1. Reflections of a GUM physician Helen Lacey Consultant GU Physician Pennine acute NHS Trust - Rochdale

2. Diagnoses of gonorrhoea seen in GUM clinics England, Scotland and Wales*, 1918 to 1999 # *As Northern Ireland data from the time period 1918 to 1999 are largely incomplete they have been excluded from this figure # As data from Scotland for 2000 are not yet available, 2000 data have been excluded from this graph 1987- HIV and CT testing 1989/90 monks report --££ 1992 – consultant Sexual health -Political Health of the nation pub 1991 First targets 20% decrease in GC by 1995 (2003 ~25000cases) White paper – further 25% reduction by2008

4. Trends in rates per 100 000 of major acute STIs among men who have sex with men, England and Wales, 1997-2003 Data source: KC60 statutory returns and HIV/AIDS Reports – reports received by the end of June 2004.

5. Proportion of STIs diagnosed in GUM clinics seen among people aged 16-24, England, Wales and Northern Ireland, 2003 1 Proportion of the total population in England, Wales and Northern Ireland age 15-64, that are aged 16-24, derived from the office for National Statistics, 2001. Data source: KC60 statutory returns and Census 2001 data. 1

6. Diagnosed HIV-infected patients seen for care, by sex and level of anti-retroviral therapy, United Kingdom, 1998-2003 Data source: SOPHID and CD4 Monitoring Scheme for Scotland.

8. Reduction in Follow ups – modernisation -phone for results, home wart treatments. Medical staff – substitution by senior nursing staff >100% increase in new patients seen- accommodation at capacity

9. Changes over past 10years Integrated with FP services Developed nursing roles with PGDs Better tests – eg chlamydia PCR – on urines Faster results – HIV same day Home treatment for warts Better IT and data Higher political profile HIV treatment and prognosis More travel abroad -more antibiotic resistance

10. What hasn’t changed Self referral - potential for abuse no link between activity and funding Level of confidentiality Cross boundary flow Level of STI care in primary care Stigma level of condom use

11. What has become worse Accommodation often inadequate Notes storage facilities inadequate Loss of walk in access with waiting times for appointments, triage systems Irate patients phones ringing constantly Pressures from data collection and paperwork with lack of admin support

16. Escalating STI rates nationally in the decade 93-2003, 197% CT, 148% GC 380% syphilis, 100% in new HIV cases

17. An image from the sexual health information campaign, England (Department of Health)

18. The future? hopes Investment catch up? Health education campaign 48 hour access target by 2008 ( nationally 38%, 28% in N.West) Chlamydia screening by march 2007 Investment and review of contraception services HPV vaccines New HIV treatments

19. Threats or challenges Chlamydia screening Public education campaign Payment by results “new STIs” – LGV Escalating HIV numbers