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Procedures for STD Testing/Screening

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For further details on recommendations for screening for STDs in MSM and women see guideline sections in “Screening for STDs in MSM” and “Screening for STDs in women.” The STD clinician, Sylvan Lowens, or the primary provider can perform the appropriate screening.

STD Reporting Procedures: click Here

STD Screening: Gonorrhea and Chlamydia

The Aptima Combo 2 test for the detection of Chlamydia (CT) and Gonorrhea (GC) nucleic acid (NA) has recently been validated (internally) and found to perform well on both rectal and pharyngeal specimens.  NAAT is more sensitive than culture of these organisms at all anatomic sites.  Previous studies have demonstrated the superiority of CT/GC NA testing over culture on cervical/vaginal, rectal, pharyngeal, urethral and urine specimens.  Therefore, Madison Clinic providers should use NA based tests for the detection of CT/GC.
The following points provide guidance for CT/GC testing at the clinic:
Preferred Specimens

  1. Regarding NA testing of the female genital tract, please know that the preferred specimen for GC/CT screening is a vaginal swab since this is the most sensitive, followed by cervical swabs and urine (but all are pretty good).
  2. The lab will perform the combination NA tests for both CT and GC no matter what specimen you send but will only report what you ask for.  In almost all cases you will want both CT and GC results but if you want only CT OR GC then order only the one test.  Although screening for pharyngeal CT is not recommended, if you detect a case of pharyngeal CT infection, the treatment is the same as that for genital CT infection.
  3. The NAAT kits with the orange colored swab are designed for collection of vaginal fluid, but while the kits are labeled for vaginal use, they are also suitable for specimen collection from the pharynx and rectum.   These swabs are larger than the blue-colored swabs to facilitate collection in a larger cavity.  These swabs are also scored to facilitate placement into the collection vials. 
  4. The NAAT kits with the blue colored, narrow swabs are designed to collect specimens from the cervical os and male urethra.  These kits also provide a “cleaning swab” (normal sized Q-tip).  Do not use the normal Q-tip for specimen collection – if you do the lab will reject the specimen.  The blue colored swabs are scored to facilitate breaking them so they fit into the collection vial.  When collecting the specimen unscrew the cap with covering foil, place the blue swab in the tube, snap off the swab at the scored site, screw on the cap, label the tube and submit it to the lab.  If the foil covering is breeched (as often happens when the wrong swab is jammed into the tube) the specimen will be rejected.
  5. It doesn’t really matter which swab you use (blue or orange) for any specimen (although I would avoid trying to insert the larger (orange swab) into the urethra) – just make sure that the swab is broken at the scored site and the foil cap on the collection vial is intact.

Screening Frequency

  1.  STD screening for “high risk” MSM should be every 3 months at all exposed anatomic sites.  High risk is defined as follows
    1. Diagnosis of a bacterial STD in the prior year (gonorrhea, chlamydial infection or early syphilis**)
    2. Methamphetamine or popper use in the prior year
    3. >10 sex partners (anal or oral) in the prior year
    4. Unprotected anal intercourse 
  2. STD screening for sexually active MSM who do not meet the high risk criteria, women and heterosexual men should be performed annually.  Those at increased risk for STDs (e.g. see #6) should be screened more frequently at the discretion of the provider.
  3. Asymptomatic CT infection of the cervix and rectum is common and asymptomatic GC infection of the cervix, rectum and pharynx is also common.  Asymptomatic male urethritis due to CT or GC is uncommon and does not require regular screening.  The sites screened for asymptomatic CT and GC infection should be dictated by sexual practices (e.g. receptive anal intercourse would require anal testing for CT and GC, vaginal intercourse would require vaginal/cervix testing for CT/GC, oral sex requires pharyngeal testing for GC (not CT). 

Culture for surveillance of reduced susceptibility GC

  • Individuals who test positive for GC by NA testing should be advised to return to clinic for treatment (ceftriaxone) and should be cultured immediately prior to treatment to help monitor for drug resistant GC.
  • Individuals who present with symptoms consistent with GC should be screened at the time of presentation with both NA testing and GC culture immediately prior to treatment. 

HSV1+HSV2:

Unroof lesion and use Dacron swab located in side drawer of exam table; get viral transport media frozen in freezer in lab (a short tube with black top); thaw media and place swab in media.

Syphilis:

For Testing: Algorithm

Persons presenting as contacts to syphilis or who have signs or symptoms concerning for syphilis should have stat qualitative RPR testing and, if a possible chancre is present, testing by darkfield microscopy. Stat serological RPR testing can be performed at the PHSKC STD clinic on the 11th floor of the Ninth and Jefferson building [NJB].

The STD clinic can also perform darkfield testing; patients should go to the clinic for darkfield testing to assure that the best specimen is obtained. Because persons with a history of syphilis usually remain positive on treponemal specific tests for life. When evalauting such patients for signs or symptoms concerning for syphilis, clinicians should order a quantitative VDRL as part of the intial laboratory evalaution and not order an EIA alone.

Serologic Testing for syphilis - Letter from Matt Golden, MD. Director of PHSKC STD Control Program [12/09] - UW Net ID required

Haemophilus ducreyi (chancroid):

This disease is very rare in the United States. To diagnose chancroid one can do a culture in chocolate agar or PCR technology may be available. If a concern arises, would recommend a call to the STD Clinic at 744-3590 for further information.

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