Update on Sexual Health

Dr Jillian PritchardConsultant 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