Hot Hot Topic

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Hot Hot Topic

• Chlamydial Screening

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National Sexual Health Strategy

• 2003 House of Commons Select Committee Report
  Depressing
• Increase in all STIs. Gonorrhoea (86),Chlamydia
  (108) ,Syphilis (500)
• Prevalence of Chlamydia in women lt 25 10
• GUM services completely over-run
• Conclusion..the whole sexual health service
  seems to be a shamblesBMJ editorial by Michael
  Alder

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The Way Forward?

• Increased involvement and funding of PCTs for
  sexual health in primary care
• a NSF to be established for sexual health, with
  explicit guidance and funding for implementation
  for PCTs (as well as great expansion of GUM
  services)
• Chlamydial screening to be rolled out more
  rapidly, and sub-optimal tests to be withdrawn in
  favour of amplification tests like PCR/LCR
• Open access for TOP and early medical abortion in
  a wider range of health care settings.
• Report concludes reason for failure diversion of
  funds to chronic disease management

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Background Facts

• CT is the commonest bacterial STI
• 80 of women and 50 of men are asymptomatic
• After one episode of PID, 15 of women become
  infertile ,10 get chronic pelvic pain and 10 of
  subsequent pregnancies are ectopic
• Previous research has shown that screening an at-
  risk population lead to a decrease in cases of
  PID and was cost effective

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Whats happening now?

• Slow implementation of screening for CT across a
  number of UK centres and 3 large ongoing studies
• DNA amplification tests being made more available
  more specific and sensitive,less invasive

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What can we do as GPs?

• Recommended opportunistic screening for
• Women requesting TOP
• Women lt 25yrs and sexually active teenagers
• Men w. urethral discharge, epididymitis or young
  men w. dysuria
• Other suggestive symptoms e.g.IMB ,pelvic pain,
  change in discharge
• New or multiple partners
• Partner w. recent STI

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Screening Tests

• Consent
• For women, current ideal ECS
• 1st void urine specimen in both men and women
  ,and vulvo-vaginal swabs may become the preferred
  specimens in yrs to come.
• If symptomatic,women should still have a speculum
  exam and swabs to screen for other possible STIs

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Positive Test?

• Give patient GUM and CT leaflets
• AntibioticsAzythromycin 1g stat or Doxycycline
  100mgs b.d. for 7 days . If pregnantor breast
  feeding,Erythromycin 500mgs qds for 7 days or
  500mgs bd for 14 days
• Contact tracing? Suggest give patient a note and
  a GUM leaflet(s) for the patient to give to their
  partner(s) to take to the GUM clinic.
  
  

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Barriers to Screening

• Perceived lack of evidence of benefits of testing
• Lack of knowledge when and how to test.
• Lack of time and resources inc. chaperones and
  contact tracing,(potential minefields)
• Embarrassment on the part of healthcare staff and
  unwillingness to raise issue outwith acceptable
  areas of consultation

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Barriers to Opportunistic Chlamydial Testing in
Primary Care

• 2 groups
• Urban and rural practicehigh test rates
• Urban and rural practice low test rates

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Feedback comments in High uptake practices

• I suspect its (CT screening) is probably more
  effective than some of the screening things that
  we do at the moment.
• Patients say I cant get an appt at GUM for 3
  wks you cant expect someone to sit around with
  their whatever for weeks.So, its force of
  circumstances you have to get involved sometimes
  and its less than ideal

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Feedback Comments in Low Uptake Practices

• I dont think they'll go out of here thinking we
  are off our rocker- they will think we are
  perverts!
• Im a bit sceptical of research which I always
  think has come out of inner city FP clinics where
  there is a very hi incidence of sexual disease.
• Too many negatives to mention!!!

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Solutions

• Test at smear consultation gtgt more routine gtgt
  more acceptable gtgt less stigma.
• Send everyone to a GUM clinic.
• Sexual Health not included in the quality
  framework- should it have been?

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Dream on.

• More Family Planning trained nurses in primary
  care
• PCT guidance on
• how to approach patients.
• how to gain consent. contact tracing.
• Staff Training.
• Patient Awareness Programs.
• Resources paralleling public health needs

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