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STD Care & Prevention During Disruption of Clinical Services

  • 1.  STD Care & Prevention During Disruption of Clinical Services

    Posted 04-16-2020 01:07
    Dear All, 

    I would appreciate your creativity, commentary, and reflections on the CDC guidance letter released on 04/06/2020 outlining STD treatment during the SARS-COV-2 pandemic. 

    https://www.cdc.gov/std/dstdp/DCL-STDTreatment-COVID19-04062020.pdf

    While providing telehealth services, I've had many patients this month with symptomatic STD concerns with barriers such as: laboratory closures, infrequent walk-in availability, calls during after clinic or pharmacy hours, inability to prescribe and administer recommended IM treatment, all of course, coupled with risk/benefit decision-making/counseling between COVID-19 and presenting to a lab, clinic, or pharmacy!

    I've been recommending that patients who need empiric treatment who either decline or don't have access to testing receive some of the treatments listed here and also encouraging them to use mail-order pharmacies, download pharmacy apps so they can prepay or have medications delivered, etc. I'm also wondering if anyone has experience with ordering IM medications at retail pharmacies and their ability to administer an IM prescription.

    I've also been adding COVID-19 shared decision-making documentation to notes when patients insist on presenting for walk-in STD treatment or laboratory testing. 

    Thanks!

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    Morgan Mako, APRN, FNP-C, AAHIVS
    Pronouns: he/him/his
    Lynn Community Health Center
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  • 2.  RE: STD Care & Prevention During Disruption of Clinical Services

    Posted 04-17-2020 10:15
    Hi MM,
    I work for a very large community clinic organization in SoCalifornia, Borrege Comm Health Foundation. We have open clinics so I am shocked your patients can't get the treatments or labs. You might search for community clinics in your area or contact the public health department STI division as to what to do. They certainly don't want too many epidemics.





  • 3.  RE: STD Care & Prevention During Disruption of Clinical Services

    Posted 04-19-2020 00:43

    Hello,
    We are doing a combination of telemedicine and having symptomatic patients come in. We couldn't see any way around it. We deal with a lot of indigent patients who would not be able to go to a lab anyway, so they would have to come thru us in order to have their STI testing processed. Despite telemedicine I find there are some patients I just have to physically have eyes on. I have a few complex cases where telemedicine will not suffice.



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    Amber Siegel
    Oviedo FL
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  • 4.  RE: STD Care & Prevention During Disruption of Clinical Services

    Posted 04-19-2020 10:25

    Daniel Pearce ddpearce1@gmail.com

    Sat, Apr 18, 1:38 PM (17 hours ago)
    to morgan.mako
    This message has been deleted. Restore message
    Hi MM,
    Risk management with STIs.
    I agree that we must strike a balance between knowing/not knowing lab results vs. SarsCoV2 exposure. I have no figures guiding me re: the risk of complications and spreading of an STI vs. getting SarsCoV2 and then the risk of complications and spread. We have the patient wait outside in their car and then come in and out of the clinic ASAP to limit airborne and surface exposure. Of course urine, anal and oral swab procedures increase that risk. With face masks on all, I am not too concerned about droplet exposure.
    We have no data so we use judgement based on poor risk evidence. Being an HIV physician, I see about 1 syphilis or GC or Chlam a week, so that colors my experience. Of course I take an STI exposure history to guide me.
    Thanks for sharing,
    Dan


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    Daniel Pearce, DO FACOI, AAHIVS
    Borrego Community Health Foundation
    San Bernardino, Riverside, San Jacinto California
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  • 5.  RE: STD Care & Prevention During Disruption of Clinical Services

    Posted 04-20-2020 05:54
    I can identify with the dilemma of seeing patients during this COVID-19 pandemic and it is challenging with regards to issues about telemedicine as we balance the risks versus benefits of various health care delivery modes of prevention and treatment. My personal option is that we should pay careful attention to reverting to face to face interaction if;
    1) It is a new patient
    2) It is a complicated patient that needs close monitoring
    3) It is patient that we do not have any data or medical records
    4) It is a patient that requires a physical examination owing to the risk of complications

    There are so many patients that are having STD/HIV disease progression because of delayed access to treatment due to the fear of acquiring COVID-19. Life has to go on in parallel to COVID-19. Have a great day.

    Regards 

    Cleophas





  • 6.  RE: STD Care & Prevention During Disruption of Clinical Services

    Posted 04-21-2020 09:54

     

     

    Sent from Mail for Windows 10

    Greetings, My name is Reese, I am nurse at an FQHC in SC, I am also over reproductive health services at my center.

     

    Prior to the COVID pandemic we were seeing 15 – 20 patients across all our sites just for dedicated on site STD screening, testing and treatment visits daily.   In addition just for regular primary care visits most of our age appropriate patients were being screened for possible STD exposure and pregnancy intention at every visit. With COVID, we too are having to think outside the box and deliver care through modern technology avenues. But.............our efforts to screen for STD's has had to be put on the back burner and thus our numbers have dropped dramatically for March and April, we have only been treating the immediate chronic care needs. We still have a few patients who present for STD treatment, check and exposure face to face, but for the most part "those" individuals are not coming in. It has become a double edge sword. Our community has been told to stay home to stay well.  When this is all over, I believe we will be inundated with increased unplanned pregnancies, and increased STD's. I want to shout from the roof tops we are still here!

     

    Reese ��






  • 7.  RE: STD Care & Prevention During Disruption of Clinical Services

    Posted 05-15-2020 20:25
    Hello Morgan,
    Have you seen the very helpful California Prevention Training Center's 1-page summary of the CDC interim guidance for treating symptomatic patients when in-person exams are limited due to COVID-19?   You can view or download it from the National STD Curriculum. 
    Julia

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    Julia Freimund
    National HIV Curriculum, University of Washington Infectious Diseases Education and Assessment (IDEA) Program
    www.hiv.uw.edu
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