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Mon 21/10/19 – Cadbury Health Young Peoples Clinic Closed Today.

Clinical Guidelines, Helpful links and FAQs

If you cannot find what you are looking for, or require additional information or help, please contact us  on 0117 342 6913.

Please read the guidance below before calling.

  • Testing in primary care

    For detailed instructions on testing for STIs, please see the British Association for Sexual Health and HIV (BASHH) STI testing guidance 2015.

     

    Infections in alphabetical order:

    Chlamydia and gonorrhoea testing

    The test

    • The test we use in BNSSG is a combined NAAT (Nucleic Acid Amplification test) which tests for chlamydial and gonorrhoeal RNA.
    • The window period for testing is up to 2 weeks– do a test at first presentation then repeat 2 weeks later if required.

     

    Penile sampling

    • The preferred sample is a first catch urine. It is advised urine should be held for at least 1 hour prior to the test.

     

    Vaginal, throat and rectal sampling

    • Vaginal sampling: The preferred sample is a self-taken vulvovaginal swab. However, if a speculum examination is being performed for clinical reasons, it is acceptable to take an endocervical sample, then, using the same swab, sample the lower lateral vaginal walls.
    • “3 site testing” is recommended for men-who-have-sex-with-men (MSM)- this involves a urine sample plus rectal and throat NAAT swabs using the pink swab and orange bottle kits used for those with female genitalia. Make sure these are carefully labelled as to which site is being sampled, as treatment can differ depending on site of infection.
    • Pharyngeal sampling: It is important to roll the swab over both tonsillar fossae and the posterior pharyngeal wall (warn the patient they are likely to gag) to get an adequate sample.
    • The only situation in which we use a throat swab in heterosexual patient is if they have only had oral sex with a partner.

     

    Contacts of infection

    • Patients who are sexual contacts of someone with gonorrhoea should be referred to the sexual health clinic. If they decline to attend it is very important to take a culture swab, as well as the NAAT test, to test for antibiotic sensitivities from any exposed sites prior to treatment.

     

    Other testing

    • All patients having an STI screen should be recommended to have blood tests for HIV and syphilis.

    Hepatitis B

    The test

    • Hepatitis B is diagnosed using serology.
    • The incubation period for hepatitis B is up to 6 months.
    • To screen for infection: Hepatitis B surface antigen and Hepatitis B core antibody
    • To screen for adequate vaccination: Hepatitis B post-vaccination (surface antibody)

     

    Who to test

    Hepatitis B is a recommended part of sexual health screening for the following groups of patients:

    • Men who have sex with men (MSM)
    • Commercial sex workers
    • People who inject drugs
    • Those who have been sexually assaulted
    • Those born in (or who have a sexual partner born in) a country with high HBV prevalence
    • Those with a sexual partner who is infected with HBV or is at high risk of this
    • Those born to a mother with HBV

    Those who have a risk factor for Hepatitis B (see list above) can be offered vaccination against Hepatitis B. Please see High Risk Groups.

     

    Management

    • Anyone found to have a positive Hepatitis B surface antigen should be referred to Hepatology at the Bristol Royal Infirmary.

    Herpes

    The test

    • A viral PCR (red topped) swab is used to test for Herpes simplex virus (HSV).

     

    Who to test

    • All genital ulcers should be tested for HSV.

     

    Other tests

    • It is also important to test for syphilis in patient with genital ulceration.

     

    Management

    • If genital herpes is suspected, treatment should commence immediately without waiting for the swab results.

    HIV

    The test

    • The fourth generation HIV tests are much more sensitive than the older tests used. The window period has therefore reduced.
    • For a low risk sexual exposure, it is recommended to test at the time of presentation, and repeat again at 4 weeks post-risk.
    • For a high risk sexual exposure, it is recommended to test at the time of presentation, again at 4 weeks and a final confirmatory test at 8 weeks.

     

    Other tests

    • All patients having an STI screen should be recommended to have blood tests for HIV and syphilis (only one yellow top bottle required for both HIV and syphilis testing)

     

    Management

    • Any patients found to be HIV positive should be informed of their result; a confirmatory HIV test should be sent and the patient should be referred to the HIV service
    • If a patient is high risk for HIV, patients can be directed to advice on accessing pre and post-exposure prophylaxis (PEPSE and PrEP) to prevent HIV acquisition.

    Syphilis

    The test

    • Serology: One yellow top bottle required for both HIV and syphilis testing.
    • The incubation period for serology testing is up to 3 months. National guidelines recommend repeat testing at 6 weeks and 12 weeks after a ‘high risk’ sexual exposure.
    • PCR: If a primary syphilis chancre is suspected, a “viral HSV” swab can be used to sample the lesion and sent to the laboratory for “Syphilis PCR”. The result can take up to 3 weeks.

     

    Clinical features

    • The majority of patients with syphilis will not develop clinical features.
    • The classic clinical features are genital ulcer (often painless) or macular rash involving palms and soles; any rash may occur.
    • If a patient has an ulcer (chancre) with primary syphilis, the serology may still be negative at that time but should be positive by 2 weeks later. See above re: PCR testing.

     

    Other tests

    • All patients having an STI screen should be recommended to have a full screen including HIV test.

     

    Management

    • Any patients testing positive for syphilis, or with suspected primary syphilis, should be referred to Unity Central for assessment, treatment and partner notification.
  • Clinical Guidelines

    All of Unity’s clinical guidance is based on national guidelines.

    National guidelines

    National guidelines on the management of STIs are available through the British Association for Sexual Health and HIV (BASSH)

    National guidance on contraception is available through the Faculty of Sexual and Reproductive Healthcare (FSRH)

    National guidance on the management of HIV is available through the British HIV Association (BHIVA)

    Clinical guidelines are available to download from the Document Management Service, which can be accessed from any NHS (nww) computer.  Click on ‘Clinical Guidelines’ then ‘University Hospitals Bristol NHS Foundation Trust’ then ‘Medicine’ and select ‘Sexual Health’If you have any queries you may call us on 0117 342 6913.

     

    Other helpful websites include:

    British Liver Trust

    British Pregnancy Advisory Service (BPAS)

    Family Planning Association (FPA)

    Herpes Virus Association

    National Osteoporosis Society

    Society of Sexual Health Advisers

  • Partner Notification: A Guide for Health Professionals

    Introduction

    When a patient is diagnosed with a sexually transmitted infection, it is important to ensure that any sexual contacts are informed.  This helps reduce the spread of infection, reduce risk of health problems for partners and ensure the asymptomatic are aware. The patient should understand the infection, be able to comply with treatment and ensure follow-up arrangements are adhered to. Any patients diagnosed with the following STI’s should have partner notification processes initiated:

    • Gonorrhoea
    • Chlamydia
    • Syphilis
    • Pelvic Inflammatory disease (PID)
    • HIV
    • Hepatitis B
    • Non-Specific Urethritis (NSU)

    Approaching Partner Notification

    It is important to take a sexual history from patients diagnosed with a sexually transmitted infection. This serves to identify anybody at risk, relative risk factors in sexual behavior and acts as a cue for the health professional to remind the patient of who needs to be informed and why.

    If the patient is concerned about informing partners, it may help to:

    • Point out the risk of re-infection from untreated partners
    • Make the patient aware that it is likely partners may not have symptoms, so wouldn’t know unless informed
    • Mention that untreated partners may develop long term harm if not informed
    • Reassure the patient that there are multiple ways to approach the topic to partners
    • Inform the patient that their partners have a right to know of any risks to their health

    Discuss with the patient how, where and when their contacts may be informed. Discussing the most appropriate time, place and how to broach the topic can help the patient minimise embarrassment. Usual methods of informing partners would be:

    • Face to face
    • Social media message
    • Text message
    • Phone call

    Try to encourage patients to talk to contacts privately, rather than in public or on publicly-viewable media networks. It may help to emphasise not to blame anybody, and to tell partners that they have been to the clinic and have been diagnosed with an infection.

    If the patient specifies the infection to their partners (for example, saying ‘chlamydia’ rather than ‘an infection’) then the partners can access treatment immediately as a contact, rather than getting a test and awaiting a result prior to treatment. This minimises the risk of further transmission or health complications.

    Which contacts need to be informed?

    Gonorrhoea

    • For men with urethral symptoms, any sexual contacts two weeks prior to the onset of symptoms should be informed.
    • For asymptomatic men and all women, any sexual contacts within the previous three months should be informed.If a patient’s last sexual intercourse was more than eight weeks before the onset of symptoms, then the patient’s most recent sexual partner should be informed and treated.

    Chlamydia

    • In symptomatic men, all contacts within four week prior to the onset of symptoms
    • For all women and asymptomatic men, all contacts within the last six months (or last sexual partner if no contacts within six months).

    Syphilis

    • All sexual partners within the last three months for primary syphilis
    • All sexual partners within two years for secondary and early latent syphilis.

    Non-Specific Urethritis (NSU) or Pelvic-Inflammatory Disease (PID)

    • Four weeks prior to the onset of symptoms in men
    • Six months for women and asymptomatic men, or until the last previous sexual partner (if no contacts within six months)
    • Contact details should be obtained at the first visit as they may subsequently be found positive for chlamydia or gonorrhoea.

    Trichomonas

    All current sexual partners should be informed and treated.

    HIV

    Sexual partners within the time frame of previous testing results or, if no previous results, then depending on risk assessment by the health professional.

    Hepatitis B

    All sexual contacts or needle-sharing contacts within two weeks prior to the onset of jaundice or until surface antigen negative. Consider vaccinating household contacts or providing immunoglobulin to those at immediate risk. Other contacts dependent on risk assessment by the health professional.

  • Calculating when an emergency IUD may be fitted
  • Patient assessment guidelines

    UK Medical Eligibility Criteria tables for contraception use (UKMEC)

    Spotting the Signs proforma (for child sexual exploitation)

    Brook Sexual Behaviour Traffic Light Tool

    BMI calculator

    Are you at risk of osteoporosis? National Osteoporosis Society

    Alcohol Use Disorders Identification Test (AUDIT)

    How to calculate the latest time in the cycle and that an emergency IUD may be fitted – please see document

 

 

Frequently Asked Questions

 

Contraception

STIs

Non-Clinical

  • What has happened to 4YP?

    As of April 2018 the 4YP brand longer exists in Bristol.

    Unity Sexual Health has taken over the sexual health related training that was previously provided by 4YP and has been renamed UYP ( Unity Young People Training).

    The UYP training programme is available on the professional development pages of our website

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