Sexually Transmitted Diseases in Milwaukee County and Other High Risk Areas: Screening, Testing and Treatment Recommendations
MSMC COMMUNITY COLLABORATION ON HEALTHCARE QUALITY (CCHQ) AND THE CITY OF MILWAUKEE HEALTH DEPARTMENT (MHD)
The Milwaukee metropolitan area has significantly elevated rates of certain sexually transmitted diseases. The US Preventive Services Task Force recommends increased STD screening in such high-prevalence areas. Milwaukee Health Department physicians developed the following screening and testing guidelines based on epidemiologic data and in cooperation with CCHQ; the treatment recommendations in this document are distilled from current CDC guidelines. There are other areas in Wisconsin with high STD rates in which these or similar screening and testing guidelines may be applicable; consult local health departments for recommendations.
Recommended Screening and Testing Schedule
Gonorrhea and chlamydia
Sexually active women: with every pelvic exam, up to annually, through age 29 (through 39 if more than one sex partner in preceding 12 months)
Sexually active men: consider annually through age 29 (recommend annually through 39 if more than one sex partner in preceding 12 months)
Anyone with any other STD, or with sexual contact to gonorrhea or chlamydia
Women with purulent cervical discharge, evidence of cervical inflammation, or cervical motion tenderness, or with sexual contact to a man with nonspecific urethritis
Men with urethral discharge
Anyone with any other STD, or newly diagnosed HIV
Anyone with a lesion or rash consistent with syphilis, known contact to a case of syphilis, or known contact to a person with any other STD
Pregnant women: three tests recommended (at initial prenatal visit, at the beginning of the third trimester / 28 weeks gestation, and when in labor)
Any person with any other STD, or known contact to another STD
Any person with syphilis (the workup and treatment for syphilis can vary depending on HIV status)
Any person with unusual infections or unexplained weight loss
Pregnant women (at initial visit; repeat later if any of the below apply)
Every 6-12 months for all sexually active persons aged 49 or less with any of the following in the preceding 6-12 months:
more than one sex partner
use of intravenous drugs
a sex partner who uses intravenous drugs, has one or more other sex partners, or is known to be positive for HIV
Recommended Screening Tests
Gonorrhea and Chlamydia
Amplified or non-amplified molecular testing (PCR, LCR, various others). Gonorrhea may also be tested for using Modified Thayer-Martin (MTM) culture. Note that amplified tests may remain positive for several weeks after adequate treatment.
The usual site of testing is the urethra for men and the cervix for women. Certain amplified tests are approved for urine as well.
If there is a history of rectal or pharyngeal exposure, gonorrhea culture and chlamydia testing should be done from those sites as well.
STD SCREENING, TESTING AND TREATMENT GUIDELINES FOR HIGH PREVALENCE AREAS Approved 11/4/03 by the MSMC Community Collaboration on Healthcare Quality & the City of Milwaukee Health Department
Treatment for Gonorrhea Updated 1/21/08
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