Clinician Updates

Drug Shortage: Erythromycin Ophthalmic Ointment

On July 7, 2022, the Food and Drug Administration (FDA) reported a shortage of erythromycin ophthalmic ointment, which is the only recommended regimen to prevent ophthalmia neonatorum caused by N. gonorrhoeae. If erythromycin ointment is unavailable, infants at risk for exposure to N. gonorrhoeae, especially those born to a mother at risk for gonococ15cal infection or with no prenatal care, can be administered ceftriaxone 25–50 mg/kg body weight IV or IM, not to exceed 250 mg in a single dose. Please see the CDC drug notice for additional guidance.

New HIV Testing Recommendations for PrEP Patients

Based on the 2021 CDC Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV Infection in the United States, A Clinical Practice Guideline, VDH now recommends adding the qualitative HIV-1 RNA test to the HIV Ag/Ab 4th generation test for those who:

    • Have taken oral PrEP or Post-Exposure Prophylaxis (PEP) medications in the past three months, or
    • Have received a cabotegravir injection in the past twelve months

Clinical trials found that the medications used for PrEP can suppress early viral replication, which can affect the timing of antibody development – a delay by a mean of 62 days in the cabotegravir group and by 34 days in the oral PrEP group.  The HIV-1 RNA test detects HIV genetic material, not antibodies, so the results are not affected by taking PrEP medications.

For questions, please reach out to Jenny Calhoun, HIV/STD/Viral Hepatitis Nurse Consultant, at jenny.calhoun@vdh.virginia.gov, or (804) 864-7328.

To view the full 2021 CDC PrEP Guidelines, visit https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf.

New Resources for Expedited Partner Therapy (EPT)

New resources have been added for Expedited Partner Therapy for health professionals.  These resources include:

    • A general EPT in Virginia FAQ
    • An EPT Fact Sheet for Medical Providers
    • An EPT Fact Sheet for Pharmacists, and
    • EPT Fact sheets for patients and partners when you provide them with medications or prescriptions as part of EPT

These resources can be found on the Health Professionals page: https://www.vdh.virginia.gov/disease-prevention/hcw/#STD_Resources.

Viral Hepatitis Recommendations

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.  

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.

Archived Updates

Last Updated: December 20, 2022