1. Sexually Transmitted Infections: UK National Screening and Testing Guidelines BASHH Guidelines 2006 Dr Olwen Williams

3. Aim of guideline To improve access to testing/screening for STIs by tailoring investigations to patients needs www.bashh.org

5. Scenarios Asymptomatic low risk non-invasive tests Symptomatic high risk microscopy

6. Asymptomatic to have no symptoms exclude contacts? excludes patients with warts? Who decides who’s asymptomatic ? the patient the receptionist the triage nurse the doctor

7. Definition ‘asymptomatic’ Women Does not complain of a vaginal discharge No abnormal vaginal discharge on examination Men Does not complain of a urethral discharge No urethral discharge on examination

8. All patients need risk assessment STI HIV Contraception Intervention strategy Partner notification

9. Asymptomatic Heterosexual Men Site or specimen GCChlamydiaNSUSyphilisHIV UrethraCultureNAATNR RectumNR OropharynxNR UrineNAAT NR BloodNR STSEIA NR: Not recommended NR

10. Asymptomatic MSM Site or specimen GCChlamydi a NSUSyphilisHIV UrethraCultureNAATNR RectumCultureNR OropharynxCultureNR UrineNAAT NR BloodNR STSEIA NR: Not recommended NR

11. Asymptomatic Women Site or specimen GCChlamydiaSyphilisHIV UrethraNR CervixCultureNAATNR VaginaNRNAATNR RectumNR OropharynxNR UrineNRNAATNR BloodNR STSEIA NR: Not recommended

12. What does this mean? Women No HVS URINE TESTING FOR ALL ??????? Men No microscopy on urethral swab

14. Microscopy Essential for diagnosis NSU in men Bacterial vaginosis Trichomoniasis Early diagnosis Gonorrhoea Immediate results

15. Who should do the microscopy? Experienced trained Biomedical scientist doctor nurse nursing assistant Cost microscope training of microscopist Consumables Time - 4min / slide

16. The way forward All sexual health clinics in Wales to adopt BASHH guideline Care pathways between CASH and GUM services for the symptomatic, the high risk and those patients requiring microscopy Press for access to NAAT technology (GC & CT) suitable for urine testing