Presentation on theme: "CAROLYN GARVEN NICOLA GRANT Sexual Health Nurse Practitioners"— Presentation transcript:
1CAROLYN GARVEN NICOLA GRANT Sexual Health Nurse Practitioners GUM SERVICE GATESHEADCAROLYN GARVENNICOLA GRANTSexual Health Nurse Practitioners
2What are sexual health services? Genitourinary Clinic (GUM)Contraception and Sexual Health (CASH)Sexual Health Promotion (including- LAC, education, LGBT, Stag, YM&B, C-Card)Teenage Pregnancy Options NurseSchool Based ServicesChlamydia Screening
3VISIONSexual health services in Gateshead are based on a framework of evidence based and needs led services.To provide value for moneySupport the delivery of national targetsBuild a patient centred serviceContribute to a reduction in health inequalities
4Access to Gum clinics100 % of patients attending GUM clinics must be offered an appointment within 48 hours of contacting the clinic. The percentage of patients attending GUM clinics who are seen within 48 hours of contacting the service is monitored by the DoH.
5Sexually transmitted infections In 2006, there were 376,508 new sexually transmitted infection diagnoses at GUM clinics in the UK, an increase of 63 per cent on 1997.Between 2005 and 2006 the number of new diagnoses increased by 2 per cent.
6Between 1997 and 2006 the largest increases were seen in diagnoses of genital chlamydia which rose by 166 per cent, gonorrhoea by 46 per cent and syphilis by 1,607 per cent.Genital chlamydia infection was the most commonly diagnosed STI at GUM clinics in the UK, with 113,585 diagnoses of uncomplicated infection made in 2006.
7Between 2003 and 2006, around one in ten of those screened for chlamydia were found to be positive. Chlamydia is implicated in more than 50 per cent of cases of pelvic inflammatory disease which can lead to ectopic pregnancy and infertility in women and fertility problems in men.
8Gonorrhoea was the second most common bacterial STI in the UK, with 19,007 diagnoses of uncomplicated infection in 2006.
9Genital warts are the most common viral STI diagnosed in GUM clinics in the UK.
10HIVAn estimated 73,000 adults are now living with HIV in the UK, according to the Health Protection Agency's latest report on the UK 's sexual health. This figure includes both those who have been diagnosed and also around a third (21,600) who remain unaware of their HIV status.In 2006, 48 per cent of HIV infections were acquired through heterosexual intercourse. The majority of these were acquired outside the UK
11Who is at risk? Sexually active population Groups with increased risk are:Young adults - account for half of all STI’s diagnosedMen having sex with menPeople living with a disadvantage, race, social status, education, LAC
12GUM Gateshead 2 Sexual Health Nurse Practitioners 2 Sexual Health Nurses2 Health Advisors4 Health Care AssistantsNewly appointed consultant starting in September
13WHAT ROUTINE SCREENING CONSISTS OF HISTORY TAKINGASSESS WHETHER PATIENT IS SYMPTOMATIC OR ASYMPTOMATICHIGH RISK OR LOW RISK? DEPENDS ON SEXUALITY, LIFESTYLE, i.e. IV DRUG USE, LARGE NUMBERS OF CASUAL SEXUAL PARTNERS
14ASYMPTOMATIC SCREENING SWABS FOR CHLAMYDIA AND GONORRHOEABLOODS FOR HIV AND SYPHILISTEXT RESULTS 7-10 DAYSLEAFLET GIVEN
15SYMPTOMATIC SCREENING SWABS FOR CHLAMYDIA AND GONORRHOEAFEMALE SWABS FOR BV/CANDIDA/TVBLOODS FOR HIV AND SYPHILISMICROSCOPY CARRIED OUT IN THE UNIT, WET/DRY SLIDES/POSSIBLE BLOOD TESTING FOR HEPATITIS B AND C
24Treatment of genital, rectal and pharyngeal uncomplicated infection see appropriate and epidemiological treatmentRecommended regimens: (Grade of recommendation A)• Doxycycline 100mg bd for 7 days (contraindicated in pregnancy)or• Azithromycin 1gm orally in a single dose
25Partner notification Symptomatic 4 weeks Asymptomatic 6 months Advised to abstain from sexual intercourse until they and their partner(s) have completed therapy (and waited 7 days if treated with Azithromycin).
26Trichomonas Sites High Vaginal secretions Difficult to isolate in men urethral infection is present in 90% of episodesDiagnosis is made by wet mount microscopy or HVS
28Signs and symptoms Females • 10 - 50% are asymptomatic. • The commonest symptoms include vaginal discharge, vulval itching, dysuria, or offensive odour.• Occasionally the presenting complaint is of low abdominal discomfort
29Male15 to 50% of men with T. vaginalis are asymptomatic and usually present as sexual partners of infected women.The commonest presentation is with urethral discharge and/or dysuria. Other symptoms include urethral irritation and frequency
31Treatment Metronidazole 2g orally in a single dose or Metronidazole 400 – 500mg twice daily for days
32PartnersSexual partner(s) should be treated simultaneously. Patients should be advised to avoid sexual intercourse (including oral sex) until they and their partner(s) have completed treatment and follow-up.
34GONORRHOEASitesCervixUrethraRectumPharynxEyeIncubation period 3-7 days
35Signs and Symptoms Female • infection at the endocervix is frequently asymptomatic (up to 50%).• increased or altered vaginal discharge is the most common symptom (up to 50%).• lower abdominal pain may be present (up to 25%).• urethral infection may cause dysuria (12%) but not frequency.
36Female Symptomsgonorrhea is a rare cause of intermenstrual bleeding or menorrhagia.rectal infection more frequently develops by transmucosal spread of infected genital secretions than from anal intercourse and is usually asymptomatic.pharyngeal infection is usually asymptomatic (>90%).
37SignsWomen:• mucopurulent endocervical discharge and endocervical bleeding (<50%).• pelvic/lower abdominal tenderness (<5%).• commonly, no abnormal findings are present on examination.
38Male Symptomsurethral infection commonly causes urethral discharge (>80%) and/or dysuria (>50%).urethral infection can be asymptomatic (<10%).rectal infection in homosexual men is usually asymptomaticpharyngeal infection is usually asymptomatic (>90%).
39SignsMen• a mucopurulent or purulent urethral discharge is commonly evident.• rarely, epididymal tenderness/swelling or balanitis may be present.
44Partner notification 2 weeks for symptomatic men 12 weeks for Asymptomatic males and all femalesAll patients with gonorrhoea should be screened for genital infection with Chlamydia trachomatis and receive presumptive treatment for this infection.
46Genital WartsIn 2005 just over 80,000 new diagnoses of Ano-genital warts were made in genitourinary (GU) medicine clinics in the United Kingdom.Although the large majority of these result in little physical discomfort, they may be disfiguring andpsychologically distressing.
47Genital warts may be associated with irritation and soreness especially around the anus Symptoms of distortion of urine flow or bleeding from the urethra or anus, may indicate internal lesions
53Genital Herpes Signs The patient may be asymptomatic Local symptoms consist of painful ulceration, dysuria, vaginal or urethral discharge.Systemic symptoms such as fever are much more common in primary than in initial or recurrent disease.
54SignsBlistering and ulceration of the external genitalia (+/- cervix/rectum)Tender inguinal lymphadenitis, usually bilateral
57Management First Episode Genital Herpes General advice Saline bathing AnalgesiaAciclovir 200mgs five times daily for 5 daysInstillagel
58Recurrent HerpesRecurrences are self-limiting and generally cause minor symptoms.Strategies include:supportive therapy onlyepisodic antiviral treatmentssuppressive antiviral therapy.
59SyphilisPrimary syphilis is characterized by an ulcer (the chancre) and regional lymphadenopathy. The chancre is classically in the anogenital region, is single, painless and indurated with a clean base discharging clear serum.
61Secondary syphilis is characterized by multisystem involvement within the first two years of infection. There is often a rash typically generalized macular, papular or macular–papular often affecting the palms and soles
65Partner Notification Required for most sexually transmitted infections Process of informing sexual contacts of infected individualsUsually initiated by Health AdvisorsVoluntary, requires consent of individualEssential to reduce the amount of infection in the communityVarious methods, patient, health advisor, mixed
66Promoting safer sex Addressed at each clinic attendance Degree depends on existing knowledge and current sexual risk takingHealth advisor can work with individuals motivated to address sexual risk taking
72Treatment BV- Metronidazole 400mgs bd for 5 days Candida- Local Clotrimazole or FluconazoleAll treatment is free of chargeDispensed in the unit by qualified nursesWritten information given about treatment and infectionHealth advisor appointments are available for discussion
73ConsentThe legal age for all young people to consent to have sex is still 16, regardless of sexual orientation. The aim of the law is to protect the rights and interests of young people, and make it easier to prosecute people who pressure or force others into having sex they don’t want.
74Young People between 13 and 16 The Sexual Offences Act 2003 reinforces that, whilst mutually agreed, non-exploitative sexual activity between teenagers does take place and that often no harm comes from it, the age of consent should still remain at 16. This acknowledges that this group of young people are still vulnerable, even when they do not view themselves as such.
75Young People under the Age of 13 Young people under the age of 13 are deemed unable to give consent to sexual activity. ‘Working Together’ makes it clear that cases involving under 13 year olds who are either having penetrative sex, or are engaged in other intimate sexual activity are likely to involve significant harm to the child or children.
76Consent to TreatmentThe Sexual Offences Act Amended (2003) does not prevent the provision of confidential contraceptive/sexual health advice or treatment to under 13’s. Young people under 13 continue to be able to consent to treatment if they are considered competent to understand the treatment proposed. The judgement of competence rests with the professional on a case-by-case basis using the Fraser Guidelines as a framework.
77ConfidentialityThe duty of confidentiality owed to a person under 16, in any setting, is the same as that owed to any other person. This is enshrined in professional codes.
78Confidentiality can only be breached in exceptional circumstances where the health, safety and welfare of the young person or others would be at grave risk and depends on the degree of likely harm, not solely on the age of the young person.
79Gateshead Sexual Health Services Confidentiality Notice You have the right not to have any information about you passed on to anyone outside the service (like parents, family, friends, Doctors, teachers, social workers, etc.) without you knowing about it and agreeing to it.
80The only time this may be different is if you tell us that you or someone else is in a dangerous situation and by us telling someone else this may prevent you or them from being harmed.If a worker felt they had to pass on information without your permission, they would still inform you of what they were going to do.