British Columbia Treatment Guidelines

1 655 West 12th Avenue Vancouver, BC V5Z 4R4. General Inquiries: Provincial STI/HIV Clinic Phone: Provincial STI/HIV Clinic Fax: British Columbia Treatment Guidelines Sexually Transmitted Infections in Adolescents and Adults 2014. Prepared by: Richard Lester, MD, FRCP(C), Medical Head, Provincial STI/HIV Clinic, Clinical Prevention Services (CPS). Carolyn Montgomery, MB, BCh, Provincial STI/HIV Clinic Physician, CPS. Barbra Arnold, MD, CCFP, DTMH, Provincial STI/HIV Clinic Physician, CPS. Sylvia Makaroff, MD, CCFP, Provincial STI/HIV Clinic Physician, CPS. Avril Spencer, BScN, Provincial STI/HIV Clinic Educator, CPS. Gina Ogilvie, MD FCFP DrPH, Medical Director, CPS.

2 These Guidelines are based on the Canadian Guidelines on Sexually Transmitted Infections (STI) 2010 Edition and online updates to 2014. Titling This document contains Treatment Guidelines for clinicians and public health professionals regarding care and Treatment of STIs in British Columbia and are based on DIDbest the YOU KNOW. available CAPTIONS: scientific knowledge and medical practices. These Guidelines are for information purposes only and are not intended in any manner to replace clinical judgment or to establish the only approach to all patients. Clinicians and public health professionals must use their independent medical judgment in the context of the individual clinical circumstances to determine patient careBody Copy: Ut wisi enimhealth ad minim veniam, quis nostrud etresources exerci tation Lorem ipsum dolor sit amet, consectetuer or Treatment .

3 Clinicians and public professionals are encouraged to consult other in order to adipiscing confirm elit, sed diam the information nonummy contained in thesenibh Guidelines , including, but not limited to, individual product monograph(s), and standards ullamcorper suscipit lobortis nisl ut aliquip ex ea commodo consequat. or instructions provided by licensed manufacturers. euismod tincidunt ut laoreet dolore magna Duis autem vel eum iriure dolor in hendrerit in vulputate velit esse aliquam erat volutpat. These Guidelines may be updated as evidence and currentmolestie practice regarding the management consequat, of STIs vel illum evolves. eu dolore Clinicians and public feugiat nullahealth professionals facilisis at veromusteros ensure the Guidelines they have are current.

4 Although all efforts are taken by BCCDC to ensure the completeness of the Guidelines , BCCDC does not guarantee the completeness or accuracy of the information nor is the BCCDC responsibleet for accumsan et from damages resulting iusto the odio misusedignissim qui blandit praesent luptatum zzril of the information. delenit augue duis dolore te feugait nulla facilisi. Lorem ipsum dolor sit Look for this mark PULL QUOTES: The level of evidence and strength of recommendations are graded and summarized below. amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod throughout the document to tincidunt ut laoreet dolore magna aliquam erat volutpat. Loreminfections identify ipsum dolor sit notifiable Table 1.

5 Levels of Recommendation to the medical amet, health officer consectetuer Recommendation: Ut wisi A. enim ad minim Strongly veniam, quisrecommends nostrudthat clinicians exerci routinely tation provide the Treatment ullamcorper to eligible individuals. Good evidence that the Treatment improves REPORTABLE suscipit lobortis nisl ut aliquip ex ea important commodo health eu concludes outcomes and feugiat nulla facilisis that benefits at substantially adipiscing elit, sed diam vero eros et accumsan et iustooutweighodioharms. dignissim qui blandit praesent nonummy nibh euismod luptatum zzril delenit augue duis dolore te feugait nulla facilisi. Include routine HIV screening with any Recommendation: B Recommends that clinicians routinely provide the Treatment to other STI testing.

6 Tincidunt ut With certaindolore laoreet sexually eligible individuals. At least fair evidence that the Treatment improves transmitted infections, it is important to important health outcomes and concludes that benefits outweigh harms. magna treat aliquam partners erat and contacts at the time of Subtitles testing, before results are available. Nam liber tempor cum soluta nobis eleifend option congue nihil imperdiet volutpat. Recommendation: C No recommendation for or against routine provision of the Treatment . doming id quod mazim placerat At leastfacer possim fair evidence assum. that the Treatment can improve health outcomes Recommendations regarding Treatment of but concludes that the balance of the benefits and harms is too close paediatric infections are excluded from these to justify a general recommendation.

7 Guidelines . In general, children diagnosed Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam with a STI should be managed in conjunction nonummy nibh euismod Recommendation: D tincidunt Recommends ut laoreet doloreproviding against routinely magnathealiquam erat Treatment to with a specialist and investigation of possible asymptomatic individuals. At least fair evidence that the Treatment is sexual abuse needs to be considered. volutpat. Duis autem vel eum iriure dolor in hendrerit in ineffective or that harms outweigh benefits. vulputate velit esse molestie consequat, vel illum dolore eu feugiat nulla facilisis at vero Contact the Provincial STI/HIV Clinic eros et accumsanI et iusto odio dignissim quitoblandit praesent luptatum Recommendation: Evidence is insufficient recommend for or against routinely Physician for further management or providing the Treatment .

8 Evidence that the Treatment is effective is the Child Protection Service Unit (a zzril delenit augue duis dolore te feugait etre nulla facilisi. lacking, of poor quality or conflicting, and the balance of benefits and multidisciplinary team located at BC harms cannot be determined. Children's Hospital) or Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam (toll free in BC only). nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat Routine STI updates are communicated volutpat. Table 2. Quality of Evidence via admin circulars on the BCCDC website. To receive ongoing STI Updates, go to the Evidence from at least one properly randomized, controlled trial.

9 BCCDC website: - CDC. Manual- Admin Circulars, enter your Email Subtitles П Evidence from at least one well-designed clinical trial without randomization, from cohort or address and SUBMIT Duis autem case-control vel eum analytic iriurestudies dolor(preferably from more in hendrerit than one centre), in vulputate velitfrom multiple time- esse series studies or from dramatic results in uncontrolled experiments. molestie consequat, vel illum dolore eu To keep the Guidelines concise, references Prepared by: are not published with the Guidelines . feugiat Ш nulla facilisis at vero eros et Evidence from opinions of respected authorities based on clinical experience, descriptive accumsanstudies et iusto odioof expert committees.

10 Or reports dignissim qui References are available on the BCCDC Name here blandit praesent luptatum zzril delenit website, Chapter 5 - CDC Manual For reportability augue duis dolore of sexually te transmitted infections refer to the Public feugait Health etreAct of Date here British Columbia (PHA): Health Act Communicable Disease Regulation or the Public Health nulla facilisi. See: Agency of Canada website: Nam liber tempor To consult with thecum soluta nobis Provincial STI/HIV Clinic Physician call eleifend option congue nihil imperdiet doming id quod mazim placerat facer possim assum. Lorem ipsum dolor sit amet, consectetuer British Columbia Treatment Guidelines - Sexually Transmitted Infections in Adolescents and Adults - Revised August 2014 1.