November 13, 2011

November 13, 2011
STI screening and Counseling


Welcome to another day in my life. Today is Sunday and I hope you are having a safe and great weekend so far. It has been another busy weekend for Dab the AIDS Bear and me.

Now monitoring HIV is very important after you have been diagnosed. But monitoring STI screening and counseling are also important.

The evidence is adequate to conclude that screening for chlamydia, gonorrhea, syphilis and hepatitis B, as well as high intensity behavioral counseling (HIBC) to prevent STIs, consistent with the grade A and B recommendations by the U.S. Preventive Services Task Force (USPSTF), is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

Therefore, CMS will cover screening for these USPSTF indicated STIs with the appropriate FDA approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations, when ordered by the primary care physician or practitioner, and performed by an eligible Medicare provider for these services.

- Screening for chlamydia and gonorrhea:

- Pregnant women who are 24 years old or younger when the diagnosis of pregnancy is known and then repeat screening during the third trimester if high risk sexual behavior has occurred since the initial screening test.

- Pregnant women who are at increased risk for STIs when the diagnosis of pregnancy is known and then repeat screening during the third trimester if high risk sexual behavior has occurred since the initial screening test.

- Women at increased risk for STIs annually.

- Screening for syphilis:

- Pregnant women when the diagnosis of pregnancy is known and then repeat screening during the third trimester and at delivery if high risk sexual behavior has occurred since the previous screening test.

- Men and women at increased risk for STIs annually.

- Screening for hepatitis B:

- Pregnant women at the first prenatal visit when the diagnosis of pregnancy is known and then rescreening at time of delivery for those with new or continuing risk factors.

Most providers will also cover up to two individual 20 to 30 minute, face to face counseling sessions annually for Medicare beneficiaries for HIBC to prevent STIs for all sexually active adolescents and for adults at increased risk for STIs, if referred for this service by a primary care provider and provided by a Medicare eligible primary care provider in a primary care setting. Coverage of HIBC to prevent STIs is consistent with the USPSTF recommendation. HIBC is defined as a program intended to promote sexual risk reduction or risk avoidance which includes each of these broad topics, allowing flexibility for appropriate patient focused elements:

- education,
- skills training,
- guidance on how to change sexual behavior.

The high/increased risk individual sexual behaviors, based on the USPSTF guidelines, include any of the following:

- Multiple sex partners
- Using barrier protection inconsistently
- Having sex under the influence of alcohol or drugs
- Having sex in exchange for money or drugs
- Age (24 years of age or younger and sexually active for women for chlamydia and gonorrhea)
- Having an STI within the past year
- IV drug use (for hepatitis B only)
- In addition for men ? men having sex with men (MSM) and engaged in high risk sexual behavior, but no regard to age

In addition to individual risk factors, in concurrence with the USPSTF recommendations, community social factors such as high prevalence of STIs in the community populations should be considered in determining high/increased risk for chlamydia, gonorrhea, syphilis and for recommending HIBC.

High/increased risk sexual behavior for STIs is determined by the primary care provider by assessing the patient?s sexual history which is part of any complete medical history, typically part of an annual wellness visit or prenatal visit and considered in the development of a comprehensive prevention plan. The medical record should be a reflection of the service provided.

So now you have the latest updates. Protect yourself so HIV is the only thing you have to worry about!

Hope you have a great Sunday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,





Daddy Dab