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CAROLYN GARVEN NICOLA GRANT Sexual Health Nurse Practitioners
GUM SERVICE GATESHEAD CAROLYN GARVEN NICOLA GRANT Sexual Health Nurse Practitioners
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What 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 Nurse School Based Services Chlamydia Screening
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VISION Sexual health services in Gateshead are based on a framework of evidence based and needs led services. To provide value for money Support the delivery of national targets Build a patient centred service Contribute to a reduction in health inequalities
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Access to Gum clinics 100 % 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.
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Sexually 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.
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Between 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.
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Between 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.
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Gonorrhoea was the second most common bacterial STI in the UK, with 19,007 diagnoses of uncomplicated infection in 2006.
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Genital warts are the most common viral STI diagnosed in GUM clinics in the UK.
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HIV An 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
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Who is at risk? Sexually active population
Groups with increased risk are: Young adults - account for half of all STI’s diagnosed Men having sex with men People living with a disadvantage, race, social status, education, LAC
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GUM Gateshead 2 Sexual Health Nurse Practitioners
2 Sexual Health Nurses 2 Health Advisors 4 Health Care Assistants Newly appointed consultant starting in September
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WHAT ROUTINE SCREENING CONSISTS OF
HISTORY TAKING ASSESS WHETHER PATIENT IS SYMPTOMATIC OR ASYMPTOMATIC HIGH RISK OR LOW RISK? DEPENDS ON SEXUALITY, LIFESTYLE, i.e. IV DRUG USE, LARGE NUMBERS OF CASUAL SEXUAL PARTNERS
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ASYMPTOMATIC SCREENING
SWABS FOR CHLAMYDIA AND GONORRHOEA BLOODS FOR HIV AND SYPHILIS TEXT RESULTS 7-10 DAYS LEAFLET GIVEN
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SYMPTOMATIC SCREENING
SWABS FOR CHLAMYDIA AND GONORRHOEA FEMALE SWABS FOR BV/CANDIDA/TV BLOODS FOR HIV AND SYPHILIS MICROSCOPY CARRIED OUT IN THE UNIT, WET/DRY SLIDES/ POSSIBLE BLOOD TESTING FOR HEPATITIS B AND C
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SEXUALLY TRANSMITTED INFECTIONS
Chlamydia Gonorrhoea Trichomonas Genital warts Herpes
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Chlamydia
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Chlamydia SITES Cervix Urethra Rectum Pharynx Eye
Incubation period up to 14 days
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Other Sites Rectal infections
Usually asymptomatic, but may cause anal discharge and anorectal discomfort (proctitis) Pharyngeal infections These are asymptomatic and are uncommon
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Signs and Symptoms Women Asymptomatic in approximately 70%
Post coital or intermenstrual bleeding Lower abdominal pain Purulent vaginal discharge Mucopurulent cervicitis and/or contact bleeding Dysuria
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Signs and Symptoms Men Asymptomatic in over 50% in a community setting
Urethral discharge Dysuria The severity of these two symptoms is variable and may be so mild as to be unnoticed by the patient.
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Treatment of genital, rectal and pharyngeal uncomplicated infection see appropriate and epidemiological treatment Recommended regimens: (Grade of recommendation A) • Doxycycline 100mg bd for 7 days (contraindicated in pregnancy) or • Azithromycin 1gm orally in a single dose
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Partner 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).
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Trichomonas Sites High Vaginal secretions Difficult to isolate in men
urethral infection is present in 90% of episodes Diagnosis is made by wet mount microscopy or HVS
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Trichomonas Trichomonas
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Signs 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
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Male 15 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
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Treatment Metronidazole 2g orally in a single dose or
Metronidazole 400 – 500mg twice daily for days
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Partners Sexual 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.
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GONORRHOEA Sites Cervix Urethra Rectum Pharynx Eye Incubation period 3-7 days
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Signs 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.
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Female Symptoms gonorrhea 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%).
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Signs Women: • mucopurulent endocervical discharge and endocervical bleeding (<50%). • pelvic/lower abdominal tenderness (<5%). • commonly, no abnormal findings are present on examination.
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Male Symptoms urethral infection commonly causes urethral discharge (>80%) and/or dysuria (>50%). urethral infection can be asymptomatic (<10%). rectal infection in homosexual men is usually asymptomatic pharyngeal infection is usually asymptomatic (>90%).
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Signs Men • a mucopurulent or purulent urethral discharge is commonly evident. • rarely, epididymal tenderness/swelling or balanitis may be present.
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Gonorrhoea Gonorrhoea
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Treatment Cefixime 400mg oral as a single dose
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Partner notification 2 weeks for symptomatic men
12 weeks for Asymptomatic males and all females All patients with gonorrhoea should be screened for genital infection with Chlamydia trachomatis and receive presumptive treatment for this infection.
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Genital Warts In 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 and psychologically distressing.
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Genital 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
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Treatment options Cryotherapy Warticon Aldara No treatment
No PN required
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Differential diagnosis; Molluscum
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Herpes
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Genital 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.
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Signs Blistering and ulceration of the external genitalia (+/- cervix/rectum) Tender inguinal lymphadenitis, usually bilateral
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Management First Episode Genital Herpes General advice Saline bathing
Analgesia Aciclovir 200mgs five times daily for 5 days Instillagel
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Recurrent Herpes Recurrences are self-limiting and generally cause minor symptoms. Strategies include: supportive therapy only episodic antiviral treatments suppressive antiviral therapy.
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Syphilis Primary 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.
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Chancre Chancre
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Secondary 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
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Partner Notification Required for most sexually transmitted infections
Process of informing sexual contacts of infected individuals Usually initiated by Health Advisors Voluntary, requires consent of individual Essential to reduce the amount of infection in the community Various methods, patient, health advisor, mixed
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Promoting safer sex Addressed at each clinic attendance
Degree depends on existing knowledge and current sexual risk taking Health advisor can work with individuals motivated to address sexual risk taking
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Vaginal Infections Candida Bacterial vaginosis
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Normal female dry slide
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Candida- Hyphae on a wet slide
Wet slide- Candida
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Candida spores on dry slide
Candida spores on a dry slide Candida spores on dry slide
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Bacterial Vaginosis Bacterial Vaginosis
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Treatment BV- Metronidazole 400mgs bd for 5 days
Candida- Local Clotrimazole or Fluconazole All treatment is free of charge Dispensed in the unit by qualified nurses Written information given about treatment and infection Health advisor appointments are available for discussion
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Consent The 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.
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Young 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.
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Young 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.
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Consent to Treatment The 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.
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Confidentiality The 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.
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Confidentiality 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.
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Gateshead 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.
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The 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.
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Any Questions?
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