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NHS Borders STI Management Protocol Version 5

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NHS Borders STI Management Protocol Version 5 NHS Borders STI Management Protocol Version 5 www.borderssexualhealth.org.uk July 2011 Contents Page No. What’s new in Version 5 4 1. Borders Sexual Health Clinics – sites and times 5 STI Screening – Flowchart 1 9 2. Patient Assessment 10 3. Testing for Sexually Transmitted Infections 11 How to take samples 14 4. Investigation and Management of Common Presenting Complaints 15 4.1: Vaginal Discharge- assessment 15 Vulvovaginal Candidiasis 16 Recurrent Vulvovaginal Candidiasis 17 Bacterial Vaginosis 18 Management of Discharge in Female Patients - Flowchart 2 19 Recurrent Bacterial Vaginosis 20 Trichomonas Vaginalis Infection 20 Gonococcal Cervicitis/Urethritis (see section 4) 21 Chlamydial Cervicitis (see section 4) 21 Non-infective Causes of Vaginal Discharge 21 4.2: Urethral Discharge (Males) - assessment 22 Non Gonococcal Urethritis 23 Chlamydial Urethritis 24 Gonococcal Urethritis 24 Recurrent and Persistent NSU 25 4.3: Genital Ulceration- assessment 26 Initial Episode Herpes Simplex Virus Infection 27 Recurrence of Genital Herpes 29 Frequent Recurrences of Genital Herpes 29 Genital Ulceration of Unknown cause 29 4.4: Genital warts and Other Lumps or Spots: 30 Genital Warts 31 Molluscum Contagiosum 33 Folliculitis 33 4.5: Itch 34 Common Diagnoses 34 Phthiriasis Pubis (pubic lice) 34 Scabies 34 Pruritus Ani 35 2 4.6: Pelvic Pain 36 Females: Pelvic Inflammatory Disease PID) 36 Males : Acute Bacterial Prostatitis 39 Chronic Bacterial Prostatitis 39 Chronic Pelvic Pain Syndrome 40 4.7: Epididymitis/Epididymo-orchitis 41 5. Sexually Transmitted Infections 42 5.1: Chlamydia 42 5.2: Gonorrhoea 44 6. Hepatitis 46 Hepatitis A 46 Hepatitis B 46 Hepatitis C 48 6. Post-exposure prophylaxis for sexual exposure to BBV (PEPSE) 50 7. Pelvic Pain : Patient Information Leaflet 52 3 What’s new in Version 5? Version 4 was released in January 2009. Since then: Nucleic acid testing for gonorrhoea was introduced in the Borders. Tests for gonorrhoea can be performed on urine (men) and self-taken vulvovaginal swabs (women) .A GP STI Testing Kit is available and specimens should be sent along with the form accompanying the kit. Routine STI screening in asymptomatic women no longer requires a high vaginal swab. (this was intended to test for Trichomonas vaginalis, which is very rare in asymptomatic women in Scotland). Performing an STI screen in general practice is now much simpler. In line with national and local moves to increase HIV testing to reduced the 30% of HIV infections that remain undiagnosed, we now recommend that all STI screens include tests for chlamydia, gonorrhoea, syphilis and HIV. See notes on Diagnostic HIV Testing page 53 Gonorrhoea treatment has changed in line with national guidance to Ceftriaxone 500mg single dose by intramuscular injection, because of evidence of reduced sensitivity to Cefixime. This reinforces our recommendation that cases of gonorrhoea should be referred to sexual health services for treatment. For treatment of occasional recurrences of genital herpes, the preferred dose and schedule recommended is Aciclovir 800mg three times daily for 2 days. This option uses 12 x 400mg tablets per course and patients can be supplied with 56 tablets at an NHS cost of around £7.00. This provides enough treatment for 4 recurrences. A new flowchart and guidance on the use of PEPSE (post exposure prophylaxis for sexual exposure for HIV), has been developed n line with national guidance. The Borders Chlamydia Protocol, incorporated in this document has been abbreviated pending a forthcoming report on Chlamydia testing by an Expert Group convened by the Chief Medical Officer. A full revised protocol will be produced separately. 4 Frequency and staffing of BSHS clinics at March 2011 Location Description Frequency Staffing Galashiels Family Planning Mon 6-7.30pm FP Nurse Health Centre Clinic Receptionist Family Planning Alt Thursday 11am- Assoc Specialist Clinic 1pm 1 FP nurse 1 Receptionist Thurs 6-7.30pm Staff Grade 1 FP Nurses Receptionist Referral Clinic Wed 9.30 -12.00 Assoc Spec (alternate weeks Receptionist/ Auxiliary with Hawick) Implant Clinic Tues 9-12.30am Nurse Specialist Thursday 6-7.30pm Nurse Specialist Drop-in Thurs 11am-1pm CNS Fri 2.30-4.30pm Receptionist/Auxiliary GUM Clinic Tues 9am-1pm Consultant (+HIV Clinic Fri 9am-1pm C NS monthly) Health Adviser Receptionist/Auxiliary Hawick Family Planning Mon 6-7.30pm Staff Grade/AS alt Community Clinic weeks Hospital FP Nurse Receptionist Implant Clinic Mon 6-7.30 (Alt Nurse Specialist Weeks) Joint Community Weds 9.30-12.00am Consultant Gynae/Sexual (ALT)Gynaecologist Health Drop-in CNS Auxiliary Referral Clinic Wed 9.30 -12.00 Assoc Spec (alternate weeks Receptionist/ Auxiliary with Galashiels) Duns Family Planning Alt Thurs 4-5.30 Staff Grade - Knoll Health Clinic FP Nurse Centre Receptionist Drop-in Alt Fri 2.30-4.30 CNS Peebles Family Planning 2nd and 4th Wed of Staff Grade - Hay Lodge Health Clinic the month 6.00-7.30 2 FP Nurses Centre Receptionist Drop-in Alt Mon 2.45- CNS 4.45pm Eyemouth Drop-in Alt Fri 2.30-4.30pm CNS – Health Centre CNS – Community Nurse Specialist For full details on opening times and to make appointments phone 01896 663700. Our website www.borderssexualhealth.org.uk contains a range of information including a Service Directory, detailing what is available at each clinic. 5 Services : All clinics welcome men and women of all ages. All clinics offer emergency contraception (the ‘morning after’ pill), male and female condoms, oral contraception, Implant insertion, injectable contraception, testing and treatment for STIs and advice on sexual health for men and women. All clinics provide pregnancy tests, advice on termination (abortion) and if required, referral for termination of pregnancy. You can come to any of our clinics for these things. All clinics provide services for Lesbian women, Gay and bisexual men and transgender men and women Most clinics offer additional services: Drop-in Clinics All the above services plus testing and treatment for a range of STIs, advice on contraception, HIV and syphilis blood tests. You don’t need an appointment for drop-in clinics. Family Planning Clinics Advice on contraception, prescriptions for the oral contraceptive pill, injectable contraception (the Depo), the diaphragm (cap) and natural methods. Male and female condoms, testing for STIs and advice on sexual health for men and women. Most clinics also offer the IUCD (coil) and Implantable contraception (Implanon) by appointment. HIV Clinic HIV Clinics are held on the first Tuesday of every month, although patients are seen in other GUM clinics as required. Borders Sexual Health GUM Clinic Where is it? The specialist GUM Clinic is at Galashiels Health Centre, Currie Road, Galashiels. All other sexual health clinics and drop-ins offer STI testing and treatment, but for GP referrals requiring medical review, please refer to the Galashiels clinic. How do you contact the clinic? Phone 01896 663700 for patient appointments and to contact consultant or sexual health adviser for advice. Advice for GPs The GUM consultant (Dan Clutterbuck) can be contacted on 01896 663700, or through RIE switchboard on 0131 536 1000. Consultant advice is available by phone 5 days per week. In case of difficulty advice is also available from the GUM consultant on-call in Edinburgh through RIE switchboard 0131 536 1000. Email for advice on: [email protected] 6 Out of hours advice is available from the Registrar on call for ID/GUM in Edinburgh through LUHT switchboard on 0131 536 1000. Community Nurse Specialists in Sexual Health can give advice or help with specific cases, such as contacts of infection in the community. They are also able to supply chlamydia postal testing kits (PTKs), STI testing kits and training on STI and sexual health management. Borders South & East: Gillian Forbes - [email protected] Borders Central/Western : Suzanne Balfour – [email protected] Borders General Hospital & Borders: Gillian Elliot – [email protected] Postal Testing Kits & Borders: Lou Graham – [email protected] Telephone advice for patients Phone 01896 663700 for appointments or other enquiries. Advice calls are directed to the doctor or health adviser. To make an appointment By letter: Referrals by letter from a GP will be offered an outpatient appointment: the waiting time is 2 weeks or less. Urgent cases can be seen in the next clinic if necessary - please phone if required. By phone: Phone 01896 663700. GPs can phone on a patient’s behalf, but anyone can phone and arrange an appointment for themselves How do you get seen? By appointment: see above The walk-in clinic. Patients with symptoms or who feel that the problem is urgent and can’t wait may attend the clinic between 9.00 and 10.00 on Tuesdays and Fridays. We guarantee to see all attendees at this clinic. Patients with appointments will be given priority, so those attending the urgent problem clinic may have to wait and the consultation may be brief if the clinic is busy. HIV care. We currently care for 28 people with HIV infection. New referrals can be made by letter or by telephone. The first Tuesday of each month is a dedicated HIV clinic. We also provide HIV support through drop-in clinics and home visits by arrangement. 7 Family planning clinics. All family planning clinics offer testing and treatment for chlamydia and advice on other STIs. This may be an option for patients unwilling to attend the GUM clinic. Drop-in Clinics. Drop-in clinics are aimed at (but not restricted to) young people under 25. The clinics are nurse led and deal with common STIs and contraceptive prescriptions. Treatments are dispensed through PGD. All Drop Ins provide: o Chlamydia testing o Syphilis testing o HIV testing o Contact tracing o Treatment for Chlamydia o Treatment for Gonorrhoea o Treatment for Herpes o Treatment for Genital warts o Pregnancy testing o Condom distribution o Family planning advice Communication Letters to GPs We routinely send letters on patients referred by their GP.
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