An introduction to sexual health screening for Health Care Assistants

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. Chlamydia5.6% of 15-24 year olds who had a test in TH in 2012 were positive Men Women 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 • >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

9. Gonorrhoea230 per 100,000 population diagnosed with GC in TH in 2012 Men Women 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 • 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

10. Syphilis26 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 B1.4% 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. HIVIn 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. 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