The Blue Book Standards for the Management and Evaluation ...

1 1 The Blue Book Standards for the Management and Evaluation of STI Clinic Clients GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV SYPHILIS YEAST SCABIES bacterial vaginosis TRICHOMONIASIS PUBIC LICE HERPES GONORHEA CHLAMYDIA NGU MPC HIV HPV YEAST pSYPHILIS YEAST SCABIES Last Revised: June 2021 2 Acknowledgements A committee of provincial sexually transmitted disease representatives convened by Alberta Health Services (AHS) prepared this manual.

2 Thanks are extended to the members of the STI Blue Book Working Group and the staff of the Alberta Provincial Laboratory for Public Health for their expertise and time to provide input and feedback in the development of the document. Special thanks extended to Tammy Troute-Wood and Marni Panas for their expert review of the Caring For the Trans, Non-Binary and Two-Spirit Client chapter. Members of the committee were: Marla Dane (Chair) Clinical Instructor, Calgary STI Clinic, AHS Lindsay Rathjen Director, Provincial STI Programs, AHS Jennifer Gratrix Manager, STI Centralized Services, AHS Logan Chinski Manager, Calgary STI Clinic, AHS Alyshah Lalany (Chair) Clinical Instructor, Edmonton STI Clinic, AHS Dawn Leduc Interim Clinical Instructor, Edmonton STI Clinic, AHS Michelle Fudge STI Clinic RN, Fort McMurray STI Clinic, AHS Diane McKimmie Associate Manager, Fort McMurray STI Clinic, AHS Garret Meyer Manager, Edmonton STI Clinic, AHS Dr.

3 Angel Chu Medical Director, Calgary STI Clinic, AHS Dr. Petra Smyczek Medical Director, Provincial STI Services, AHS Committee Reports to: Christopher Wood Executive Director, Communicable Disease Control, AHS 3 Table of Contents 2 Members of the committee were: .. 2 Committee Reports to: .. 2 Summary of Changes (Updates/Revisions) since April 2019 .. 11 II Physical Assessment .. 11 D. Specific Examination .. 11 E. Testicular Pain/Swelling Algorithm .. 12 Added: Section C. Transgender Males and Females (see section XV Caring for the Trans Client) .. 12 A. External Reproductive organs (male) .. 12 C. Testing .. 12 Added: history of 3 documented doses of Hepatitis B immunization.. 12 G. Lesions .. 12 1. Direct testing for Herpes Simplex virus and Syphilis PCR testing.

4 12 F. Diagnosis of genital ulcer disease .. 12 2. Herpes Simplex Virus (HSV) .. 12 G. Treatment of Genital Ulcer Disease .. 13 1. Syphilis .. 13 G. Treatment of Genital Ulcer Disease .. 13 1. Syphilis .. 13 C. Testing .. 13 2. Screening for Hepatitis B (HBsAb, HBsAg, Anti-HBc) .. 13 C. Testing .. 13 C. Testing .. 14 2. Hepatitis B (HBsAG, HBsAb, Anti-HBc) .. 14 C. Testing .. 14 3. Hepatitis C (Anti-HCV antibody and HCV RNA) .. 14 E. Counselling .. 14 E. Counselling .. 14 Notification of Sexually Transmitted Infections (STI) and Treatment .. 15 Notifiable Disease Management Guidelines .. 16 Consent .. 17 Overview .. 17 Most Responsible Health Practitioner .. 18 Implied Consent .. 18 Minors / Mature Minors .. 18 Assessment of Mature Minors.

5 19 Documentation of Assessment .. 20 Consent via an Interpreter / Telephone / Fax .. 20 Blood and Blood Products: Consent Policy: .. 20 I. History .. 21 A. Chief Complaint .. 21 B. Functional Inquiry .. 21 1. Male .. 21 2. 22 4 C. Drug/Other Allergy .. 22 D. Concomitant Medication .. 22 E. Past History .. 22 F. Social History .. 23 G. Sexual History .. 24 H. Identifying Vulnerable or At Risk Clients .. 24 II. Physical Examination .. 26 A. Environment and Equipment .. 26 B. Psychological Assessment .. 26 C. General Outline .. 26 D. Specific Examination .. 27 1. Mouth and Throat .. 27 2. Skin and Pubic Hair .. 27 3. Lymphadenopathy .. 27 4. Male .. 27 5. Female .. 28 6. Surgically Constructed Sex Organs (see section XV.)

6 Caring for the Trans, Non-Binary and Two-Spirit Client) .. 29 III. Routine STI Testing .. 30 A. Male .. 30 B. Female .. 31 C. Transgender Males and Females (see section XV Caring for the Trans, Non-Binary and Two-Spirit Client) .. 33 IV. Laboratory Procedures (Specimen Collection) .. 34 A. Venous Blood Specimen .. 34 B. Urethral Specimen .. 34 1. Urethra of people with a penis for Gram Stain .. 34 2. Urethra for culture of Neisseria gonorrhea or herpes simplex virus PCR .. 35 3. Urine for NAAT testing of Neisseria gonorrhea and Chlamydia trachomatis (Aptima Urine Specimen Collection Guide) .. 36 C. Endocervix Specimen .. 37 1. Endocervix for culture of Neisseria gonorrhea and herpes simplex virus PCR .. 37 2. Endocervix for NAAT testing of Neisseria gonorrhea and Chlamydia trachomatis (Aptima Swab Specimen Collection Guide).

7 38 3. Endocervix for Cervical Cancer Screening (Papanicolaou) Test .. 39 D. Vaginal Swab .. 42 1. Vaginal swab for wet mount and/or gram stain .. 42 2. Vaginal swab for culture .. 42 3. Vaginal swab for NAAT testing of Neisseria gonorrhea and Chlamydia trachomatis (Aptima Multitest Swab Specimen Collection Guide) .. 43 4. Rectum for culture/NAAT of Neisseria gonorrhoea and Chlamydia trachomatis .. 44 E. Throat for culture/NAAT of Neisseria gonorrhoea .. 45 F. Eyes for culture/NAAT of Neisseria gonorrhea, Chlamydia trachomatis, and herpes simplex virus .. 46 G. Lesions .. 47 1. Direct testing for Herpes Simplex virus and Syphilis PCR testing .. 47 2. Haemophilus ducreyi (Chancroid) PCR Testing .. 47 5 3. Lymphogranuloma Venereum (LGV) Specimen Collection for Laboratory Testing or Arranging confirmation of Chlamydia trachomatis L1-L3.

8 48 H. Inoculation of Culture Media/Agar Plate for Neisseria gonorrhea .. 49 V. Microscopy .. 52 A. Kohler Illumination .. 52 B. Gram Stain .. 53 C. Use of Oil Immersion Lens .. 53 D. Wet Mount Preparation (Candida albicans, Clue Cells and Trichomonas vaginalis) .. 54 E. KOH Preparation and Whiff Test for bacterial 54 F. Darkfield Microscopy/Fluorescent Antibody (FA) for T. pallidum .. 55 VI. Genital Ulcer Disease - Approach to Assessment and Management .. 56 A. Differential Diagnosis .. 56 B. Introduction .. 56 C. Clinical Assessment .. 57 1. History .. 57 D. Examination .. 57 1. Ulcer .. 57 2. Lymph nodes .. 57 3. Other clinical findings .. 57 E. Testing .. 57 F. Diagnosis of Genital Ulcer Disease (see genital ulcer algorithm pg.)

9 71) .. 58 1. Syphilis .. 58 2. Herpes Simplex Virus (HSV) .. 61 3. Chancroid (Haemophilus ducreyi) .. 62 4. Lymphogranuloma venereum (LGV) .. 62 G. Treatment of Genital Ulcer Disease .. 63 1. Syphilis .. 63 2. Genital Herpes .. 66 3. Chancroid .. 67 4. Lymphogranuloma Venereum (LGV) .. 67 H. Client Follow Up .. 68 1. Syphilis .. 68 2. 68 3. Chancroid .. 69 4. LGV .. 69 I. Contact Management .. 70 1. Syphilis .. 70 2. 70 3. Chancroid .. 70 4. LGV .. 70 J. Genital Ulcer Disease Algorithm .. 72 VII. Urethritis .. 73 A. Introduction .. 73 B. Clinical Assessment .. 73 C. Testing (see Urethritis algorithm) .. 73 D. Diagnosis .. 74 1. Non-Gonococcal Urethritis .. 74 2. Chlamydia Urethritis .. 74 6 3. Gonorrhea Urethritis.

10 74 E. Treatment .. 74 1. Non-gonococcal Urethritis .. 74 2. Chlamydia .. 77 3. Gonorrhea .. 78 F. Non-gonococcal Urethritis (NGU) Treatment Failure .. 80 G. Chlamydia Treatment Failure (urogenital, pharyngeal) .. 81 H. Gonorrhea Treatment Failure (urogenital, pharyngeal, rectum).. 81 I. Client 82 1. Non-Gonococcal Urethritis (NGU) .. 82 2. Chlamydia Urethritis .. 82 3. Gonorrhea Urethritis .. 83 J. Contact Management .. 84 1. Non-Gonococcal Urethritis (NGU) .. 84 2. Chlamydia .. 84 3. Gonorrhea .. 84 K. Urethritis Algorithm .. 85 L. NGU Treatment Failure/Relapse Algorithm .. 86 M. CT Treatment Failure/Relapse Algorithm .. 87 N. GC Treatment Failure/Relapse Algorithm .. 88 VIII. Epididymo-orchitis .. 89 A.