Managing sexually transmitted infections in community sexual health clinics: an audit of a community service

Partner notification

Partner notification is an essential part of case management for sexually transmitted infections. Done correctly it reduces persistent or recurrent infection in the index patient, identifies previously undiagnosed infections, and may thus contribute to reduced transmission in the population. The effectiveness of patient referral of partners can be enhanced through the provision of written information and easy access to tests and medication. A recent systematic review of partner notification found that enhanced partner therapy (helping get treatment to partners more rapidly) reduced re-infection in the index case by almost 30% compared with simple patient referral. Provider referral, where the healthcare worker contacts partners directly, can also be effective, and provides an important service for patients who are wary of informing partners themselves. Partner notification services should be available for all patients found to have a sexually transmitted infection, whether the diagnosis is made in specialist settings, or in primary or community-based care. For patients with HIV, partner notification should be addressed when the infection is first diagnosed and revisited for subsequent partners. Access to specialist partner notification services is an important part of any sexual healthcare system. The professional competencies required to undertake partner notification have now been clearly defined.

Evaluation of a partnership between primary and secondary care providing an accessible Level 1 sexual health service in the community

Summary

Comprehensive testing for asymptomatic sexually transmitted infections in Northern Ireland has traditionally been provided by genitourinary medicine clinics. As patient demand for services has increased while budgets have remained limited, there has been increasing difficulty in accommodating this demand. In May 2013, the newly commissioned specialist Sexual Health service in the South Eastern Trust sought to pilot a new model of care working alongside a GP partnership of 12 practices. A training programme to enable GPs and practice nurses to deliver Level 1 sexual health care to heterosexual patients aged >16 years, in accordance with the standards of BASHH, was developed. A comprehensive care pathway and dedicated community health advisor supported this new model with close liaison between primary and secondary care. Testing for Chlamydia, gonorrhoea, HIV and syphilis was offered. The aims of the pilot were achieved, namely to provide accessible, cost-effective sexual health care within a framework of robust clinical governance. Furthermore, it uncovered a high positivity rate for Chlamydia, especially in young men attending their general practice, and demonstrated a high level of patient satisfaction. Moreover the capacity of secondary care to deliver Levels 2 and 3 services was increased.

Is everyone treated equally? Management of genital Chlamydia trachomatis infection in New Zealand

Health disparities often reflect inequitable access to appropriate health care. This study aimed to establish if cases of genital chlamydia infection were managed equitably by age, gender and ethnicity in a region of New Zealand with high rates of chlamydia infection (858 per 100,000 population). Clinical records of 415 genital chlamydia cases from 19 different health-care sites, including general practice and community settings, were reviewed. Data were analysed by demographic variables. For those treated, men were treated more quickly than women (median 3 days versus 6 days, P < 0.001), but there was no difference by ethnicity. Cases without documented treatment were more likely to be women (8.2% versus 2.1%, P = 0.037) and more likely to be Māori than non-Māori (13.6% versus 4.8%, P = 0.036). Overall, the most notable issue was the lack of effective partner notification across all demographic variables. Ongoing efforts are required to ensure equitable access to timely treatment and to ensure that more effective partner notification strategies are implemented.

Management of under-16-year olds in UK genitourinary medicine clinics: British Co-operative Clinical Group

Summary:

In 2004, the management of under-16-year olds in UK genitourinary (GU) medicine clinics was surveyed. Questionnaires were sent to 185 lead GU medicine consultants. A total of 111 questionnaires were returned (60%). Ninety-eight percent of respondents managed young people aged 13-16. Fifty percent managed under 13-year-olds. Twenty-nine percent of respondents ran dedicated young people's clinics. Ninety-eight percent were aware of the National Guidelines, and 74%had adopted them. Fifty-seven percent had a named departmental child protection lead. Thirty-seven percent of consultants had received training specific to child protection issues in GU medicine. Improvements had been made since a similar survey published in 2001, but the need for further training was still apparent.