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

2. 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

3. 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

4. Condoms fail Humans fail

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

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

7. 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”

8. Syphilis -WHO Global prevalence and incidence of selected curable STIs www.who.int/docstore/hiv/GRSTI/000.htm

9. Gonorrhoea in Sweden www.who.int/docstore/hiv/GRSTI/000.htm Steady decline to 1996 17% rise in 1997 Upward trend in 1998

10. Chlamydia prevalence in asymptomatic women 1990’s WHO - Global prevalence and incidence of selected curable STIs www.who.int/docstore/hiv/GRSTI/000.htm

11. Chlamydia in EC users H Kettle et al, Contraception, 66 (2002) Age<2020-2425-29>30 No tested79197187139 % 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)

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

13. Practical considerations Size of problem Education Signposting Testing Treatment Partners

14. 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

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

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