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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