Transcript Sexual Health in General Practice

Sexual Health in General Practice
Role of the Practice Nurse
Jane Deehan RGN
Bradshaw Lane Surgery
 Location: Arklow, Co. Wicklow
 Staff: 3 GPs, 1 GP Registrar, 2 Practice Nurses, Practice
Manager, 3 Receptionists.
 Demographic: Urban and Rural
 Patient population approx 60% GMS and 40% Private
Nursing Responsibilities
 Childhood vaccinations
 Cervical Cytology
 Heartwatch
 Shared Care Diabetic Programme
 Travel vaccinations
 Cryotherapy
 Dressings
 ECG/ 24 hr blood pressure monitoring
 Phlebotomy
 Sexual Health Screening
 Spirometery
 Ear Syringing
 Admin – Recalls, ordering, prescriptions, phone results service
 Family Planning
 And so on ……………
Health Protection Surveillance Centre
Annual Summary Report 2007 (Dec 09)
“During 2007, the total number of notifications for STI (n=
11,915) rose by more than 20% compared to 2006”
STI
%
Chlamydia Trachomatis
42%
Anogenital Warts
28%
Non Specific Urethritis
16%
Total
86%
Chlamydia Screens in Bradshaw Lane
 National Virus Reference Lab – Data set 2009
- 70 Screens preformed (56 female, 14 male)
- 11 positives (6 female, 5 male)
- Urethral/endocervical swabs 93%
- Urine Tests in 7% - both male and female.
 Factors which may influence these data include
- Non coding at site
- Data filters dependant on free text entry at NVRL
Reporting other STIs
 Anogential Warts
 Herpes Simplex Virus (genital)
 NSU
Highlights a need to improve STI surveillance
 Accurate epidemiological data
 Allow us to quantify extent of exposure and identify
populations at risk
Sexual Health in GP land
 Sexual History
 STI screen
 Treat /Await results
 Test of Cure/Follow up
 Referral
 Education
 Contact Trace
 Report
Sexual History
 Presenting Problem
 Sexual Partners (Casual/Regular/Male/Female)
 Kind of sex
 Protected/Unprotected
 History of STI
 Contraception
 IVDU/Alcohol use
 Recent Antibiotic therapy
 Last PU
 Obs/Gynae/Cytology History
STI Screen Female
• Blood HIV/Syphillis serology /HEP A,B,C screen
• Cervical swab /Urine for Chlamydia/Gonorrhoea
•
High Vaginal swab for culture and sensitivity
-Candida
- Bacterial Vaginosis
- Trichomonas
• Viral Transport Medium Swab – HSV
• Cervical Cytology if appropriate
• All IUDs have chlamydia screen prior to insertion
STI screen Male
• Blood HIV/Syphillis serology /HEP A,B,C screen
• Urethral swab /Urine for Chlamydia/Gonorrhoea
• Swab for culture and sensitivity
-Candida
-Bacterial Infection
• Viral Transport Medium Swab – HSV
Treatment
STI
Treatment
Chlamydia
Await results >Antibiotic > Chemist
If contact treat
Gonnorhoea
Await results>Antibiotic> Chemist
If contact treat
Nonspecific Urethritis
Await results>Antibiotic>Chemist
Treat symptomatically
BacterialVaginosis
Await results >Antibiotic>Chemist
Treat symptomatically
Trichomonas
Await results >Antibiotic>Chemist
Pelvic Inflammatory Disease
Await results> Antibiotic regime>Chemist
Referral
Herpes Simplex Virus
Await results>VALTREX/Acyclovir
Offer treatment symptomatically
AnogenitalWarts
Molloscum Contangiousm
Crytotherapy Weekly clinic
+/- Podophyllin
Follow Up
All patients return for results in 1 week
- Helps with confidentiality
- Opportunity for education
- Referral
- Contact Tracing
Test of Cure
STI
TOC
Time
Chlamydia
_
Chlamydia complicated
Pregnant/ IUD insitu
X
4 Weeks
Gonnorhoea
X
2Weeks
Trichomonas
X
2Weeks
AnogenitalWarts /
Molloscum Contangiousm
_
1Week
Referral
• QUIDE CLINIC
- Syphillis
- HIV
- Complicated cases
• Dermatology
• Psychosexual
• Gynae
Education
 Safe Sex
 Contraception
 Re infection / STI transmission
 Alcohol/ Drug Use
 Hygiene
 General Health – diet/exercise/smoking
 Cervical Cytology
 Breast /Testicular self exam
 QUESTIONS
Contact Tracing
 Tricky
 Mostly self notification
 Will treat partners even if they are not registered patients
 Offer to contact/speak to partners on sources behalf
Options
Contact slips HPSC codes
More resources required
Report
 Improve reporting procedures
 Conduct internal audit
 Develop coding with NVRL
 Health One IT system coding
Challenges
 Time to do STI screening properly
 Confidentiality
 Getting to the root of the problem
 Working in a family orientated practice
 Bumping into patients in schoolyard/supermarket
 Lack of resource – microscopy, drugs, health advisors etc…
In conclusion
 STI screening well worth while and valued service in the
practice.
 More resource $$$$ needs to be made available to develop an
STI service fully.
 Liaison with QUIDE Clinic is key.
 Training /updates for staff essential.