Update on Sexual Health Dr Jillian Pritchard Consultant St Peter’s Hospital,Chertsey

COMMISSIONING SEXUAL HEALTH LOCAL AUTHORITY: STI screening and treatment Contraception (except outside GP contract) Prevention of infection including HIV Some psychosexual therapy(sexual health)

CCG COMMISSIONING Most abortion services Other psychosexual therapy Gynaecology including gynae IUS Sterilisation and vasectomy

NHS COMMISSIONING BOARD Contraception outside GP contract HIV treatment and care Sexual health in prisons Sexual Assault Referral Services Cervical screening Promotion of STI screening and patient requested screening in general practice

future disaster?

Now significant resistance to all but Ceftriaxone Far East -suggestion of resistance Nothing in reserve Essential to identify and treat correctly:Ceftriaxone IM + Azithromycin 1G Gonorrhoea-future treatment?

Chlamydia Chlamydia screening only screens for chlamydia-gonorrhoea may be missed Evidence for resistance to Azithromycin Contact tracing very important May need test of cure Chlamydia may be multiple sites- cervix;throat;rectum;urethra

Sexual health in practice Coding all important NB GUMCAD One consultation may encompass all 3 How can GUM service work best with GPs? How can we determine cost effective use of resources? Technology/expertise to best effect

HIV detection Prevalence in Crawley>3.5 per 1000 In Woking >2 per 1000 Indication for low threshold testing At registration: indicator disease: if you think of it TEST Ensure smooth pathway for further care

GP role Promote all testing -code for it Refer to best place for patient eg GUM Identify HIV early Work with HIV provider/patient to see best way for each aspect of chronic care Keep your head above water

Spire Gatwick Park role Offering ‘Quick check’ screening Positive result-consultation Symptomatic-offered consultation Competitively priced for those who wish private service Appointment through outpatients