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| The New 2010 CDC STI Treatment Guidelines and Implications for Screening: Everything You’re Itching to Know! |
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by R. Mimi Secor, MS, M.Ed, FNP-BC, FAANP - February 14, 2011
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The New CDC STD Treatment Guidelines were released in December 2010 and provide the most current, evidence-based recommendations for screening, diagnosis and treatment of Sexually Transmitted Infections.
As both the incidence and prevalence of STIs in the US and Worldwide continue to burgeon, the proportion of patients that are appropriately screened is significantly lower than recommended in these recently published guidelines. This is especially a problem among the highest risk populations of young adults 25 years old and younger. It is estimated that only 40- 60% of young adults are appropriately screened for chlamydia.
Yet, rates of chlamydia, gonorrhea, trichomoniasis, genital herpes, HPV, HIV and syphilis are all increasing particularly among adolescents, young adults and high risk populations. Often asymptomatic (over half of women with chlamydia or bacterial vaginosis) and unaware they harbor various STIs, many go undetected and untreated. This contributes to further transmission of STIs and may also increase the risk of developing associated complications and sequelae such as PID, chronic pelvic pain, infertility and preterm labor.
For these reasons, there is an urgent need for more comprehensive STI screening particularly targeting high risk populations, adolescents, young adults, and individuals of any age who are “at risk” by history.
Opportunistic screening is a growing trend in the US (widely implemented in Canada and the UK) that involves screening for STIs at the same time patients are seen for other health problems. With convenient and accurate urine testing for chlamydia and gonorrhea, office based-outpatient HIV testing, and new vaginal pH screening tests now available, opportunistic screening is an idea whose time has come and is an approach more feasible than ever before.
Vaginal microscopy is fairly accurate (approximately 60% for average proficiency) for diagnosing vaginal infections including some STIs such as trichomoniasis. However, accuracy depends largely on the skill of the clinician, is fairly complex and time consuming. Therefore many clinicians rely on their clinical judgment “eyeballing” discharge and treating based on symptoms and empiric diagnosis. This approach is inaccurate and not recommended by the CDC. Relying on Pap smear reports suggesting vaginitis or STIs is also not recommended due to low sensitivity and specificity.
Use of vaginal pH testing is another diagnostic option for vaginitis and vaginitis related STI screening (e.g. checking for trichomoniasis). Traditionally, vaginal pH testing involves the use of Nitrazine pH paper (on a roll) requiring multiple steps to conduct the test including use of a color and numerical scale to determine if the test is normal or abnormal. Considered too cumbersome and time consuming for many busy clinicians, vaginal pH testing is not widely utilized.
New, improved vaginal pH tests are now available affording a simple and quick way to screen patients during both routine and problem gynecologic visits.
The new VS-SENSE diagnostic vaginal swab test facilitates diagnosis of bacterial vaginosis (BV) and trichomoniasis by identifying changes in the acidity parameters of the vaginal secretions. The VS-SENSE swab is coated with an innovative proprietary polymer which contains a colorimetric pH indicator, Nitrazine yellow. When the polymer in the swab, which is yellow before use, contacts vaginal fluid and reaches a specific threshold, the user observes a blue or green color change on the swab. When the tip of the swab stains blue or green the VS-SENSE test is positive indicating an elevated vaginal pH level (>4.7 +.3/-.2) which is associated with both bacterial vaginosis and trichomoniasis. If after 10 seconds the swab tip does not change color, but remains yellow, the VS-SENSE test is negative, indicating that vaginal acidity is normal and the risk of having an infection associated with elevated vaginal pH level in unlikely.
The VS-SENSE technology is based on combining the measurement of the vaginal pH with buffer capacity (the concentration of protein within the discharge) which together raises the overall accuracy of the test to over 90%.
This new vaginal pH test, VS-SENSE, provides a quick, easy, accurate approach for screening and diagnosis of vaginitis and is especially well suited for busy primary care and women’s health practices.
For more information on testing for vaginal infections and STIs, and to download a PDF copy of the New 2010 CDC STI Treatment Guidelines, visit, www.mimisecor.com or go to, www.cdc.gov/stds.org
Mimi is a national speaker and consultant. She has worked for 33 years as a Nurse Practitioner specializing in women's health and is currently working at Newton Wellesley ObGyn in Newton, Massachusetts. She is also a visiting scholar at Boston College Graduate School of Nursing and guest lecturer at the Massachusetts General Hospital Institute of Health Professions. Not only has Mimi been published extensively, but she also has years of media experience including hosting a new radio show on ReachMD XM 160, Partners in Practice. She has also been a guest on Good Morning America, and interviewed by the Wall Street Journal, Boston Globeand many others. Mimi is a member of the Editorial Advisory Board for the PA and NP online community Clinician 1and has received several awards in patient care and education.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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