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 vulvo-vaginal 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 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 50% asymptomatic Symptoms 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

Did you know there are health benefits of knowing you have an STI? 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