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<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-family:"Arial",sans-serif">Hello!<br>
<br>
Please see the below letter from the CDC, and this <a href="https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le4344.pdf">
guide for clinicians</a> created for Oregon providers.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-family:"Arial",sans-serif">Thank you!<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-family:"Arial",sans-serif">Shelley (on behalf of the HIV/STD team at OHA)<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
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<p class="MsoNormal" align="right" style="text-align:right"><span style="font-family:"Arial",sans-serif">October 11, 2022<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
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<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Dear Colleagues,
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Thank you for your ongoing work to improve sexual health in U.S. communities, including addressing the current monkeypox outbreak in the U.S.
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">During the 2022 monkeypox outbreak, the main route of transmission has been through sexual contact, primarily affecting gay and bisexual men and other men who have
sex with men and transgender women. Therefore, although transmission can, and has, occurred through non-sexual contact, many of the health communications, facilities, and programs that we use for STIs and HIV are applicable for monkeypox prevention and treatment.
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">The same populations that are disproportionately affected by STIs and HIV, are also experiencing the brunt of the monkeypox outbreak. Because of this overlap, consideration
should be given to incorporating monkeypox diagnosis, treatment, and, per CDC’s </span>
<a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbea%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3DBqHUqgupFoauaW6b3oFX6cDNBIyJ0u9MDbHvhARo6A4&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058094192%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=nx1K3M3%2BWt%2BwTibZxXVXVCuN7k0DrT0i333DA5DqNk0%3D&reserved=0"><span style="font-family:"Arial",sans-serif">updated
recommendations</span></a><span style="font-family:"Arial",sans-serif">, vaccination into existing sexual health services. This
</span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbeb%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3DrRKud5ag5mzq-YD1qXBNtmJICIgnZE-NAHGpERBZ3Is&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058094192%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=l59u4if2vOv8fkjWSy95aKMI6RqjeTdHxOrpFWgKDoo%3D&reserved=0"><span style="font-family:"Arial",sans-serif">syndemic
approach</span></a><span style="font-family:"Arial",sans-serif"> to addressing monkeypox and other infections that are sexually transmitted is better for patient care and is more programmatically efficient.
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><b><span style="font-size:15.0pt;font-family:"Arial",sans-serif">Monkeypox should be considered as part of the differential diagnosis during a sexual health visit. </span></b><span style="font-family:"Arial",sans-serif"><o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">The features of early monkeypox cases can be confused with other STIs, such as syphilis and herpes. It is important to comprehensively evaluate patients presenting
with genital or perianal ulcers for STIs per the </span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbec%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3D2sBAoNOHK1fjjSrb3mbuZZs-1SIYLTB9hgT6xcCVaxk&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058250091%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=zyjRh7JOSXoVYUn5nezAya0j46hsdq8IZcHLxqpXMj4%3D&reserved=0"><span style="font-family:"Arial",sans-serif">2021
CDC STI Treatment Guidelines</span></a><span style="font-family:"Arial",sans-serif">, as well as for monkeypox.
</span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbed%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3DwUCkIP_MNkxaMFxZOumnLSdOgz8Yz1qAdOFeuVrRFJM&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058250091%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=i0sGD%2BajIou8yM3YW2bfHTqhXJCHwe5N%2BDBOyqK9TmY%3D&reserved=0"><span style="font-family:"Arial",sans-serif">Co-infection
with monkeypox and STIs is common</span></a><span style="font-family:"Arial",sans-serif">, with 41% of persons diagnosed with monkeypox reporting an STI in the prior year, and 38% having HIV at the time of monkeypox diagnosis. The presence of an STI does not
rule out the potential for co-occurring monkeypox virus infection. Patients with a new rash or lesion, especially those who meet one or more of the
</span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbee%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3DJXNejd_WVMCkkG97qv6yvYj80KdgOE7o8cJxxc045Vg&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058250091%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=GgfExtcFvq7I34NKf9PMp4vwMLDLsITFT84eHww2muU%3D&reserved=0"><span style="font-family:"Arial",sans-serif">epidemiologic
criteria</span></a><span style="font-family:"Arial",sans-serif"> should be tested for monkeypox. Additional
</span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbef%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3D9NKr-JZU3im3M_Y_wTSFbP0MS7U9SAwNf_Ugdbr23Jk&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058250091%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=wbGGdy2tMfoG7PZtuv0w3ju3mSxHojV1HusD%2FITWCrc%3D&reserved=0"><span style="font-family:"Arial",sans-serif">clinical
information</span></a><span style="font-family:"Arial",sans-serif"> about monkeypox, including
</span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbf0%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3Dk8J38X_tGjWTezcDhTwqlUfdS5SBTAdolMsFqKcvrA0&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058250091%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=%2FTv4pebY5eUecajVjEffVOZ1Jc9Uih7rLNtM8gkSfqU%3D&reserved=0"><span style="font-family:"Arial",sans-serif">clinician
FAQs</span></a><span style="font-family:"Arial",sans-serif">, may be found on the CDC website. <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">As we work to prevent and control monkeypox, we have an opportunity to provide STI and HIV screening to populations who can most benefit from it. We can leverage that
opportunity to provide routine STI screening, including HIV testing, and refer eligible patients to HIV pre-exposure prophylaxis (PrEP), or link people with HIV to HIV care and treatment. We cannot afford to miss the opportunity to provide holistic care to
people affected by monkeypox as we know they may be disproportionately affected by other health conditions. CDC,
</span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbf1%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3DCUFAWoNn8Fe5Ymp1Vbd-h6WpIBOJRMM9AIG13FSEzuM&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058250091%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=JoSw86AW27XRSfFwomDbgcSTVYECNTnbwDwxs2CwZyw%3D&reserved=0"><span style="font-family:"Arial",sans-serif">HRSA</span></a><span style="font-family:"Arial",sans-serif">,
and </span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbf2%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3DS5Nl5oaTpTIt4r_Wlm_m3JZ7ugxsOtK5oIXytCXtLtk&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058250091%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=hqF2hKG%2FWP3%2F%2BDqfzRV7qr567JAJ1J2TEdpFcz2jLkc%3D&reserved=0"><span style="font-family:"Arial",sans-serif">SAMHSA</span></a><span style="font-family:"Arial",sans-serif">
have provided flexibility with many of their cooperative agreements that allows resources to be used to support monkeypox-related work when conducted in conjunction with provision of other
</span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ft.emailupdates.cdc.gov%2Fr%2F%3Fid%3Dh6f5d0bf5%2C178b8ec5%2C178cdbf3%26e%3DQUNTVHJhY2tpbmdJRD1VU0NEQ05QSU5fMTYyLURNOTE3NzYmQUNTVHJhY2tpbmdMYWJlbD1Nb25rZXlwb3glMjBDb25zaWRlcmF0aW9ucyUyMGZvciUyMFNleHVhbCUyMEhlYWx0aCUyMFNlcnZpY2Vz%26s%3DMaRp4tiBFucdn6kOWSFXgjlBzEFys67TQzmq2bf3XEY&data=05%7C01%7Ctimothy.w.menza%40dhsoha.state.or.us%7C32d21e0daea345b27d3108daab9deef8%7C658e63e88d39499c8f4813adc9452f4c%7C0%7C0%7C638010992058250091%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=%2BdsmUNh95axlIA05GlQMVe3fV2Q4kwkuj5VzKCSTEaI%3D&reserved=0"><span style="font-family:"Arial",sans-serif">services</span></a><span style="font-family:"Arial",sans-serif">.<o:p></o:p></span></p>
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<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">We recognize that this is a challenging time for everyone, and we appreciate all you do to prevent, diagnose, and treat sexually transmitted infections and to support
sexual health throughout the nation.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Best regards,
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">/Jonathan Mermin/
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Jonathan Mermin, MD, MPH (RADM, USPHS)
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">US Centers for Disease Control and Prevention
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">/Leandro Mena/
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Leandro Mena, MD, MPH, FIDSA
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Director, Division of STD Prevention
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">National Center for HIV, Viral Hepatitis, STD, and TB Prevention
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">US Centers for Disease Control and Prevention
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">/Robyn Neblett Fanfair/
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Robyn Neblett Fanfair, MD, MPH
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">CAPT, USPHS
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">Acting Director, Division of HIV Prevention
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">National Center for HIV, Viral Hepatitis, STD, and TB Prevention
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="font-family:"Arial",sans-serif">US Centers for Disease Control and Prevention
<o:p></o:p></span></p>
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<b><span style="font-size:15.0pt;font-family:"Century Gothic",sans-serif;color:white">Centers for Disease Control and Prevention</span></b><span style="font-family:"Century Gothic",sans-serif;color:white"><o:p></o:p></span></p>
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<span style="font-size:9.0pt;font-family:"Century Gothic",sans-serif;color:white">1600 Clifton Rd Atlanta, GA 30329 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348<br>
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