Increasing STI & HIV Screening in Primary Care
Learn key facts, testing procedures, and strategies to increase STI & HIV screening in primary care. Understand the importance of screening, management of patient responses, and referral processes. Explore the Sexual Health enhanced service contract and gain insights into common STIs like Chlamydia, Gonorrhoea, Syphilis, Hepatitis B, and HIV.
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Presentation Transcript
How can Health Care Assistants & Practice Nurses increase STI & HIV screening in primary care Dr Jane Hutchinson 5thMarch 2015
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 why screening for STIs is important Develop some strategies to manage patients who opt out of testing Consider some issues specific to young people Know about the work of Step Forward & how to refer to that organisation Understand You re Welcome accreditation
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? What things do you need to think about in relation to young people? From the point of view of the YP From the point of view of the professional
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 177.75 for vaccinating someone against Hepatitis B if they are at risk of acquiring it sexually Many of you will be offering the screening tests as part of the new patient check Remember to enter the patient onto the Sexual Health Template to ensure payment is received by your practice
Key facts about common STIs Chlamydia Gonorrhoea Syphilis Hepatitis B HIV
Chlamydia (CT) 10,442 15-24 year olds had a Chlamydia test in TH in 2013; 6% were positive Men Women 70% asymptomatic Symptoms Vaginal discharge Lower abdominal pain Abnormal vaginal bleeding >50% asymptomatic Symptoms Urethral discharge Dysuria Testicular pain Complications Chronic pelvic pain Pelvic Inflammatory Disease Infertility Ectopic pregnancy Complications Epididymo-orchitis Incubation period is 2 weeks NAATs test on self taken vulvo- vaginal swab Treat with azithromycin or doxycycline Incubation period is 2 weeks NAATs test on first void urine after holding urine for 30 mins Treat with azithromycin or doxycycline
Gonorrhoea (GC) 271.5 per 100,000 population diagnosed with GC in TH in 2013 Men Women 50% asymptomatic Symptoms Vaginal discharge Abnormal vaginal bleeding Lower abdominal pain 80% urethral discharge Symptoms Dysuria Testicular pain Complications Epididymo-orchitis 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 Incubation period is 2 weeks NAATs test on first void urine after holding urine for 30 mins Treat with ceftriaxone injection plus oral azithromycin
Syphilis Approx. 34 per 100,000 population diagnosed with syphilis in TH in 2013 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 B 1.4% of 1975 people of south Asian origin tested in East London diagnosed with chronic Hep B 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
HIV TH is considered a high prevalence area 6.4 people in every 1000 population aged 15-59 have HIV infection (across whole of UK it is 2.8 per 1000) 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
Herpes Not included in sexual health NIS If you are examining a patient you may see it Which leads onto which swabs you should use
Swabs (A: VTM - GREEN All virology GUM only) B:UTM - RED All virology sample types outside of GUM C: Transwab - PURPLE (used to be Orange) Micro M,C+S e.g. High vaginal swab
Screening for STIs in the new patient check
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 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 1 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 1 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 2 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 girlfriend
Case 2 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
Or Case 2 v2 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 girlfriend
Case 2 v2 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 & Gonorrhoea tests are both positive The GP discusses partner notification with her and she discloses that her boyfriend is Craig They are both advised to attend a GUM clinic for confirmation of the Gonorrhoea diagnosis appropriate treatment for Gonorrhoea (injection & tablets)
Case 2 v2 At GUM clinic Craig discloses that he is unsure of his sexuality and has had unprotected anal sex with men on a couple of occasions Both Craig & Penny confirmed to have Chlamydia & Gonorrhoea What other issues need to be considered here?
Or Case 2 v3 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 girlfriend
Or Case 2 v3 You gave Craig a leaflet about sexual health as part of the new patient registration information He is worried that he may have an infection but didn t know where to go to find out 2 weeks later Craig has taken note of the offer of STI screening He makes an appointment to come back on his own to see the Practice Nurse
Case 3 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
