GUM SERVICE GATESHEAD

1. GUM SERVICEGATESHEAD CAROLYN GARVEN NICOLA GRANT Sexual Health Nurse Practitioners

2. 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

3. 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

4. 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.

5. 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.

6. 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.

7. 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.

8. Gonorrhoea was the second most common bacterial STI in the UK, with 19,007 diagnoses of uncomplicated infection in 2006.

9. Genital warts are the most common viral STI diagnosed in GUM clinics in the UK.

10. 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

11. 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

12. GUM Gateshead 2 Sexual Health Nurse Practitioners 2 Sexual Health Nurses 2 Health Advisors 4 Health Care Assistants Newly appointed consultant starting in September

13. 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

14. ASYMPTOMATIC SCREENING • SWABS FOR CHLAMYDIA AND GONORRHOEA • BLOODS FOR HIV AND SYPHILIS • TEXT RESULTS 7-10 DAYS • LEAFLET GIVEN

15. 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

17. SEXUALLY TRANSMITTED INFECTIONS • Chlamydia • Gonorrhoea • Trichomonas • Genital warts • Herpes

18. Chlamydia

19. Chlamydia SITES • Cervix • Urethra • Rectum • Pharynx • Eye • Incubation period up to 14 days

20. Other Sites • Rectal infections • Usually asymptomatic, but may cause anal discharge and anorectal discomfort (proctitis) • Pharyngeal infections • These are asymptomatic and are uncommon

21. 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

22. 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.

24. 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

25. 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).

26. 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

27. Trichomonas Trichomonas

28. 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

29. 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

31. Treatment • Metronidazole 2g orally in a single dose or • Metronidazole 400 – 500mg twice daily for 5 - 7 days

32. 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.

34. GONORRHOEA Sites • Cervix • Urethra • Rectum • Pharynx • Eye Incubation period 3-7 days

35. 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.

36. 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%).

37. Signs • Women: • mucopurulent endocervical discharge and endocervical bleeding (<50%). • pelvic/lower abdominal tenderness (<5%). • commonly, no abnormal findings are present on examination.

38. 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%).

39. Signs Men • a mucopurulent or purulent urethral discharge is commonly evident. • rarely, epididymal tenderness/swelling or balanitis may be present.

40. Gonorrhoea Gonorrhoea

43. Treatment Cefixime 400mg oral as a single dose

44. 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.

46. 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.

47. 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

49. Treatment options • Cryotherapy • Warticon • Aldara • No treatment • No PN required

50. Differential diagnosis; Molluscum