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
Unity’s guidance is based on 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 Pregnancy Advisory Service (BPAS)
- 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.
Please see the table below for time frames :
Infection Who needs to be informed? Chlamydia Male with urethral symptoms All contacts within the 4 weeks prior to onset of symptoms Female/ asymptomatic male/male with infection at other (non urethral) sites All contacts within the last 6 months Gonorrhoea Male with urethral symptoms
All contacts within the 2 weeks prior to onset of symptoms
Female/ asymptomatic male/male with infection at other (non urethral) sites All contacts within the last 3 months Syphilis Primary
All contacts within the last 3 months
Secondary/early latent All contacts within the last 2 years Non specific urethritis (NSU) All contacts within the 4 weeks prior to onset of symptoms Pelvic inflammatory disease (PID) All contacts within the 6 months prior to onset of symptoms Trichomonas Vaginalis (TV) All current sexual partners 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 or needle-sharing contacts within 2 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
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
- A patient has come in for a coil removal and I cannot see the threads
Consider the need for emergency contraception.
Advise other means of contraception.
Organise an ultrasound to confirm the position of the coil.Refer to Complex Coil Removal clinic, please see Clinical services and How to Refer
- A patient has come for a coil removal. I could see the threads and tried to remove it and was unable to
Refer to Complex Coil Removal clinic, please see Clinical services and How to refer
Please consider whether the attempted removal may have dislodged the intra-uterine contraceptive device and offer bridging contraception if necessary.
- I have a patient with lost threads; an USS was organised which shows the coil is embedded, what should I do?
The patient should be referred to Gynaecology rather than Unity sexual health in this instance for removal with hysteroscopy.
Advise other means of contraception.
- My patient is on the depo and is asking whether she can take this away with her on holiday as it will be due when she is away?
At present, this service is not available; she will need to consider alternative contraception.
- My patient has presented today for a coil removal, she has had unprotected sex in the last seven days, can I still do it?
In both cases whether it is an IUD or an IUS, the coil should not be removed if there has been any unprotected sex in the last 7 days due to risk of pregnancy from any remaining viable sperm.
- A patient has come for an implant removal but I cannot feel the implant
Consider the need for emergency contraception. Advise interim contraception.
Refer to the Deep Implant clinic, please see Clinical services and How to refer
- My patient came for implant removal, I tried to but was unable to remove it
Refer to the Deep Implant clinic, please see Clinical services and How to refer
- My patient has already had oral emergency contraception this cycle, can I give it again?
Yes you can. The FSRH guidance recommends giving oral emergency contraception for every episode of unprotected sex in a cycle.
For further guidance:
- My patient has a Mirena coil and has just been prescribed carbamazepine, do I need to do anything?
Enzyme inducers, like carbamazepine, can affect all progesterone containing contraception, with the exception of Depot medroxyprogesterone acetate and the Intra-uterine system.
So carbamazepine does not have any significant interaction with the IUS
For further guidance:
- I have a transgender patient- what are their contraceptive needs?
From FSRH CEU statement
The medical help required by transgender and non-binary patients is highly individualised. People’s goals, from hormone therapy and surgery vary enormously, therefore so will the appropriateness and acceptability of different methods of contraception. Sensitive communication, with a clear attempt to avoid any stigmatising language, is therefore the key issue.
The Faculty of sexual and reproductive healthcare have produced a statement on Contraceptive Choices and Sexual Health for Transgender and Non-Binary People (October 2017).
STIs
- I have a pregnant woman with herpes, what do I do?
Aciclovir is safe to use at any point during pregnancy. Normal dosing regimen applies.
If she is more than 28 weeks, and if this is a primary episode, she will need to be referred for consultant led antenatal care and may require caesarean delivery.
For further guidance:
- My patient’s results have come back positive for gonorrhoea
We advise that patients are seen by our service so they can receive the correct treatment and discuss partner notification and test of cure.
If you are happy to do this is in surgery then they do not need to be seen by us.
Please refer to our local guidelines for recommended treatment regimens.
For further guidance:
- I have a patient that has been treated for epidydmo-orchitis, do I need to treat their partner?
Yes.
We recommend partner notification and treatment for recent sexual partners.
All partners should be treated empirically with Doxycycline 100mg BD for 7days. Advise no sex until both partners finished treatment.
- I have a patient that has been treated for PID, do I need to treat their partner?
Yes.
We recommend partner notification and treatment for recent sexual partners.
All partners should be treated empirically with Doxycycline 100mg BD for 7days. Advise no sex until both partners finished treatment.
- I have a patient who has tested positive for Trichomonas vaginalis (TV) with a IUC in situ, does this need to come out?
No, treat the patient as per guidelines for TV but the coil does not need to be removed.
- I have a patient I have a high suspicion for PID with a IUC in situ, does the coil need to come out?
No, treat the patient for PID but the coil does not need to be removed routinely.
- I’m unsure of diagnosis of a genital lump, how do I refer the patient to you for second opinion?
You can advise the patient of our clinics and opening times and to come to the next available walk in slot.
If you feel they need to be seen urgently, please ring us on 0117 342 6900
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