General Practice STI protocol

What to consider:
Whether the patient is symptomatic
What is the risk of STI (whether symptomatic or not)
Whether testing in general practice is appropriate
If so, what tests you are able to do in general practice

Background:

• Asymptomatic STIs are so common that lack of symptoms is not a reliable indicator of the likelihood of an STI. A sexual history is important – particularly in the assessment of risk factors.
• All the tests we routinely use in the clinic can be used in the community.
• A routine STI screen should include tests for chlamydia, gonorrhoea, syphilis and HIV
• In low risk individuals it may be appropriate not to test, or if under 20 to test for chlamydia (and  gonorrhoea) alone
• Tests for Hepatitis B and Hepatitis C may be indicated in those with risk factors.

New patients:
• History:
  ∗ Assess symptoms:

• Symptom algorithms for the commoner presentations
• Take a full sexual history including date of last sexual intercourse, geographical location of contact, casual or regular partner, partner’s gender, nationality and details of condom use and nature of sexual activity.
• Ask about other partners in the last 3 months as well as sex outside the UK.
• Check previous STIs including hepatitis and hepatitis B status in those at risk

Examination

• Men: external genitalia including inspection under the foreskin and of the urethral meatus
• Women: presence of genital ulceration, appearance of any discharge, cervical inflammation or discharge, pain on bimanual examination

Procedure

• take a sexual history
• assess level of risk
• explain the tests involved
• informed consent for testing
• complete testing form
• explain consent for partner notification
• perform tests
• make arrangements for receiving result

Options

• Refer to BSHS
• obtain an STI screen in the community

Routine testing for STIs in men*:

Routine testing for STIs in women*:

Basic STI risk assessment

High risk factors: sex abroad, multiple partners, sex with partners from abroad, MSM (men who have sex with men), previous STI.

Moderate risk factors: new partner in last year, more than one partner in last year, under 25, high risk but consistent condom use, partners elsewhere in UK.

Low risk factors: same partner>1 year, over 25, no partner, WSW, moderate risk but all partners from Borders.

Blood Tests

HIV and syphilis testing is regarded as part of routine screening for STIs.

Tests for Hepatitis B are indicated in men-who-have-sex-with-men, those from endemic areas (including but not exclusively Asia, Southern Africa), sex workers and those using or partners of those using intravenous drugs. Request HepBcAb (Hepatitis B core antibody) and HepBsAg (Hepatitis B surface antigen). If a client reports previously having been vaccinated, request HepBsAb (Hepatitis B surface antibody) to assess response to vaccine only if high risk ongoing or uncertainty about completion of vaccination course.

Hepatitis C is very rarely transmitted through sexual contact. Regular partners of those with Hepatitis C infection should be tested.

For advice and support, contact us:

Main line:   01896 663700
Direct line: 01896 663703

or email:

Generic mailbox - sexual.health2@borders.scot.nhs.uk

Our Specialist Services include:

• Testing and treatment of sexually transmitted infections including chlamydia, gonorrhoea, syphilis, HIV and Hepatitis B & C
• Self-testing kits for chlamydia and gonorrhoea
• Advice on a range of contraceptive options, including long-acting contraception (LARC)
• Long-acting contraception – IUD and IUS, implants and injectable contraception
• Pregnancy tests and advice on termination of pregnancy. If required, referral for TOP
• Emergency contraception (the ‘morning after’ pill or IUD)
• PrEP (pre-exposure for HIV) and PEPSE (post-exposure prophylaxis)
• HIV care
• Vaccination for Hepatitis B and HPV

Please note we no longer offer a drop-in service. Instead, we have introduced telephone advice clinics and self-testing kits.

All welcome, regardless of age, sexuality, gender, and ethnicity. 

Referrals:
For specialist advice, please refer by letter or:

Contact us:
Main line - 01896 663700
Direct line - 01896 663703
Email: Sexual.Health2@borders.scot.nhs.uk

Sexual assault – contact BSH as above
Psychosexual problems – refer to Relationships Scotland.
Menopause – we do not have a menopause specialist in our service.

Where we are:
The Clinics are in Galashiels Health Centre, Currie Road, Galashiels.
We also have peripheral clinics in Hawick, Peebles, Duns and Eyemouth.
The following link has more information on our clinics: BSH clinics

Who we are:

Clinical Lead                                 Dr Maria Fowler
Consultant GU                              Dr Sally Wielding
Consultant HIV                             Dr James Taylor
Specialty Doctor                           Dr Ewan Barrack
Lead Nurse Specialist                    Michelle Robinson
Nurse Specialist BSH/GBV              Leila Dunn
Nurse Specialist BSH/TOP              Dawn Watson
Nurse Specialist BSH/TOP              Lynne Sloan
Receptionist/HCSW                       Lorna Young
Receptionist/HCSW                       Cheryl Lamb
Business & Admin Manager            Debbie White

In case of difficulty, advice is also available from the GUM senior at the Chalmers Centre medical hub 0131 5361 585

Out of hours advice is available from the Registrar on call for ID/GUM in Edinburgh through LUHT switchboard on 0131 536 1000

Communication
Letters to GPs

We send letters for the following (with the patient’s consent):

• GP referrals by letter
• Patients diagnosed with conditions with long term implications, genital skin conditions or those requiring long term treatment.
• LARC procedures
• Contraception new starts
• HIV care
• Complicated STIs

Occasionally patients who have been referred by letter do not want us to write back to their GP.

We take between two weeks and a month to produce letters. If you need information on a patient’s visit before then, please phone or email.

We use standard letters in most cases. If you require further information, please get in touch.