Transcript Beyond Didactic Presentations in Clinical Training

Beyond Didactic Presentations in
Clinical Training:
Thinking Outside the Powerpoint Box
March 11, 2008
Presented by the
National Network of Prevention Training Centers (NNPTC)
Parts I (Clinical), II (Behavioral) and III (Partner Services)
Featuring …
Cornelis Rietmeijer, MD, PhD
Laura Bachman, MD, MPH
Linda Creegan, MS, FNP
M. Terry Hogan, MPH
Katherine Hsu, MD, MPH
Patricia Jennings, DrPH, PA-C
Patricia Coury-Doniger, NP, MSN
Anne Rompalo, MD, ScM
Laboratory Procedure Courses
National Network of Prevention Training Centers
Linda Creegan, MS, FNP
California STD/HIV Prevention Training Center
Oakland, CA
National STD Prevention Conference
Chicago, March 2008
CLINICIANS…..
Are you new to the STD clinic?
Herpes?
Trichomoniasis?
Bacterial
Vaginosis?
Syphilis?
Is your clinic starting to use a new test?
Rapid HIV test?
Darkfield microscopy?
NNPTC Laboratory Procedure
Courses
Participants learn to perform.....
• Tests for STD specialty clinics
– Syphilis tests
• Rapid RPR test
• Darkfield microscopy
– Gram stains
– Saline and KOH wet mounts
• Other Point-of-Care (POC) tests for STD
and HIV
Tests for STD Specialty Clinics
Serologic Tests for Syphilis
• Utility of rapid RPR test
– Evaluate patients with
symptoms of primary or secondary syphilis
– Assess contacts to syphilis infection
– Facilitate immediate diagnosis, treatment, and
initiation of partner management activities
• Learn to perform and interpret qualitative
and quantitated RPR tests
Darkfield Microscopy
• Evaluate patients with ulcers typical of
primary syphilis
• Learn to
– Obtain the specimen
– Use the darkfield microscope
– Identify T. pallidum by morphology and motility
Photo credit: Dr. Joseph Engelman,
San Francisco City Clinic
Identifying T. pallidum by DF
• Morphology
– Rigid, uniform, tightlycoiled spirals
– Length: 6-20 micrometers
– Width: VERY thin
• 0.10-0.18 micrometers,
below the resolution of the
light microscope
• Motility
– Exhibits three types of
movement
• Translation: slow, forward
or backwards movement
• Rotation: turning around
the longitudinal axis
• Flexion: stiff bending,
usually in the middle, and
returning to original
position
Gram Stains
• Evaluate male urethral specimens
• Learn to
– Obtain the specimen
– Identify polymorphonuclear leukocytes (PMNs) and
Gram-negative intracellular diplococci (GNID)
– Diagnose gonococcal vs non-gonococcal urethritis
STD Atlas, 1997
Saline and KOH Wet Mounts
Vaginal Specimens
• Differentiate the causes of vaginal discharge
• Learn to
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Obtain the specimen
Use the light microscope
Identify findings (clue cells, yeast forms, trichomonads)
Diagnose bacterial vaginosis, yeast, trichomoniasis
Photo credit: Seattle STD/HIV
Prevention Training Center
http://depts.washington.edu/nnptc/online_training/wet_preps_video.html
Other Rapid Point-of-Care
Tests for STD
What are Point-of-Care tests?
• Run in clinic or field setting
• Provide results at same clinic visit
• Very easy to perform
– Usually require only microscope or simple lab
equipment
– Often CLIA waived
Point-of-Care STD Tests:
A Paradox
• Generally not as sensitive/specific as delayed
lab tests
– Not intended to replace traditional STD tests,
where these are available
HOWEVER…
• In populations of patients less likely to return
for results or when F/U is difficult, higher
treatment levels can be achieved with POC
than with delayed tests
– Homeless clinics
– Emergency rooms
– Correctional facilities
Point-of-Care STD Tests
• POC tests for common STD • Learn about
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HSV 2
Bacterial vaginosis
Trichomoniasis
Chlamydia
Gonorrhea
– Lab regulatory issues
(CLIA)
– Obtaining specimens
– Using test kits
– Interpreting results
– Maintaining quality
assurance
Rapid HIV Tests
Learn about…..
• Performing oral fluid and fingerstick tests
• Giving positive and negative test results
Enroll in a
Lab Procedure Course
offered by your regional
Prevention Training Center!