SEXUALLY TRANSMITTED DISEASE AND HUMAN
IMMUNODEFICIENCY VIRUS GENERAL INFORMATION FOR
PATIENT SERVICES
Purpose:
 The purpose of Sexually Transmitted Disease (STD) and Human Immunodeficiency Virus
Counseling and Testing (HIVCT) Services is to prevent the spread and resultant sequelae of
STDs, including Human Immunodeficiency Virus (HIV) infection.
 Under provisions of KRS Chapter 211, the Cabinet shall establish a network of voluntary HIV
testing programs in every county of the state. The programs shall be conducted in each Local
Health Department (LHD) and at selected other locations on an as need basis. Patients seeking
services at HIVCT sites are given face-to-face pretest and post-test counseling by a qualified
counselor trained in the HIV Counseling, Testing and Partner Notification Course instructed by
personnel assigned to the STD and HIVCT programs or the AIDS Prevention Program staff.
Anonymous counseling and testing services must be offered to persons who do not consent to
confidential testing. Services must not be denied for those who choose confidential testing, but
do not have the ability to pay. When it is necessary to test a patient for HIV-2 infection, contact
the HIV Lab Testing Section at the Division of Laboratory Services, (502) 564-4446, ext. 4483,
for instructions on specimen labeling.
Services:
 Adequate examination with diagnosis and treatment services
 Face-to-face counseling for suspected infection, infection, and/or a contact to infection
 Rapid follow-up of positive laboratory results
 Rapid follow-up for contacts to STD or HIV
 Provide professional and public information and education
Target Population:
 Persons presently infected or who have the potential for being infected with STD/HIV
 Pregnant and non-pregnant women
 High risk newborns and children
 Minorities
 Men who have sex with men
 Injecting drug users and their needle sharing and sexual partners
Scope of Services:
 Disease Intervention Specialists (DIS) are assigned to four LHD locations: Louisville, Lexington,
Bowling Green, and Florence. They are available to serve the STD/HIV needs of any county in
Kentucky on short notice. The DIS perform priority STD interviews and assist with HIV
counseling sessions at their assigned bases and in the counties within their jurisdiction. The
interviewing process involves elicitation, location, and referral to examination of sexual and
needle-sharing partners. Often field visits to the patient’s home are necessary. Investigative
activities adhere to the rules of confidentiality. In addition to field staff, a manager, an assistant
manager, and support staff are assigned to Frankfort.
Service Sites:
 LHDs are required to provide STD/HIV services
 Louisville Metro Health Department Specialty Clinic is a clinic solely devoted to STD/HIV
services
 Lexington-Fayette County Health Department operates a full-time HIVCT site
Page 1 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
HIV COUNSELING/TESTING GUIDELINES
Counseling and testing can only be done by persons who have attended the two day HIV
Counseling and Partner Notification Course provided by the State STD Program or the AIDS
Prevention Program.
Types of Appointments: Client’s choice of confidential or anonymous for service.
 Confidential: Confidential client record initiated.
 Anonymous: No client record initiated. ID number used to identify testing and
results.
 Court Ordered: No client record initiated. LHD involvement confined to specimen
collection only and routing the specimen to the Division of Laboratory Services
(DLS).
Pre-Test Counseling Visit
 ACH 263 What You Should
Know About HIV/AIDS
 Meaning of results: Positive,
Negative, Indeterminate
 Review and plan for individual
risk factor reduction
 Possibility of up to 6 months
after exposure for antibody
appearance
 Prognosis
 Prevention
 Review symptoms of other
STDs, offer screening services
 Condom availability
 Explanation of HIV testing
procedure
 Explain NO phone results given
 Must have ID number to obtain
anonymous test results
 Written results will not be
provided for test done
anonymously
 Give appointment for Post-Test
Counseling and results in two
weeks with same provider, if
feasible
 Initiate HIV Counseling and
Testing Report Form
Testing Procedure
 Submit 7-10 cc red
stopper tube of
whole blood to
Virology Section of
DLS, a green sticker
which corresponds
to the number of the
lab slip, must be
placed on the blood
tube.
 Confidential Test:
Name and ID
number on lab form
and specimen tube
 Anonymous Test:
ID number only on
lab form and
specimen tube
 Court-Ordered Test:
Name and ID
number on lab form
and specimen tube.
Send
Administrative
Order of the Courts
Form 499 to DLS
with specimen
 OraSure or
OraQuick testing
Post-Test Counseling Visit
for Negative Results
 Show results
 Explanation of no
immunity to HIV
 Advise retest 6 months
from last exposure
incident
 Review risk factor
reduction
 Review condom
availability
 Review STD screening
services
 Complete HIV
Counseling and Testing
Report Form*
*Submit top copy of form to
Kentucky STD Program.
Retain bottom copy at local
site for at least six months.
If client does not return for
Post-Test Counseling and
results within two months,
this form must still be
completed, with top copy
submitted, and bottom copy
retained.
Post-Test Counseling
Visit for Positive Results
 Show results
 Assess coping ability
 Refer to KHCCP
(Kentucky HIV Care
Coordinator Program)
 Refer to area STD
Program Supervisor for
counseling and
assistance
 Encourage
anonymously tested
clients to agree to
confidential services
 Refer for nutritional
counseling
 TB skin test (if not
already done)
 Review symptoms of
other STDs and offer
screening services
 Review condom
availability
 Review need to protect
others from spread of
infection
 Advise on need for
notification of sex and
needle sharing partners
for testing
 Complete HIV
Counseling and Testing
Report Form*
*Submit top copy of form to Kentucky STD Program. Retain bottom copy at local site for at least six months. If client does not return for
Post-Test Counseling and results within two months, this form must still be completed, with top copy submitted, and bottom copy retained.
Page 2 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
RYAN WHITE STATE FUNDED SERVICES PROGRAMS
Overall intent of these services programs is to provide clients with a continuum of care utilizing existing
community-based services to the greatest possible extent.
Kentucky HIV Care Coordinator Program (KHCCP)
Purpose: Facilitate provision of quality care services to HIV infected individuals and families in timely and
consistent manner across a continuum of care. Provides Care Coordinators in six regional sites through
arrangements with LHDs to aid the client in identifying and accessing needed services. KHCCP acts as umbrella
program for other client assistance programs: Kentucky AIDS Drug Assistance Program (KADAP), Outpatient
Health Care and Support Services, and the Kentucky Health Insurance Assistance Program (KHIAP). Following is a
list of counties served by regions including Area Development Districts (ADDs):
Barren River Region:
Matthew 25, 411 Letcher Street, Henderson, KY 42420
Care Coordinator(s):
270-826-0200
ADDs:
Barren River, Green River, and Lincoln Trail
Counties:
Allen, Barren, Breckinridge, Butler, Daviess, Edmonson, Grayson, Hancock, Hardin, Hart,
Henderson, Larue, Logan, McLean, Marion, Meade, Metcalfe, Monroe, Nelson, Ohio, Simpson,
Union, Warren, Washington, Webster
Cumberland Valley Region:
based in Cumberland Valley District Health Department
Care Coordinator(s):
606-864-3776
ADDs:
Lake Cumberland, Cumberland Valley, Kentucky River, and Big Sandy
Counties:
Adair, Bell, Breathitt, Casey, Clay, Clinton, Cumberland, Floyd, Green, Harlan, Jackson, Johnson,
Knott, Knox, Laurel, Lee, Leslie, Letcher, Magoffin, Martin, McCreary, Owsley, Perry, Pike,
Pulaski, Rockcastle, Russell, Taylor, Wayne, Whitley, Wolfe
Lexington Region:
based in Lexington-Fayette County Health Department
Care Coordinator(s):
859-288-2362
ADDs:
Bluegrass, Buffalo Trace, FIVCO, Gateway
Counties:
Anderson, Bath, Bourbon, Boyd, Boyle, Bracken, Carter, Clark, Elliott, Estill, Fayette, Fleming,
Franklin, Garrard, Greenup, Harrison, Jessamine, Lawrence, Lewis, Lincoln, Madison, Mason,
Menifee, Mercer, Montgomery, Morgan, Nicholas, Powell, Robertson, Rowan, Scott, Woodford
Louisville Region:
based in Volunteers of America, 850 Barret Avenue, Suite 302, Louisville, KY 40204
Care Coordinator(s):
502-574-0161
ADDs:
KIPDA
Counties:
Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, Trimble
Northern Kentucky Region:
based in Northern Kentucky District Health Department
Care Coordinator(s):
859-578-7660
ADDs:
Northern Kentucky
Counties:
Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen, Pendleton
Purchase Region:
Heartland Cares Inc., 3025 Clay Street, Paducah, KY 42002
Care Coordinator(s):
877-444-8183 (toll free)
ADDs:
Pennyrile, Purchase
Counties:
Ballard, Caldwell, Calloway, Carlisle, Christian, Crittenden, Fulton, Graves, Hickman, Hopkins,
Livingston, Lyon, McCracken, Marshall, Muhlenberg, Todd, Trigg
For more information, contact
HIV Services Program Administrator 502-564-6539
Page 3 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
COMMON SEXUALLY TRANSMITTED DISEASES
These guidelines reflect minimal services, and address the most common STDs currently
presenting in the clinic setting in LHDs. LHDs with appropriate staff and capability to provide
additional diagnostic and treatment services should add to or modify these guidelines.
The guidelines included are based on the 2006 STD Treatment Guidelines and recent revisions,
published by the Centers for Disease Control and Prevention (CDC). The treatment regimens
described are for medications generally available for use in LHDs. Alternative regimens using
medications not readily available are omitted for the sake of clarity. A copy of the 2006 (CDC)
STD Treatment Guidelines must be available at each service site for reference and additional
information. Copies of the Guidelines can be obtained from the Kentucky STD Control Program,
Frankfort.
Overall goals for providing STD services are to:











Request area DIS for epidemiologic follow-up for 100% of suspected or diagnosed cases of
priority STD (early syphilis and HIV infection), and darkfield microscopy.
Assure that quality examination, diagnostic and treatment services are available to all females
and males seeking or who are in need of such services.
Include as a minimum for all patients evaluated for STD:
o Examination for signs/symptoms of STD, to include visual examination of external
genitalia for male and female patients and a speculum examination for female patients.
o Appropriate screening test (gonorrhea [GC] and chlamydia tests [CT] from exposed site[s],
Venereal Disease Research Laboratory [VDRL] rapid plasma regain [RPR], HIV antibody,
etc.). A swab specimen will be collected from the urethra of males who are symptomatic.
Urine samples will be collected from females without a cervix and for non-sexually active
adolescent females and males.
o Risk reduction counseling. Assessment for HIV risk. Counseling/testing offered to persons
assessed to be at increased risk.
Female patients suspected of having PID must be treated by the LHD or referred to another
provider for management and care.
Assure that patients with positive chlamydia and/or gonorrhea tests return for treatment within
seven (7) days of receipt of laboratory report.
Provide patients diagnosed with gonorrhea, male patients with urethritis (test results pending)
and their sexual contacts with treatment effective against both gonorrhea and chlamydia.
At time of original examination, provide epidemiologic/prophylactic treatment to all contacts
exposed to gonorrhea within the past 60 days.
At time of original examination provide epidemiologic/prophylactic treatment to all contacts to
chlamydia, Nongonococcal Urethritis (NGU) and Mucopurulent Cervicitis who were exposed
within the past 60 days.
Provide face-to-face counseling/interviewing to public clinic patients diagnosed with chlamydia,
gonorrhea, NGU or Mucopurulent Cervicitis. Interviews would be achieved in a timely manner,
with the goal of obtaining an average of at least one contact elicited per case interviewed. This
service should be available to privately diagnosed and treated patients upon request of their
physician.
Assure that contacts to chlamydia, gonorrhea, NGU, Mucopurulent Cervicitis named in
interviews with infected patients are referred for medical evaluation in a timely manner.
Assure reporting of suspected sexual abuse to the Department for Community-Based Services.
Page 4 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
Overall goals for providing STD services are to:


Provide all patients through counseling and/or printed material, adequate motivation that will:
o Increase patients’ awareness of signs and symptoms of STDs and prompt patient to seek
medical care immediately should evidence of symptoms occur.
o Increase the number of sexual partners referred for evaluation by STD patients.
o Increase patients’ rate of compliance with prescribed medication regimen.
o Increase the practice of preventive behaviors in the patient population (use of condoms,
selection of partners, etc.).
Provide reporting vehicle to local private physicians and encourage voluntary reporting in order
to more accurately determine the extent of the local STD problem.
Should a clinician decide that a test-of-cure is needed, culture is the prescribed method but is
unavailable through the DLS. A specimen can be collected for Gen-Probe testing by the DLS but
a positive result may represent nonviable chlamydia remnants from the earlier infection.
STD Offices by Area Developmental Districts (ADD)
ADD
STD Office
1–4 Warren County Health Dept., Bowling Green, KY
5–6 Specialty Clinic, Louisville, KY
Northern Kentucky Independent District Health Dept.,
7
Florence, KY
8–15 Fayette County Health Dept., Lexington, KY
Page 5 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
Telephone
(270) 781-2490, ext. 213 or ext. 214
(502) 574-6699
(859) 363-2060
(859) 255-6152
Guideline for Non-Occupational Post Exposure Prophylaxis (nPEP)
In the case of exposure to blood, genital secretions, or other potentially infectious fluids of a known
HIV+ person, a local health department, or other public health contracting agency or partner should:
1. If the client has the financial means or is medically insured, they should be recommended to go to
their regular healthcare provider within 72 hours of exposure.
2. Otherwise, the client should be recommended to go to an emergency room within 72 hours of
exposure.
3. Recommend HIV testing.
Page 6 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
Protocols for Treatment of Common Sexually Transmitted Diseases
Before treating a pregnant woman for a sexually transmitted disease, confer with the physician responsible for her maternity
care. Generally, treatment for STD’s found in a pre-pubertal child should be managed by the child’s physician. Unless
contraindicated (e.g., allergy or pregnancy), the first drug listed is the drug of choice.
Condition
Treatment
Management of Sexual
Follow-up
Partner
Chlamydia trachomatis*
Do not need to retest

Azithromycin 1g (two 500 mg
 All persons sexually
for chlamydia after
 Confirmed infections
tablets) p.o or
exposed to Chlamydia
completed therapy
with laboratory test(s)
trachomatis infections

Doxycycline 100 mg p.o. BID x 7
unless symptoms
within the previous 60
 If there is a possibility
days (not to be used if patient is
persist or reinfection is
days should be tested for
of medical/legal
pregnant, allergic to drug, or
suspected.
chlamydia, gonorrhea,
considerations, patient
under 8 years old) or
and syphilis and
should have a culture

Erythromycin (base or stearate)
promptly treated.
done at a laboratory
500 mg p.o. QID x 7 days or
certified to perform

Amoxicillin 500 mg p.o. TID x 7
culture tests for
to 10 days. May be substituted for
chlamydia and
erythromycin in pregnancy
gonorrhea.
Note: Symptomatic patients should
also be treated for gonorrhea (see next
page).
Chlamydia–associated
Syndromes
 NGU/NSU Male
patients with urethral
discharge and/or lab
report on Gram stained
smear of exudates
indicates 4 or more
polymorphonuclear
leukocytes



Azithromycin 1g (two 500 mg
tablets) p.o. or
Doxycycline 100 mg p.o. BID x 7
days or
Erythromycin (base or stearate)
500 mg p.o. QID x 7 days may be
used if patient cannot take
doxycycline; i.e., allergy.
Also treat for gonorrhea (see next
page).
 Sex partners in the
previous 60 days should
be examined, tested for
chlamydia, gonorrhea,
and syphilis and treated
at one sitting
 If no improvement
repeat treatment x 1,
then refer to private
physician
 Advise patient to
return to clinic if
symptoms persist or
recur.
 Sex partners in the past
 Advise patients to
Azithromycin 1g (two 500 mg
60 days should be
return to clinic if
tablets) p.o. or
examined and tested for
symptoms persist or
 Doxycycline 100 mg p.o. BID x 7
chlamydia,
gonorrhea
recur.
days (not to be used if patient is
and
syphilis
and
pregnant, allergic to drug, or
promptly treated.
under 8 years old) or
 Erythromycin (base or stearate)
500 mg p.o. QID x 7 days.
Also treat for gonorrhea (see end
of this section).
*The Department for Public Health recommends that symptomatic male or female patients be treated with a regimen appropriate
for both gonorrhea and chlamydia at the time of their initial visit.

Mucopurulent
Cervicitis Female
patient with
mucopurulent
secretion from the
endocervix which
appears yellow/green
on a white tipped swab
(positive swab test)

Note: Beginning in late June 2006, the STD Program began supplying Azithromycin in 500 mg. tablets only. Sites should use the
1 gram sachets previously supplied until their supply is exhausted and re-order 500 mg. tablets for future needs. Costs for filling
pediatric prescriptions will be borne by the patient or LHD.
____________________________________
M.D. Signature
Page 7 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
Date
PROTOCOL FOR TREATMENT OF COMMON STDs
(Continued)
Condition
Treatment
GC Infections
 Male or female with positive
genital or rectal test(s) for
gonorrhea.
 Male with gram stained smear
of urethral exudates indicating
“Gram negative intracellular
diplococci” should be presumed
to have gonorrhea and should
be treated.
 Oral and rectal specimens must
be confirmed by culture
results.*
 An important concern in the
treatment of GC is coexisting
chlamydial infection. Patient
compliance with multiple-day
treatment regimens can be a
problem. To address these
concerns a single dose regimen
for gonorrhea should be
administered in conjunction
with the doxycycline or
azithromycin regimen. This
should be curative for both GC
and chlamydial infections.
 If there is a possibility of
medical/legal considerations,
patients should have a culture
done at a laboratory.
Uncomplicated GC infections of
the cervix, urethra, rectum, and
pharynx in adults and adolescents:
 Ceftriaxone 125 mg IM in a
single dose or
 Cefixime 400 mg, orally in a
single dose (when available),
except for GC infections of the
pharynx
Management of
Sexual Partner
 All persons
exposed to GC in
the previous 60
days should be
examined and
tested for
chlamydia,
gonorrhea and
syphilis and treated
at one sitting.
ALTERNATIVE REGIMEN FOR
PATIENTS ALLERGIC TO
CEPHALOSPORINS:
 Azithromycin 2 g, orally in a
single dose
 Spectinomycin 2 g IM (when
available)
PLUS
TREATMENT FOR
CHLAMYDIA IF
CHLAMYDIAL INFECTION IS
NOT RULED OUT (unless the
2 g Azithromycin regimen is used)
Uncomplicated GC Infections of
the cervix, urethra, rectum, and
pharynx in Pregnancy
Drug regimens of choice:
 Ceftriaxone 125 mg IM in a
single dose or
 Cefixime 400 mg, orally in a
single dose (when available),
except for GC infections of the
pharynx
Follow-up
 Follow-up tests
are not indicated
for persons with
uncomplicated
gonorrhea who
are treated with
one of the listed
regimens.
 Individuals in
whom symptoms
persist after
treatment should
be reevaluated.
Infections
detected after
treatment with
one of the listed
regimens more
commonly occur
because of
reinfection rather
than treatment
failure,
indicating a need
for improved sex
partner referral
and patient
information.
The DPH recommends that symptomatic male or female patients be treated with a regimen appropriate for
both gonorrhea and chlamydia at the time of their initial visit.
*Testing of oral and rectal specimens by nucleic acid probe has not been approved by the FDA.
__________________________________
M.D. Signature
Date
Page 8 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
PROTOCOL FOR TREATMENT OF COMMON STDs
(continued)
Condition
GC Infections
(continued)
Treatment
Management of
Sexual Partner
Follow-up
ALTERNATIVE REGIMEN FOR
PATIENTS ALLERGIC TO
CEPHALOSPORINS:
 Azithromycin 2 g, orally in a single
dose
 Spectinomycin 2 g IM (when
available)
PLUS
TREATMENT FOR CHLAMYDIA
IF CHLAMYDIAL INFECTION IS
NOT RULED OUT (unless the 2 g
Azithromycin regimen is used)
Consult clinician responsible for
patient’s maternity care prior to
treatment if feasible and acceptable to
patient.*
Syphilis
Due to complexity of diagnoses, written
 Partner contact
 Patients treated for
orders should be obtained prior to
referral will be
primary, secondary, or
treatment.
 Notify area STD
coordinated by area
early latent syphilis
Primary, Secondary, or Early Latent (less
representative
STD
should have blood test
than one year duration)
immediately for
representative.
(VDRL) 6 months and 12
treatment,
 Benzathine Penicillin G (Bicillin LA)  Contacts exposed
months post treatment.
management and
2.4 million units deep IM at one
to early syphilis
 Patients treated for
follow-up.
sitting (unless patient is allergic to
within 90 days
primary, secondary, or
penicillin)
before the patient’s
early latent syphilis
 Doxycycline 100 mg p.o BID x 14
date of treatment
should be offered testing
days (total dose 2.8 Gm)
should be given
for HIV infection at time
Latent Syphilis
prophylactic
of diagnosis of syphilis.
(more than one year duration)
treatment.
 If HIV infected, the
 Benzathine Penicillin G (Bicillin LA)
patient should be retested
2.4 million units deep IM once a week
for syphilis every 3
for a total of three injections.
months up to one year.
 Patients allergic to penicillin who are
 Patients treated for latent
pregnant or co-infected with
syphilis should have
HIV/AIDS should be desensitized and
VDRL repeated at 6, 12,
then treated with a penicillin regimen
and 24 months.
appropriate for the stage of syphilis
infection.
*OK to treat without consulting obstetric physician if patient objects or if contacting the physician will result in
undue delay.
______________________________________
M.D. Signature
Date
Page 9 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
PROTOCOL FOR TREATMENT OF COMMON STDs
(continued)
Condition
Syphilis
(continued)
Treatment
Management of
Sexual Partner
Follow-up
Late Manifest
(Neurosyphilis, Cardiovascular, Benign)
 Consult CDC Guidelines
Syphilis in Pregnancy
 Patients with syphilis who are pregnant
should be treated with penicillin using the
penicillin regimen appropriate for the
woman’s stage of syphilis. If the patient is
allergic to penicillin, arrangements should be
made for desensitization and subsequent
treatment with the penicillin regimen
appropriate for the woman’s stage of
syphilis.
Consult physician responsible for patient’s
maternity care prior to treatment and consult
area STD representative for assistance.
Condition
Venereal Warts
(Condylomata acuminata, Human Papillomavirus
(HPV) visible or on Pap test report



Herpes Simplex

Pubic Lice (Crabs)



Management/Treatment
Test for chlamydia, gonorrhea and syphilis
Refer to clinician for treatment or management of
visible lesions
Follow protocol for abnormal Pap test for HPV found
on Pap test.
When Herpes is suspected, test for chlamydia,
gonorrhea, and syphilis
Refer to clinician for management
Test for chlamydia, gonorrhea and syphilis
Recommend that the patient use one of the following
over-the-counter treatments: permethrin 1%; i.e.,
Nix. Alternative: Pyrethins and Piperonyl Butoxide;
i.e., RID, A-200, (over-the-counter preparations for
which a second application one week later is
recommended)
__________________________________
M.D. Signature
Medications available from the state for the treatment of STDs include:
Amoxicillin (1 gram or 500 mg. tablets)
Doxycycline Hyclate
Azithromycin (500 mg. tablets)
Erythromycin (250 mg. and 500 mg.)
Benzathine Penicillin G (Bicillin LA)
Ceftriaxone (Rocephin) 250mg
Page 10 of 10
Kentucky Public Health Practice Reference
Section: HIV/STD
July 31, 2008
Date