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Sexually Transmitted Infections: UK National Screening and
Testing Guidelines
BASHH Guidelines2006
Dr Olwen Williams
Aim of guideline
• To improve access to testing/screening for STIs by tailoring investigations to patients needs
• www.bashh.org
Scenarios
Asymptomatic
low risk
non-invasive tests
Symptomatic
high risk
microscopy
Asymptomatic
• to have no symptoms• exclude contacts?• excludes patients with warts?
Who decides who’s asymptomatic ?• the patient• the receptionist• the triage nurse• the doctor
Definition ‘asymptomatic’
Women
Does not complain of a
vaginal discharge
No abnormal vaginal
discharge on
examination
Men
Does not complain of a
urethral discharge
No urethral discharge
on examination
All patients need risk assessment
• STI• HIV• Contraception
• Intervention strategy• Partner notification
Asymptomatic Heterosexual Men
Site or specimen
GC Chlamydia NSU Syphilis HIV
Urethra Culture NAAT NR NR NR
Rectum NR NR NR NR NR
Oropharynx NR NR NR NR NR
Urine NAAT NAAT NR NR NR
Blood NR NR NR STS EIA
NR: Not recommended
NR
Asymptomatic MSM
Site or specimen
GC Chlamydia
NSU Syphilis HIV
Urethra Culture NAAT NR NR
Rectum Culture NR NR NR NR
Oropharynx Culture NR NR NR NR
Urine NAAT NAAT NR NR NR
Blood NR NR NR STS EIA
NR: Not recommended
NR
Asymptomatic Women
Site or specimen
GC Chlamydia Syphilis HIV
Urethra NR NR NR NR
Cervix Culture NAAT NR NR
Vagina NR NAAT NR NR
Rectum NR NR NR NR
Oropharynx NR NR NR NR
Urine NR NAAT NR NR
Blood NR NR STS EIA
NR: Not recommended
What does this mean?
Women
No HVS
URINE TESTING FOR ALL ???????
Men
No microscopy on
urethral swab
Microscopy
Essential for diagnosis
NSU in men Bacterial vaginosis
Trichomoniasis
Early diagnosis
Gonorrhoea
Immediate results
Who should do the microscopy?
• Experienced
• trained
• Biomedical scientist
• doctor
• nurse
• nursing assistant
• Cost microscope
• training of microscopist
• Consumables
• Time - 4min / slide
The way forward
• All sexual health clinics in Wales to adopt BASHH guideline
• Care pathways between CASH and GUM services for the symptomatic , the high risk and those patients requiring microscopy
• Press for access to NAAT technology (GC & CT) suitable for urine testing