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Table 1.  

Population Screening specifics Guideline group, yr of recommendation
USPSTF, 2018 ACOG, 2016 ACS, 2020
Persons at average risk Age to start screening 21 yrs 21 yrs 25 yrs
Age to end screening 65 yrs 65 yrs 65 yrs
If three consecutive negative cytology tests or two negative cytology plus HPV tests or two negative HPV tests (ACS) with the most recent within the previous 5 yrs and no abnormal tests within the previous 10 yrs (ACS) and no CIN 2 or CIN 3 within the previous 25 yrs
Screening test options and intervals Aged 21–65 yrs: Cytology alone every 3 yrs
or
Aged 21–29 yrs: Cytology alone every 3 yrs
Aged 30–65 yrs: Cytology plus HPV testing every 5 yrs
or
Aged 21–29 yrs: Cytology alone every 3 yrs
Aged 30–65: HPV testing alone every 5 yrs*
HPV testing alone every 5 yrs
or
Cytology plus HPV testing every 5 yrs
or
Cytology alone every 3 yrs
Preferred strategies Cytology alone every 3 yrs and HPV testing alone every 5 yrs (equally preferred) Cytology plus HPV testing every 5 yrs HPV testing alone every 5 yrs
Previous hysterectomy with removal of cervix Screening not recommended after hysterectomy for benign indications
Surveillance testing recommended for previous diagnosis of high-grade precancer, AIS, or cancer
Persons with an immunocompromising medical condition (e.g., HIV infection or solid organ transplantation) Age to start screening No specific recommendation Within 1 yr of onset of sexual activity or, if already sexually active, within the first year after HIV or other immunocompromising medical condition diagnosis but no later than age 21 yrs
Age to end screening None; lifelong screening recommended
Screening test options and intervals Aged 21–65 yrs: Cytology every year; after three consecutive annual normal cytology test results, screening can be every 3 yrs
or
Aged 21–29 yrs: Cytology every year
Aged 30–65 yrs: Cytology plus HPV testing every 3 yrs
Previous hysterectomy with removal of cervix Not specified
Persons with in utero exposure to diethylstilbestrol§ Age to start screening No specific recommendation Not specified No specific recommendation
Age to end screening Not specified
Screening test options and intervals Cytology alone annually
Previous hysterectomy with removal of cervix Not specified
Persons who have received HPV vaccination No changes to the screening approaches above
Population Screening specifics ASCCP, 2019, and ACOG, 2020
Persons with a diagnosis of CIN 2 or CIN 3 (histologic HSIL) within the previous 25 yrs Age to start screening Not applicable
Age to end screening May end at age 65 yrs if CIN diagnosis ≥25 yrs ago and criteria for ending screening met, otherwise continue screening past age 65 yrs
Continued screening for ≥25 yrs after diagnosis is acceptable if patient is in good health
Screening test options and intervals Initial surveillance:
   HPV testing alone or cytology plus HPV testing at 6, 18, and 30 mos
    or
   Cytology at 6, 12, 18, 24, and 30 mos
Long-term surveillance:
   HPV testing alone or cytology plus HPV testing every 3 yrs
    or
   Cytology alone annually
   Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs
   Routine screening can resume after the posttreatment surveillance period
Previous hysterectomy with removal of cervix HPV testing alone or cytology plus HPV testing every 3 yrs
    or
   Cytology alone annually
   Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs

TABLE 1. Cervical cancer screening and surveillance recommendations

Source: Perkins R, Guido R, Saraiya M, et al. Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016–2020. J Womens Health (Larchmt) 2021;30:5–13.
Abbreviations: ACS = American Cancer Society; ACOG = American College of Obstetricians and Gynecologists; AIS = adenocarcinoma in situ; ASCCP = American Society for Colposcopy and Cervical Pathology; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; USPSTF = U.S. Preventive Services Task Force.
*Considered an alternative screening strategy by ACOG.
Panel for Opportunistic Infections, ACOG, 2016.
§ACOG, 2016.
Either by cytology or by histology; includes a persistent cytologic diagnosis of atypical squamous cells, cannot rule out HSIL.

Table 2.  

Current HPV result Current Pap test result Previous result Management by 2012 guidelines Management by 2019 guidelines
Negative ASC-US Unknown or HPV negative* Repeat Pap plus HPV testing in 3 yrs Repeat HPV test with or without concurrent Pap test in 3 yrs
Negative LSIL Unknown or HPV negative* Repeat Pap plus HPV testing in 1 yr preferred, colposcopy acceptable Repeat HPV test with or without concurrent Pap test in 1 yr
Negative ASC-H Noncontributory Colposcopy Colposcopy
Noncontributory AGC Noncontributory Colposcopy Colposcopy
Positive NILM Unknown or HPV negative* Repeat Pap plus HPV testing in 1 yr Repeat HPV test with or without concurrent Pap test in 1 yr
Positive NILM HPV positive Colposcopy Colposcopy
Positive for genotype HPV 16, HPV 18, or both NILM Noncontributory Colposcopy Colposcopy
Positive for genotype HPV 16, HPV 18, or both ASC-US or LSIL Noncontributory Not applicable, genotyping not recommended for ASC-US or LSIL in 2012 Colposcopy
Positive ASC-US or LSIL Unknown or HPV positive Colposcopy Colposcopy
Positive ASC-US or LSIL Negative screening results with HPV testing or HPV plus Pap testing within the previous 5 yrs Colposcopy Repeat HPV test with or without concurrent Pap test in 1 yr§
Positive ASC-US or LSIL Colposcopy confirming the absence of high-grade lesion within the past yr Colposcopy Repeat HPV test with or without concurrent Pap test in 1 yr§
Positive ASC-H Noncontributory Colposcopy Colposcopy or expedited treatment
Positive untyped, positive for genotype other than HPV 16, or negative HSIL Noncontributory Colposcopy or expedited treatment Colposcopy or expedited treatment
Positive for genotype HPV 16 HSIL Noncontributory Colposcopy or expedited treatment Expedited treatment

TABLE 2. Comparison of 2012 and 2019 consensus recommendations for management of common abnormalities — American Society for Colposcopy and Cervical Pathology

Sources: Massad LS, Einstein MH, Huh WK, et al.; 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013;121:829–46; Perkins RB, Guido RS, Castle PE, et al; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020;24:102–31; Perkins R, Guido R, Saraiya M, et al. Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016–2020. J Womens Health (Larchmt) 2021;30:5–13.
Abbreviations: AGC = atypical glandular cells; AIS = adenocarcinoma in situ; ASC-H = atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion; ASC-US = atypical squamous cells of undetermined significance; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; LSIL = low-grade squamous intraepithelial lesion; NILM = negative for intraepithelial lesion or malignancy; Pap = Papanicolaou.
*Colposcopy may be warranted for patients with a history of high-grade lesions (CIN 2 or CIN 3, histologic or cytologic HSIL, ASC-H, AGC, or AIS).
Previous Pap test results do not modify the recommendation; colposcopy is always recommended for two consecutive HPV-positive tests
§Negative HPV test or cotest (HPV plus Pap test) results only reduce risk sufficiently to defer colposcopy if performed for screening purposes within the last 5 years. Colposcopy is still warranted if negative HPV test or cotest results occurred in the context of surveillance for a previous abnormal result.
Expedited treatment is preferred for nonpregnant patients aged ≥25 years. Colposcopy with biopsy is an acceptable option if desired by patient after shared decision-making.

Table 3.  

Vaccine Trade name (manufacturer) Age group (yrs) Dose Route Schedule Booster
Hep A inactivated (2 doses) Havrix (GlaxoSmithKline) 1–18 0.5 mL (720 ELISA units inactivated HAV) IM 0, 6–12 mos None
≥19 1 mL (1,440 ELISA units inactivated HAV IM 0, 6–12 mos None
Hep A inactivated (2 doses) Vaqta (Merck) 1–18 0.5 mL (25 units HAV antigen) IM 0, 6–18 mos None
≥19 1 mL (50 units HAV antigen) IM 0, 6–18 mos None
Combined Hep A and Hep B* (3 doses) Twinrix (GlaxoSmithKline) ≥18 (primary) 1 mL (720 ELISA units inactivated plus 20 μg HBsAg IM 0, 1, 6 mos None
≥18 (accelerated) 1 mL (720 ELISA units inactivated plus 20 μg HBsAg IM 0, 7, 21–30 days 12 mos

TABLE 3. Vaccines for preventing hepatitis A infection

Source: Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5).
Abbreviations: ELISA = enzyme-linked immunosorbent assay; HAV = hepatitis A virus; HBsAg = hepatitis B surface antigen; Hep A = hepatitis A; Hep B = hepatitis B; IM= intramuscular.
*Combined Hep A and Hep B vaccine (Twinrix) should not be used as postexposure prophylaxis.

Table 4.  

Indication and age group Risk category and health status Hepatitis A vaccine IG*
Postexposure prophylaxis
0–11 mos Healthy No 0.1 mL/kg body weight
12 mos to 40 yrs Healthy 1 dose None
>40 yrs Healthy 1 dose 0.1 mL/kg body weight§
≥12 mos Immunocompromised or chronic liver disease 1 dose 0.1 mL/kg body weight
≥12 mos Vaccine contraindicated** No 0.1 mL/kg body weight
Pre-exposure protection (e.g., travel)††
<6 mos Healthy No 0.1–0.2 mL/kg body weight§§
6–11 mos Healthy 1 dose¶¶ None
12 mos to 40 yrs Healthy 1 dose*** None
>40 yrs Healthy 1 dose*** 0.1–0.2 mL/kg body weight§§,†††
>6 mos Immunocompromised or chronic liver disease 1 dose*** 0.1–0.2 mL/kg body weight§§,†††
>6 mos Persons who elect not to receive vaccine or for whom vaccine is contraindicated** No 0.1–0.2 mL/kg body weight§§

TABLE 4. Recommendations for hepatitis A postexposure prophylaxis and pre-exposure protection, by age group and risk category — Advisory Committee on Immunization Practices, 2020

Source: Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5).
Abbreviations: HAV = hepatitis A virus; IG = immune globulin.
*Measles, mumps, and rubella vaccine should not be administered for ≥2 weeks before and 6 months after administration of IG.
A second dose of hepatitis A vaccine is not required for postexposure prophylaxis; however, for long-term immunity, the vaccination series should be completed with a second dose ≥6 months after the first dose.
§The provider's risk assessment should determine the need for IG administration. If the provider's risk assessment determines that both vaccine and IG are warranted, hepatitis A vaccine and IG should be administered simultaneously at different anatomic sites (e.g., separate limbs).
Vaccine and IG should be administered simultaneously at different anatomic sites (e.g., separate limbs).
**Life-threatening allergic reaction to a previous dose of hepatitis A vaccine or allergy to any vaccine component.
††IG should be considered before travel for persons with special risk factors for either HAV infection or severe disease from HAV infection.
§§0.1 mL/kg body weight for travel ≤1 month; 0.2 mL/kg body weight for travel ≤2 months; 0.2 mL/kg every 2 months for travel of ≥2 months' duration.
¶¶This dose should not be counted toward the routine 2-dose series, which should be initiated at age 12 months.
***For persons not previously vaccinated with hepatitis A vaccine, administer dose as soon as travel is considered and complete the series according to routine schedule if the next dose is needed before travel.
†††Can be administered on the basis of the provider's risk assessment.

Table 5.  

Serologic marker Interpretation
HBsAg Total anti-HBc IgM anti-HBc Anti-HBs
- - - - Never infected
+ - - - Early acute infection; transient (≤18 days) after vaccination
+ + + - Acute infection
- + + - Acute resolving infection
- + - + Recovered from past infection and immune
+ + - - Chronic infection
- + - - Past infection; low-level chronic infection§; passive transfer to infant born to HBsAg-positive mother; false positive (no infection)
- - - + Immune if concentration is >10 mIU/mL after vaccination, passive transfer after HBIG administration

TABLE 5. Interpretation of serologic test results* for hepatitis B virus infection

Source: Adapted from Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1).
Abbreviations: anti-HBc = antibody to hepatitis B core antigen; anti-HBs = antibody to hepatitis B surface antigen; HBIG = hepatitis B immune globulin; HBsAg = hepatitis B surface antigen; IgM = immunoglobulin M.
*- = negative test result; + = positive test result.
To ensure that an HBsAg-positive test result is not false positive, samples with repeatedly reactive HBsAg results should be tested with a neutralizing confirmatory test cleared by the Food and Drug Administration.
§Persons positive for only anti-HBc are unlikely to be infectious, except under unusual circumstances involving direct percutaneous exposure to large quantities of blood (e.g., blood transfusion or organ transplantation) or mutant HBsAg-related infection.

Table 6.  

Age group (yrs) Single-antigen vaccine Combination vaccine
Recombivax HB Engerix-B Heplisav-B* Twinrix
Dose (μg)§ Volume (mL) Dose (μg)§ Volume (mL) Dose (μg)§ Volume (mL) Dose (μg)§ Volume (mL)
Infants (<1) 5 0.5 10 0.5 NA NA
Children (1–10) 5 0.5 10 0.5 NA NA
Adolescents (11–15) 10** 1.0 NA NA NA NA
Adolescents (11–19) 5 0.5 10 0.5 NA NA
Adults (≥18) †† †† †† †† 20* 0.5 20 1
Adults (≥20) 10 1 20 1 20 0.5 20 1
Hemodialysis patients and other immunocompromised persons (<20§§) 5 0.5 10 0.5 20 0.5 NA NA
Hemodialysis patients and other immunocompromised persons (≥20) 40¶¶ 1 40*** 2.0 20 0.5 NA NA

TABLE 6. Recommended doses of licensed formulations of hepatitis B vaccines

Source: Adapted from Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1).
Abbreviation: NA = not applicable.
*Administered on a 2-dose schedule.
Combined hepatitis A and B vaccines. This vaccine is recommended for persons aged ≥18 years who are at increased risk for both hepatitis B and hepatitis A virus infections.
§Recombinant hepatitis B surface antigen protein dose.
Heplisav-B should not be used for vaccination of infants, children, or adolescents because the safety and effectiveness of Heplisav-B has not been established in persons aged <8 years and is not approved for use in these populations.
**Adult formulation administered on a 2-dose schedule.
††Engerix-B and Recombivax HB are approved for use in persons of all ages.
§§Higher doses might be more immunogenic; however, no specific recommendations have been made.
¶¶Dialysis formulation administered on a 3-dose schedule at 0, 1, and 6 months.
***Two 1.0-mL doses administered at one site, on a 4-dose schedule at 0, 1, 2, and 6 months.

Table 7.  

Source of exposure Unvaccinated person§ Previously vaccinated person
HBsAg-positive source
   Percutaneous (e.g., bite or needlestick) or mucosal exposure to HBsAg-positive blood or body fluids
    or
   Sex or needle-sharing contact with an HBsAg-positive person
    or
   Victim of sexual assault or abuse by an assailant who is HBsAg positive
Administer hepatitis B vaccine series and HBIG Complete hepatitis B vaccine series and HBIG, if vaccine series not completed
    or
   Administer hepatitis B vaccine booster dose, if previous vaccination without testing**
Source with unknown HBsAg status
   
Percutaneous (e.g., bite or needlestick) or mucosal exposure to potentially infectious blood or body fluids from a source with unknown HBsAg status
    or
   Sex or needle-sharing contact with person with unknown HBsAg status
    or
   Victim of sexual assault or abuse by a perpetrator with unknown HBsAg status
Administer hepatitis B vaccine series Complete hepatitis B vaccine series

TABLE 7. Guidelines for postexposure prophylaxis* of persons with nonoccupational exposure† to blood or body fluids that contain blood, by exposure type and hepatitis B vaccination status

Sources: CDC. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep 2013;62(No. RR-10); CDC. Postexposure prophylaxis to prevent hepatitis B virus infection. MMWR Recomm Rep 2006;55(No. RR-16).
Abbreviations: HBIG = hepatitis B immune globulin; HBsAg = hepatitis B surface antigen.
*When indicated, immunoprophylaxis should be initiated as soon as possible, preferably within 24 hours. Studies are limited regarding the maximum interval after exposure during which postexposure prophylaxis is effective, but the interval is unlikely to exceed 7 days for percutaneous exposures or 14 days for sexual exposures. The hepatitis B vaccine series should be completed. These guidelines apply to nonoccupational exposures.
These guidelines apply to nonoccupational exposures.
§A person who is in the process of being vaccinated but who has not completed the vaccine series should complete the series and receive treatment for hepatitis B as indicated.
A person who has written documentation of a complete hepatitis B vaccine series and who did not receive postvaccination testing.
**No booster dose is needed for persons who have written documentation of hepatitis B vaccine series with serologic response.

Table 8.  

Infection Evidence for sexual abuse Recommended action
Gonorrhea* Diagnostic Report
Syphilis* Diagnostic Report
HIV§ Diagnostic Report
Chlamydia trachomatis* Diagnostic Report
Trichomonas vaginalis* Diagnostic Report
Anogenital herpes Suspicious Consider report†,¶
Condylomata acuminata (anogenital warts)* Suspicious Consider report†,¶,**
Anogenital molluscum contagiosum Inconclusive Medical follow-up
Bacterial vaginosis Inconclusive Medical follow-up

TABLE 8. Implications of commonly encountered sexually transmitted or sexually associated infections for diagnosis and reporting of sexual abuse among infants and prepubertal children

Sources: Adapted from Kellogg N; American Academy of Pediatrics Committee on Child Abuse and Neglect. The evaluation of child abuse in children. Pediatrics 2005;16:506–12; Adams JA, Farst KJ, Kellogg ND. Interpretation of medical findings in suspected child abuse: an update for 2018. J Pediatr Adolesc Gynecol 2018;31:225–31.
*If unlikely to have been perinatally acquired and vertical transmission, which is rare, is excluded.
Reports should be made to the local or state agency mandated to receive reports of suspected child abuse or neglect.
§If unlikely to have been acquired perinatally or through transfusion.
Unless a clear history of autoinoculation exists.
**Report if evidence exists to suspect abuse, including history, physical examination, or other identified infections. Lesions appearing for the first time in a child aged >5 years are more likely to have been caused by sexual transmission.

Box 1.  

1. Partners
  • "Are you currently having sex of any kind?"
  • "What is the gender(s) of your partner(s)?"
2. Practices
  • "To understand any risks for sexually transmitted infections (STIs), I need to ask more specific questions about the kind of sex you have had recently."
  • "What kind of sexual contact do you have or have you had?"
    • "Do you have vaginal sex, meaning 'penis in vagina' sex?"
    • "Do you have anal sex, meaning 'penis in rectum/anus' sex?"
    • "Do you have oral sex, meaning 'mouth on penis/vagina'?"
3. Protection from STIs
  • "Do you and your partner(s) discuss prevention of STIs and human immunodeficiency virus (HIV)?"
  • "Do you and your partner(s) discuss getting tested?"
  • For condoms:
    • "What protection methods do you use? In what situations do you use condoms?"
4. Past history of STIs
  • "Have you ever been tested for STIs and HIV?"
  • "Have you ever been diagnosed with an STI in the past?"
  •  "Have any of your partners had an STI?"
Additional questions for identifying HIV and viral hepatitis risk:
  • "Have you or any of your partner(s) ever injected drugs?"
  • "Is there anything about your sexual health that you have questions about?"
5. Pregnancy intention
  • "Do you think you would like to have (more) children in the future?"
  • "How important is it to you to prevent pregnancy (until then)?"
  • "Are you or your partner using contraception or practicing any form of birth control?"
  • "Would you like to talk about ways to prevent pregnancy?"
 

BOX 1. The Five P’s approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention

Box 2.  

Gastrointestinal symptoms
Headache
Pruritis without rash
Localized rash
Delayed onset rash (>24 hours)
Symptoms unknown
Family history of penicillin or another drug allergy
Patient denies allergy but it is on the medical record

BOX 2. Low-risk history in patients who report penicillin allergy

Box 3.  

Major determinant
  •    Benzylpenicilloyl polylysine injection (Pre-Pen) (AllerQuest) (6 × 10−5M)
Minor determinant precursors
  • Benzylpenicillin G (10−2M, 3.3 mg/mL, 10,000 units/mL)
  • Benzylpenicilloate (10−2M, 3.3 mg/mL)
  • Benzylpenicilloate (or penicilloyl propylamine) (10−2M, 3.3 mg/mL)
Aged penicillin is not an adequate source of minor determinants. Penicillin G should either be freshly prepared or come from a fresh-frozen source.
Positive control
  • Commercial histamine for scratch testing (1.0 mg/mL)
Negative control
  • Diluent (usually saline) or allergen diluent

BOX 3. Skin test reagents for identifying persons at risk for adverse reactions to penicillin

Source: Adapted from Saxon A, Beall GN, Rohr AS, Adelman DC. Immediate hypersensitivity reactions to beta-lactam antibiotics. Ann Intern Med 1987;107:204–15.

Box 4.  

Uncomplicated vulvovaginal candidiasis (VVC)
  • Sporadic or infrequent VVC
       and
  • Mild-to-moderate VVC
       and
  • Likely to be Candida albicans
      and
  • Nonimmunocompromised women
Complicated VVC
  • Recurrent VVC (three or more episodes of symptomatic VVC in <1 year)
       or
  • Severe VVC
       or
  • Non–albicans candidiasis
       or
  • Women with diabetes, immunocompromising conditions (e.g., HIV infection), underlying immunodeficiency, or immunosuppressive therapy (e.g., corticosteroids)

BOX 4. Classification of vulvovaginal candidiasis

Source: Sobel JD, Faro S, Force RW, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol 1998;178:203–11.

Box 5.  

Children

  • All children aged 12–23 months
  • Unvaccinated children and adolescents aged 2–18 years

Persons at increased risk for hepatitis A virus (HAV) infection

  • International travelers
  • Men who have sex with men
  • Persons who use injecting or noninjecting drugs (i.e., all those who use illegal drugs)
  • Persons with occupational risk for exposure
  • Persons who anticipate close personal contact with an international adoptee
  • Persons experiencing homelessness

Persons at increased risk for severe disease from HAV infection

  • Persons with chronic liver disease
  • Persons with HIV infection

Other persons recommended for vaccination

  • Pregnant women at risk for HAV infection or severe outcome from HAV infection
  • Any persons who requests a vaccine

Vaccination during outbreaks

  • Unvaccinated persons in outbreak settings who are at risk for HAV infection or at risk for severe disease from HAV

Implementation strategies for settings providing services to adults

  • Persons in settings that provide services to adults where a high proportion of those persons have risk factors for HAV infection

Hepatitis A vaccination is no longer recommended by the Advisory Committee on Immunization Practices

  • Persons who receive blood products for clotting disorders (e.g., hemophilia)

BOX 5. Populations recommended for hepatitis A vaccination — Advisory Committee on Immunization Practices, 2020

Source: Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5).

CME / ABIM MOC / CE

Sexually Transmitted Infections Treatment Guidelines, 2021

  • Authors: Kimberly A. Workowski, MD; Laura H. Bachmann, MD; Philip A. Chan, MD; Christine M. Johnston, MD; Christina A. Muzny, MD; Ina Park, MD; Hilary Reno, MD, PhD; Jonathan M. Zenilman, MD; Gail A. Bolan, MD
  • CME / ABIM MOC / CE Released: 10/27/2021
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 10/27/2022
Start Activity


Target Audience and Goal Statement

This activity is intended for family medicine clinicians, internists, adolescent medicine clinicians, obstetricians/gynecologists, emergency medicine clinicians, infectious disease clinicians, and other clinicians caring for patients with or at risk for sexually transmitted infections (STIs).

The goal of this activity is to describe on-site STI treatment and partner services, operational determinants of quality services in various clinical settings, and indications for consultation with or referral to a specialist for patients with STI-related conditions, according to updated Centers for Disease Control and Prevention (CDC) guidelines.

Upon completion of this activity, participants will:

  • Describe treatment recommendations for sexually transmitted infections (STIs), according to updated Centers for Disease Control and Prevention (CDC) guidelines
  • Determine vaccine and other preventive strategy recommendations for STIs, according to updated CDC guidelines
  • Identify diagnostic and counseling recommendations for STIs, according to updated CDC guidelines


Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Faculty

  • Kimberly A. Workowski, MD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Department of Medicine, Emory University
    Atlanta, Georgia

    Disclosures

    Disclosure: Kimberly A. Workowski, MD, has disclosed no relevant financial relationships.

  • Laura H. Bachmann, MD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Laura H. Bachmann, MD, has disclosed no relevant financial relationships.

  • Philip A. Chan, MD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia
    Brown University
    Providence, Rhode Island

    Disclosures

    Disclosure: Philip A. Chan, MD, has disclosed no relevant financial relationships.

  • Christine M. Johnston, MD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia
    University of Washington
    Seattle, Washington

    Disclosures

    Disclosure: Christine M. Johnston, MD, has disclosed the following relevant financial relationships:
    Serve(d) as advisor or consultant for: AbbVie, Inc.; Gilead Sciences, Inc.; MedPace, Inc.
    Received grants for clinical research from: Bill and Melinda Gates Foundation
    Other (Royalties for HSV sections): UpToDate

  • Christina A. Muzny, MD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia
    University of Alabama at Birmingham

    Disclosures

    Disclosure: Christina A. Muzny, MD, has disclosed the following relevant financial relationships:
    Serve(d) as advisor or consultant for: Abbott Laboratories; Becton, Dickinson and Co.; Cepheid; Lupin Pharmaceuticals, Inc.; PhagoMed Biopharma GmbH; Roche Diagnostics
    Received grants for clinical research from: Lupin Pharmaceuticals, Inc.

  • Ina Park, MD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia
    University of California San Francisc

    Disclosures

    Disclosure: Ina Park, MD, has disclosed no relevant financial relationships.

  • Hilary Reno, MD, PhD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia
    Washington University
    St Louis, Missouri

    Disclosures

    Disclosure: Hilary Reno, MD, PhD, has disclosed the following relevant financial relationships:
    Received grants for clinical research from: Hologics, Inc.

  • Jonathan M. Zenilman, MD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia
    Johns Hopkins University
    Baltimore, Maryland
    Participation by Dr. Jonathan M. Zenilman does not constitute or imply endorsement by the Johns Hopkins University or the Johns Hopkins Hospital and Health System.

    Disclosures

    Disclosure: Jonathan M. Zenilman, MD, has disclosed no relevant financial relationships.

  • Gail A. Bolan, MD

    Division of STD Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Disclosure: Gail A. Bolan, MD, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

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CME / ABIM MOC / CE

Sexually Transmitted Infections Treatment Guidelines, 2021

Authors: Kimberly A. Workowski, MD; Laura H. Bachmann, MD; Philip A. Chan, MD; Christine M. Johnston, MD; Christina A. Muzny, MD; Ina Park, MD; Hilary Reno, MD, PhD; Jonathan M. Zenilman, MD; Gail A. Bolan, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC / CE Released: 10/27/2021

Valid for credit through: 10/27/2022

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Summary

These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11–14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.

Introduction

The term "sexually transmitted infection" (STI) refers to a pathogen that causes infection through sexual contact, whereas the term "sexually transmitted disease" (STD) refers to a recognizable disease state that has developed from an infection. Physicians and other health care providers have a crucial role in preventing and treating STIs. These guidelines are intended to assist with that effort. Although the guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed.

This report updates Sexually Transmitted Diseases Treatment Guidelines, 2015[1] and should be regarded as a source of clinical guidance rather than prescriptive standards. Health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. These guidelines are applicable to any patient care setting that serves persons at risk for STIs, including family planning clinics, HIV care clinics, correctional health care settings, private physicians' offices, Federally Qualified Health Centers, clinics for adolescent care, and other primary care facilities. These guidelines are focused on treatment and counseling and do not address other community services and interventions that are essential to STI and HIV prevention efforts.

These STI treatment guidelines complement Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020[2] regarding quality clinical services for STIs in primary care and STD specialty care settings. This guidance specifies operational determinants of quality services in various clinical settings, describes on-site treatment and partner services, and indicates when STI-related conditions should be managed through consultation with or referral to a specialist.