Questions & Answers - 2010 Treatment Guidelines
Question 1: When treating asymptomatic heterosexual patients with a history of oral and anal sex, in addition to genital sex, should screening involve collecting pharyngeal and/or rectal swabs, or only collecting genital swabs, but treating for all sites?
Question 2: Is chlamydia screening recommended for men who have sex with men (MSM) and HIV-positive individuals? What other STIs should MSM or HIV-positive individuals be screened for?
Question 3: Is the use of urine aptima tests for annual gonorrhea/chlamydia screening with HIV positive clients still appropriate?
Question 4: When patients want to be tested for “everything” does CDC suggest testing for syphilis and herpes simplex virus (HSV) as well?
Question 5: Why are there not specific recommendations for more frequent HIV/chlamydia screening for at-risk individuals?
Question 6: Recent study showed STDs in those claiming abstinence. Should we ignore self-reported high risk and screen everyone?
Question 7: What specific screening should be done in military recruit settings?
Question 8: Do you recommend use of anoscopy routinely in screening men who have sex with men (MSM)?
Question 9: What are the recommendations for asymptomatic college students who come in for STI testing and who want to be tested for “everything"?
Question 10: In the Iowa Department of Corrections we automatically screen females <25 years of age and between ages 25 and 35 if they have risk factors. There is no automatic screening for men. There is no age restriction; screening depends entirely on risk factors. Why do you think this is?
Question 11: Are correctional health providers generally doing STD follow-up for women under 35 who are incarcerated? If a patient has recently been released from a correctional facility, is a screening within a specific number of days a recommendation by the CDC, or is this screening recommendation based solely upon individual risk factors?
Question 12: Should all sexually active women under 24 be screened for chlamydia, regardless of how long they have been with their partner? For example, a 22-year-old who states she has had the same partner for two years and had a negative test one year prior.
Question 13: What female age groups are recommended for chlamydia screening?
Question 14: In addition to nucleic acid amplification testing (NAAT) of urine for gonorrhea and chlamydia, is there any guidance on when individuals should have rectal and/or oral testing for gonorrhea and chlamydia? Is it recommended for all individuals? Does it depend on other factors?
Question 15: Are there alternatives for gonorrhea (GC) testing?
Question 16: Most pharyngeal gonorrhea (GC) infections are asymptomatic. What is the risk of transmission (to genitals, to other pharynx)?
Question 17: The guidelines seem to recommend screening all sexually active women age <26 for gonorrhea, even in the absence of other risk factors. The guidelines do not mention high-risk geographic area or race as risk factors, therefore, I'm concerned that this recommendation is not a cost-effective strategy.
Question 18: Is there any recommendation on screening men who have sex with men (MSM) with anal cytologic exams?
Question 19: When performing nucleic acid amplification testing (NAAT), is one testing site preferred or more sensitive than another (i.e., urethral more sensitive than urine)?
Question 20: When should patient collected vaginal swabs be used?
Question 21: If a female gets chlamydia (CT) from rectal penetration without any vaginal penetration will it show up on a cervical culture?