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Sexualhealthtayside.org

S E X U A L & R E P R O D U C T I V E H E A L T H S E R V I C E
S E X U A L L Y T R A N S M I T T E D I N F E C T I O N S
Q U I C K R E F E R E N C E G U I D E

Sexually transmitted infections
Who to test for STIs: targeted screening in
asymptomatic groups
 NHS Tayside has the highest rates of genital Gonorrhoea and Chlamydia (in all ages) in Scotland  Genital Chlamydia infection remains asymptomatic in Chlamydia Sexual partners of those with suspected Chlamy- The highest prevalence of STIs is seen in those Under 25s (especially those who have had more Sexual History
MSM and those identified with higher risk taking sexual behaviours should be advised to attend the sexual health Which tests to perform
clinic (these patients are prioritised and usually seen the
Male (MSM)
(heterosexual)
Chlamydia and Gonorrhoea – combined PCR assay

Who to test for STIs : symptomatic patients

First void
 FVU
 Endocervical
urine (FVU)*
 Pharyngeal
symptomatic)
swab (if patient
has oral sex)

 Vulvovaginal
swab (VVS)
Rectal swab (if
patient or
patient has
anal sex)
clinician
Inflamed/friable cervix (which may bleed on con- taken (only if
asympto-
Suspected pelvic inflammatory disease (PID) Genital Herpes
HSV swab to be taken from base of genital ulcer
*Men with urethal discharge should be seen within specialist services for a urethral swab and point-of-care testing for urethritis  FVU samples - yellow-topped Cobas PCR urine  Rectal/Pharyngeal/Endocervical/VVS samples - yellow-topped Cobas PCR female swab container  HSV swab - Copan PCR Universal transport me-  All above specimens should be kept at room tem-
perature whilst awaiting transport to the lab
 All patients diagnosed with any STI should be rec- ommended to have screening for syphilis and HIV regardless of risk - single Gold vacutainer
 Obtain consent for all positive results (HSV ex- *Symptoms are more typically found in men who have cluded) to be shared with the sexual health service sex with men (MSM). Refer to Specialist Services. – document on request form if patient declines
** These patients should be tested for genital Herpes  Record the current mobile phone number on the test request form. A sexual health adviser will con- tact the patient to inform them of their positive result www.sexualhealthtayside.org

S E X U A L L Y T R A N S M I T T E D I N F E C T I O N S
Q U I C K R E F E R E N C E G U I D E

First line management of common STIs
Quick risk assessment for HIV/blood borne viruses

Uncomplicated chlamydia

 Have you ever had an HIV test before? (date and Uncomplicated gonorrhoea
Ceftriaxone 500mg i.m. stat and Chlamydia treat-
Have you ever had sex with someone you know has ment (regardless of Chlamydia test result) Trichomonas
(refer to the specialist service for confirmation of the di-
 Have you ever had sex with anyone who injects  Have you had sex with anyone from abroad? (record
Pelvic inflammatory disease
Ofloxacin 400mg bd 14 days and metronidazole
 Male patients: Have you ever had sex with another
Epididymitis
 Female patients: Have you ever had sex with a man If <35 years old, sexually transmissible pathogen more  Have you ever paid for sex or been paid for sex? Referral to specialist services
If >35 years old, urinary pathogen more likely  Please refer electronically through the Referral
Ofloxacin 200mg bd 14 days (if risk of sexually Management System
If Gonorrhoea suspected refer to specialist ser- vices – add in ceftriaxone 500mg i.m. stat Additional management considerations for above
conditions

Sexual abstinence until treatment completed (7 days for uncomplicated infection)  Testing and treatment of sexual partners Recurrent bacterial vaginosis or vulvovaginal candidiasis  Safer sex advice and condom provision Primary and recurrent genital herpes
Aciclovir 200mg 5 times daily for five days Individuals seeking post-exposure prophylaxis for HIV Suppressive treatment for confirmed recurrent geni-
tal herpes

Further Information
Indication: > 6 recurrences per year  Aciclovir 400mg bd for 12 months followed by Websites:
Await more than two recurrences before considering re-
Considerations for individuals who disclose sexual
 Forensic examination via police as soon as possible Sexual Health Advisers:
Ninewells Hospital, Dundee: Telephone 01382 632 600 Hepatitis B vaccination – ultra-rapid schedule day 0, 7 Drumhar Health Centre, Perth: Telephone 01738 564272 Abbey Health Centre, Arbroath: Telephone 01241  Consider post-exposure prophylaxis for HIV depend-  Consider prophylaxis against bacterial STIs especially Consultants:
 STI testing at 2 weeks (or 6 weeks if given prophylac- tic treatment) for all orifices involved  Psychological support and referral to services www.sexualhealthtayside.org

Source: http://www.sexualhealthtayside.org/cms/STIGuide.pdf

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Evaluation and Management (E/M) Services Billed to WPS Medicare - Part B ~CERT Error Examples and How to Avoid Them~ Insufficient Documentation Error Examples How to prevent this type of error Billed CPT 99211. Submitted documentation supports the Services billed to Medicare under CPT code 99211 must be only face to face service provided on the billed date of reasonable and

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