Some questions physicians may want to ask patients include: Have you ever exchanged sex for money, food, or shelter? Have you been forced to have sex against your will? Have you been asked to have sex with multiple partners? If the patient answers yes, physicians should follow child abuse protocols and mandatory reporting requirements. If the patient is aged 18 or older, doctors should obtain the patient’s permission to call law enforcement or assist the patient in calling 911.
AMWA recently launched Physicians Against the Trafficking of Humans (PATH). The PATH website includes resources for physicians and an online video about trafficking that doctors can share with their practices and colleagues.
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Indiana HIV outbreak prompts national advisory
BY SHARON WORCESTER
FRONTLINE MEDICAL NEWS
As health officials continue to battle an intravenous drug use–related HIV outbreak in a rural county in Indiana, the Centers for Disease Control and Prevention has issued an official health advisory stressing the need for vigilance at the state and local levels with respect to detecting and controlling similar outbreaks across the United States.
The Indiana outbreak began in November, with 11 new HIV infections diagnosed by January in Scott County, where fewer than 5 infections per year had been identified previously; since January, an unprecedented 135 infections have been confirmed, and 6 others are under investigation, according to Dr Jerome M. Adams, Indiana State Health Commissioner.
“To put this in further perspective, from 2009 through 2013, the county only reported three new cases of HIV,” Dr Adams said in a joint Indiana State Department of Health/CDC teleconference.
The affected community includes only 4,200 people, and 84% of those diagnosed with HIV also tested positive for hepatitis C virus (HCV) infection, Dr Joan Duwve, chief medical consultant, Indiana State Department of Health, said during the teleconference.
According to the CDC advisory, 96% of 108 infected individuals who were interviewed reported injecting dissolved prescription-type oxymorphone, as well as sharing syringes.
“The United States is facing an epidemic of prescription opioid abuse that must be addressed. Opioid poisoning deaths have nearly quadrupled from 1999 through 2011. This epidemic of opioid abuse has already contributed to a severe and growing epidemic of viral hepatitis among people who inject drugs,” said Dr Jonathan Mermin, director of the National Center for HIV/AIDS Viral Hepatitis, STD, and TB Prevention, who also participated in the teleconference.
New CDC data on HCV show a 150% increase in reports of acute HCV infections nationwide between 2010 to 2013.
“The majority of these infections are believed to be attributable to injection drug use, so we must act now to reverse this trend and to prevent this from undoing progress in HIV prevention to date,” he said.
Among the recommendations were routine opt-out of HIV testing as well as HCV testing per current recommendations. Further, health care professionals should report suspected clusters to their local or state health department, ensure that HCV-infected patients are also tested for HIV and vice versa, and ensure that those receiving treatment for either HIV or HCV are adhering to prescribed therapy and are engaged in ongoing care.
Syringe-sharing and sexual partners of those diagnosed with HIV or HCV should be encouraged to undergo testing, and all persons with substance abuse problems should be referred for medication-assisted treatment and counseling. In Indiana, where a public health emergency was declared on March 26 and has been extended until May 24, care includes HIV and HCV treatment, as well as substance abuse counseling and treatment, according to a “Notes From the Field Report” in the Morbidity and Mortality Weekly Report (MMWR 2015 April 24;64:1-2).
sworcester@frontlinemedcom.com
Most accidental genital trauma cases manageable in ED
BY SHARON WORCESTER
AT THE NASPAG ANNUAL MEETING
Vitals Key clinical point: With adequate sedation, most girls with AGT requiring treatment can undergo evaluation and repair in the ED. Major finding: 82% of cases reviewed were minor and managed expectantly. Data source: A retrospective medical records review of 359 cases of accidental genital trauma. Disclosures: Dr Dowlut-McElroy reported having no disclosures. One of her coauthors, Dr Julie Strickland, is a Nexplanon trainer for Merck. |
ORLANDO – Most cases of accidental genital trauma in girls are caused by straddle injuries and are isolated to the labia, and most can be managed expectantly or treated in the emergency department, according to findings from a retrospective cohort study.
Penetrating injuries, however, should be considered an indication for management in the operating room, Dr Tazim Dowlut-McElroy reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.