MateSafe Platinum

$179.00

Description

S.No. Test name Test Code
1 RPR (MONITOR) W/REFLEX TO TITER 799
2 HSV 1/2 IGG, HERPESELECT TYPE SPECIFIC AB 6447
3 HEPATITIS C ANTIBODY 8472
4 CHLAMYDIA/GC, DNA BY SDA (ON URINE) 17305
5 HIV 1/2 ANTIGEN/ANTIBODY, FOURTH GENERATION W/RFL 91431

100 % Matesafe Platinum Package $179

HSV 1/2 IGG, HERPESELECT TYPE SPECIFIC AB

 

HIV 1/2 ANTIGEN/ANTIBODY, FOURTH GENERATION W/Reflexes

 

HIV 1/2 ANTIGEN/ANTIBODY, FOURTH GENERATION W/Reflexes

This is a test that can detect HIV as soon as you think you might have been infected which means that you can start taking action to avoid further transmission of the virus to others. It may even be possible to take emergency HIV pills (PEP: post-exposure prophylaxis) to prevent the infection from taking hold. By doing this, you will help to stop the spread of the disease.

What are the symptoms?

  • flu-like symptoms immediately after infection
  • you may not know that you have HIV until your immune system has become really compromised

What can I do about it?

  • Avoid unprotected sex
  • Don’t share needles and syringes
  • Emergency HIV pills
  • Antiretroviral treatment can improve your quality and length of life
  • Maintain a healthy lifestyle – good diet, exercise, not smoking, and moderate alcohol consumption
  • You may feel stigmatised or depressed about having HIV/AIDS. Therapy or counselling can help you with the challenges of living with the disease.

What is the worst that can happen?

Once you begin to experience a variety of infections that your body is struggling to fight off, you will have developed AIDS, or acquired immune deficiency syndrome. There is no cure yet for HIV/AIDS but antiretroviral treatment will help you to maintain good health for much longer than it was possible in the past.

HEPATITIS C ANTIBODY

 

Hepatitis C

HCV infection is the most common chronic bloodborne infection in the United States, with an estimated 2.7 million persons living with chronic infection . HCV is not efficiently transmitted through sex . Studies of HCV transmission between heterosexual or homosexual couples have yielded mixed results, but generally have found either no or very minimally increased rates of HCV infection in partners of persons with HCV infection compared with those whose partners are not HCV-infected . However, data indicate that sexual transmission of HCV can occur, especially among persons with HIV infection. Increasing incidence of acute HCV infection among MSM with HIV infection has been reported in New York City. and Boston along with multiple European cities . These men usually engage in high-risk and traumatic sexual practices and might have concurrent genital ulcerative disease or STD-related proctitis . Other common practices associated with new cases of HCV infection include group sex and use of cocaine and other nonintravenous drugs during sex. Certain studies have revealed that risk increases commensurate with increasing numbers of sex partners among heterosexual persons with HIV infection and MSM especially if their partners are also coinfected with HIV

Persons newly infected with HCV typically are either asymptomatic or have a mild clinical illness. HCV RNA can be detected in blood within 1–3 weeks after exposure. The average time from exposure to antibody to HCV (anti-HCV) seroconversion is 8–9 weeks, and anti-HCV can be detected in >97% of persons by 6 months after exposure. Chronic HCV infection develops in 70%–85% of HCV-infected persons; 60%–70% of chronically infected persons develop evidence of active liver disease. Most infected persons remain unaware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk for CLD and other HCV-related chronic diseases decades after infection.

HCV is primarily transmitted parenterally, usually through shared drug-injection needles and paraphernalia. HCV also can be transmitted through exposures in health-care settings as a consequence of inadequate infection-control practices . Transmission following receipt of blood, tissues, and organs from donors with HCV infection has occurred only rarely since 1992, when routine screening of these donated products was mandated in the United States. Tattoos applied in regulated settings have not been associated with HCV transmission, although those obtained in unregulated settings have been linked to such transmission . Occupational and perinatal exposures also can result in transmission of HCV, but such transmission is uncommon.

Acute hepatitis C is a reportable condition in 49 states, and matching viral hepatitis and HIV surveillance registries can facilitate early detection of social networks of HCV transmission among MSM with HIV infection. Suspected clusters of acute HCV infection should be reported to the appropriate public health authorities.

HCV screening is recommended by CDC and USPSTF for all persons born during 1945–1965 and others based on their risk for infection or on a recognized exposure, including past or current injection drug use, receiving a blood transfusion before 1992, long-term hemodialysis, being born to a mother with HCV infection, intranasal drug use, receipt of an unregulated tattoo, and other percutaneous exposures .

Diagnosis

Testing for HCV infection should include use of an FDA-cleared test for antibody to HCV (i.e., immunoassay, EIA, or enhanced chemiluminescence immunoassay and, if recommended, a supplemental antibody test) followed by NAAT to detect HCV RNA for those with a positive antibody result . Persons with HIV infection with low CD4-positive cell count might require further testing by NAAT because of the potential for a false-negative antibody assay.

Persons determined to be anti-HCV positive should be evaluated (by referral or consultation, if appropriate) for the presence of acute infection; presence, severity, or development of CLD; and eligibility for treatment. Nucleic acid testing, including reverse transcriptase polymerase chain reaction (RT-PCR) to detect HCV RNA, is necessary to confirm the diagnosis of current HCV infection, and testing of liver function (alanine aminotransferase level) provides biochemical evidence of CLD.

Treatment

Providers should consult with specialists knowledgeable about management of hepatitis C infection. Further, they can consult existing guidelines to learn about the latest advances in the management of hepatitis C (www.hcvguidelines.org).

Management of Sex Partners

Because incident HCV has not been demonstrated to occur in heterosexual couples followed over time condom use might not be necessary in such circumstances. Persons with HCV infection with one long-term, steady sex partner do not need to change their sexual practices. However, they should discuss the low but present risk for transmission with their partner and discuss the need for testing . Heterosexuals and MSM with HCV infection and more than one partner, especially those with concurrent HIV infection, should protect their partners against HCV and HIV acquisition by using male latex condoms . Partners of persons with HCV and HIV infection should be tested for HCV and HIV, if not known to be infected.

Other Management Considerations

All persons with HCV for whom HIV and HBV infection status is unknown should be tested for these infections. Those who have HIV or HBV should be referred for or provided with appropriate care and treatment.

Prevention

Reducing the burden of HCV infection and disease in the United States requires implementation of both primary and secondary prevention activities. Primary prevention reduces or eliminates HCV transmission, whereas secondary prevention activities are aimed at reducing CLD and other chronic diseases in persons with HCV infection by first identifying them and then providing medical management and antiviral therapy, if appropriate. No vaccine for hepatitis C is available, and prophylaxis with immune globulin is not effective in preventing HCV infection after exposure.

Persons with HCV infection should be provided information regarding how to protect their liver from further harm (i.e., hepatotoxic agents); for instance, persons with HCV infection should be advised to avoid drinking alcohol and taking any new medicines (including over-the-counter and herbal medications) without checking with their clinician. In addition, a determination for the need of hepatitis A and B vaccination should be made; persons who are not immune should be vaccinated.

To reduce the risk for transmission to others, persons with HCV infection should be advised 1) not to donate blood, body organs, other tissue, or semen; 2) not to share any personal items that might have blood on them (e.g., toothbrushes and razors); and 3) to cover cuts and sores on the skin to keep the virus from spreading by blood or secretions. Women with HCV infection do not need to avoid pregnancy or breastfeeding.

Persons who use or inject drugs should be counseled about the importance of stopping drug-use behaviors and provided with assistance to enter and complete substance-abuse treatment (including relapse prevention). Persons who continue to inject drugs despite counseling should be encouraged to take the following additional steps to reduce personal and public health risks:

  • never reuse or share syringes, water, or drug preparation equipment;
  • only use syringes obtained from a reliable source (e.g., pharmacies);
  • use a new, sterile syringe to prepare and inject drugs;
  • if possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (e.g., fresh tap water);
  • use a new or disinfected container (i.e., cooker) and a new filter (i.e., cotton) to prepare drugs;
  • clean the injection site before injection with a new alcohol swab; and
  • safely dispose of syringes after one use.

Postexposure Follow-Up

No postexposure prophylaxis has been demonstrated to be effective against HCV. HCV testing is recommended for health-care workers after percutaneous or permucosal exposures to HCV-positive blood. Children born to women with HCV infection also should be tested for HCV. Prompt identification of acute infection is important, because outcomes are improved when treatment is initiated early in the course of illness.

Special Considerations

Pregnancy

Routine screening for HCV infection is not recommended for all pregnant women. Pregnant women with a known risk factor for HCV infection should be offered screening. Although the rate for transmission is highly variable, up to six of every 100 infants born to HCV-infected women become infected; this infection occurs predominantly during or near delivery, and no treatment or delivery method—such as caesarian section—has been demonstrated to decrease this risk . However, the risk is increased by the presence of maternal HCV viremia at delivery and is two- to threefold greater if the woman is coinfected with HIV. HCV has not been shown to be transmitted through breast milk, although mothers with HCV infection should consider abstaining from breastfeeding if their nipples are cracked or bleeding. Infants born to mothers with HCV infection should be tested for HCV infection; because maternal antibody is present for the first 18 months of life and before the infant mounts an immunologic response, nucleic acid testing is recommended. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a5.htm).

HIV Infection

All persons with HIV infection should undergo serologic screening for HCV at initial evaluation. Providers should be aware of the likelihood that MSM with HIV infection will acquire HCV after initial screening. Because of accumulating evidence of acute HCV infection acquisition in persons with HIV infection, especially MSM, and cost-effectiveness of regular screening periodic HCV screening should be considered . For persons with HIV infection, HCV screening with HCV antibody assays can be considered at least yearly in those at high risk for infection and more frequently depending on specific circumstances (e.g., community HCV prevalence and incidence, high-risk sexual behavior, and concomitant ulcerative STDs and STD-related proctitis). Indirect testing (e.g., ALT) is not recommended for detecting incident HCV infections because such testing, especially if performed once a year, can miss many persons who have reverted after acute HCV infection to a normal ALT level at the time of testing. Conversely, ALT can be elevated by antiretroviral and other medications, alcohol, and toxins. If ALT levels are being monitored, persons with HIV infection who experience new and unexplained increases in ALT should be tested for acute HCV infection and evaluated for possible medication toxicity or excessive alcohol use.

Continued unprotected sexual contact between partners with HIV infection can facilitate spread of HCV, as the virus can be recovered from the semen of men with HIV . Specific prevention practices (e.g., barrier precautions that limit contact with body fluids during sexual contact with other MSM) should be discussed.

Because a minimal percentage of persons with HIV infection fail to develop HCV antibodies, HCV RNA testing should be performed in persons with unexplained liver disease who are anti-HCV negative. The course of liver disease is more rapid in HIV/HCV coinfected persons, and the risk for cirrhosis is nearly twice that of persons with HCV infection alone. Coinfected persons receiving HIV antiviral regimens are now being treated for HCV after their CD4+ cell counts increase, optimizing their immune response.

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Mycoplasma genitalium

M. genitalium was first identified in the early 1980s and has become recognized as a cause of male urethritis, responsible for approximately 15%–20% of nongonococcal urethritis (NGU) cases, 20%–25% of nonchlamydial NGU, and approximately 30% of persistent or recurrent urethritis . In most settings, it is more common than N. gonorrhoeae but less common than C. trachomatis. While M. genitalium is often the sole pathogen detected, coinfection with C. trachomatis is not uncommon in selected areas .

Although strong and consistent evidence has linked M. genitalium to urethritis in men, it remains unknown whether this infection can cause male infertility or other male anogenital tract disease syndromes. The organism has been detected in men with epididymitis in a limited number of cases, but this has not been extensively investigated. Similarly, M. genitalium has been found in the rectum, but detection is infrequently accompanied by rectal symptoms, and its presence does not appear to cause a syndrome of clinical proctitis.

The pathogenic role of M. genitalium is less definitive in women than it is in men. M. genitalium can be found in the vagina, cervix, and endometrium and, like chlamydial and gonococcal infections, M. genitalium infections in women are commonly asymptomatic. M. genitalium can be detected in 10%–30% of women with clinical cervicitis, and most studies have found that this organism is more common among women with cervicitis than those without this syndrome .

M. genitalium is found in the cervix and/or endometrium of women with PID more often than in women without PID and endosalpingitis develops in nonhuman primates after inoculation with M. genitalium, suggesting that this organism can cause PID. M. genitalium has been detected in 2%–22% of PID cases (median: 10%) depending on the setting, but the frequency with which M. genitalium-infected women experience PID has been under studied. Although one study in Sweden reported a substantial increase in risk for postabortal PID among women with M. genitalium the proportion of M. genitalium-positive women who subsequently experienced PID in two other studies was relatively low (<5%) and evidence from serologic studies assessing the association of PID with antibody to M. genitalium is inconsistent. Overall, evidence suggests that M. genitalium can cause PID, but that this occurs less frequently than it does with C. trachomatis .

A few seroepidemologic studies have found that women with tubal factor infertility are more likely to have antibodies to M. genitalium than fertile women, suggesting that this organism might cause female infertility. However, more research is needed. On the basis of certain reports, M. genitalium was uncommonly identified in women who experience adverse pregnancy outcomes, but was associated with increased risk for preterm delivery in one U.S. and another Peruvian study . Data are scarce regarding M. genitalium and ectopic pregnancy.

Diagnostic Considerations

M. genitalium is a slow-growing organism. Culture can take up to 6 months, and only a few laboratories in the world are able to recover clinical isolates. Therefore, NAAT is the preferred method for M. genitalium detection. In research settings, M. genitalium is diagnosed by NAAT testing of urine, urethral, vaginal, and cervical swabs and through endometrial biopsies, typically using in-house PCR or assays intended for research use only. NAAT tests (polymerase chain reaction or transcription mediated amplification) for M. genitalium are available in some large medical centers and commercial laboratories, but there is no diagnostic test for M. genitalium that is cleared by the FDA for use in the United States. In the absence of validated tests, M. genitalium should be suspected in cases of persistent or recurrent urethritis and may be considered in persistent or recurrent cases of cervicitis and PID.

Treatment

M. genitalium lacks a cell wall, and thus antibiotics targeting cell-wall biosynthesis (e.g., beta-lactams including penicillins and cephalosporins) are ineffective against this organism. Given the diagnostic challenges, treatment of most M. genitalium infections will occur in the context of syndromic management for urethritis, cervicitis, and PID.

Urethritis and cervicitis

The 7-day doxycycline regimen recommended for treatment of urethritis is largely ineffective against M. genitalium with a median cure rate of approximately 31% . The 1-g single dose of azithromycin was significantly more effective against M. genitalium than doxycycline in two randomized urethritis treatment trials and is preferred over doxycycline. However, resistance to azithromycin appears to be rapidly emerging. The median cure rate for both men and women is approximately 85%, but was only 40% in the most recent trial . Persons with treatment failures after the 1-g azithromycin regimen frequently have macrolide-resistant strains, suggesting that single-dose azithromycin therapy might select for resistance. A longer course of azithromycin (an initial 500-mg dose followed by 250 mg daily for 4 days) might be marginally superior to the single dose regimen . However, in some settings, approximately 50% of all M. genitalium infections are caused by organisms that are already resistant to azithromycin (282), and persons who do not respond to the 1-g azithromycin regimen generally do not benefit from retreatment with the extended dose regimen.

Moxifloxacin (400 mg daily x 7, 10 or 14 days) has been successfully used to treat M. genitalium in men and women with previous treatment failures, with cure rates of 100% in initial reports . However, moxifloxacin has been used in only a few cases, and the drug has not been tested in clinical trials. Although generally considered effective, studies in Japan, Australia, and the United States have reported moxifloxacin treatment failures after the 7 day regimen .

PID

Recommended PID treatment regimens are based on antibiotics that are not effective against M. genitalium. Therefore, clinicians might consider M. genitalium in cases that do not respond to therapy within 7–10 days. Where validated M. genitalium testing is available, clinicians might test women with PID for M. genitalium. When M. genitalium is detected, a regimen of moxifloxacin 400 mg/day for 14 days has been effective in eradicating the organism . Nevertheless, no data have been published that assess the benefits of testing women with PID for M. genitalium, and the importance of directing treatment against this organism is currently unknown.

Follow-up

In settings where validated M. genitalium testing is available, persons with persistent urethritis, cervicitis, or PID accompanied by persistent detection of M. genitalium might be treated with moxifloxacin. However, routine tests-of-cure in asymptomatic persons are not recommended.

Management of Sex Partners

Sex partners should be managed according to guidelines for patients with nongonococcal urethritis (NGU), cervicitis, and PID. In settings with access to validated M. genitalium tests, partner testing and treatment of identified infections might be considered.

Special considerations

HIV infection

Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative. Treatment of most M. genitalium infections will occur in the context of syndromic management for urethritis, cervicitis, and PID (See Mycoplasma genitalium, Treatment).

CHLAMYDIA/GONORRHOEAE Combined, DNA BY SDA (ON URINE) (17305)

 

Chlamydia

What is chlamydia?

1Chlamydia is a common STD that can infect both men and women. It can cause serious, permanent damage to a woman’s reproductive system, making it difficult or impossible for her to get pregnant later on. Chlamydia can also cause a potentially fatal ectopic pregnancy (pregnancy that occurs outside the womb).

How is chlamydia spread?

You can get chlamydia by having vaginal, anal, or oral sex with someone who has chlamydia.

If your sex partner is male you can still get chlamydia even if he does not ejaculate (cum).

If you’ve had chlamydia and were treated in the past, you can still get infected again if you have unprotected sex with someone who has chlamydia.

If you are pregnant, you can give chlamydia to your baby during childbirth.

How can I reduce my risk of getting chlamydia?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting chlamydia:

  • Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
  • Using latex condoms the right way every time you have sex.

Am I at risk for chlamydia?

Anyone who has sex can get chlamydia through unprotected vaginal, anal, or oral sex. However, sexually active young people are at a higher risk of getting chlamydia. This is due to behaviors and biological factors common among young people. Gay, bisexual, and other men who have sex with men are also at risk since chlamydia can be spread through oral and anal sex.

Have an honest and open talk with your health care provider and ask whether you should be tested for chlamydia or other STDs. If you are a sexually active woman younger than 25 years, or an older woman with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection, you should get a test for chlamydia every year. Gay, bisexual, and men who have sex with men; as well as pregnant women should also be tested for chlamydia.

I’m pregnant. How does chlamydia affect my baby?

If you are pregnant and have chlamydia, you can pass the infection to your baby during delivery. This could cause an eye infection or pneumonia in your newborn. Having chlamydia may also make it more likely to deliver your baby too early.

If you are pregnant, you should be tested for chlamydia at your first prenatal visit. Testing and treatment are the best ways to prevent health problems.

How do I know if I have chlamydia?

illustration of female anatomy showing fallopian tubes, ovary, cervix, uterus, and vagina

Most people who have chlamydia have no symptoms. If you do have symptoms, they may not appear until several weeks after you have sex with an infected partner. Even when chlamydia causes no symptoms, it can damage your reproductive system.

Women with symptoms may notice

  • An abnormal vaginal discharge;
  • A burning sensation when urinating.

Symptoms in men can include

  • A discharge from their penis;
  • A burning sensation when urinating;
  • Pain and swelling in one or both testicles (although this is less common).

Men and women can also get infected with chlamydia in their rectum, either by having receptive anal sex, or by spread from another infected site (such as the vagina). While these infections often cause no symptoms, they can cause

  • Rectal pain;
  • Discharge;
  • Bleeding.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

How will my doctor know if I have chlamydia?

There are laboratory tests to diagnose chlamydia. Your health care provider may ask you to provide a urine sample or may use (or ask you to use) a cotton swab to get a sample from your vagina to test for chlamydia.

Can chlamydia be cured?

Yes, chlamydia can be cured with the right treatment. It is important that you take all of the medication your doctor prescribes to cure your infection. When taken properly it will stop the infection and could decrease your chances of having complications later on. Medication for chlamydia should not be shared with anyone.

Repeat infection with chlamydia is common. You should be tested again about three months after you are treated, even if your sex partner(s) was treated.

I was treated for chlamydia. When can I have sex again?

You should not have sex again until you and your sex partner(s) have completed treatment. If your doctor prescribes a single dose of medication, you should wait seven days after taking the medicine before having sex. If your doctor prescribes a medicine for you to take for seven days, you should wait until you have taken all of the doses before having sex.

What happens if I don’t get treated?

The initial damage that chlamydia causes often goes unnoticed. However, chlamydia can lead to serious health problems.

If you are a woman, untreated chlamydia can spread to your uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID often has no symptoms, however some women may have abdominal and pelvic pain. Even if it doesn’t cause symptoms initially, PID can cause permanent damage to your reproductive system and lead to long-term pelvic pain, inability to get pregnant, and potentially deadly ectopic pregnancy (pregnancy outside the uterus).

Men rarely have health problems linked to chlamydia. Infection sometimes spreads to the tube that carries sperm from the testicles, causing pain and fever. Rarely, chlamydia can prevent a man from being able to have children.

Untreated chlamydia may also increase your chances of getting or giving HIV – the virus that causes AIDS.


Gonorrhea

What is gonorrhea?cta_gonorrhea_1

Gonorrhea is a sexually transmitted disease (STD) that can infect both men and women. It can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people ages 15-24 years.

How is gonorrhea spread?

You can get gonorrhea by having vaginal, anal, or oral sex with someone who has gonorrhea. A pregnant woman with gonorrhea can give the infection to her baby during childbirth.

How can I reduce my risk of getting gonorrhea?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting gonorrhea:

  • Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
  • Using latex condoms the right way every time you have sex.

Am I at risk for gonorrhea?

Any sexually active person can get gonorrhea through unprotected vaginal, anal, or oral sex.

If you are sexually active, have an honest and open talk with your health care provider and ask whether you should be tested for gonorrhea or other STDs. If you are a sexually active man who is gay, bisexual, or who has sex with men, you should be tested for gonorrhea every year. If you are a sexually active women younger than 25 years or an older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection, you should be tested for gonorrhea every year.

I’m pregnant. How does gonorrhea affect my baby?

If you are pregnant and have gonorrhea, you can give the infection to your baby during delivery. This can cause serious health problems for your baby. If you are pregnant, it is important that you talk to your health care provider so that you get the correct examination, testing, and treatment, as necessary. Treating gonorrhea as soon as possible will make health complications for your baby less likely.

How do I know if I have gonorrhea?

Some men with gonorrhea may have no symptoms at all. However, men who do have symptoms, may have:

  • A burning sensation when urinating;
  • A white, yellow, or green discharge from the penis;
  • Painful or swollen testicles (although this is less common).

Most women with gonorrhea do not have any symptoms. Even when a woman has symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Women with gonorrhea are at risk of developing serious complications from the infection, even if they don’t have any symptoms.
Symptoms in women can include:

  • Painful or burning sensation when urinating;
  • Increased vaginal discharge;
  • Vaginal bleeding between periods.

Rectal infections may either cause no symptoms or cause symptoms in both men and women that may include:

  • Discharge;
  • Anal itching;
  • Soreness;
  • Bleeding;
  • Painful bowel movements.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

How will my doctor know if I have gonorrhea?

Most of the time, urine can be used to test for gonorrhea. However, if you have had oral and/or anal sex, swabs may be used to collect samples from your throat and/or rectum. In some cases, a swab may be used to collect a sample from a man’s urethra (urine canal) or a woman’s cervix (opening to the womb).

bacteria

Can gonorrhea be cured?

Yes, gonorrhea can be cured with the right treatment. It is important that you take all of the medication your doctor prescribes to cure your infection. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not undo any permanent damage caused by the disease.

It is becoming harder to treat some gonorrhea, as drug-resistant strains of gonorrhea are increasing. If your symptoms continue for more than a few days after receiving treatment, you should return to a health care provider to be checked again.

I was treated for gonorrhea. When can I have sex again?

You should wait seven days after finishing all medications before having sex. To avoid getting infected with gonorrhea again or spreading gonorrhea to your partner(s), you and your sex partner(s) should avoid having sex until you have each completed treatment. If you’ve had gonorrhea and took medicine in the past, you can still get infected again if you have unprotected sex with a person who has gonorrhea.

Photo of woman in pain.

What happens if I don’t get treated?

Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, untreated gonorrhea can cause pelvic inflammatory disease (PID). Some of the complications of PID are

In men, gonorrhea can cause a painful condition in the tubes attached to the testicles. In rare cases, this may cause a man to be sterile, or prevent him from being able to father a child.
Rarely, untreated gonorrhea can also spread to your blood or joints. This condition can be life-threatening.

Untreated gonorrhea may also increase your chances of getting or giving HIV – the virus that causes AIDS.

SYPHILIS (RPR MONITOR) W/REFLEX TO TITER (799)

 

What is syphilis?

Syphilis is an STD that can cause long-term complications if not treated correctly. Symptoms in adults are divided into stages. These stages are primary, secondary, latent, and late syphilis.

How is syphilis spread?

You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores can be found on the penis, vagina, anus, in the rectum, or on the lips and in the mouth. Syphilis can also be spread from an infected mother to her unborn baby.

What does syphilis look like?

Syphilis has been called ‘the great imitator’ because it has so many possible symptoms, many of which look like symptoms from other diseases. The painless syphilis sore that you would get after you are first infected can be confused for an ingrown hair, zipper cut, or other seemingly harmless bump. The non-itchy body rash that develops during the second stage of syphilis can show up on the palms of your hands and soles of your feet, all over your body, or in just a few places. Syphilis can also affect the eye and can lead to permanent blindness. This is called ocular syphilis. You could also be infected with syphilis and have very mild symptoms or none at all.

Example of a primary syphilis sore.

Example of a primary syphilis sore.

How can I reduce my risk of getting syphilis?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting syphilis:

  • Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
  • Using latex condoms the right way every time you have sex. Condoms prevent transmission of syphilis by preventing contact with a sore. Sometimes sores occur in areas not covered by a condom. Contact with these sores can still transmit syphilis.

Am I at risk for syphilis?

Any sexually active person can get syphilis through unprotected vaginal, anal, or oral sex. Have an honest and open talk with your health care provider and ask whether you should be tested for syphilis or other STDs. You should get tested regularly for syphilis if you are pregnant, are a man who has sex with men, have HIV infection, and/or have partner(s) who have tested positive for syphilis.

I’m pregnant. How does syphilis affect my baby?

If you are pregnant and have syphilis, you can give the infection to your unborn baby. Having syphilis can lead to a low birth weight baby. It can also make it more likely you will deliver your baby too early or stillborn (a baby born dead). To protect your baby, you should be tested for syphilis during your pregnancy and at delivery and receive immediate treatment if you test positive.

An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies can have health problems such as cataracts, deafness, or seizures, and can die.

Secondary rash from syphilis on palms of hands.

How do I know if I have syphilis?

Symptoms of syphilis in adults can be divided into stages:

Primary Stage

During the first (primary) stage of syphilis, you may notice a single sore, but there may be multiple sores. The sore is the location where syphilis entered your body. The sore is usually firm, round, and painless. Because the sore is painless, it can easily go unnoticed. The sore lasts 3 to 6 weeks and heals regardless of whether or not you receive treatment. Even though the sore goes away, you must still receive treatment so your infection does not move to the secondary stage.

Secondary Stage

During the secondary stage, you may have skin rashes and/or sores in your mouth, vagina, or anus (also called mucous membrane lesions). This stage usually starts with a rash on one or more areas of your body. The rash can show up when your primary sore is healing or several weeks after the sore has healed. The rash can look like rough, red, or reddish brown spots on the palms of your hands and/or the bottoms of your feet. The rash usually won’t itch and it is sometimes so faint that you won’t notice it. Other symptoms you may have can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue (feeling very tired). The symptoms from this stage will go away whether or not you receive treatment. Without the right treatment, your infection will move to the latent and possibly late stages of syphilis.

Secondary rash from syphilis on torso.

Secondary rash from syphilis on torso.

Latent and Late Stages

The latent stage of syphilis begins when all of the symptoms you had earlier disappear. If you do not receive treatment, you can continue to have syphilis in your body for years without any signs or symptoms. Most people with untreated syphilis do not develop late stage syphilis. However, when it does happen it is very serious and would occur 10–30 years after your infection began. Symptoms of the late stage of syphilis include difficulty coordinating your muscle movements, paralysis (not able to move certain parts of your body), numbness, blindness, and dementia (mental disorder). In the late stages of syphilis, the disease damages your internal organs and can result in death.

A syphilis infection is called an ‘early’ case if a patient has been infected for a year or less, such as during the primary or secondary stages of syphilis. People who have ‘early’ syphilis infections can more easily spread the infection to their sex partners. The majority of early syphilis cases are currently found among men who have sex with men, but women and unborn children are also at risk of infection.

How will my doctor know if I have syphilis?

Most of the time, a blood test can be used to test for syphilis. Some health care providers will diagnose syphilis by testing fluid from a syphilis sore.

Can syphilis be cured?

Darkfield micrograph of Treponema pallidum.

Yes, syphilis can be cured with the right antibiotics from your health care provider. However, treatment will not undo any damage that the infection has already done.

I’ve been treated. Can I get syphilis again?

Having syphilis once does not protect you from getting it again. Even after you’ve been successfully treated, you can still be re-infected. Only laboratory tests can confirm whether you have syphilis. Follow-up testing by your health care provider is recommended to make sure that your treatment was successful.

Because syphilis sores can be hidden in the vagina, anus, under the foreskin of the penis, or in the mouth, it may not be obvious that a sex partner has syphilis. Unless you know that your sex partner(s) has been tested and treated, you may be at risk of getting syphilis again from an untreated sex partner.

HEPATITS B SURFACE AG W/CONFIRMATION (498)

 

Hepatitis B

Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva . HBV is more infectious and more stable in the environment than other bloodborne pathogens (e.g., HCV and HIV).

HBV infection can be self-limited or chronic. In adults, approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death . Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected compared with 2%–6% of persons who become infected as adults . Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma (HCC) is 15%–25% .

HBV is efficiently transmitted by percutaneous or mucous membrane exposure to HBV-infected blood or body fluids that contain HBV. The primary risk factors associated with infection among adolescents and adults are unprotected sex with an infected partner, multiple partners, MSM, history of other STDs, and injection-drug use. In addition, several studies have demonstrated other modes of HBV transmission, including premastication and lapses in health-care infection-control procedures, as less common sources of transmission .

TABLE 3. Interpretation of serologic test results* for HBV infection

Serologic marker Interpretation
HBsAg Total anti-HBc IgM anti-HBc Anti-HBs

Never infected

+

Early acute infection; transient (up to 18 days) after vaccination

+

+

+

Acute infection

+

+

Acute resolving infection

+

+

Recovered from past infection and immune

+

+

Chronic infection

+

False positive (i.e., susceptible); past infection; “low-level” chronic infection§; passive transfer to infant born to HBsAg-positive mother

+

Immune if concentration is >10 mIU/mL, passive transfer after HBIG administration

Abbreviations: anti-HBc = antibody to hepatitis B core antigen; anti-HBs = antibody to hepatitis B surface antigen; HBsAg = hepatitis B surface antigen; IgM = immunoglobulin M; mIU/mL = Milli-international units per milliliter.

* Symbol for negative test result, “–“; symbol for positive test result, “+.”
To ensure that an HBsAg-positive test result is not false-positive, samples with repeatedly reactive HBsAg results should be tested with an FDA-cleared neutralizing confirmatory test.
§ Persons positive for only anti-HBc are unlikely to be infectious except under unusual circumstances involving direct percutaneous exposure to large quantities of blood (e.g., blood transfusion and organ transplantation).

CDC’s national strategy to eliminate transmission of HBV infection includes 1) prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of infants born to mothers with HBsAg or mothers whose HBsAg status is unknown, 2) routine infant vaccination, 3) vaccination of previously unvaccinated children and adolescents through age 18 years, and 4) vaccination of previously unvaccinated adults at increased risk for infection. High vaccination coverage rates with subsequent declines in acute hepatitis B incidence have been achieved among infants and adolescents . The aging of persons vaccinated as children and adolescents likely has led to improved vaccination coverage in adults aged <30 years and corresponding lower rates of acute HBV infection in this group. In contrast, vaccination coverage among most high-risk adult populations aged >30 years (e.g., persons with multiple sex partners, MSM, and IDUs) has remained low; these groups account for the highest rates of preventable acute infections . STD clinics and other settings providing STD services to high-risk adults should administer hepatitis B vaccine to those who are unvaccinated, as adults seeking STD services are at risk for this infection.

Diagnosis

Diagnosis of acute or chronic HBV infection requires serologic testing . Because HBsAg is present in both acute and chronic infection, the presence of IgM antibody to hepatitis B core antigen (IgM anti-HBc) is diagnostic of acute or recently acquired HBV infection. Antibody to HBsAg (anti-HBs) is produced after a resolved infection and is the only HBV antibody marker present after vaccination. The presence of HBsAg and total anti-HBc, with a negative test for IgM anti-HBc, indicates chronic HBV infection. The presence of anti-HBc alone might indicate acute, resolved, or chronic infection or a false-positive result.

Treatment

No specific therapy is available for persons with acute hepatitis B; treatment is supportive. Persons with chronic HBV infection should be referred for evaluation to a provider experienced in the management of chronic HBV infection. Therapeutic agents cleared by FDA for treatment of chronic hepatitis B can achieve sustained suppression of HBV replication and remission of liver disease .

Prevention

Two products have been approved for hepatitis B prevention: hepatitis B immune globulin (HBIG) for postexposure prophylaxis and hepatitis B vaccine . HBIG provides temporary (i.e., 3–6 months) protection from HBV infection and is typically used as PEP as an adjunct to hepatitis B vaccination (in previously unvaccinated persons) or in persons who have not responded to vaccination. HBIG is prepared from plasma known to contain high concentrations of anti-HBs. The recommended dose of HBIG is 0.06 mL/kg.

Hepatitis B vaccine contains HBsAg produced in yeast by recombinant DNA technology and provides protection from HBV infection when used for both pre-exposure vaccination and PEP. The two available monovalent hepatitis B vaccines for use in the United States are Recombivax HB (Merck and Co., Inc., Whitehouse Station, New Jersey) and Engerix-B (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania). A combination hepatitis A and hepatitis B vaccine for use in persons >18 years, Twinrix (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania), also is available.

TABLE 4. Recommended doses of currently licensed formulations of adolescent and adult hepatitis B vaccines

Group

Single-antigen vaccine

Combination vaccine

Recombivax HB

Engerix-B

Twinrix*

Dose (µg)

Volume (mL)

Dose (µg)

Volume (mL)

Dose (µg)

Volume (mL)

Adolescents aged 11–19 years§

5

0.5

10

0.5

NA

NA

Adolescents aged 11–15 years

10

1.0

NA

NA

NA

NA

Adults (aged ≥20 years)

10

1.0

20

1.0

20

1.0

Hemodialysis and other immunocompromised persons aged <20 years §

5

0.5

10

0.5

NA

NA

Hemodialysis and other immunocompromised persons aged ≥20 years

40**

1.0

40††

2.0

NA

NA

Sources: CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep 2005;54(No. RR-16). CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep 2006;55(No. RR-16).
* Combined hepatitis A and hepatitis B vaccine. This vaccine is recommended for persons aged ≥18 years at increased risk for both hepatitis B and hepatitis A virus infections.
Recombinant hepatitis B surface antigen protein dose, in micrograms.
§ Pediatric formulation administered on a 3-dose schedule; higher doses might be more immunogenic, but no specific recommendations have been made.
Adult formulation administered on a 2-dose schedule.
** Dialysis formulation administered on a 3-dose schedule at 0, 1, and 6 months.
†† Two 1.0-mL doses of the adult formulation administered at one site on a 4-dose schedule at 0, 1, 2, and 6 months.

When selecting a hepatitis B vaccination schedule, health-care providers should consider the need to achieve completion of the vaccine series. The recommended HBV dose and schedule varies by product and age of recipient . Three different 3-dose schedules for adolescents and adults have been approved for both monovalent hepatitis B vaccines (i.e., Engerix-B and Recombivax HB); these vaccines can be administered at 0, 1, and 6 months; 0, 1, and 4 months; and 0, 2, and 4 months. A 4-dose schedule of Engerix-B at 0, 1, 2, and 12 months is licensed for all age groups. A 2-dose schedule of Recombivax HB adult formulation (10 µg) is licensed for adolescents aged 11–15 years, with a 4 month minimal interval between doses. When scheduled to receive the second dose, adolescents aged 16–19 years should be switched to a 3-dose series, with doses two and three consisting of the pediatric formulation (5 µg) administered on an appropriate schedule. Twinrix is a 3-dose schedule administered at 0, 1, and 6 months to persons aged ≥18 years at risk for both HAV and HBV infections.

Hepatitis B vaccine should be administered IM in the deltoid muscle and can be administered simultaneously with other vaccines. If the vaccine series is interrupted after the first or second dose of vaccine, the missed dose should be administered as soon as possible. The series does not need to be restarted after a missed dose. HBV vaccination is available for eligible children and adolescents aged <19 years through the VFC program (telephone: 800–232–4636).

In adolescents and healthy adults aged <40 years, approximately 30%–55% achieve a protective antibody response (i.e., anti-HBs ≥10 mIU/mL) after the first vaccine dose, 75% after the second, and >90% after the third. Vaccine-induced immune memory has been demonstrated to persist for at least 20 years . Periodic testing to determine antibody levels after routine vaccination in immunocompetent persons is not necessary, and booster doses of vaccine are not currently recommended.

Hepatitis B vaccination is generally well tolerated by most recipients. Pain at the injection site and low-grade fever are reported by a minority of recipients. For children and adolescents, a causal association exists between receipt of hepatitis B vaccination and anaphylaxis: for each 1.1 million doses of vaccine administered, approximately one vaccinee will experience this type of reaction. No deaths have been reported in these patients . Vaccine is contraindicated in persons with a history of anaphylaxis after a previous dose of hepatitis B vaccine and in persons with a known anaphylactic reaction to any vaccine component. No other adverse events after administration of hepatitis B vaccine have been demonstrated.

Pre-exposure Vaccination

Hepatitis B vaccination is recommended for all unvaccinated children and adolescents, all unvaccinated adults at risk for HBV infection (especially IDU, MSM, and adults with multiple sex partners), and all adults seeking protection from HBV infection . For adults, acknowledgment of a specific risk factor is not a requirement for vaccination.

Hepatitis B vaccine should be routinely offered to all unvaccinated persons attending STD clinics and to all unvaccinated persons seeking evaluation or treatment for STDs in other settings, especially correctional facilities, facilities providing drug-abuse treatment and prevention services, federally qualified health centers, and settings serving MSM (e.g., HIV care and prevention settings). If hepatitis B vaccine is unavailable at a particular facility, persons should be linked to a setting where they can receive vaccine. Persons with a reliable vaccination history (i.e., a written, dated record of each dose of a complete series) or reliable history of hepatitis B infection (i.e., a written record of infection and serologic results showing evidence of past infection) do not require vaccination. In all settings, vaccination should be initiated at the initial visit, even if concerns about completion of the vaccine series exist.

Prevaccination Serologic Testing

Conducting prevaccination serologic testing for susceptibility just before the initial vaccine dose is administered might be considered to reduce the cost of completing the vaccination series in adult populations that have an expected high prevalence (20%–30%) of HBV infection (e.g., IDUs and MSM, especially those in older age groups). In addition, prevaccination testing for susceptibility is recommended for unvaccinated household, sexual, and needle-sharing contacts of HBsAg-positive persons . Serologic testing should not be a barrier to vaccination. The first vaccine dose should be administered immediately after collection of the blood sample for serologic testing. Vaccination of persons who are immune to HBV infection because of current or previous infection or vaccination is not harmful and does not increase the risk for adverse events.

Anti-HBc is the test of choice for prevaccination testing. Persons who are anti-HBc–positive should be tested for HBsAg. If persons are determined to be HBsAg negative, no further action is required. Persons with HBsAg should be referred to a specialist in the management of hepatitis B infection and receive further serologic evaluation, prevention counseling, and evaluation for antiviral treatment (see Management of HBsAg-Positive Persons).

Postvaccination Serologic Testing for Response

Postvaccination serologic testing for immunity is not necessary after routine vaccination of adolescents or adults. However, such testing is recommended for persons whose subsequent clinical management depends on knowledge of their immune status (e.g., health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids). In addition, postvaccination testing is recommended for 1) persons with HIV infection and other immunocompromised persons to determine the need for revaccination and 2) sex and needle-sharing partners of HBsAg-positive persons to determine the need for revaccination and other methods to protect themselves from HBV infection.

If indicated, anti-HBs testing should be performed 1–2 months after administration of the last dose of the vaccine series. Persons determined to have anti-HBs levels of <10 mIU/mL after the primary vaccine series should be revaccinated with a 3-dose series and tested again for anti-HBs 1–2 months after the third dose. Persons who do not respond to revaccination should be tested for HBsAg. If HBsAg positive, the person should receive appropriate management (see Management of HBsAg-Positive Persons); if HBsAg negative, the person should be considered susceptible to HBV infection and counseled concerning precautions to prevent HBV infection and the need for HBIG PEP for any known exposure (see Postexposure Prophylaxis).

Postexposure Prophylaxis

Both passive-active PEP (the simultaneous administration of HBIG [i.e., 0.06 mL/kg] and hepatitis B vaccine at separate sites) and active PEP (the administration of hepatitis B vaccination alone) have been demonstrated to be highly effective in preventing transmission after exposure to HBV . HBIG alone also has been demonstrated to be effective in preventing HBV transmission, but with the availability of hepatitis B vaccine, HBIG typically is used as an adjunct to vaccination.

Exposure to an HBsAg-Positive Source

Unvaccinated persons or persons known not to have responded to a complete hepatitis B vaccine series should receive both HBIG and hepatitis vaccine as soon as possible (preferably ≤24 hours) after a discrete, identifiable exposure to blood or body fluids that contain blood from a person with HBsAg . Hepatitis B vaccine should be administered simultaneously with HBIG at a separate injection site, and the vaccine series should be completed by using the age-appropriate vaccine dose and schedule . Exposed persons who are in the process of being vaccinated but who have not completed the vaccine series should receive HBIG (i.e., 0.06 mL/kg) and complete the vaccine series. Exposed persons who are known to have responded to vaccination are considered protected; therefore, they need no additional doses of vaccine or HBIG. Persons who have written documentation of a complete hepatitis B vaccine series who did not receive postvaccination testing should receive a single vaccine booster dose. These persons should be managed according to guidelines for management of persons with occupational exposure to blood or body fluids that contain HBV .

Exposure to a Source with Unknown HBsAg Status

Unvaccinated persons and persons with previous nonresponse to hepatitis B vaccination who have a discrete, identifiable exposure to blood or body fluids containing blood from a person with unknown HBsAg status should receive the hepatitis B vaccine series, with the first dose initiated as soon as possible after exposure (preferably <24 hours) and the series completed using the age-appropriate dose and schedule. Exposed persons who are not fully vaccinated should complete the vaccine series. Generally, exposed persons with written documentation of a complete hepatitis B vaccine series who did not receive postvaccination testing require no further treatment.

TABLE 5. Guidelines for postexposure prophylaxis* of persons with nonoccupational exposure to blood or body fluids that contain blood, by exposure type and vaccination status

Source of exposure

Treatment

Unvaccinated person§

Previously vaccinated person

HBsAg-positive source
Percutaneous (e.g., bite or needlestick) or mucosal exposure to HBsAg-positive blood or body fluids Administer hepatitis B vaccine series and HBIG Administer hepatitis B vaccine booster dose
Sex or needle-sharing contact of an HBsAg-positive person Administer hepatitis B vaccine series and HBIG Administer hepatitis B vaccine booster dose
Victim of sexual assault/abuse by a perpetrator who is HBsAg positive Administer hepatitis B vaccine series and HBIG Administer hepatitis B vaccine booster dose
Source with unknown HBsAg status
Victim of sexual assault/abuse by a perpetrator with unknown HBsAg status Administer hepatitis B vaccine series No treatment
Percutaneous (e.g., bite or needlestick) or mucosal exposure to potentially infectious blood or body fluids from a source with unknown HBsAg status Administer hepatitis B vaccine series No treatment
Sex or needle-sharing contact of person with unknown HBsAg status Administer hepatitis B vaccine series No treatment

Source: CDC. Postexposure prophylaxis to prevent hepatitis B virus infection. MMWR Recomm Rep 2006;55(No. RR-16).

Abbreviations: HBIG = hepatitis B immune globulin. HBsAg = hepatitis B surface antigen.

* When indicated, immunoprophylaxis should be initiated as soon as possible, preferably within 24 hours. Studies are limited on the maximum interval after exposure during which postexposure prophylaxis is effective, but the interval is unlikely to exceed 7 days for percutaneous exposures or 14 days for sexual exposures. The hepatitis B vaccine series should be completed.

These guidelines apply to nonoccupational exposures. Guidelines for management of occupational exposures have been published separately and also can be used for management of nonoccupational exposures, if feasible.

Source: CDC. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep 2013;62(No. RR-10.

§ A person who is in the process of being vaccinated but who has not completed the vaccine series should complete the series and receive treatment as indicated.

A person who has written documentation of a complete hepatitis B vaccine series and who did not receive postvaccination testing.

Special Considerations

Pregnancy

Regardless of whether they have been previously tested or vaccinated, all pregnant women should be tested for HBsAg at the first prenatal visit and at delivery if at high risk for HBV infection (see Special Populations Pregnant Women). Pregnant women at risk for HBV infection should receive hepatitis B vaccination. All pregnant women with HBsAg should be reported to state and local perinatal hepatitis B prevention programs and referred to a specialist. Information on the management of pregnant women with HBsAg and their infants is available at http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf.

HIV Infection

HIV infection can impair the response to hepatitis B vaccination. Persons with HIV infection should be tested for anti-HBs 1–2 months after the third vaccine dose (see Postvaccination Serologic Testing). Modified dosing regimens, including a doubling of the standard antigen dose and administration of additional doses, might increase the response rate . Additional recommendations for management of persons with HBsAg and HIV infection are available .

Management of HBsAg-Positive Persons

Recommendations for management of all persons with HBsAg-include the following:

  • All persons with HBsAg documented on laboratory results should be reported to the state or local health department.
  • To verify the presence of chronic HBV infection, persons with HBsAg should be retested. The absence of IgM anti-HBc or the persistence of HBsAg for 6 months indicates chronic HBV infection.
  • Persons with chronic HBV infection should be referred for evaluation to a specialist experienced in the management of chronic hepatitis B infection.
  • Household, sexual, and needle-sharing contacts of chronically infected persons should be evaluated. Unvaccinated sex partners and household and needle-sharing contacts should be tested for susceptibility to HBV infection (see Prevaccination Serologic Testing) and receive the first dose of hepatitis B vaccine immediately after collection of the blood sample for serologic testing. Susceptible persons should complete the vaccine series by using an age-appropriate vaccine dose and schedule.
  • Sex partners of persons with HBsAg should be counseled to use latex condoms to protect themselves from sexual exposure to infectious body fluids (e.g., semen and vaginal secretions), unless they have been demonstrated to be immune after vaccination (anti-HBs ≥10 mIU/mL) or previously infected (anti-HBc positive).
  • To prevent or reduce the risk for transmission to others in addition to vaccination, persons with HBsAg also should be advised to:
    • use methods (e.g., condoms) to protect nonimmune sex partners from acquiring HBV infection from sexual activity until the partner can be vaccinated and immunity documented;
    • cover cuts and skin lesions to prevent spread by infectious secretions or blood;
    • refrain from donating blood, plasma, body organs, other tissue, or semen; and
    • refrain from sharing household articles (e.g., toothbrushes, razors, or personal injection equipment) that could become contaminated with blood and
    • refrain from premastication of food.
  • To protect the liver from further harm, persons with HBsAg should be advised to:
    • avoid or limit alcohol consumption because of the effects of alcohol on the liver;
    • refrain from starting any new medicines, including OTC and herbal medicines, without checking with their health-care provider; and
    • obtain vaccination against hepatitis A.

When seeking medical or dental care, HBsAg-positive persons should be advised to inform their health-care providers of their HBsAg status so that they can be appropriately evaluated and managed. The following are key counseling messages for persons with HBsAg:

  • HBV is not usually spread by hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.
  • Persons should not be excluded from work, school, play, child care, or other settings because they are infected with HBV.
  • Involvement with a support group might help patients cope with chronic HBV infection.

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