Form 0920-0995 STD Tx Guidelines Short Post-Course Evaluation wordversi

National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC): Evaluation

OMB No. 0920-0995

Attachments 25 & 26

Treatment Guidelines Short Post-course Evaluation Instrument

Word version and screenshot

TODAY’S DATE

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M M D D Y Y

Your confidential ID number is the first two letters of your FIRST name, the first two letters of your LAST name, the MONTH of your birth, and the DAY of your birth.

FN	FN	LN	LN	M	M	D	D

CONFIDENTIAL IDENTIFIER

STD Treatment Guidelines Short Post-Course Evaluation

Public reporting burden of this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0995).

How satisfied were you with:

S1 …your overall learning experience?	Very Unsatisfied						Very Satisfied
S2 …the quality of the content?	Very Unsatisfied						Very Satisfied
S3 …the trainer(s)?	Very Unsatisfied						Very Satisfied
S4 …the teaching methods?	Very Unsatisfied						Very Satisfied

CE1 Do you believe this activity was influenced by commercial interests?

 Yes

 No

CE2 Was this presentation evidence-based?

 Yes

 No

CE3a Were the learning objectives met?

 Yes

 No

CE3b If the learning objectives were not met, please explain

A3 Will you be able to apply the knowledge gained from this activity to your practice, job, or work setting?.

 Yes

 No

 Not applicable to my practice, job or patients

 I already do the things discussed today

As a result of the information presented do you intend to…

	Yes	No	NA	I already do this
SGCH1 …incorporate the 2015 STD Treatment Guidelines into your practice?	1	0	2	3
SGCH2 …download the CDC STD Treatment Guidelines app?	1	0	2	3
SGCH3 …increase the proportion of your sexually active asymptomatic female patients under age 25 screened annually for urogenital chlamydia and gonorrhea?	1	0	2	3
SGCH4 …increase the proportion of your male patients who have sex with men screened for syphilis, gonorrhea, and chlamydia at least annually?	1	0	2	3
SGCH5 …use dual antibiotic therapy to treat uncomplicated gonorrhea?	1	0	2	3
SGCH6 …send a consult to the STD Clinical Consultation Network? www.stdccn.org	1	0	2	3

EPT As a result of the information presented, do you intend to provide Expedited Partner Therapy (EPT)? to

heterosexual partners of those diagnosed with gonorrhea and/or chlamydia?

 Yes

 No

 Not applicable to my practice or job

 Not allowed in my state/practice

 In planning stages

 I was already doing this

 EPT was not discussed

KSG1 What is the recommended treatment for a patient diagnosed with uncomplicated urethral, cervical, or rectal gonorrhea?

 Ceftriaxone 250 mg intramuscularly only

 Azithromycin 2 g orally in a single dose only

 Ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally in a single dose

 Cefixime 400 mg orally plus doxycycline 100 mg orally BID for 7 days

 

KSG2 What is the recommended follow-up for a non-pregnant patient after diagnosis and treatment of chlamydia, gonorrhea, and/or trichomonas?

   A test of cure at 2 weeks, and repeat test at 3 months

 A test of cure at 2 weeks, and repeat test at 12 months

 Repeat test in 3 months

 Repeat test in 12 months

 

KSG3 What is recommended for STD screening of an HIV-negative man who reports oral sex (oral and penile exposure) and receptive anal sex with multiple male partners?

   Pharyngeal GC, rectal GC/CT, urethral GC/CT, and syphilis every 3-6 months

 Pharyngeal GC, Rectal GC/CT, urethral GC/CT, and syphilis every 12-24 months

 Urethral GC/CT and syphilis every 3-6 months, with pharyngeal GC and rectal GC/CT if symptoms are present

 Urethral GC/CT and syphilis every 12-24 months, with pharyngeal GC and rectal GC/CT if symptoms are present

 

S6 What would make the information presented more useful to your practice or job?