Genitourinary Guidelines

Referral

All patients seen in the ED are usually referred with the Sandyford Initiative (OOH next day advised). Advice on any GUM problem can be obtained from the Sandyford (reception direct line ext 38601, secretary 38608 or Nurse help-line on 38646 - **NB the nurse help-line number should never be given to patients as it is for professional advice only**).

There is a “first come first served” walk-in clinic (see Clinics) Mon – Fri from 08:30, to which patients can self-refer (they may need to wait the whole morning depending on how busy the clinic is; queue often begins at 8am). They should be advised not to pass urine for 2 hours prior to attendance. Out of hours advice can be obtained by telephoning the duty GUM consultant via Gartnavel switchboard.

Treatment

Condition	1st Choice	Penicillim allergy
PID	Ofloxacin 400mg bd (14d) and metronidazole 400mg bd (14d)	Doxycycline 100mg bd
PID ?gonorrhoea (gonorrhoea contact)	Refer to sandyford
Trichonomiasis	Metronidazole 400mg bd for 5 days or 2g single dose (C/I pregnancy)
Candidiasis	Clotrimazole 500mg pessary stat
Chlamydia or NGU (uncomplicated)	azithromycin 1 g orally stat	Doxycycline 100mg bd x 7 days
Genital herpes	Aciclovir 200mg orally 5 times daily for 5 days Treat immediately. Don’t attempt vaginal or preputial examination if primary attack. Consider syphilis if ulcer.

Emergency Contraception is usually prescribed and administered by ENPs according to protocols. It is also now available from pharmacies.

Additional Information

HIV Testing

Consider offering and recommending an HIV test if the clinical presentation suggests. This is especially important when the patient may have an unacknowledged but identifiable risk, or have symptoms or signs of HIV infection. As well as non-specific symptoms such as malaise and weight loss, patients with HIV may present across a range of clinical conditions, see website for full advice (section 6+8).

The Archway Project is available for rape situations. Please see website for full details.

Referral

Treatment

Additional Information

Editorial Information