1. An introduction to sexual health screening for Health Care Assistants
Dr Jane Hutchinson
&
Laura Greaves
13th March 2014

2. Learning objectives
Know the key facts about the common STIs including symptoms, treatment & local prevalence rates
Know what tests to use & how to take them to screen for common STIs in asymptomatic patients
Understand delegation & legal responsibilities as it affects Health Care Assistants in the primary care setting
Know the components of assessing Fraser competency
Understand why screening for STIs is important
Develop some strategies to manage patients who opt out of testing

3. The Sexual Health enhanced service contract
Some key aims of this contract are to:
reduce rates of STIs among people of all ages in TH by increasing rates of diagnosis & treatment
reduce spread of STIs
Your network or practice earns:
£15 for every Chlamydia & Gonorrhoea test you take
£10 for a blood test which screens for some or all of Syphilis, Hepatitis B & HIV
Many of you will be offering these tests as part of the new patient check
Remember to enter the patient onto the Sexual Health Template to ensure payment is received

4. Ice Breaker
Laura Greaves

5. Delegation & legal responsibility
Vicky Souster

6. Key facts about 5 important STIs
Jane Hutchinson & Laura Greaves

7. Key facts about common STIs
Chlamydia
Gonorrhoea
Syphilis
Hepatitis B
HIV

8. Chlamydia 5.6% of 15-24 year olds who had a test in TH in 2012 were positive
Men
Women
>50% asymptomatic
Symptoms
Urethral discharge
Dysuria
Testicular pain
Complications
Epididymo-orchitis
Incubation period is 2 weeks
NAATs test on first void urine after holding urine for 30 mins
Treat with azithromycin or doxycycline
70% asymptomatic
Symptoms
Vaginal discharge
Lower abdominal pain
Abnormal vaginal bleeding
Complications
Chronic pelvic pain
Pelvic Inflammatory Disease
Infertility
Ectopic pregnancy
Incubation period is 2 weeks
NAATs test on self taken vulvo-vaginal swab
Treat with azithromycin or doxycycline

9. Gonorrhoea 230 per 100,000 population diagnosed with GC in TH in 2012
Men
Women
80% urethral discharge
Symptoms
Dysuria
Testicular pain
Complications
Epididymo-orchitis
Incubation period is 2 weeks
NAATs test on first void urine after holding urine for 30 mins
Treat with ceftriaxone injection plus oral azithromycin
50% asymptomatic
Symptoms
Vaginal discharge
Abnormal vaginal bleeding
Lower abdominal pain
Complications
Pelvic Inflammatory Disease
Bartholin’s abscess
Incubation period is 2 weeks
NAATs test on self taken vulvo vaginal swab
Treat with ceftriaxone injection plus oral azithromycin

10. Syphilis 26 per 100,000 population diagnosed with syphilis in TH in 2012
Symptoms
Primary: genital ulcer
Secondary: rash
Latent: none
Tertiary: affects heart, brain & soft tissues
Complications
Multiple affecting any part of the body
Diagnosis
Blood test
Treatment
Penicillin injections or oral doxycycline

11. Hepatitis B 1.4% of 1975 people of south Asian origin tested in East London diagnosed with chronic infection
Can have acute or chronic infection
Symptoms & complications
Acute infection:
jaundice, pain over liver; vomiting; sometimes no symptoms
most people make full recovery and become immune
Some develop Chronic infection:
can lead to cirrhosis and liver cancer
Diagnosis
Blood test
Treatment:
chronic infection can be treated with anti-virals

12. HIV In TH 6 people in every 1000 population aged 15-59 have HIV infection
Symptoms & complications:
Primary infection – 60% have flu like illness
Then asymptomatic for months or years
As immune system damaged by HIV, person starts to develop health problems which can affect any part of the body including rashes, chronic diarrhoea, infections & tumours
Treatment
antiretrovirals
Diagnosis
Blood test

13. Fraser Competency
Dr Salma Ahmed

14. Screening for STIs in the new patient check
Jane Hutchinson

15. Screening for STIs in the new patient check
How many of you are involved in doing this?
How are patients informed that they will be offered STI screening?
What responses do you get from patients to the offer of STI screening?
How do you manage these responses?
What might you say to a patient who opts out of testing?
Why do we recommend STI screening for everyone in Tower Hamlets?
What else can you do to encourage patients to accept testing?

16. Suggestions of things you could say to patients who opt out of sexual health screening
There are high rates of STIs in TH and many people have them without knowing that they do
Many people with infections don’t know they have them because they don’t have symptoms (eg Chlamydia: >50% males & >70% females are asymptomatic)
Some STIs can be cured and others can be controlled by having appropriate treatment

17. Did you know there are health benefits of knowing you have an STI?
Suggestions of things you could say to patients who opt out of sexual health screening
These are routine tests which we offer to everyone who has ever been sexually active
Did you know there are health benefits of knowing you have an STI?
You can access treatment for yourself
You can prevent yourself developing complications of the infection
You can reduce the chances of transmitting the infection to someone else

18. Case scenarios
Dr Jane Hutchinson

19. Case 1
39 year old white woman who works as a solicitor registers with your practice
She declines sexual health screening at new patient check
2 years later she develops liver problems and is found to have chronic Hepatitis B infection
On further questioning she states that she briefly injected drugs in her late teens

20. Case 2
30 year old married British-born Bengali man registers with practice
His wife is already registered
She is also Bengali
They have been married for 3 years & are trying to have a baby
At NPC he declines sexual health testing

21. Case 2
One year later his wife attends booking visit at ante-natal clinic
She is tested for HIV along with other routine bloods
Her HIV test comes back positive
She cannot identify any risk factors in her own past; her husband is her only sexual partner

22. Case 2
She attends local HIV clinic and is started on HIV treatment to prevent her passing the virus to her baby
Partner notification is discussed with her
She has already told her husband and he is refusing to have a test
Health advisor at HIV clinic talks to her husband and he accepts testing
His HIV test is also positive
After further discussion with the Health Advisor he admits to having sex with men on occasions

23. Case 3
Craig who is 17 years old attends for his new patient check with his dad.
His dad refuses STI screening on his behalf stating that it is not necessary because he doesn’t have a girl friend

24. Case 3
6 weeks later his 16 year old girlfriend, Penny, attends the practice with lower abdominal pain and is diagnosed with Pelvic inflammatory disease
Her chlamydia test is positive
The GP discusses partner notification with her and she discloses that her boyfriend is Craig
He attends for screening and is also found to have Chlamydia