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VISI

T AI

DSET

C.O

RG

November 2019

Sexu

ally

tran

smitt

ed G

C/CT

and

tric

hom

onas

in

fect

ions

: all

med

s ad

min

iste

red

on s

ite b

y pr

ovid

er4 -

azi

thro

myc

in l

gram

PO

x l

& c

eftri

axon

e 25

0 m

g IM

x l

& (i

f ris

k of

vag

initi

s) m

etro

nida

zole

2

gram

s PO

x l.

HIV

prop

hyla

xis:

TDF

/FTC

300

/200

mg

(Tru

vada

®) +

do

lute

grav

ir 50

mg

(Tiv

icay

®) –

1 ta

b ea

ch P

O d

aily

x

28 d

ays.

If w

ithin

the

first

trim

este

r of p

regn

ancy

(p

ost-L

MP

or b

y ul

traso

und

datin

g)  O

R m

ay b

ecom

e pr

egna

nt  w

ithin

the

next

28

days

, pre

scrib

e TD

F/FT

C 30

0/20

0mg

(Tru

vada

®) 1

tab

PO d

aily

+

ralte

grav

ir 40

0mg

(Isen

tress

®) 1

tab

PO tw

ice

a da

y x

28 d

ays.

7,8 A

dmin

iste

r firs

t dos

e on

site

as

soon

as

poss

ible

afte

r rap

id H

IV n

egat

ive

stat

us o

btai

ned3 o

r no

n-ra

pid

HIV

test

sen

t. TD

F/FT

C (T

ruva

da®) s

houl

d no

t be

used

for t

hose

with

est

imat

ed C

rCl l

ess

than

60

mL/

min

; an

alte

rnat

ive

regi

men

mus

t be

used

in th

ose

circ

umst

ance

s.Em

erge

ncy

cont

race

ptio

n: fo

r per

sons

at r

isk

of p

regn

ancy

with

a n

egat

ive

preg

nanc

y te

st. I

f pre

scrib

ed d

olut

egra

vir,

coun

sel o

n ne

ed fo

r pre

gnan

cy

prev

entio

n w

hile

on

nPEP

.Ad

min

iste

r 1 d

ose

of h

epat

itis

B va

ccin

e (w

ithou

t hep

atiti

s B

imm

une

glob

ulin

) to

per

sons

not

pre

viou

sly

vacc

inat

ed o

r inc

ompl

etel

y va

ccin

ated

. If t

he e

xpos

ure

sour

ce is

ava

ilabl

e fo

r tes

ting

& is

HBs

Ag

posi

tive,

unv

acci

nate

d nP

EP p

atie

nts

shou

ld

rece

ive

both

hep

atiti

s B

vacc

ine

& h

epat

itis

B im

mun

e gl

obul

in d

urin

g th

e in

itial

eva

luat

ion.

Fo

llow

-up

dose

(s) s

houl

d be

adm

inis

tere

d as

per

vac

cine

pac

kage

inse

rt. P

revi

ousl

y va

ccin

ated

exp

osed

per

sons

who

did

not

re

ceiv

e po

stva

ccin

atio

n te

stin

g sh

ould

re

ceiv

e a

sing

le v

acci

ne b

oost

er d

ose.

Fo

r tho

se 9

-45

year

s in

clus

ivel

y, o

ffer

first

HPV

vac

cina

tion

dose

if n

ot a

dequ

atel

y va

ccin

ated

pre

viou

sly.9

BASE

LIN

E TE

STS

TO C

ON

SID

ER F

OR

PERS

ON

S BE

ING

SEE

N F

OR

NO

NO

CC

UPA

TIO

NA

L PO

ST-

EXPO

SURE

PRO

PHYL

AX

IS (

nPEP

):Go

norr

hea

& c

hlam

ydia

(GC

/CT)

1 - s

wab

s of

all

site

s of

sex

ual c

onta

ct in

clud

ing

orop

hary

ngea

l, re

ctal

, and

gen

ital:

urin

e te

stin

g m

ay b

e co

nsid

ered

in p

lace

of

geni

tal t

estin

g

Rapi

d HI

V Ag

/Ab

test

ing2,

3

Urin

e pr

egna

ncy

test

for p

erso

ns a

t ris

k of

pre

gnan

cy

Rout

ine

bloo

dwor

k in

ass

essi

ng re

nal &

live

r fun

ctio

n (s

erum

cre

atin

ine,

ALT

, AS

T: e

stim

ated

cre

atin

ine

clea

ranc

e)

Syph

ilis

Sero

logy

: RPR

Hepa

titis

B v

irus

surf

ace

antig

en (H

BsAg

) for

thos

e w

ith k

now

n or

pro

babl

e pr

ior

HBV

infe

ctio

n10

For p

erso

ns a

t ris

k of

pre

gnan

cy w

ith a

neg

ativ

e

preg

nanc

y te

st, o

ffer e

mer

genc

y co

ntra

cept

ion.

For a

ll po

st-s

exua

l exp

osur

es (o

ral,

vagi

nal,

rect

al e

xpos

ures

), of

fer

on-s

ite tr

eatm

ent f

or G

C/CT

, & fo

r tric

hom

onas

(whe

n ris

k of

vag

initi

s).

INIT

IAL

TREA

TMEN

T, P

ATI

ENT

EDU

CA

TIO

N/

CO

UN

SELI

NG

& F

OLL

OW

-UP

VIS

ITS:

Fo

llow

-up

mus

t be

sche

dule

d at

72

hour

s &

4 w

eeks

afte

r ini

tiatin

g nP

EPPo

ssib

le d

rug

side

effe

cts:

naus

ea, G

I ups

et, h

eada

che,

mya

lgia

sPo

ssib

le d

rug

inte

ract

ions

: ant

acid

s, ca

lciu

m, i

ron

supp

lem

ents

Stre

ss a

dher

ence

impo

rtanc

e to

nPE

P re

gim

en fo

r 28

days

with

out i

nter

rupt

ion

PrEP

6 ini

tiatio

n im

med

iate

ly a

fter fi

nish

ing

28-d

ay n

PEP

pres

crip

tion

for t

hose

with

on

goin

g ris

kSy

phili

s se

rolo

gy a

t 4-6

wee

ksHI

V Ag

/Ab

test

ing

at 6

wee

ks &

3 m

onth

s af

ter i

nitia

l non

-reac

tive

test

HBV

& H

CV s

erol

ogy

test

ing

at 6

mon

ths

afte

r ini

tial n

on-re

activ

e te

st

1l F

or p

ost-s

exua

l ass

ault

patie

nts,

the

need

for S

TI te

stin

g sh

ould

be

cons

ider

ed.

12 P

refe

rabl

y a

rapi

d 4t

h ge

nera

tion

(Ag/

Ab) t

est s

houl

d be

don

e, b

ut if

not

ava

ilabl

e, n

on-ra

pid

HIV

test

ing

shou

ld b

e do

ne. I

f non

-rapi

d te

stin

g is

don

e, S

TART

nPE

P im

med

iate

ly &

arra

nge

follo

w-u

p in

l-2

days

for

HIV

resu

lts.

13 If

the

HIV

test

is re

activ

e/po

sitiv

e, th

e pe

rson

sho

uld

NO

T be

giv

en n

PEP,

but

be

prov

ided

sup

porti

ve

coun

selin

g &

con

nect

ed to

an

HIV

prim

ary

care

or s

peci

alty

car

e (ID

) pro

vide

r im

med

iate

ly (b

efor

e be

ing

disc

harg

ed).

14 C

eftri

axon

e is

the

reco

mm

ende

d tre

atm

ent f

or G

C &

sho

uld

not b

e su

bstit

uted

with

ano

ther

ant

ibio

tic

unle

ss th

ere

are

clea

r con

train

dica

tions

for i

ts u

se. I

f con

train

dica

ted,

refe

r to

CDC

2015

STD

Tre

atm

ent

guid

elin

es fo

r alte

rnat

ive:

http

s://w

ww.

cdc.

gov/

std/

tg20

15/g

onor

rhea

.htm

15 A

ll pe

rson

s of

fere

d nP

EP s

houl

d be

pre

scrib

ed a

28-

day

cour

se o

f a 3

-dru

g AR

V re

gim

en.

16 P

re-e

xpos

ure

prop

hyla

xis

(PrE

P): c

onta

ct th

e Cl

inic

ian

Cons

ulta

tion

Cent

er a

t 1-8

88-4

48-7

737

for

clin

icia

n-to

-clin

icia

n ad

vice

.17

Add

ition

al in

form

atio

n on

the

use

of d

olut

egra

vir i

n pr

egna

ncy

can

be fo

und

at: h

ttps:

//ww

w.gs

ksou

rce.

com

/pha

rma/

cont

ent/d

am/G

laxo

Smith

Klin

e/US

/en/

Pres

crib

ing_

Info

rmat

ion/

Tivi

cay/

pdf/

TIVI

CAY-

PI-P

IL.P

DF

18 R

alte

grav

ir (Is

entre

ss®),

to b

e do

sed

400

mg

PO tw

ice

a da

y, a

nd N

OT

Isen

tress

HD

® 6

00 m

g PO

twic

e a

day,

for n

PEP.

19 E

xpan

ded

use

of G

arda

sil:

http

s://w

ww.

fda.

gov/

New

sEve

nts/

New

sroo

m/P

ress

Anno

unce

men

ts/

ucm

6227

15.h

tm

10 S

ever

e ac

ute

exac

erba

tions

of H

BV h

ave

been

repo

rted

in H

BV-in

fect

ed p

eopl

e w

ho h

ave

disc

ontin

ued

Truv

ada®

): h

ttp://

ww

w.gi

lead

.com

/~/m

edia

/File

s/pd

fs/m

edic

ines

/hiv

/truv

ada/

truva

da_p

i.pdf

Cont

act u

s at

info

@ai

dset

c.or

g fo

r mor

e re

sour

ces,

que

stio

ns o

r fee

dbac

k.

IF R

API

D H

IV T

ESTI

NG

RES

ULT

IS “

NEG

ATI

VE”

(NO

N-R

EAC

TIV

E)2 ,

OFF

ER n

PEP

AN

D:

Additional Information• Healthcare providers should evaluate persons rapidly for nPEP

when care is sought ≤72 hours after an exposure that presents a substantial risk for HIV acquisition. The decision to recommend nPEP should not be influenced by the geographic location of the assualt/expoure.

• nPEP is not recommended when care is sought >72 hours after potential exposure.

• Regimens are available for children, and persons with decreased renal function.

• A case-by-case determination about nPEP is recommended when the HIV infection status of the source of the body fluids is unknown and the reported exposure presents a substantial risk for transmission if the source did have HIV infection.

• Follow-up for people receiving nPEP is important and should be provided by or in consultation with a clinician experienced in managing nPEP. Providers who do not have access to a clinician expereinced in providing nPEP follow-up should make linkages with community providers with this experience or contact the Clinician Consultation Center PEPline at (888)448-4911 for assistance http://nccc.ucsf.edu/.

When the source is knownto have HIV

Source ofunknownHIV status

Sourceknown

to have HIV

Nov

embe

r 201

9

nPEP is not recommended when care is sought >72 hours after exposure. If >72 hours after exposure, consult with an expert or contact the Clinician Consultation Center PEPline.