Transcript Case scenarios

An introduction to sexual health
screening for Health Care Assistants
Dr Jane Hutchinson
&
Laura Greaves
13th 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
Chlamydia
5.6% of 15-24 year olds who had a test in TH in 2012 were positive
Men
Women
• >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
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 vulvovaginal swab
• Treat with azithromycin or
doxycycline
Gonorrhoea
230 per 100,000 population diagnosed with GC in TH in 2012
Men
Women
• 80% urethral discharge
• Symptoms
• 50% asymptomatic
• 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
– 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
Syphilis
26 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 B
1.4% 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
HIV
In 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