1. Role of the Practice Nurse Sexual Health in General Practice Jane Deehan RGN

2. Bradshaw Lane Surgery Location: Arklow, Co. Wicklow Staff: 3 GPs, 1 GP Registrar, 2 Practice Nurses, Practice Manager, 3 Receptionists. Demographic: Urban and Rural Patient population approx 60% GMS and 40% Private

3. Nursing Responsibilities Childhood vaccinations Cervical Cytology Heartwatch Shared Care Diabetic Programme Travel vaccinations Cryotherapy Dressings ECG/ 24 hr blood pressure monitoring Phlebotomy Sexual Health Screening Spirometery Ear Syringing Admin – Recalls, ordering, prescriptions, phone results service Family Planning And so on ……………

4. Health Protection Surveillance Centre Annual Summary Report 2007 (Dec 09) “During 2007, the total number of notifications for STI (n= 11,915) rose by more than 20% compared to 2006” STI% Chlamydia Trachomatis42% Anogenital Warts28% Non Specific Urethritis16% Total86%

5. Chlamydia Screens in Bradshaw Lane National Virus Reference Lab – Data set 2009 - 70 Screens preformed (56 female, 14 male) - 11 positives (6 female, 5 male) - Urethral/endocervical swabs 93% - Urine Tests in 7% - both male and female. Factors which may influence these data include - Non coding at site - Data filters dependant on free text entry at NVRL

6. Reporting other STIs Anogential Warts Herpes Simplex Virus (genital) NSU Highlights a need to improve STI surveillance  Accurate epidemiological data  Allow us to quantify extent of exposure and identify populations at risk

7. Sexual Health in GP land Sexual History STI screen Treat /Await results Test of Cure/Follow up Referral Education Contact Trace Report

8. Sexual History Presenting Problem Sexual Partners (Casual/Regular/Male/Female) Kind of sex Protected/Unprotected History of STI Contraception IVDU/Alcohol use Recent Antibiotic therapy Last PU Obs/Gynae/Cytology History

9. STI Screen Female Blood HIV/Syphillis serology /HEP A,B,C screen Cervical swab /Urine for Chlamydia/Gonorrhoea High Vaginal swab for culture and sensitivity - Candida - Bacterial Vaginosis - Trichomonas Viral Transport Medium Swab – HSV Cervical Cytology if appropriate All IUDs have chlamydia screen prior to insertion

10. STI screen Male Blood HIV/Syphillis serology /HEP A,B,C screen Urethral swab /Urine for Chlamydia/Gonorrhoea Swab for culture and sensitivity - Candida -Bacterial Infection Viral Transport Medium Swab – HSV

11. Treatment STITreatment ChlamydiaAwait results >Antibiotic > Chemist If contact treat GonnorhoeaAwait results>Antibiotic> Chemist If contact treat Nonspecific UrethritisAwait results>Antibiotic>Chemist Treat symptomatically Bacterial VaginosisAwait results >Antibiotic>Chemist Treat symptomatically TrichomonasAwait results >Antibiotic>Chemist Pelvic Inflammatory DiseaseAwait results> Antibiotic regime>Chemist Referral Herpes Simplex VirusAwait results>VALTREX/Acyclovir Offer treatment symptomatically Anogenital Warts Molloscum Contangiousm Crytotherapy Weekly clinic +/- Podophyllin

12. Follow Up All patients return for results in 1 week - Helps with confidentiality - Opportunity for education - Referral - Contact Tracing

13. Test of Cure STITOCTime Chlamydia _ _ Chlamydia complicated Pregnant/ IUD insitu X 4 Weeks Gonnorhoea X 2 Weeks Trichomonas X 2 Weeks Anogenital Warts / Molloscum Contangiousm 1 Week

14. Referral QUIDE CLINIC - Syphillis - HIV - Complicated cases Dermatology Psychosexual Gynae

15. Education Safe Sex Contraception Re infection / STI transmission Alcohol/ Drug Use Hygiene General Health – diet/exercise/smoking Cervical Cytology Breast /Testicular self exam QUESTIONS

16. Contact Tracing Tricky Mostly self notification Will treat partners even if they are not registered patients Offer to contact/speak to partners on sources behalf Options Contact slips HPSC codes More resources required

17. Report Improve reporting procedures Conduct internal audit Develop coding with NVRL Health One IT system coding

18. Challenges Time to do STI screening properly Confidentiality Getting to the root of the problem Working in a family orientated practice Bumping into patients in schoolyard/supermarket Lack of resource – microscopy, drugs, health advisors etc…

19. In conclusion STI screening well worth while and valued service in the practice. More resource $$$$ needs to be made available to develop an STI service fully. Liaison with QUIDE Clinic is key. Training /updates for staff essential.