NM Department of Health Family Planning Program

Services and Clinics

Appendix

This section contains discussion and/or specific guidelines for the following topics:

• Case Study Discussion

• Instructions for Obtaining Continuing Education Credit

• Post-test

• Score Sheet

• Participant Continuing Education Registration Form

• Participant Feedback Form

• Resources

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Case Study Discussion

CASE 1

This client should be tested for chlamydia and other STDs, but it is too soon to test for something she may have acquired only last night.  Any tests done at this clinic visit will pick up any STDs previously acquired.  She needs education on the importance of returning to the clinic for follow-up testing and comprehensive STD counseling to help her assess her risks for contracting an STD infection and modify her behavior, if needed.  Presumptive treatment may be provided if allowed by written protocol.

CASE 2

Chlamydia testing requires columnar epithelial cells.  Pus or mucus on the swab can indicate that the inside of the cervix was not adequately cleaned before sampling.  This could cause a false-negative test result.

CASE 3

Although chlamydia culture is the only recognized test-of-cure, you may use a non-culture method such as Gen-Probe, if done at least 3 weeks after treatment.  Routinely, tests of cure are not required.

CASE 4

The male partner should be treated as a contact to a partner diagnosed with Ct.  His other contacts should be referred to a clinic for screening, diagnosis and treatment.  The clinician may opt not to treat the female client again at this time.

CASE 4a

Start first with reflecting her feelings - "This news about chlamydia is very upsetting to you." Then see where she goes - you might need to reflect several times so that she can calm down. Then I would say "you have several concerns, which question/issue would you like to discuss first?"

Remember: It is important for counselors to always address feelings first and when the client is calmer only then start addressing questions.

CASE 5

Results with DNA Probe are not totally reliable on bloody specimens.  The clinician must determine whether or not the face of the exocervix can be sufficiently cleaned to obtain an adequate specimen.  This client may need immediate follow-up to rule out other conditions.

CASE 6

The laboratory will reject specimens not submitted with swabs approved for use and supplied in the collection kits.  Wooden swabs or other non-Gen-Probe swabs may interfere with the testing process.

CASE 7

No – For optimal results, transport and store specimens at refrigerator or room temperature and test within 7 days of collection.  Frozen specimens can cause a false-negative result.

CASE 8

No – Environmental contaminants may interfere with test performance.

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Instructions For Obtaining Continuing Education Credit

Please make your own two copies of the Post-test and Participant Evaluation forms to complete and submit for continuing education credits. Complete the Participant Evaluation Form and record your answers to the post-test.  Keep one copy of your post-test answers for your records.  Mail only the completed evaluation form and your post-test answers. Employees of the Public Health Division and Family Planning Program Contractors and Providers are no charge. All other applicants please include a $15.00 check or money order made payable to The Center for Health Training. Certificates will be issued to participants upon successful completion of the post-test with a minimum passing score of 70%, receipt of the completed evaluation form, and payment if applicable.

Questions:  call Family Planning @ 505-476-8882

Completed forms should be mailed to:

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Post-test

Clinical Management of Chlamydia trachomatis

Post-test (printable Word document)

Post-test (printable PDF document)

1. All of the following statements concerning chlamydia are true EXCEPT:

   1. It is the most common bacterial sexually transmitted disease in the United States.

   2. Only one million cases of chlamydia genital infection occur annually in the United States.

   3. Sequelae of asymptomatic infections include infertility and ectopic pregnancy.
       

2. In women, the initial site of chlamydia infection is usually:

   1. Cervical columnar epithelium

   2. Cervical squamous epithelium

   3. Uterine endometrial tissue

   4. Vaginal mucosal epithelium
       

3. Which of the following statements about salpingitis and pelvic inflammatory disease are true?

   1. Silent and untreated salpingitis is a major cause of infertility.

   2. Without adequate treatment, approximately 20-50 percent of women infected with chlamydia develop PID.

   3. Acute symptomatic chlamydial PID is more common in older women.
       

4. If a female client needs a pap test and gonorrhea/chlamydia screening the specimen for chlamydia should be obtained:

   1. Before the pap

   2. After the pap

   3. At the discretion of the clinician based on client history

   4.  It doesn’t matter
       

5.  A specimen collection error that can effect chlamydia results is:

   1. Presence of excessive blood on swab

   2. Absence of mucous on swab

   3. Presence of epithelial cells on swab
       

6.  Which of the following medications used for treatment of chlamydia is contraindicated during pregnancy?

   1. Azithromycin

   2. Doxycyclin

   3. Erythromycin
       

7.  Which of the following women would be considered most at risk for chlamydia?

   1. A 17 year old woman who has been with her new partner for the past 2 months

   2. A 23 year old woman in a mutually monogamous relationship who has an IUD

   3. A 25 year old single woman who uses a diaphragm for contraception
       

8.  Which of the following statements about salpingitis and pelvic inflammatory disease is true?

   1. Most women who have tubal infertility have had previously diagnosed salpingitis.

   2. After each episode of PID, the rate of infertility significantly decreases.

   3. Among women with PID, inflammation and scarring will cause as many as 20% to become infertile.
       

9.  All of the following statements about antigen detection tests (gen-probe)  for chlamydia are true EXCEPT:

   1. Compared to culture they are less expensive, faster to process, and have fewer specimen transport restrictions.

   2. These tests are less specific than culture and may produce false-positive results.

   3. The accuracy of these tests is not dependent on correct specimen collection.
       

10.  Which of the following statements about laboratory testing for chlamydia are true:

    1. Cell culture should be used for cases of suspected sexual abuse or assault.

    2. Laboratories are required to reject specimens that do not meet essential elements of laboratory quality assurance standards.

    3. Nucleic acid amplification tests have found Ct prevalence rates to be lower than previously believed.
        

11.  When would a client be considered “cured” for chlamydia?

    1. 24 hours after taking the single dose therapy

    2. Upon completion of the recommended 7-day treatment regimen

    3. 48 hours after beginning the recommended 7-day treatment regimen
        

12.  Which of the following partners would be considered most at risk for chlamydia?

    1. A sex partner exposed within prior 60 days of the infected client’s diagnosis and treatment.

    2. A sex partner exposed within prior 6 months of the infected client’s diagnosis and treatment.

    3. A sex partner exposed within prior 12 months of the infected client’s diagnosis and treatment.
        

13. Chlamydia-infected clients should be counseled to abstain from sexual intercourse until:

    1. Client and partner(s) have completed 48 hours of treatment with Doxycycline.

    2. Client and partner(s) have completed the full course of medication and any symptoms have subsided.

    3. 24 hours after client has taken single dose Azithromycin.
        

14.  The most common signs and symptoms of chlamydial infections in males are:

    1. Urethral discharge and/or pyuria

    2. Conjunctivitis

    3. Prostatitis
        

15.  The most common signs and symptoms of chlamydia infections in females are:

    1. Conjunctivitis

    2. Perihepatitis

    3. Mucopurulent cervicitis
        

16.  As many as _______% of women and up to ______% of men who are infected with chlamydia may asymptomatic:

    1. 25%, 50%

    2. 50%, 25%

    3. 70%, 50%
        

17.  Screening is commonly defined as:

    1. Testing in asymptomatic populations.

    2. Testing in symptomatic populations.

    3. Evaluation and treatment of all sex partners.
        

18.  Sensitivity in a laboratory test is defined as:

    1. The ability of a test to give few false-positive results.

    2. The ability of a test to detect infection if it is present.

    3. The ability of a test to detect absence of infection if it is not present.
        

19.  A common complication of infection caused by Chlamydia trachomatis is:

    1. Recurrent vulvar and vaginal growths

    2. Vaginismus

    3. Involuntary infertility

    4. Abnormal Pap smear
        

20.  Which of the following statements about presumptive treatment for chlamydial infections is true?

    1. Clients with signs or symptoms of disease should not be tested for C. trachomatis infection if presumptive treatment is given.

    2. Presumptive treatment is indicated if physical exam is consistent with mucopurulent cervicitis and the client is considered unlikely to return for treatment.

    3. Presumptive treatment is indicated if physical exam is consistent with conjunctivitis.

Score Sheet (see page 4 of post-test printable Word document)

Score Sheet (see page 4 of post-test printable PDF document)

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Participant Continuing Education Registration Form

Registration Form (printable Word document)

Registration Form (printable PDF document)

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Participant Feedback Form

Feedback Form (printable Word document)

Feedback Form (printable PDF document)

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Resources Available

BIBLIOGRAPHY

•  AGI (Alan Guttmacher Institute). Sex and America’s Teenagers. New York: AGI, 1994.

• ARHP, ANPRH (Association of Reproductive Health Professionals and Association of Nurse Practitioners in Reproductive Health).  STD counseling practices and needs survey. Silver Spring, MD: Schulman, Ronca, and Bucuvalas, Inc., January 1995.

• ASHA (American Social Health Association).  International survey reveals lack of knowledge about STDs.  STD News 1995;3 (Fall): 1, 10.

• ASHA. Teenagers know more than adults about STDs, but knowledge among both groups is low.  STD News 1996;3(Winter): 1,5.

• Britton, TF, Delisle S, Fine K. STD and family planning clinics: a regional program for chlamydia control that works.  Am J Gynecol Health 1992;6:80-7.

• Cates W Jr. Epidemiology and control of sexually transmitted diseases in adolescents. In: Schydlower m, Shafer MA, eds. AIDS and Other Sexually Transmitted Diseases. Philadelphia: Hanly and Belfus, Inc., 1990: 409-27.

•  CDC. Sexually Transmitted Diseases Treatment Guidelines 2002. MMWR May 10, 2002/Vol. 51/No. RR-6.

• CDC. Ectopic pregnancy-- United States, 1990-1992. MMWR 1995a;44:46-8.

• Division of STD Prevention. Sexually Transmitted Disease Surveillance, 1996. U.S. Department of Health and Human Services, Public Health Services. Atlanta: Centers for Disease Control and Prevention, September 1997.

• Handsfield HH, Jasman LL, Roberts PL, Hanson VW, Kothenbeutel RL, Stamm WE. Criteria for selective screening for Chlamydia trachomatis infection in women attending family planning clinics, JAMA 1986;255:1730-4.

• IOM (Institute of Medicine). The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Eng, Thomas R., Butler, William T. eds. Washington, D.C.: National Academy Press, 1997.

• Scholes D, Stergachis A, Heidrick F.E, Andrilla H, Holmes K.K, Stamm W.E, Prevention of Pelvic Inflammatory Disease by Screening for Cervical Chlamydial Infection.  New England Journal of Medicine 1996; 334:1362-6.

WEBLIOGRAPHY

http://www.agi-usa.org/ - Alan Guttmacher Institute website provides information on reproductive health research, policy analysis, and public education.

www.ashastd.org/

www.cdc.gov/ - The Centers for Disease Control and Prevention home website.

www.cdcnpin.org - CDC’s National Prevention Information Network develops, identifies, and collects information on the prevention, treatment, and control of HIV/AIDS, sexually transmitted diseases and tuberculosis.

www.cdc.gov/nchstp/dstd/

http://www.nlm.nih.gov/nlmhome.html - National Library of Medicine with links to Medlines, databases and electronic resources and special projects.

www.pslgroup.com/STD.HTM - The latest medical news and information for clients affected by STDs, Doctor’s guide to the internet.

 VIDEOS

•              PACE 2 Specimen Collection Procedure Gen-Probe 1994

“Effective HIV/STD Prevention Counseling for the Busy Primary Care Physician”, Downlink from Denver Co. Prevention Training Center March 18, 1999. Available at Region VI IPP sites.

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