Clinical Manual for Management of the HIV-Infected ... - myCME.com

1–18 | Clinical Manual for Management of the HIV-Infected Adult/2006
Women
Gonorrhea,
Chlamydia, and
Trichomoniasis
Testing
Gonorrhea
and Chlamydia
Testing, Rectal
Men
• STD screening in sexually active • Negative
• Counsel about safer sex and avoiding STDs.
women at risk
• Repeat every 6-12 months; more frequently if at high
risk.
• Positive
• Treat patient; refer partner(s) of previous 60 days for
evaluation and treatment; counsel about safer sex.
• STD screening in sexually active • Negative
• Counsel about safer sex and avoiding STDs.
women at risk
• Repeat every 6-12 months; more frequently if at high
• STD screening in sexually active
risk.
women who have receptive anal sex • Positive
• Treat patient; refer partner(s) of previous 60 days for
evaluation and treatment; counsel about safer sex.
Gonorrhea • STD screening in sexually active men • Negative
• Retest every 3-6 months in patients with risk factors.
and Chlamydia
Testing, Urethral
who are at risk, especially men who
have sex with men (MSM)
• Positive
• Treat; refer partner(s) of previous 60 days for
evaluation and treatment; counsel about safer sex.
Gonorrhea • STD screening in sexually active men • Negative
• Retest every 3-6 months in patients with risk factors.
and Chlamydia
Testing,
Pharyngeal
who are at risk, especially MSM who
have oral-genital contact
• Positive
• Treat; refer partner(s) of previous 60 days for
evaluation and treatment; counsel about safer sex.
Gonorrhea • STD screening in sexually active men • Negative
• Retest every 3-6 months in patients with risk factors.
and Chlamydia who are at risk, especially MSM who
Testing, Rectal
Consider/Optional
have receptive anal sex
• Positive
• Treat; refer partner(s) of previous 60 days for
evaluation and treatment; counsel about safer sex.
G6PD Level • Prevent hemolytic reactions by • Normal range
• No intervention is necessary beyond documentation.
screening susceptible men of African,
Mediterranean, Asian, Sephardic
Jewish descent
• Abnormal range
• Avoid oxidant drugs such as dapsone, primaquine, and
sulfonamides, if possible.
• Some would recommend screening
all patients
Cytomegalovirus • Detects exposure; may reveal future • Negative
• Avoid exposure by practicing safer sex.
(CMV) Antibody
(anti-CMV IgG) for
those at low risk
of CMV, especially
those who are not
MSM or injection
drug users
disease risk
• Positive
•
•
If blood transfusion is required, use CMV-negative or
leukocyte-reduced blood.
Be aware of disease risk in advanced HIV infection,
when CD4 count 10-year life
expectancy)
• Abnormal
• Refer to urology specialist for evaluation.
Urinanalysis (UA) • Detects proteinuria or pyuria
• Normal
• Repeat annually.
• Abnormal
• Rule out HIV-associated nephropathy and other causes
of nephropathy.
Dilated Retinal • Detects CMV, ophthalmic
• Normal
• CD4 count >100 cells/µL: repeat annually.
Examination toxoplasmosis, or HIV retinopathy
• CD4 count