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Prevention of Sexually Transmitted Infections

All programs should have the ability to provide prophylaxis for STIs. The patient should not be referred to another treatment facility for prophylaxis. This is particularly true for HIV prophylaxis—in which it is critical that medications be initiated within 72 hours of exposure. The Centers for Disease Control and Prevention (CDC) provides guidance for post-exposure prophylaxis after sexual assault. A program may determine that alternative therapies are needed in their community based on STI surveillance data. It is not recommended that routine testing for STIs be performed for adult/adolescent patients. In children, where any sexual contact may be considered evidence of assault, the presence of an STI may be important evidence, therefore, testing policies may differ by age group; however, when findings require a differential diagnosis, testing may be indicated.

For more information, please refer to the National Protocol-Examination Process: STI Evaluation and Care.

Hospital-based programs should be able to provide these medications readily, but community-based programs will need to procure medications in advance to have them available for administration and to follow the pharmacy laws of the state.

All programs should have a policy in place for HIV risk screening and prophylaxis. They should work closely with infectious disease physicians who treat HIV patients in the community to create the policy. Unlike prophylaxis for gonorrhea, syphilis, and chlamydia, HIV prophylaxis medications require oversight by a licensed provider. If a patient has a significant risk of HIV infection, the SANE should consult with a licensed prescriber. In some communities, the SANEs may be in the best position to start HIV prophylaxis and may not have a licensed prescriber onsite for consultation. In those situations, there should be an arrangement for the option of a telephone consult if the patient is pregnant or has a chronic medical condition that may create a need to alter treatment protocols. A protocol should include how patients will be screened, how to obtain baseline lab tests, and what mechanism to use for immediate provision of the medication since HIV prophylaxis is extremely time sensitive. It is essential to identify sources of payment for medication since they can cost in excess of $2,000 for the required 28-day supply. This may include providing access to patient assistance programs provided by the drug manufacturers