GYN

CMECNE

Screening for Sexually Transmitted Diseases – Who, When and How Often?

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. List the screening recommendations for sexually active women and pregnant women
2. Identify the risk factors for acquiring a new sexually transmitted disease

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

Sexually transmitted diseases (STDs) are common with potential for serious long term outcomes, and remain a serious public health concern.

Screen women for sexually transmitted Infections (STIs) based on age and risk factors
- Annual screening is recommended for all sexually active women aged <25 years and for older women at increased risk for infection
- Pregnant women should be screened at the first prenatal visit, with HIV and syphilis screening repeated in the third trimester (see ‘Related ObG Topics’ for more on screening in pregnancy)
- Tests may be repeated more frequently, based on clinical findings at presentation and risk factors

SYNOPSIS:

There are an estimated 2.8 million new chlamydia infections each year in the US. The highest rates of both gonorrhea and chlamydia are reported in women aged 15 to 24. Symptoms are vague and sequelae can include pelvic inflammatory disease, ectopic pregnancy and infertility.

KEY POINTS:

Increased Risk for STI

A new sex partner
More than one sex partner
A sex partner with concurrent partners
A sex partner who has a sexually transmitted infection

Increased Risk for Hepatitis B

Those born in a region of high endemicity (see map in ‘Learn More – Primary Sources’ below)
- High rates are present in sub-Saharan Africa, East Asia, the Amazon, the southern parts of Eastern and Central Europe
- Born in geographic regions with HBsAg prevalence of ≥2%
- US born persons not vaccinated as infants whose parents were born in geographic regions with HBsAg prevalence of ≥8%
IV drug use | Needle-sharing contacts
Men who have sex with men
Persons on immunosuppression
Hemodialysis patients
HIV positive
elevated ALT/AST of unknown etiology
Household contacts and sex partners of HBV-infected persons

Note: USPSTF 2020 guidance recommends screening for HBV in persons at high risk for infection | The recommendations are in keeping with the previous 2014 guidelines but are “strengthened by new evidence from trials and cohort studies reporting that antiviral therapy reduces risk of mortality and hepatocellular carcinoma and improves intermediate outcomes that are consistently associated with better health outcomes”

Increased Risk for hepatitis C

Note: CDC has updated guidelines recommending universal HepC screening

All adults 18 years and older (except in settings where the prevalence is > 0.1%)
All pregnant persons should be screened for HCV during each pregnancy (except in settings where the prevalence of HCV infection is > 0.1%)
All persons with risk factors (eg., persons with HIV, prior recipients of blood transfusions, persons who ever injected drugs and shared needles, and persons who are born to an HCV-infected mother) should be tested for HCV, with periodic testing while risk factors persist

Note: According to CDC “For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody is recommended”

Learn More – Primary Sources:

Screening Recommendations from 2015 STD Screening Guideline, CDC

CDC: A Guide to Taking a Sexual History

CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020

USPSTF: Screening for Hepatitis B Virus Infection in Adolescents and Adults

Map: Prevalence of hepatitis B virus infection

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