Practice Policy Statement: Integrating Effective Weight Management Into Practice.

The American College of Preventive Medicine Prevention Practice Committee contributes to policy guidelines and recommendations on preventive health topics for clinicians and public health decision makers. As an update to a previously published statement on weight management counseling of overweight adults, the College is providing a consensus-based recommendation designed to more effectively integrate weight management strategies into clinical practice and to incorporate referrals to effective evidence-based community and commercial weight management programs. The goal is to empower providers to include lifestyle interventions as part of the foundation of clinical practice.

The American College of Preventive Medicine Position Statement on Hepatitis C Virus Infection.

The American College of Preventive Medicine Prevention Practice Committee contributes to policy guidelines and recommendations on preventive health topics for clinicians and public health decision makers. After review of the currently available evidence, the College is providing a consensus-based set of recommendations designed to increase screening for and prevention of hepatitis C virus infection, increase linkage to care, improve access to treatment, and encourage development of hepatitis C virus-related quality measures.

Diagnosis and management of gonococcal infections.

Neisseria gonorrhoeae causes urogenital, anorectal, conjunctival, and pharyngeal infections. Urogenital tract infections are most common. Men with gonorrhea may present with penile discharge and dysuria, whereas women may present with mucopurulent discharge or pelvic pain; however, women often are asymptomatic. Neonatal infections include conjunctivitis and scalp abscesses. If left untreated, gonorrhea may cause pelvic inflammatory disease in women, or it may disseminate, causing synovial and skin manifestations. Urogenital N. gonorrhoeae infection can be diagnosed using culture or nucleic acid amplification testing. Urine nucleic acid amplification tests have a sensitivity and specificity comparable to those of cervical and urethral samples. Fluoroquinolones are no longer recommended for the treatment of gonorrhea because of antimicrobial resistance. A single intramuscular injection of ceftriaxone, 250 mg, is first-line treatment for uncomplicated urogenital, anorectal, or pharyngeal gonococcal infections. This dosage is more effective for common pharyngeal infections than the previously recommended dose of 125 mg. Ceftriaxone should routinely be accompanied by azithromycin or doxycycline to address the likelihood of coinfection with Chlamydia trachomatis. Azithromycin may be used as an alternative treatment option for patients with previous allergic reactions to penicillin, but because of the likelihood of antimicrobial resistance, its use should be limited. Gonococcal infection should prompt physicians to test for other sexually transmitted infections, including human immunodeficiency virus. Because of high reinfection rates, patients should be retested in three to six months. The U.S. Preventive Services Task Force recommends screening for gonorrhea in all sexually active women at increased risk of infection. It also recommends intensive behavioral counseling for persons with or at increased risk of contracting sexually transmitted infections. Condom use is an effective strategy to reduce the risk of infection.

Diagnosis and management of genital ulcers.

Herpes simplex virus infection and syphilis are the most common causes of genital ulcers in the United States. Other infectious causes include chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections, and fungi. Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also lead to genital ulcers. Although initial treatment of genital ulcers is generally based on clinical presentation, the following tests should be considered in all patients: serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum, culture or polymerase chain reaction test for herpes simplex virus, and culture for Haemophilus ducreyi in settings with a high prevalence of chancroid. No pathogen is identified in up to 25 percent of patients with genital ulcers. The first episode of herpes simplex virus infection is usually treated with seven to 10 days of oral acyclovir (five days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies. One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis. Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin. Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline. Treatment of noninfectious causes of genital ulcers varies by etiology, and ranges from topical wound care for ulcers caused by sexual trauma to consideration of subcutaneous pegylated interferon alfa-2a for ulcers caused by Behçet syndrome.