Aussi disponible en français sous le titre: Lignes directrices Canadiennes sur les infections transmissibles sexuellement - PDF

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Our mission is to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. Public Health Agency of Canada Revised version of the Canadian STI Guidelines 2006 edition. This publication can also be found on the Internet at the following address: Aussi disponible en français sous le titre: Lignes directrices Canadiennes sur les infections transmissibles seuellement Correspondence: Seual Health and Seually Transmitted Infections Section Community Acquired Infections Division Centre for Communicable Diseases and Infection Control Public Health Agency of Canada Ottawa, ON K1A 0K9 Fa: (613) HER MAJESTY THE QUEEN IN RIGHT OF CANADA (2008) For paper copies: Catalogue number: HP40-1/2010E ISBN : For online copies: Catalogue number: HP40-1/2010E-PDF ISBN : FOR FUTURE UPDATES FILL IN AND FAX NOW Foreword I Table of Contents Epert Working Group on the Canadian Guidelines on Seually Transmitted Infections Acknowledgments Introduction Levels and Quality of Evidence for Treatment Recommendations Important Considerations for Guidelines Users TABLE OF CONTENTS Section 1 Epert Working Group on the Canadian Guidelines on Seually Transmitted Infections Acknowledgements Introduction Levels and Quality of Evidence for Treatment Recommendations Important Considerations for Guidelines Users Section 2 Primary Care and Seually Transmitted Infections Section 3 Laboratory Diagnosis of Seually Transmitted Infections Collection and Transportation of Specimens Laboratory Testing Methods Laboratory Diagnosis of Specific Infections Canadian Guidelines on Seually Transmitted Infections Public Health Agency of Canada January 2008 Table of Contents 1 Canadian Guidelines on Seually Transmitted Infections Public Health Agency of Canada January 2008 Section 4 Management and Treatment of Specific Syndromes Syndromic Management of Seually Transmitted Infections Epididymitis Genital Ulcer Disease (GUD) Pelvic Inflammatory Disease (PID) Prostatitis Seually Transmitted Intestinal and Enteric Infections Urethritis Vaginal Discharge (Bacterial Vaginosis, Vulvovaginal Candidiasis, Trichomoniasis) Section 5 Management and Treatment of Specific Infections Chancroid Chlamydial Infections Ectoparasitic Infestations (Pubic Lice, Scabies) Genital Herpes Simple Virus (HSV) Infections Genital Human Papillomavirus (HPV) Infections 2 Table of Contents Gonococcal Infections Hepatitis B Virus Infections Human Immunodeficiency Virus (HIV) Infections Lymphogranuloma Venereum (LGV) Syphilis Section 6 Specific Populations Immigrants and Refugees Inmates and Offenders Men Who Have Se with Men (MSM)/ Women Who Have Se with Women (WSW) Pregnancy Seual Abuse in Peripubertal and Prepubertal Children Seual Assault in Postpubertal Adolescents and Adults Se Workers Substance Use Travellers Canadian Guidelines on Seually Transmitted Infections Public Health Agency of Canada January 2008 Table of Contents 3 Canadian Guidelines on Seually Transmitted Infections Public Health Agency of Canada January 2008 Section 7 Appendices A: Patient Counselling Guide on Condom Use B: How to Use a Male Condom/ How to Use a Female Condom C: Resources and Reference Tools for Health Professionals D: Provincial and Territorial Offices for the Prevention and Control of STI E: Provincial Laboratories F: Forensic Evidence, Services and Laboratories G: Referral Centres for STIs in Peripubertal and Prepubertal Children H: Tanner Scale of Seual Maturity Section 8 General inde 4 Table of Contents Epert Working Group for the Canadian GuidELINES on Seually TransmITTEd INFECTIONS Chair Section Chairs Members Secretariat Tom Wong, MD, MPH, FRCPC, Director, Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada Primary Care and Seually Transmitted Infections Marc Steben, MD, FCFP, médecin-conseil, Direction risques biologiques, environnementau et occupationnels, Institut national de santé publique du Québec et clinique des maladies de la vulve, Hôpital Notre-Dame, Centre hospitalier de l Université de Montréal Laboratory Diagnosis of Seually Transmitted Infections Ma Chernesky, PhD, Professor Emeritus, McMaster University Management and Treatment of Specific Syndromes Mark Yudin, MD, MSc, FRCSC, Assistant Professor, University of Toronto; Deputy Head, Department of Obstetrics and Gynecology, St. Michael s Hospital Management and Treatment of Specific Infections Barbara Romanowski, MD, FRCPC, Clinical Professor of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta Specific Populations Rhonda Kropp, BScN, MPH, Head, Strategic Analysis and Knowledge Transfer, Seual Health and STI Section, Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada Joanne Embree, MD, FRCPC, Departments of Medical Microbiology & Pediatrics and Child Health, University of Manitoba William Fisher, PhD, Professor, Departments of Psychology and Obstetrics and Gynaecology, University of Western Ontario Cathy Latham-Carmanico, RN, BScN, Knowledge Development and Research Analyst, Seual Health and STI Section, Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada Lai-King Ng, PhD, Director of Bacteriology and Enteric Diseases Program, National Microbiology Laboratory, Public Health Agency of Canada David Patrick, MD, MHSc, FRCPC, Associate Professor, UBC Healthcare & Epidemiology; Director, Epidemiology Services, British Columbia Centre for Disease Control Michael Rekart, MD, DTM&H, MHSc, Director, HIV/AIDS Control, British Columbia Centre for Disease Control Ameeta Singh, MD, BMBS, MSc, FRCPC, Infectious Diseases Medical Consultant, Alberta Health and Wellness; Clinical Associate Professor, Department of Medicine, University of Alberta; Medical Director, Capital Health STD Centre Allison Ringrose, BHSc, Prevention and Research Analyst, Seual Health and STI Section, Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada Canadian Guidelines on Seually Transmitted Infections Public Health Agency of Canada January 2008 Epert Working Group for the Canadian Guidelines on Seually Transmitted Infections 5 Canadian Guidelines on Seually Transmitted Infections Public Health Agency of Canada January 2008 ACKNOWLEDGMENTS With the assistance of the Seual Health and Seually Transmitted Infections Section, Community Acquired Infections Division, Centre for Communicable Diseases & Infection Control, Public Health Agency of Canada: Editor-in-Chief: Dr. Tom Wong Associate Editor: Cathy Latham-Carmanico Production Coordinator: Robert Lerch Editing and Production Support: Tory Atwood, Barbara Jones, Leila Khalaf, Rhonda Kropp, Jacques Néron, Allison Ringrose, Dr. Maim Trubnikov Many health professionals from across Canada volunteered their time to author chapters for these guidelines, and their participation is acknowledged by chapter: Fred Y. Aoki, MD, Professor of Medicine, Medical Microbiology and Pharmacology & Therapeutics Member, Section of Adult Infectious Diseases, Faculty of Medicine, University of Manitoba, Author: Genital Herpes simple virus (HSV) Infections; Dr. Ma Chernesky, PhD, Professor Emeritus, McMaster University, Author: Laboratory Diagnosis of Seually Transmitted Infections; Francois Coutlée, Clincial Researcher, Laboratoire de Virologie Moléculaire, Centre de Recherche Centre Hospitalier de l université de Montréal Hôpital Notre- Dame, Co-Author : Genital Human Papillomavirus (HPV) Infections; Laurent Delorme, MD CSPQ FRCP(C), médecin microbiologiste infectiologue, Hôpital Charles-LeMoyne, Co-Author : Genital Ulcer Disease (GUD); Francisco Diaz-Mitoma, M.D., Ph.D., FRCPC, Professor and Chief, Division of Virology, Children s Hospital of Eastern Ontario, University of Ottawa, Co-Author : Genital Ulcer Disease (GUD); Ale Ferenczy, MD, Professor of Pathology and Obstetrics & Gynecology, McGill University and the Sir Mortimer B. Davis-Jewish General Hospital Montreal, Co-Author : Genital Human Papillomavirus (HPV) Infections; William A. Fisher, PhD, Professor, Departments of Psychology and Obstetrics and Gynaecology, University of Western Ontario, Author: Primary Care and Seually Transmitted Infections; Sarah Forgie, MD FRCPC, Assistant Professor, Pediatrics, Division of Infectious Diseases, University of Alberta, Associate Director, Infection Control, Stollery Children s Hospital and University of Alberta Hospital, Co-Author: Seual Abuse in Peri-Pubertal and Prepubertal Children, Seual Assault in Post Pubertal Adolescents and Adults; Eduardo L. Franco, MPH, DrPH, James McGill Professor of Epidemiology and Oncology Director, Division of Cancer Epidemiology, McGill University, Co-Author : Genital Human Papillomavirus (HPV) Infections; Deana Funaro, MD, FRCPC dermatology, Clinical professor at Notre-Dame Hospital and Ste-Justine Hospital, University of Montreal, Co-Author : Genital Ulcer Disease (GUD); David Haase, MD, Professor, Department of Medicine, Division of Infectious Diseases, Dalhousie University, Author: Human Immunodeficiency Virus (HIV) Infections; Rhonda Kropp, BScN, MPH, Head, Strategic Analysis and Knowledge Transfer, Seual Health and STI Section, Community Acquired Infections Division, Public Health Agency of Canada, Author: Men Who Have Se With Men (MSM)/Women Who Have Se With Women (WSW), Substance Use, Co-Author: Lymphogranuloma Venereum (LGV); Annie-Claude Labbé, MD, FRCPC, Department of microbiology, Hopital Maisonneuve-Rosemont Montreal, Co-Author : Genital Ulcer Disease (GUD); Cathy Latham Carmanico, RN, BScN, Knowledge Development and Research Analyst, Seual Health and STI Section, Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Author: Primary Care and Seually Transmitted Infections; Janice Mann, MD, Senior Knowledge Transfer Advisor, Strategic Communications and Knowledge Echange, Canadian Agency for Drugs and Technologies in Health, Author: Inmates and Offenders, Lymphogranuloma Venereum (LGV); Lynette J. Margesson, MD, FRCPC, Assistant Professor of Obstetrics and Gynecology and of Medicine(Dermatology)Dartmouth Medical School, Co-Author : Genital Ulcer Disease (GUD); Deborah M. Money, MD, FRCSC, Associate Professor, University of British Columbia, B.C. Women s Hospital, Co-Author: Pregnancy; Gina Olgilvie, MD, MSc, University of British Columbia, Vancouver, Author: Urethritis; Ron Read, MD, Head, Infectious Diseases, Department of Medicine, Microbiology and Infectious Diseases, University of Calgary/Calgary Health Region, Author: Hepatitis B Virus Infections; Michael L. Rekart, MD, DTM&H, MHSc, Director, HIV/AIDS Control, British Columbia Centre for Disease Control, Author: Se Workers; Barbara Romanowski, MD, FRCPC, 6 Acknowledgments Clinical Professor of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Author: Ectoparasitic Infestations, Gonococcal Infections; Allan Ronald, MD, Distinguished Professor Emeritus, University of Manitoba, Author: Chancroid; Shelly Sarwal, MD, MSc, FRCP(C), Medical Officer of Health, Nova Scotia Department of Health, Author: Vaginal Discharge; Rita Shahin, MD, Toronto Public Health, Author: Travellers; Ameeta Singh, BMBS, MSc, FRCPC, Infectious Diseases Medical Consultant, Alberta Health and Wellness Clinical Associate Professor, Department of Medicine, University of Alberta, Medical Director, Capital Health STD Centre, Author: Seual Abuse in Peri-Pubertal and Prepubertal Children, Seual Assault in Post Pubertal Adolescents and Adults, Syphilis; Marc Steben, MD, médecin-conseil, Direction risques biologiques, environnementau et occupationnels, Institut national de santé publique du Québec et clinique des maladies de la vulve hôpital Notre-Dame Centre hospitalier de l Université de Montréal, Author: Genital Human Papillomavirus (HPV) Infections, Genital Ulcer Disease (GUD), Primary Care and Seually Transmitted Infections; : Bruno Turmel, MD, médecin-conseil, Direction générale de la santé publique, Ministère de la Santé et des Services sociau du Québec, Author: Epididymitis, Prostatitis, Seually Transmitted Intestinal and Enteric Infections; Julie van Schalkwyk, MD, MSc, FRCSC, Assistant Clinical Professor, Department of Obstetrics and Gynecology, University of British Columbia, Author: Pregnancy; Tom Wong, MD, MPH, FRCPC, Director Community Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Author: Chlamydial Infections, Immigrants and Refugees; Mark H. Yudin, MD, MSc, FRCSC, Assistant Professor, University of Toronto, Deputy Head, Department of Obstetrics and Gynecology St. Michael s Hospital, Author: Pelvic Inflammatory Disease (PID), Co-Author: Urethritis. The following people are thanked for volunteering their time as eternal reviewers for the guideline chapters: Robert Brunham, MD, Director of Medical and Academic Affairs, BC Centre for Disease Control, Director, UBC Centre for Disease Control, Professor of Medicine, Division of Infectious Diseases, University of British Columbia; Susan Comay, MD, Medical Director, Seual Assault Service, BC Women s Hospital; Curtis Cooper, MD, FRCPC, University of Ottawa; Francisco Diaz-Mitoma, MD, PhD, FRCPC, Professor and Chief, Division of Virology, Children s Hospital of Eastern Ontario, University of Ottawa; Harold Dion, MD, CCFP, FCFP, Clinique médicale l Actuel, Chair of the Board, Quebec College of Family Physicians; Shelia Dunn, MD, CCFP(EM), University of Toronto, Sunnybrook and Women s College Health Sciences Centre; Ale Ferenczy, MD, Professor of Pathology and Obstetrics & Gynecology, McGill University, Sir Mortimer B. Davis-Jewish General Hospital; David Fisman, MD, MPH, Visiting Scholar Center for Health and Wellbeing, Woodrow Wilson School, Princeton University; Jennifer Geduld, Manager, HIV/AIDS Surveillance Section, CIDPC, Surveillance and Risk Assessment Division, HIV/AIDS Epidemiology and Surveillance, Public Health Agency of Canada; Mary Gordon, MD, City of Ottawa, Public Health, Seual Health Centre; Kevin Gough, MD, FRCPC, MEd, St. Michael s Hospital, University of Toronto; Andree Gruslin, MD, FRCS, Post Graduation Program Director, Assistant Professor, MFM Department of Obstetrics and Gynecology, University of Ottawa; Hunter Handsfield, MD, Professor of Medicine, University of Washington, Center for AIDS and Seually Transmitted Diseases; Sandra Hooper, RN(EC), MScN, Nurse Practitioner Seual Health Centre, Ottawa Public Health; Robbi Howlett, MASc, PhD, Manager, Ontario Cervical Screening Program, Division of Preventive Oncology, Cancer Care Ontario; Gaya Jayaraman, PhD, MPH, Manager, Hepatitis C and Seually Transmitted Infections Surveillance Section, Community Acquired Infections Division, Public Health Agency of Canada; Hugh D Jones, MD, Dip Ven, STD/AIDS Control, Clinic Physician; Fadel Kane, MD, MSc, HIV/AIDS Programs and Policy Division, Public Health Agency of Canada; Sari Kives, MD, University of Toronto, St. Michael s Hospital; Claude Laberge, MD, Service de lutte contre les ITSS, Direction générale de la santé publique, Ministère de la santé et des services sociau du Québec; Gilles Lambert, MD, Institut national de santé publique du Québec; Debbie Lindsay, MD, University of Manitoba, Child Protection Centre, Health Sciences Centre; Noni MacDonald, MD, MSc, FRCP, Dalhousie University, IWK Health Centre; Louisa MacKenzie, MD, FRCPC, DTMH, Calgary Refugee Health Program, Margaret Chisholm Resettlement Centre; Lorette Madore, RN, DPHN, BN, Supervisor, Clinical Services, Healthy Seuality and Risk Reduction Program, Ottawa Public Health/Santé publique d Ottawa; Cheryl Main, MD, FRCPC, Assistant Professor Pathology and Molecular Medicine, McMaster University; Nathalie Mondain, PhD, Groupe de Recherche Interdisciplinaire en Santé (GRIS), University of Montreal; Deborah Money, MD, FRCSC, Associate Professor, University of British Columbia, BC Women s Hospital; Carolyn A Montgomery, MB, STD/AIDS Control, Clinic Physician; Curtis Nickel, MD, Professor of Urology, Queen s University; Gina Ogilvie, MD, MSc, University Canadian Guidelines on Seually Transmitted Infections Public Health Agency of Canada January 2008 Acknowledgments 7 Canadian Guidelines on Seually Transmitted Infections Public Health Agency of Canada January 2008 of British Columbia; Caroline Paquet, SF, MSc, Professeure, Baccalauréat en pratique sage-femme, Département de Chimie-biologie, Université du Québec à Trois-Rivières; Gordon Phaneuf, Director of Strategic Initiatives, Child Welfare League of Canada; Raphael Saginur, MD, FRCPC, Ottawa Hospital and University of Ottawa; John Sellors, MD, Senior Medical Advisor, Reproductive Health, PATH; Alberto Severini, MD, National Microbiology Laboratory, Public Health Agency of Canada; Stephen Shafran, MD, FRCPC, Professor and Director, Division of Infectious Diseases, Department of Medicine, University of Alberta; Rita Shahin, MD, Toronto Public Health; Brenna Shearer-Hood, MSA(HSA), BMR (OT) Cancer Care Manitoba; Jonathan M. Smith, CSC Epidemiologist, Tuberculosis Prevention and Control, Community Acquired Infections Division, Public Health Agency of Canada; Gwen Stephens, MD, FRCPC, University of British Columbia, Department of Pathology & Laboratory Medicine; Jill Tinmouth, MD, PhD, Sunnybrook and Women s Health Sciences Centre, University of Toronto; Baldwin Toye, MD, FRCPC, Head, Division of Microbiology, Ottawa Hospital, University of Ottawa; Sharonie Valin, MD, CCFP, MHSc, North York General Hospital, Women s College Hospital, Bay Centre for Birth Control; Heidi Wood, PhD, Head, Diagnostics, Zoonotic Diseases and Chlamydia Section, National Microbiology Laboratory, Public Health Agency of Canada. 8 Acknowledgments INTRODUCTION These guidelines were created as a resource for clinical and public health professionals especially nurses and physicians for the prevention and management of STIs across a diverse patient population, including neonates, children, adolescents and adults. Since the release of the Canadian Guidelines on Seually Transmitted Infections-2006 Edition, the Epert Working Group (EWG) for the guidelines which includes STI eperts from the fields of medicine, nursing, laboratory, public health and research have volunteered their time and effort as authors and reviewers to maintain updated, evidence-based recommendations for the prevention, diagnosis, treatment and management of STIs in Canada. The content of these current Canadian Guidelines on Seually Transmitted Infections reflects emerging issues and highlight changes in the STI literature since the release of the 2006 guidelines. Guidelines presented in this document reflect the views of the Epert Working Group on Canadian Guidelines for Seually Transmitted Infections. They should be construed not as rules but rather as recommendations. Canada is a signatory of the WHO global strategy for the prevention and control of seually transmitted infections which stipulates that STI prevention and control need to be linked to HIV prevention and seual and reproductive health programmes and services. The strategy also highlights the need for collaborative efforts at various levels and venues of service delivery for programmes to reach and have the greatest impact on those at risk of STI/HIV and other communicable diseases. Practitioners should be aware of the emerging research linking STI to preventable chronic diseases in both men and women, such as cancers. Primary care providers are well positioned to offer patient centered STI screening, diagnosis, management and treatment services to a wide range of their patients. Making such a c
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