Based on TIP 6

Screening for Infectious

Diseases among Substance

Abusers

KAP Keys

For Clinicians

CSAT’s

Knowledge Application Program

KAP KEYS 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" information.

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:
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 brittle, 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 containing nonoxynol-9, to provide some additional protection

against STDs. Vaginal use of spermicides along with condoms 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 spermicide has been suggested. However, whether a post-ejaculation application of spermicide has protective value in reducing 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.

Recommendations for the Use

of Condoms

1

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. 
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.

Behavioral Risk Factors 2
KAP KEYS Based on TIP 6

Screening for Infectious Diseases Among Substance Abusers

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 developmentally 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 immediately to health authorities. In addition, the health department 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 protected 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 disease and jurisdiction. For example, case reporting of gonorrhea is required by all States, chancroid is reportable in

many States, and herpes simplex and chlamydia are

reportable in only some States.
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 without specific, written authorization from the Office of

Communications, Substance Abuse and Mental Health

Services Administration, U.S. Department of Health and

Human Services.

Ordering Information

TIP 6

Screening for Infectious Diseases 

Among Substance Abusers 

DHHS Publication No. (SMA) 01-3554

Printed 2001