Title : KK-tip6 9-05-01ph.qxd (Page 1) Description : Keywords : Author : ----------------------------------------------- KAP KEYS Based on TIP 6 Screening for Infectious Diseases Among Substance Abusers CSAT’s Knowledge Application Program KAP Keys For Clinicians Based on TIP 6 Screening for Infectious Diseases among Substance Abusers U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment www.samhsa.gov ----------------------------------------------- KAP KEYS Based on TIP 6 Screening for Infectious Diseases Among Substance Abusers These KAP Keys were developed to accompany the Treatment Improvement Protocol (TIP) Series published by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration. These KAP Keys are based entirely on TIP 6 and are designed to meet the needs of the busy clinician for concise, easily accessed "how-to" infor mation. For more information on the topics in these KAP Keys, readers are referred to TIP 6. Introduction TIP 11, Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases (1994) BKD143 TIP 16, Alcohol and Other Drug Screening of Hospitalized Trauma Patients (1995) BKD164 TIP 18, The Tuberculosis Epidemic: Legal and Ethical Issues for Alcohol and Other Drug Abuse Treatment Providers (1995) BKD173 TIP 37, Substance Abuse Treatment for Persons With HIV/AIDS (2000) BKD359 Other Treatment Improvement Protocols (TIPs) that are relevant to these KAP Keys: ----------------------------------------------- Recommendations for the Use of Condoms 1 KAP KEYS Based on TIP 6 Screening for Infectious Diseases Among Substance Abusers 1. Use latex condoms because they offer greater protection against HIV and other viral STDs than natural membrane condoms. 2. Store condoms in a cool, dry place out of direct sunlight. 3. Do not use condoms in damaged packages or those that show obvious signs of age (for example, those that are brit tle, sticky, or discolored). 4. Handle condoms with care to prevent puncture. 5. Put on the condom before any genital contact is made to prevent exposure to fluids that may contain infectious agents. Hold the tip of the condom and unroll it onto the erect penis, leaving space at the tip to collect semen. Make sure there is no air trapped in the tip of the condom. 6. Use only water-based lubricants. Petroleum- or oil-based lubricants such as petroleum jelly, cooking oils, shortening, and lotions should not be used because they weaken the latex and may cause the condom to break. 7. Use condoms containing spermicide, particularly those con taining nonoxynol-9, to provide some additional protection against STDs. Vaginal use of spermicides along with con doms is likely to provide still greater protection. 8. Replace the condom immediately if it breaks. If ejaculation occurs after the condom breaks, the application of spermi cide has been suggested. However, whether a post-ejacula tion application of spermicide has protective value in reduc ing the risk of STD transmission is unknown. 9. Take care after the ejaculation that the condom does not slip off the penis before withdrawal. The base of the condom should be held throughout withdrawal. The penis should be withdrawn while still erect. 10. Never reuse a condom. SOURCE: Centers for Disease Control and Prevention (CDC). Sexually Transmitted Diseases: Treatment Guidelines. Atlanta, GA: U.S. Department of Health and Human Services, September 1989. ----------------------------------------------- Behavioral Risk Factors 2 KAP KEYS Based on TIP 6 Screening for Infectious Diseases Among Substance Abusers • Syphilis is primarily transmitted through contact with an infectious lesion, usually during sexual intercourse. • Syphilis can be acquired by kissing or touching a person who has infectious lesions on the lips, breast, genitals or rectum, or in the oral cavity. • Syphilis may be transmitted by the sharing of needles for injection drug use. • The fetus of an infected mother can contract syphilis. Syphilis can also be transmitted in breast milk. • Persons using crack cocaine, especially those engaging in sexual activity in crack houses, are at highest risk. • Persons with multiple sexual partners, especially in areas where illegal drug usage is endemic, are at an increased risk for acquiring syphilis. • Men or women exchanging sex for drugs, money, or shelter are at risk for syphilis infection. ----------------------------------------------- Risk Factors for Acquisition of Viral Hepatitis B 3 • Multiple sexual partners (heterosexuals, homosexuals, or bisexuals) • Use of injection drugs, especially with multiple partners • Household contacts of HBV carriers • Use or sharing of contaminated needles, syringes, and other drug paraphernalia • Hemodialysis patients • Perinatal exposure to HBsAg-positive mother • Workers at occupational risk, especially health care workers and public safety workers exposed to blood in the workplace • Inmates of long-term correctional facilities • Patients and staff members in institutions for the develop mentally disabled • Persons born in or having resided in parts of the world where hepatitis B infections are endemic, such as Southeast Asia, Africa, the People's Republic of China, the Amazon Basin, and Alaska (among Alaska Natives) KAP KEYS Based on TIP 6 Screening for Infectious Diseases Among Substance Abusers ----------------------------------------------- Symptoms of Acute Hepatitis • Fever absent or mild occurring from 2 to 7 days before the onset of jaundice • Headache, malaise, chills • Vague abdominal discomfort, especially in the right upper quadrant • Nausea and occasional vomiting; diarrhea • Rash erythematous, maculopapular • Anorexia, loss of appetite with an aversion to food and tobacco • Pruritus • Arthralgias/arthritis • Dark urine (tea-colored) and light- or clay-colored stools • Scleral, mucous membrane, and cutaneous icterus • Enlarged tender liver • Palpable spleen • Lymphadenopathy, especially posterior cervical nodes 4 KAP KEYS Based on TIP 6 Screening for Infectious Diseases Among Substance Abusers ----------------------------------------------- Reporting of Individual Infectious Diseases 5 Infectious disease reporting requirements vary widely among the States. Be aware of the requirements in your State, and develop protocols and training programs to ensure compliance. TB: All cases of active, infectious TB must be reported immedi ately to health authorities. In addition, the health depart ment will notify any persons they believe may have been exposed to active TB. HIV and AIDS: All States require the reporting of AIDS cases (as defined by the CDC) to health departments. Syphilis: All cases must be reported immediately to health authorities. Confidential patient information is usually pro tected under State law. Hepatitis: All cases of potentially communicable viral hepatitis must be reported immediately to health authorities. Other STDs: Reporting requirements vary significantly by dis ease and jurisdiction. For example, case reporting of gonor- rhea is required by all States, chancroid is reportable in many States, and herpes simplex and chlamydia are reportable in only some States. KAP KEYS Based on TIP 6 Screening for Infectious Diseases Among Substance Abusers ----------------------------------------------- Ordering Information TIP 6 Screening for Infectious Diseases Among Substance Abusers Easy Ways to Obtain Free Copies of All TIP Products 1. Call SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) at 800-729-6686, TDD (hearing impaired) 800-487-4889. 2. Visit CSAT's Website at www.csat.samhsa.gov Do not reproduce or distribute this publication for a fee with out specific, written authorization from the Office of Communications, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. DHHS Publication No. (SMA) 01-3554 Printed 2001