1. SEXUAL HEALTH AND CONTRACEPTION SERVICE ASHCROFT SURGERY Veena Mills April 2010

2. Levels of Service LEVEL 1 Standard GP care, contraceptive advice and prescribing, screening asymptomatic women and investigating symptomatic women for STIs LEVEL 2 Additionally providing LARC Screening asymptomatic men and investigating symptomatic men for STIs LEVEL 3 Secondary care, gynaecology and GUM clinics

3. Why should we do it? NATIONALLY AND LOCALLY Increasing rates of all STIs (sexually transmitted infections) Increasing teenage pregnancy rates Rising numbers of unwanted pregnancies Rising numbers of terminations

4. What's in it for the patients? Easier access to services Shorter waiting times Patient Choice Unified service for contraception and sexual health Reduce potential complications if treated early Reduce stigma attached to STIs Reduce anxieties when attending for procedures and tests

5. What's in it for us? Renumerated for the work we do Job satisfaction Practice based commissioning Health promotion

6. SEXUAL HEALTH Ashcroft and non-Ashcroft patients Men and Women Asymptomatic and Symptomatic Full sexual history Examination Investigations Results Treatment Contact tracing Referral (if necessary)

7. Investigations BASIC INVESTIGATIONS Chlamydia Gonorrhoea HIV Syphilis Trichomonas SPECIFIC INVESTIGATIONS Herpes Hep B/C Other conditions seen: Genital warts, Thrush, bacterial vaginosis

8. Extra Considerations Confidentiality Appointment length 48 hour access Contact tracing Business matters Clinical governance

9. How to refer into the service.. Practice note " SEXUAL HEALTH " Patient name and emis no. What they need to have done Make sure their contact phone number is correct Tell them someone will call them within 24hrs to offer an appointment

10. CONTRACEPTION NICE Guidance 2005 " all LARC (long acting reversible contraceptives) methods are more cost effective than the cocp and depo-provera at 1year " " increased uptake of LARC results in reduced numbers of unintended pregnancies " Implanon/ IUS/ IUD

11. IMPLANON Subdermal implant of etonorgestrel Prevents ovulation Duration of use 3yrs failure rate 24 per million No delay in return to fertility Disadvantages: altered bleeding patterns 1 in 3 minor general progestogenic side effects & weight changes 1in 20 local adverse reaction 1 in 100 Timing of insertion- ensure not pregnant so ideally during menses, if amenorrhoeic ask them to discuss with me

12. IUD- Intrauterine device Copper coil Prevents fertilisation and inhibits implantation Duration of use 5-10yrs depending on type of coil failure rate 2 in 100 after 5 years No delay in return to fertility Disadvantages: increased menstrual loss and dysmenorrhoea perforation <1 in 1000 PID <1 in 100 expulsion 1in 20 ectopic <1 in 1000

13. IUS- Intrauterine system Levonorgestrel coil (mirena) Prevents implantation and sometimes fertilisation Duration of action 5 yrs (7yrs if >45) Failure rate 1 in 100 over 5 years Possibly some delay to fertility- not proven Disadvantages: irregular bleeding and spotting for 6m by 1year most periods are lighter or have stopped hormonal side effects perforation/expulsion/pid/ectopic same as IUD

14. IUD/IUS cont.. Insertion- during menses * if at risk of STI (young, multiple partners, previous STI) need full STI screen first If low risk ok to insert with swabs taken at time of insertion TO REFER FOR IMPLANON/ IUD/ IUS Practice note " SEXUAL HEALTH " What needs doing, when would be a good time (period) ensure contact phone number is correct

15. RESOURCES www.ffprhc.org.uk The faculty of family planning and reproductive healthcare www. bashh.org British association for sexual health and HIV ANY QUESTIONS??