Should STI testing be available at the same time as EC? Dr Anne Webb Abacus Clinics for Contraception and Reproductive Health Liverpool

IPPF statement on dual protection against unwanted pregnancy and STI, including HIV Family planning associations should promote the concept and practice of dual protection Consistent and correct use of condoms is highly effective for the prevention of both unwanted pregnancy and STI/HIV Clients may choose to use condoms alone for dual protection or to use them with another method May 2000

Practical consequences Education to include conception and STI Active encouragement of dual protection by all who deal with contraception, abortion and STIs Measures to deal with failures of either aspect of dual protection

Condoms fail Humans fail

Treatment of dual protection failure Emergency contraception Hormonal IUD Testing for STI Prophylaxis against STI (high risk)

If backup not provided? Within months Unwanted pregnancy A few symptoms of infection Delayed consequences PID, epidydimo-orchitis, neonatal Ectopic pregnancy, tubal infertility

Barriers against dual protection Gynecologists think pregnancy not STI Venereologists think STI not pregnancy “the rate of STI is very low in my country, so is not a problem”

Syphilis -WHO Global prevalence and incidence of selected curable STIs

Gonorrhoea in Sweden Steady decline to % rise in 1997 Upward trend in 1998

Chlamydia prevalence in asymptomatic women 1990’s WHO - Global prevalence and incidence of selected curable STIs

Chlamydia in EC users H Kettle et al, Contraception, 66 (2002) Age< >30 No tested % positive EC users 7.6(6)7.6 (15)5.3 (10)1.4 (2) % positive FPC 9.8 (244) 8.4 (296) 1.1 (363) 1.2 (251)

EC in pharmacies AlbaniaBelgium DenmarkFinland FranceIsrael Norway*Portugal Sweden*Switzerland UK * No involvement of pharmacist

Practical considerations Size of problem Education Signposting Testing Treatment Partners

Holism is the concept that the whole is greater than the sum of its parts. Human physical, social and mental well being is inextricably linked particularly in sexual health

To deliver sexual health you need: Holistic thinking Joined up working

Sensitivity(%) of Chlamydia DNA amplification using various Specimen types Van Doornum et al 2001