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43.3.5.3 STD Testing
Syphilis Testing
Syphilis testing should be performed on adolescents that are at high risk for infection. These high-risk adolescents include sexually active individuals living in an area with a high prevalence of STD, endemic for syphilis, or individuals at risk (e.g., past family history or prior history of other STDs or for adolescents who have had vaginal, anal, or oral sex, or have had a sexual partner who is at risk for infection). RPR card test is no longer a required test but should be obtained based on risk assessment.
Laboratory Procedure
Specimens for syphilis screening must be sent to the DSHS Austin laboratory. A RPR card test is the screening procedure. Due to changes in specimen collection, handling, and submission criteria, recommended by CLIA (Regulatory Agency), contact the DSHS laboratory for the most current specimen requirements at 1-888-963-7111, Ext. 7430. The provider should note the following:
• The RPR card test is a macroscopic nontreponemal testing procedure similar in sensitivity and reliability to the Venereal Disease Research Laboratory (VDRL).
•False-positive reactions occur with variable frequency as a result of reagin produced in diseases other than syphilis or provoked by immunization antigens.
•Specimens found reactive by RPR card test are confirmed for syphilis by TP-PA or FTA-ABS tests.
•The RPR Card Test cannot be performed if hemolysis of the specimen has occurred, the specimen volume is less than 0.5 mL, or the specimen is grossly contaminated with bacteria, lipemic, or otherwise extremely turbid.
Gonorrhea and Chlamydia Infection Testing
Gonorrhea and chlamydia infections are the most common reportable STDs in the United States today. For this reason, sexually active adolescents are tested for both these diseases simultaneously. Untreated infections may result in severe complications, including sterility and pelvic inflammatory disease.
HIV Testing
It is critical to maintain confidentiality when caring for clients, as well as their specimens. Providers must not leave specimens identified for HIV testing in open view of unauthorized medical personnel. Discussions with clients about their risk factors should be confidential. Testing should be performed only after informed consent is obtained from the adolescent. Providers must not mail the client consent to the laboratory; the consent must be retained with the client's records.
HIV testing may be performed for adolescents without requirement of parental consent. Adolescents at risk for HIV infection should be offered confidential HIV screening. If the client refuses the HIV test, the provider may not perform the test and must explain the option of anonymous testing and refer the client to a testing facility that offers anonymous testing. A notation must be made in the medical record that notification of the HIV test and the right to refuse was given. Providers may call the HIV/STD InfoLine for referrals to HIV/AIDS testing sites; prevention, case management, and treatment providers; STD clinics; and other related service organizations. The HIV/STD InfoLine is 1-800-299-2437. This toll-free HIV/AIDS and STD information and referral service is available for English- and Spanish-speaking callers and for those who are hearing-impaired.
Laboratory Procedure
Specimens for HIV screening must be sent to the DSHS Austin laboratory. The presence of HIV-1 antibodies in client serum is a long-term marker of infection. Specimens are tested on an enzyme immunoassay (EIA) that identifies antibodies that are specific for the HIV-1 virus. Specimens that are initially reactive on the EIA screen are retested in duplicate on the EIA. If either of the duplicate retests are reactive, the EIA is considered repeatedly reactive and a confirmatory test, the Western blot, is performed.
The Western blot involves the separation of the virus proteins by size on a special strip of filter paper. This strip is soaked in a dilution of client serum. If antibodies specific for the different proteins are present, they will bind to that portion of the strip. The antibodies are then detected with enzyme-labeled antibodies that cause a darkening on the strip where client antibodies have bound. Western blot bands are named by a letter indicating the type of molecule (p=protein, gp=glycoprotein), and a number that indicates their relative size in kilodaltons (e.g., p17=a protein 17 kilodaltons in size).
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