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Assessing and Interpreting HIV and STD Risk History, Symptoms

and Lab ResultsChristina DeMatteo, DO, MPH

Kim Meehan Brown, DISNortheast Epidemiology Conference; Portland, Maine

November 14, 2019

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Disclosure

• Christina DeMatteo has nothing to disclose with regard to commercial relationships

• Kim Meehan-Brown has nothing to disclose with regard to commercial relationships

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Objectives

• Understand the components of sexual health history and how this affects recommended testing

• Understand how verbal and non-verbal communication affects accuracy of sexual health history

• Understand the process and interpretation of HIV and syphilis testing

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Why take a sexual history?

• Sexual health is an integral part of physical and mental health• Affirms personal identity,

normalizes discussion about socially stigmatized behaviors• Identify physical and mental

health risks• Identify substance use risks• Provides an opportunity for risk

reduction counseling

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Taking a Sexual History

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CDC Basics

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Language and body language

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What Tests to Choose?- One size does NOT fit all

• Chlamydia• Gonorrhea• Syphilis• HIV• Hepatitis C

• Bacterial vaginosis• Candida vaginitis• Trichomoniasis • HPV• Herpes

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Interpreting the Results

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HIV

doi: 10.1016/j.jcv.2012.01.022

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HIV-1/HIV-2 EIA 4th Generation

HIV negative

HIV-1/HIV-2 Discriminatory Assay (MultiSpot)

HIV-1 positive

HIV-2 positive

HIV-1 RNA Nucleic Acid Testing (NAT)

HIV Indeterminate

HIV-1 negative

HIV-1 positive

Non-Reactive

HIV-2 Non-Reactive

HIV-1 Non-Reactive

HIV-1 Non-ReactiveHIV-2 Non-Reactive

Not Done

Detected

Not Detected

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Syphilis

Early Latent Late Latent

Sutton, M, Dorell, C, Glob. libr. women's med.,(ISSN: 1756-2228) 2009; DOI 10.3843/GLOWM.10030

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DOI: https://doi.org/10.1212/01.CPJ.0000435752.17621.48

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CSF RPR has lower sensitivities than the CSF VDRL: 56.4-59.0% vs. 71.8% for laboratory-diagnosed neurosyphilis and 51.5-57.6% vs. 66.7% for symptomatic neurosyphilis.

www.health.nsw.gov.au/

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RPR Biologic False-Positive Results: • HIV • Lyme• Malaria• Lupus

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Syphilis

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EIA/CIA/MFI RPR TP-PA Interpretation Next steps

- N/A N/A -+ + N/A ++ - - -+ - + + …

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GonorrheaCeftriazone 250 mg PLUS azithromycin 1g PO x1

CDC

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Disclosure

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