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An introduction to sexual health screening for Health Care Assistants. Dr Jane Hutchinson & Laura Greaves 13 th March 2014. Learning objectives. Know the key facts about the common STIs including symptoms, treatment & local prevalence rates - PowerPoint PPT Presentation
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An introduction to sexual health screening for Health Care Assistants
Dr Jane Hutchinson&
Laura Greaves13th March 2014
Learning objectives
• Know the key facts about the common STIs including symptoms, treatment & local prevalence rates
• Know what tests to use & how to take them to screen for common STIs in asymptomatic patients
• Understand delegation & legal responsibilities as it affects Health Care Assistants in the primary care setting
• Know the components of assessing Fraser competency• Understand why screening for STIs is important• Develop some strategies to manage patients who opt
out of testing
The Sexual Health enhanced service contract• Some key aims of this contract are to:
– reduce rates of STIs among people of all ages in TH by increasing rates of diagnosis & treatment
– reduce spread of STIs• Your network or practice earns:
– £15 for every Chlamydia & Gonorrhoea test you take– £10 for a blood test which screens for some or all of Syphilis, Hepatitis
B & HIV• Many of you will be offering these tests as part of the new
patient check• Remember to enter the patient onto the Sexual Health
Template to ensure payment is received
Ice Breaker
Laura Greaves
Delegation & legal responsibility
Vicky Souster
Key facts about 5 important STIs
Jane Hutchinson & Laura Greaves
Key facts about common STIs
• Chlamydia• Gonorrhoea• Syphilis• Hepatitis B• HIV
Chlamydia5.6% of 15-24 year olds who had a test in TH in 2012 were positive
Men• >50% asymptomatic• Symptoms
– Urethral discharge– Dysuria– Testicular pain
• Complications– Epididymo-orchitis
• Incubation period is 2 weeks• NAATs test on first void urine after
holding urine for 30 mins• Treat with azithromycin or doxycycline
Women• 70% asymptomatic• Symptoms
– Vaginal discharge– Lower abdominal pain– Abnormal vaginal bleeding
• Complications– Chronic pelvic pain– Pelvic Inflammatory Disease– Infertility– Ectopic pregnancy
• Incubation period is 2 weeks• NAATs test on self taken vulvo-vaginal
swab• Treat with azithromycin or doxycycline
Gonorrhoea230 per 100,000 population diagnosed with GC in TH in 2012
Men• 80% urethral discharge• Symptoms
– Dysuria– Testicular pain
• Complications– Epididymo-orchitis
• Incubation period is 2 weeks• NAATs test on first void urine after
holding urine for 30 mins• Treat with ceftriaxone injection
plus oral azithromycin
Women• 50% asymptomatic• Symptoms
– Vaginal discharge– Abnormal vaginal bleeding– Lower abdominal pain
• Complications– Pelvic Inflammatory Disease– Bartholin’s abscess
• Incubation period is 2 weeks• NAATs test on self taken vulvo vaginal
swab• Treat with ceftriaxone injection plus
oral azithromycin
Syphilis26 per 100,000 population diagnosed with syphilis in TH in 2012
• Symptoms– Primary: genital ulcer– Secondary: rash – Latent: none– Tertiary: affects heart, brain & soft tissues
• Complications– Multiple affecting any part of the body
• Diagnosis– Blood test
• Treatment– Penicillin injections or oral doxycycline
Hepatitis B1.4% of 1975 people of south Asian origin tested in East London diagnosed with chronic
infection
• Can have acute or chronic infection• Symptoms & complications– Acute infection:
• jaundice, pain over liver; vomiting; sometimes no symptoms• most people make full recovery and become immune
– Some develop Chronic infection: • can lead to cirrhosis and liver cancer
• Diagnosis– Blood test
• Treatment: – chronic infection can be treated with anti-virals
HIVIn TH 6 people in every 1000 population aged 15-59 have HIV infection
• Symptoms & complications:– Primary infection – 60% have flu like illness– Then asymptomatic for months or years– As immune system damaged by HIV, person starts to develop
health problems which can affect any part of the body including rashes, chronic diarrhoea, infections & tumours
• Treatment– antiretrovirals
• Diagnosis– Blood test
Fraser Competency
Dr Salma Ahmed
Screening for STIs in the new patient check
Jane Hutchinson
Screening for STIs in the new patient check• How many of you are involved in doing this?• How are patients informed that they will be offered STI
screening?• What responses do you get from patients to the offer of STI
screening?• How do you manage these responses?• What might you say to a patient who opts out of testing?• Why do we recommend STI screening for everyone in Tower
Hamlets?• What else can you do to encourage patients to accept testing?
Suggestions of things you could say to patients who opt out of sexual health screening
• There are high rates of STIs in TH and many people have them without knowing that they do
• Many people with infections don’t know they have them because they don’t have symptoms (eg Chlamydia: >50% males & >70% females are asymptomatic)
• Some STIs can be cured and others can be controlled by having appropriate treatment
Suggestions of things you could say to patients who opt out of sexual health screening
• These are routine tests which we offer to everyone who has ever been sexually active
• Did you know there are health benefits of knowing you have an STI?– You can access treatment for yourself– You can prevent yourself developing complications
of the infection– You can reduce the chances of transmitting the
infection to someone else
Case scenarios
Dr Jane Hutchinson
Case 1
• 39 year old white woman who works as a solicitor registers with your practice
• She declines sexual health screening at new patient check
• 2 years later she develops liver problems and is found to have chronic Hepatitis B infection
• On further questioning she states that she briefly injected drugs in her late teens
Case 2
• 30 year old married British-born Bengali man registers with practice
• His wife is already registered• She is also Bengali• They have been married for 3 years & are
trying to have a baby• At NPC he declines sexual health testing
Case 2
• One year later his wife attends booking visit at ante-natal clinic
• She is tested for HIV along with other routine bloods
• Her HIV test comes back positive • She cannot identify any risk factors in her own
past; her husband is her only sexual partner
Case 2
• She attends local HIV clinic and is started on HIV treatment to prevent her passing the virus to her baby
• Partner notification is discussed with her• She has already told her husband and he is refusing to
have a test• Health advisor at HIV clinic talks to her husband and he
accepts testing• His HIV test is also positive • After further discussion with the Health Advisor he
admits to having sex with men on occasions
Case 3
• Craig who is 17 years old attends for his new patient check with his dad.
• His dad refuses STI screening on his behalf stating that it is not necessary because he doesn’t have a girl friend
Case 3
• 6 weeks later his 16 year old girlfriend, Penny, attends the practice with lower abdominal pain and is diagnosed with Pelvic inflammatory disease
• Her chlamydia test is positive• The GP discusses partner notification with her
and she discloses that her boyfriend is Craig• He attends for screening and is also found to
have Chlamydia