Clinician Updates

Hepatitis Awareness Month

Hepatitis Awareness Month is observed during May.  Virginia Department of Health works with public health partners across the state to prevent and treat viral hepatitis.  During the month of May, we shed light on this hidden epidemic by raising awareness of viral hepatitis and encouraging people to get tested.

Learn and Share the ABCs of Viral Hepatitis

While there are several different types of viral hepatitis, the three most common types in the United States are A, B, and C.  Visit the online feature “the ABCs of Viral Hepatitis” from the Centers for Disease Control and Prevention (CDC).  On this website you can learn more about hepatitis A, hepatitis B, and hepatitis C.  Share the website so others can learn as well.

CDC has also provided a fact sheet that is specific to health professionals.  This can be accessed in an online PDF table: https://www.cdc.gov/hepatitis/resources/professionals/pdfs/ABCTable.pdf.  

CDC Recommendations for Hepatitis C Screening Among Adults

CDC now recommends one-time hepatitis C testing of all adults (18 and older) and all pregnant women during every pregnancy.  CDC continues to recommend people with risk factors, including people who inject drugs, be tested regularly.

For more information, visit the full recommendations at CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020 | MMWR.    

Updated Hepatitis B Vaccination Recommendations

The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis B vaccination among all adults aged 19-59 years and adults 60 years and older with risk factors for hepatitis B or without identified risk factors but seeking protection.

Learn more by visiting the full recommendations: https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7113a1-h.pdf.  

Share Your Passion

Virginia has a coalition of community members and health providers who work together to share their experiences and use their voice to eliminate viral hepatitis.  If you are a provider that works with viral hepatitis and want to use your voice to make a difference, visit their website today at https://vahep.org/.   

If you can’t commit to a coalition but still want to get involved, consider contributing to the needs assessment that VDH and the Virginia Hepatitis Coalition have put together.  This assessment will identify barriers and service gaps in hepatitis services throughout the Commonwealth.  Help us better serve our community and provide better services by participating: State of Viral Hepatitis in Virginia, 2022 Assessment.


New HIV PrEP Option Approved by FDA

The first long-acting injectable that prevents HIV has been approved by the U.S. Food and Drug Administration (FDA).

On December 20, 2021, the U.S. Food and Drug Administration (FDA), approved Apretude® (cabotegravir) for HIV pre-exposure prophylaxis, or PrEP.  The medication is approved for adults and adolescents - 15 years old and older - weighing at least 77 pounds, and who are at risk of getting HIV through sexual activity.  All other options have been oral tablets.  In approving the new medication, the FDA noted that an injectable could make it easier for patients to maintain adherence, a key factor in the effectiveness of PrEP as an HIV prevention strategy.

Apretude is given first as two initiation injections administered one month apart, and then every two months thereafter. Potential patients may take an oral lead-in for four weeks to assess tolerance for the medication.   Side effects include: injection site reaction, headache, pyrexia, fatigue, back pain, myalgia and rash.  Manufacturer’s warnings also include precautions regarding hypersensitivity reactions, hepatotoxicity and depressive disorders.

For more information, visit the press release from the FDA.


 

STI Treatment Guidelines, 2021 Update

CDC has issued updated guidelines for the treatment of sexually transmitted infections (STI). Following adjustments to gonorrhea treatment practices (published in late- 2020), the new guidelines include other notable updates:

    • Updated treatment recommendations for chlamydia, trichomoniasis, and pelvic inflammatory disease
    • Updated treatment recommendations for uncomplicated gonorrhea in neonates, children, and other specific clinical situations (e.g., proctitis, epididymitis, sexual assault) which builds on broader treatment changes published in Morbidity and Mortality Weekly Report.
    • Information on FDA-cleared diagnostic tests for Mycoplasma genitalium and rectal and pharyngeal chlamydia and gonorrhea
    • Expanded risk factors for syphilis testing among pregnant patients
    • Recommended two-step serologic testing for diagnosing genital herpes simplex virus
    • Harmonized recommendations for human papillomavirus vaccination with the Advisory Committee on Immunization Practices
    • Recommended universal hepatitis C testing in alignment with CDC’s 2020 hepatitis C testing recommendations

Key resources are available on the CDC website.

**Please note: the summary above is not comprehensive; refer to the updated guidelines for the complete set of recommendations, including alternative treatment regimens and treatment regimens for special populations.


2020 Update to CDC's Treatment for Gonococcal Infections

CDC has revised its recommendation for the treatment of uncomplicated gonorrhea in adults.  The new recommendations, briefly summarized below, are available in the 2020 Update to CDC's Treatment for Gonococcal Infections.  This new recommendation supersedes the gonorrhea treatment recommendation included in the 2015 STD Treatment Recommendations. The summary below is not comprehensive and only includes the most important highlights; refer to the whole document for the complete set of recommendations.

    • Treat gonorrhea infections with a single 500 mg intramuscular injection of ceftriaxone.  Dual therapy with azithromycin is no longer the recommended approach.
        • For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.
    • A test-of-cure is not needed for people diagnosed with uncomplicated urogenital or rectal gonorrhea unless symptoms persist.
    • A test-of-cure is recommended in people with pharyngeal gonorrhea 7-14 days after the initial treatment, regardless of the regimen.
    • Patients who have been treated for gonorrhea should be retested three months after treatment to ensure there is no reinfection.
    • Oral doxycycline (100 mg twice daily for 7 days) should now be administered when chlamydial infection has not been excluded, unless the patient is pregnant. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.
    • When ceftriaxone cannot be used for treating urogenital or rectal gonorrhea because of cephalosporin allergy, a single 240 mg intramuscular injection of gentamicin plus a single 2 g oral dose of azithromycin is an option.
    • As always, facilitate partner testing and treatment.

Archived Updates

Last Updated: May 11, 2022.