Meeting Demand for Comprehensive Sexual Health Needs: the Experience within a Primary Care Setting in the UK.

1. Meeting Demand for Comprehensive Sexual Health Needs: the Experience within a Primary Care Setting in the UK. Dr Deborah Lee MFFP MRCGP DRCOG Dip GUM Associate Specialist in Reproductive Health, The Alma Clinic, Winton Health Centre, Bournemouth, UK. May 2006

2. Introduction We are in the midst of an STI crisis in the United Kingdom1 Until recently, testing for Sexually Transmitted Infections (STI�s), and Contraceptive Services, have been provided at separate clinic sites. The National Strategy for Sexual Health & HIV1 has highlighted the importance of comprehensive and integrated sexual health services. Aimed to pilot �One stop shops� To evaluate the role of GP�s and Primary Care Teams with a special interest in sexual health 1. Better prevention, better services, better sexual health - The national strategy for sexual health and HIV. Department of Health 2001

3. Why a �One Stop� Service? Both contraceptive and STI related sexual health needs, may be identified and addressed in one single consultation. This may reduce long-term poor sexual health outcomes. �One Stop� models of care have been endorsed by the Independent Advisory Group (IAG) on Sexual Health and HIV. 2 Published outcomes of other combined sexual health clinics are highly relevant. 2. Response to Health Select Committee Report on Sexual Health & HIV. Independent Sexual Health Advisory Group on Sexual Health and HIV (IAG). January 2004.

4. Setting We took an established Family Planning Clinic (Winton Family Planning Clinic), located within General Practice premises, in Bournemouth, a large south coastal town, and introduced the availability of full STI screening: The Alma Clinic.

5. The Alma Clinic STI appointment Confidentiality Patients registered and have separate clinic notes Appointment only/emergency access Mondays, Tuesday evenings, Fridays, and first and last Saturday morning of the month New patients 30 minutes, follow up 10 minutes Follow recommendations for testing for STI in a Primary Care Setting (BASHH 2005)3 Full sexual history taking & risk assessment Standard clinic proforma Patient satisfaction surveyed separately with a highly favourable outcome. 3. Sexually Transmitted Infections: Screening & Testing Guidelines draft 2005. British Association of Sexual Health & HIV (BASHH)

6. The Alma Clinic STI screen NAAT testing for chlamydia and gonorrhoea One endocervical swab/first pass urine, tests for the presence of both infections BD Tech probe kit: sensitivity endocervical swab for chlamydia/gonorrhoea is 97.6%, specificity 98-100% If NAAT test positive for gonorrhoea, patient treated and referred to GUM for culture and sensitivity We swab all separate sites of sexual contact No microscopy High Vaginal Swab (HVS) for bacterial vaginosis (BV), candida & trichomonas vaginalis (TV), pH paper Laboratory Standard Operating Procedure: HVS: gram stained for microscopy, plus culture (Sabaraud�s medium) for candida, and specific culture for TV Serology; hepatitis B & C, syphilis and HIV Viral culture medium for herpes simplex (HSV)

7. The Alma Clinic: combined services offered �one stop� approach GUM services STI assessment, testing & treatment for males and females Positive STIs managed in line with BASHH recommendations Work in liaison with local GUM department Health Advisor: Contact tracing/contact slips Diagnosis and treatment of genital warts Cryotherapy/Podophyllotoxin home treatments eg Warticon Diagnose and treat Pelvic Inflammatory Disease Free condoms: Sexual health advice Hepatitis B imminusation Contraceptive services All currently available forms of contraception �LARC� methods IUD/IUS/Implants Emergency contraception Pregnancy testing & referral Counselling & referral for sterilisation (A vasectomy service operates in-house) Counselling & referral for unplanned pregnancy (including Early Medical Abortion (EMA) run by the local Family Planning Service) Cervical cytology