincidunt ut laoreet dolore magna
HIV Testing
Guidelines for the Province
aliquam
erat volutpat.
Lorem
ipsum
dolor sit
offer an HIV
test:
• Routinely, every five years, to all
amet,
consectetuer
patients
aged 18 – 70 years
• Routinely, every year, to all patients
adipiscing
elit, sed diam
aged 18 – 70 years who belong to
populations with a higher burden of HIV
nonummy
nibh euismod
infection
• Once at age
or older if dolore
the patient’s
tincidunt
ut 70
laoreet
HIV status is not known
magna
aliquam
erat including
• Offer an
HIV test to patients
adults 18 – 70, youth and the elderly
volutpat.
whenever:
▫
▫
▫
▫
▫
(BC-PHMRL) at BCCDC.
Point-of-care (POC) rapid tests for HIV
•
questions
contact the
Utantibodies
wisi enim
minim
veniam, quis nostrud For
exerci
tationplease
ullamcorper
aread
widely
available.
Provincial
STI/HIV
Clinic
Physician
• All positive
HIV
POC
require
suscipit
lobortis
nisl
ut tests
aliquip
ex ea commodo eu feugiat nulla facilisis
at at
604.707.5606.
HIV testing
vero confirmatory
eros et accumsan
et iusto odio dignissim qui blandit praesent
• HIV treatment and primary care
luptatum
zzril delenit
augue
duis dolore te feugait
nulla
Post-exposure
prophylaxis
(PEP)
resources
canfacilisi.
be found at the
Antiretroviral therapy may be offered
BC Centre for Excellence in HIV/AIDS
within 72 hours of a high risk exposure by
www.cfenet.ubc.ca/therapeutic-guidelines
contacting:
Subtitles
• BC Centre for Excellence in HIV/AIDS
Pregnancy/Lactation
Nam St.
liber
tempor
cumPharmacy
soluta nobis eleifend option congue nihil imperdiet
Paul’s
Hospital
• HIV testing should be offered to all
Accidental
Program at
doming
id quodExposure
mazim placerat
facer possim
assum.
pregnant
women as part of routine
1.888.511.6222
they present with a new or
prenatal care.
OR
worsening medical condition that
Antiretroviral
therapy
Lorem ipsum dolor sit amet, consectetuer •adipiscing
elit,
sed (ARV)
diam is available,
warrants laboratory investigation
• St. Paul’s Hospital switchboard at
and
significantly
decreases
risk of
nonummy
nibh euismod
tincidunt
dolore magna aliquam the
erat
604.682.2344.
Ask for the
Infectiousut laoreet mother-to-child
they present with symptoms of
transmission.
volutpat.
Duis
autemon-call
vel eum iriure dolor in hendrerit in vulputate velit
Disease
physician
HIV infection or advanced HIV
• Repeat testing later in pregnancy may
disease
esse molestie consequat, vel illum dolore eubefeugiat
nulla facilisis
at vero is
recommended
if risk of exposure
Referral/Follow
Up
their providers identify a risk for eros
et accumsan et iusto odio dignissim quihigh.
blandit praesent luptatum
Newly diagnosed HIV positive individuals
HIV acquisition
zzril
delenit
augue
duis
dolore
te
feugait
etre
nulla
facilisi.
• HIV
positive
women are advised not to
often require specialized medical care
they request an HIV test
breastfeed, but rather to use formula or
including emotional and psychological
they are pregnant
donated breast milk.
support
for their
new diagnosis.
Lorem
ipsum
dolor
sit amet,Timely
consectetuer adipiscing elit, sed diam
referral andnibh
follow
up is recommended.
nonummy
euismod
tincidunt ut laoreet dolore magna aliquam erat
Considerations:
• Obtaining informed consent for HIV
testing is the same as for any other
diagnostic test.
• If the pretest probability of a positive
HIV test is high, then a more extensive
discussion may be warranted.
Partners/Contacts
Positive HIV results are reported to public
health via the Medical Health Officer
(MHO) or the HIV designate nurse (HIVDN). An HIV-DN will contact the ordering
clinician to offer assistance with reporting
forms, partner notification, counseling and
referrals.
The MHO or the HIV-DN can provide
volutpat.
assistance to clients and help arrange
follow up and ongoing community suport
when requested. Please contact
Subtitles
your local public health department.
Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse
Medical support is also available through:
molestie
consequat,
vel in HIV/AIDS:
illum dolore eu
• BC Centre
for Excellence
Prepared by:
www.cfenet.ubc.ca/healthcarefeugiat
nulla facilisis at
vero eros et
resources.ca
accumsan
et iusto odio
dignissim qui
Name here
•
REACH
(Rapid
Expert
Advice
&
blandit praesent luptatum
zzril delenit
Consultation for HIV):
augue
duis
dolore
te
feugait etre
Toll free at 1.800.665.7677 or Date here
nulla www.hivguide.ca
facilisi.
• BC Women’s Hospital & Healthcare Centre
Clinic -cum
Providing Care to
Nam Oak
liberTree
tempor
soluta nobis
Women & Families Living with HIV/AIDS
eleifend option congue nihil imperdiet doming id quod mazim placerat
www.oaktreeclinic.bc.ca
facer possim assum. Lorem ipsum dolor sit amet, consectetuer
British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014
9
adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet
HIV
dolore magna aliquam erat volutpat.
STI/HIV Resources
BCCDC Provincial STI/HIV Clinic
Clinical Prevention Services
655 West 12th Avenue
Vancouver, BC V5Z 4R4
General Inquires: 604.707.2400
Provincial STI/HIV Clinic Phone: 604.707.5600
Provincial STI/HIV Clinic Fax: 604.707.5604
Provincial STI/HIV Physician: 604.707.5606
Provincial STI/HIV Nurse: 604.707.5603
BC STI Treatment Guidelines and the
BC Physician STI Treatment Guideline Summary
(printable copy or updates) available at:
health files are available at:
www.bccdc.ca
www.smartsexresource.com
Health Authorities in BC
Fraser Health Authority
www.fraserhealth.ca
Interior Health Authority
www.interiorhealth.ca
Northern Health Authority
www.northernhealth.ca
Island Health Authority
www.viha.ca
www.bccdc.ca
Vancouver Coastal Health Authority
www.vch.ca
Public Health STI clinics, services, programs and
Provincial Health Services Authority
www.phsa.ca
First Nations Health Authority
www.fnha.ca