Robert Irwin, BA (Hons), MSc, RN.
Senior Charge Nurse, HIV and Sexual Health Team, Kennet and North Wiltshire Primary Care Trust, Chippenham, WiltshireThis is a two-part series comprising: - May 2003: Reducing the transmission of STIs. - July 2003: Treatments and screening for STIs and problems for health-care staff.
This is a two-part series comprising: - May 2003: Reducing the transmission of STIs. - July 2003: Treatments and screening for STIs and problems for health-care staff.
The information required to assess a patient's risk of STIs is listed in Box 1. For those presenting with urogenital symptoms suggestive of an STI - or conditions that may be associated with STIs such as pelvic pain (pelvic inflammatory disease), unilateral testicular pain (epididymitis) or joint pain (Reiter's syndrome or sexually acquired reactive arthritis) - such an assessment can provide information that will assist diagnosis and enable management to be adjusted according to the probability of symptoms being caused by an STI.
While the health benefits associated with early detection and treatment of STI are considerable, the costs of screening in terms of adverse effects on a patient's well-being are less easily quantifiable (Duncan and Hart, 1999). Reaction to such a diagnosis may range from a sense of inconvenience to extreme distress. Green (2002) suggests that high levels of anxiety are common. The level of distress experienced by an individual will be influenced by a number of factors including:
The diagnosis of an STI/STIs can cause considerable distress, and the listening and supportive skills of practitioners are crucial (Nelson, 1999; Irwin, 2002). For patients with bacterial STIs, compliance with treatment may be improved if there is a positive professional relationship between practitioner and patient. It is essential that patients undergoing treatment for conditions such as chlamydia, gonorrhoea, non-specific urethritis, Trichomonas vaginalis and syphilis are provided with clear verbal and written information on their management.
Partner notification is the process of contacting the sexual partners of patients diagnosed with an STI, and advising them to attend for screening and treatment. Prompt identification, education and treatment of those exposed to infection(s) helps to:
Working to reduce the spread of STIs is an important aspect of promoting individual and public health. Practitioners working outside GUM services are presented with a number of challenges. These range from bringing up the issue of STI risk with patients to facilitating partner notification. Strategies to control the spread of STIs invariably pose dilemmas for all clinicians when their duty of care to the individual comes into conflict with the requirement to protect public health.
Barton, S., Jewitt, C. (1995) Talking about sex. In: Curtis, H., Hoolaghan, T., Jewitt, C. (eds). Sexual Health Promotion in General Practice. Abingdon: Radcliffe Medical.
Bilney, C., d'Ardenne, P. (2001) The truth is rarely pure and never simple: a study of some factors affecting history-sharing in the GUM clinic setting. Sexual and Relationship Therapy 16: 4, 349-364.
Bor, R., Watts, M. (1993) Talking to patients about sexual matters. British Journal of Nursing 2: 13, 657-661.
Chippindale, S. (2002) Partner notification: the management of partners in the sexual health setting. In: Miller, D., Green, J. (eds). The Psychology of Sexual Health. Oxford: Blackwell Science.
Cowan, F.M., French, R., Johnson, A.M. (1996) The role and effectiveness of partner notification in STD control: a review. Genitourinary Medicine 72: 247-252.
Curtis, J.R., Holmes, K.K. (1999) Individual-level risk assessment for STD/HIV infections. In: Holmes, K.K., Sparling, P.F., Mardh, P-A. et al. (eds). Sexually Transmitted Diseases. New York, NY: McGraw-Hall.
Department of Health. (2001) The National Strategy for Sexual Health and HIV: Consultation document. London: DoH.
Department of Health. (2002) The National Strategy for Sexual Health and HIV: Implementation action plan. London: DoH.
Duncan, B., Hart, G. (1999) Sexuality and health: the hidden costs of screening for Chlamydia trachomatis. British Medical Journal 318: 931-933.
Duncan, B., Hart, G., Scoular, A., Bigrigg, A. (2001) Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening. British Medical Journal 322: 195-199.
Foley, E., Patel, R., Green, N., Rowan, D. (2001) Access to genitourinary medicine clinics in the United Kingdom. Sexually Transmitted Infections 77: 12-14.
Green, J. (2002) Psychological factors in sexually transmitted diseases. In: Miller, D., Green, J. (eds). The Psychology of Sexual Health. Oxford: Blackwell Science.
Hart, G., Wellings, K. (2002) Sexual behaviour and its medicalisation: in sickness and in health. British Medical Journal 324: 896-900.
Irwin, R. (2002) Psychosexual Nursing. London: Whurr.
Jones, K., Webb, A., Mallinson, H., Birley, H. (2002) Outreach health adviser in a community clinic screening programme improves management of genital chlamydia infection. Sexually Transmitted Infections 78, 101-105.
Mathews, C., Coetzee, N., Zwarenstein, M. et al. (2001) Strategies for partner notification for sexually transmitted diseases (Cochrane Review). In: The Cochrane Library, Issue 4. Oxford: Update Software.
Matthews, P. (1998) Sexual history taking in primary care. In: Carter, Y., Moss, C., Weyman, A. (eds). RCGP Handbook of Sexual Health in Primary Care. London; Royal College of General Practitioners.
McClean, H.L., Reid, M., Scoular, A. (1995) Healthy alliances? - other sexual health services and their views of genitourinary medicine. Genitourinary Medicine 71: 396-399.
Nelson, S. (1999) Psychosexual issues in sexual health care. In: Weston, A. (ed.). Sexually Transmitted Infections. London: NT Books.
Oxman, A.D., Scott, E.A.F., Sellors, J.W. et al. (1994) Partner notification for sexually transmitted diseases: an overview of the evidence. Canadian Journal of Public Health 85: 127-132.
Pimenta, J.M., Catchpole, M., Rogers, P.A. et al. (2003a) Opportunistic screening for genital chlamydial infection. Acceptability of urine testing in primary and secondary healthcare settings. Sexually Transmitted Infections 79: 16-21.
Pimenta, J.M., Catchpole, M., Rogers, P.A. et al. (2003b) Opportunistic screening for genital chlamydial infection. Prevalence among healthcare attenders, outcome, and evaluation of positive cases. Sexually Transmitted Infections 79: 22-27.
Pitts, M.K., Woolliscroft, J., Cannon, S. et al. (2000) Factors influencing delay in treatment seeking by first-time attenders at a genitourinary clinic. International Journal of STD and AIDS 11: 375-378.
Rothenberg, R.B., Potterat, J.J. (1999) Partner notification for sexually transmitted diseases and HIV infection. In: Holmes, K.K., Sparling, P.F., Mardh, P-A. et al. (eds) Sexually Transmitted Diseases. New York: McGraw-Hill.
Scheer, S., Lee Chu, P., Klausner, J.D. et al. (2001) Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet 357: 432-435.
Scoular, A., Duncan, B., Hart, G. (2001) 'That sort of place ... where filthy men go ...': a qualitative study of women's perceptions of genitourinary medicine services. Sexually Transmitted Infections 77: 340-343.
Stephenson, J.M., Imrie, J., Davis, M.M.D. et al. (2003) Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection? Sexually Transmitted Infections 79: 7-10.
Weinhardt, L.S., Carey, M.P., Johnson, B.T., Bickman, N.L. (1999) Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997. American Journal of Public Health 89: 9, 1397-1405.
Wolitski, R.J., MacGowan, R.J., Higgins, D.L., Jorgensen, C.M. (1997) The effects if HIV counseling and testing on risk-related practices and help-seeking behaviour. AIDS Education and Prevention 9: (suppl B), 52-67.