Tag: reproduction

Sexual and Reproductive Health – STI Referral

Scott McLaughlin

Sexual & Reproductive Health

The departments of Sexual & Reproductive Health (formerly known as Family Planning) and Genitourinary Medicine merged in 2008 and are now known as the department of Sexual Health.

The administrative base is at Glenalmond House, Coathill Hospital, Coatbridge ML5 4DN and there are clinics every day across Lanarkshire. Most clinics are combined clinics and patients can be see and managed in a single clinic with both Genitourinary Medicine and contraceptive consultations.

There are still a few traditional Family Planning/Sexual & Reproductive Health clinics dealing with contraception mainly.

There is a dedicated appointment line which patients or GPs can refer into: 0845 618 7191.
This is open 9am – 4.45pm Monday to Friday.

There is a sexual health link on FirstPort under clinical service. This has links to protocols etc. Link to come

There is also a public website, Lanarkshire Sexual Health, which has up to date information on all clinics and on contraception and sexual transmitted infections.

Notes

Symptoms suggestive of an acute sexually transmitted infection (STI) (urgent)
We aim to offer an appointment within 48 hours to all clients who have symptoms suggestive of an acute STI eg genital ulcers, new onset vaginal discharge, urethral discharge, pelvic pain, testicular pain. However, we may not be able to offer them an appointment in their local clinic within this time frame.
It may be quicker for the patient to call the appointment line themselves: 0845 618 7191

For treatment if already diagnosed with acute STI: (urgent)
The following link takes you to a list of the recommended treatments (assuming no contraindications.) Please see protocol available on FirstPort for further guidance.
List of the recommended treatments

Sexual contact with someone who as Chlamydia, Gonorrhoea, Syphilis, Trichomoniasis, Epididymo-orchitis or PID (urgent)

Sexual contact with someone who has HIV (urgent)
If exposure has occurred less than 72 hours, please refer urgently to A&E or d/w Infectious Disease Consultant On-call as patient may be eligible for Post Exposure Prophylaxis After Sexual Exposure (PEPSE)
The window period for HIV is 3 months but many HIV infections show up by 4 weeks post exposure. Initial blood test can be done at that time.

Sexual Assault (urgent)

Women or men who make an allegation of sexual assault within the last seven days should be encouraged to self refer to Archway: Telephone: 0141-211-8175
The forensic examination can be carried out whether or not the woman or man wishes police involvement.
If the assault took place more than 7 days ago, the patient can be seen within sexual health for STI screening, Hepatitis B vaccination and further management.
We do NOT offer forensic examination.

Genital warts (routine)

If appropriate, please prescribe topical treatments in the first instance. Only cryotherapy can be used in pregnancy. If Podophyllotoxin has been ineffective after 4 weeks of use, please advise patients to attend a sexual health clinic. If Imiquimod has been ineffective after 4 weeks of use please ask patient to attend a sexual health clinic. However, if Imiquimod has started to take effect further treatments can be prescribed (maximum of 16 weeks in total).
It is good practise to offer an STI screen to all patients attending with genital warts.

Recurrent genital herpes (routine)

A HSV positive swab is required to confirm diagnosis prior to initiation of antiviral prophylaxis.
Suppressive antivirals are usually started in patients who have greater than 6 outbreaks of HSV/ per year.

Asymptomatic testing for STIs (routine)

This can usually be offered within Primary Care. For a male, a First void urine (after having not passed urine within the past hour) into a white topped universal container can be sent for Chlamydia and Gonorrhoea testing.
For females, a self obtained low vaginal swab (patient inserts swab 5cm into the vaginal and rotates for 15 seconds before placing it into container) can be sent for Chlamydia and gonorrhoea testing. Urine is not a good method of testing for these infections in women.
Blood samples can be sent in two yellow top tubes to microbiology for HIV and Syphilis testing.

Blood Borne Virus testing – Hepatitis B, C and HIV (routine)

This can usually be offered within Primary Care by sending 3 blood samples in yellow top tubes to microbiology.

Hepatitis B Immunisation (may need urgent referral depending on reason for referral)

We offer Hepatitis B Immunisation for the following groups :

  • Sexual assault within past 6 weeks
  • Post or pre sexual contact with someone who has Hepatitis B
  • Men who have sex with Men
  • Sex workers
  • Clients who have regular contact with sex workers
  • IVDU
  • Partners of IVDUs
  • Clients with multiple partners

We do not offer hepatitis B immunisation for travel purposes.

Sexual and Reproductive Health – Contraception

Scott McLaughlin

Sexual & Reproductive Health

The departments of Sexual & Reproductive Health (formerly known as Family Planning) and Genitourinary Medicine merged in 2008 and are now known as the department of Sexual Health.

The administrative base is at Glenalmond House, Coathill Hospital, Coatbridge ML5 4DN and there are clinics every day across Lanarkshire. Most clinics are combined clinics and patients can be see and managed in a single clinic with both Genitourinary Medicine and contraceptive consultations.

There are still a few traditional Family Planning/Sexual & Reproductive Health clinics dealing with contraception mainly.

There is a dedicated appointment line which patients or GPs can refer into: 0845 618 7191.
This is open 9am – 4.45pm Monday to Friday.

There is a sexual health link on FirstPort under clinical service. This has links to West of Scotland Protocols

There is also a public website, Lanarkshire Sexual Health, which has up to date information on all clinics and on contraception and sexual transmitted infections.

Contraception Referral Notes:

Chlamydia testing in women requesting Intrauterine Contraception

It is good practice to perform a Chlamydia test prior to fitting an Intrauterine Device in women under the age of 25 years and women over 25 years old with a new sexual partner in the past year or more than 1 partner in the last year or if their regular partner has other partners. A self obtained vulval vaginal swab for Chlamydia should be taken prior to referral. If this is not done, this will be done at the time of fitting of the device, however, it may be that the fitting of the device is deferred if the women has symptoms etc.

Additional Information

Patients who request an intrauterine system (IUS) for Gynaecological reasons and are not requiring contraception, should be referred to Gynaecology.

Patients on Nexplanon commonly get nuisance bleeding patterns. Patients with no contra-indications to the combined pill may use Combined Oral Contraceptive (COC) for up to three months while they have the Nexplanon in-situ, provided they have a pregnancy test which is negative. This is an off label use of the COC but is recommended by the Clinical Effectiveness Unit (CEU) of the Faculty of Sexual & Reproductive Health (FSRH).

The following priority conditions are not suitable for SCI Referral and women should self-refer via the Appointment Line: 0845 618 7191

Emergency Contraception

Women requiring emergency contraception can be prescribed Levonelle which is free in many community pharmacies in NHSL. Women presenting after 72 hours or more i.e. 72 hours since unprotected sexual intercourse can use oral emergency hormonal contraception called EllaOne. This works up to 120 hours after unprotected sex. EllaOne is available in the sexual health services or on prescription via the GP. As EllaOne is four times the price of Levonelle, it is only used between 72 – 120 hours after the unprotected sex. EllaOne can be used in young (under 16’s) vulnerable chaotic clients who are mid cycle and who do not wish an Intrauterine Device (IUD).

Women who wish the most effective method of emergency contraception need counselled re-fitting of an Intrauterine Device (IUD) as this is 99% effective in preventing pregnancy. An IUD can be fitted up to five days after unprotected sexual intercourse or up to five days after the earliest possible ovulation (i.e. up to day 19 on a 28 day cycle).

The Protocol for Emergency Hormonal Contraception is available on West of Scotland Protocols website, where you can also view the Emergency Hormonal Contraception protocol.

Termination of Pregnancy

Women who require a termination of pregnancy can be referred to the Sexual Health Service where the GP does not offer referral to women’s health unit. They will be seen within 48 hours if they ask for an emergency appointment.

Recent Sexual Assault (within last 7 days)

Women or men who make an allegation of sexual assault within the last seven days should be encouraged to self refer to Archway:

Telephone: 0141-211-8175

The forensic examination can be carried out whether or not the woman or man wishes police involvement.