Pediatric emergency medicine trisk 4241 4241
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (129.83 KB, 1 trang )
replaced vaginal/cervical/urethral culture in both prepubertal and pubertal
female and male patients. In addition, while NAATs are not FDA-approved
for extragenital sites, the extensive use and reliability of this technology has
resulted in reliable use on pharyngeal, urine, and rectal specimens for GC
and CT. While culture may be used, compared to NAATs, it is an inferior
testing method for chlamydia detection. If NAAT is performed, all positive
tests should be confirmed by a second NAAT that targets a different genomic
sequence to increase specificity of the test; most commercial test kits include
a second DNA probe for this purpose. Cervical specimens are not
recommended for prepubertal females. All vesicular or ulcerative genital or
perianal lesions should be sent for PCR and/or viral culture to test for genital
herpes. The preferred testing method for Trichomonas vaginalis is NAAT,
given the poor sensitivity and specificity of wet mount. Syphilis testing
should be performed using rapid plasma reagin (RPR) test, and Hepatitis B
testing is indicated if the patient has not been fully immunized against this
infection. Hepatitis C has been associated with intravenous drug abuse and
should be considered as part of the STI testing when there is a perpetrator
history of drug use. HIV serum testing should be performed using a fourthgeneration p-24 antigen/HIV-1 and HIV-2 antibody combination (preferred)
or a third-generation HIV-1/2 antibody immunoassay. HIV testing should be
performed after appropriate counseling, emphasizing that the test result will
only provide evidence of infection acquired prior to 6 months, although the
new fourth-generation HIV immunoassays can detect more acute HIV-1
infection.
Postexposure Prophylaxis
The risk of a child acquiring an STI as a result of sexual assault/abuse has
not been well studied. In prepubertal patients, prophylaxis is not
recommended because the incidence of infection is low after assault/abuse as
is the risk for ascending infection, and regular follow-up of children can
usually be ensured. In contrast, all pubertal patients should be offered STI
prophylaxis due to higher pretest probability of having an STI, and poor
follow-up rates among this patient population. Empiric antibiotics for GC,
CT, and TV are given. See Table 127.5 for recommended treatments and
doses. It is recommended to refer to the CDC STD treatment guidelines for
those requiring alternative regimens. Patients who have not been previously
