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Sexual Health for Practice Nurses

Sexual Health for Practice Nurses. Aim. For you to have the knowledge to assess, test and manage vaginal discharge and simple STIs in your patients. You will. Be aware of opportunities for STI testing

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Sexual Health for Practice Nurses

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  1. Sexual Health for Practice Nurses

  2. Aim For you to have the knowledge to assess, test and manage vaginal discharge and simple STIs in your patients

  3. You will • Be aware of opportunities for STI testing • Consider why you should, and how you will incorporate sexual history taking into your consultations • Have some knowledge of Sexual/vaginal infections and how to screen/test for common infections • Understand the implications of manging your results correctly • Be aware of local sexual health service provision

  4. Sexual Health Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence

  5. Sexual health is a UK government priority HIV continues to be one of the most important communicable diseases in the UK. The number of people living with HIV in the UK continues to rise and Around 1 in 4 of those infected are unaware of their infection. General practice has a role in caring for patients with HIV and assessing the risk of having undiagnosed HIV The scale and impact of the under-diagnosis of Hepatitis B and C is apparent

  6. STI testing has moved towards self-taken swabs and home sampling • Rates of sexually transmitted infections (STIs) continue to rise, in some cases dramatically • There are serious implications for health

  7. General practice is the largest provider of sexual and reproductive health care (SRH) in the UK RCGP 2017

  8. General Practice is uniquely accessible. You need to discern people at high risk of having a sexual health problem from those with zero risk • GPs and practice nurses may be unaware of the extent of their lack of knowledge in what is a very rapidly changing field • Many lack confidence in discussing sexual health with their patients and lack time-efficient strategies

  9. Screening/Testing for Sexual Infections in your setting When?

  10. Referred by GP Vaccinations Screening for STIs New patient registration Post natal checks Any consultation! Cervical screening Repeat contraception Health education and prevention advice Chronic disease/medication reviews

  11. Young/Vulnerable people Confidentiality Consent Fraser competent Capacity to consent to SI Adult/child safeguarding CSE Domestic violence Honour based violence Trafficking The law

  12. Consent Children under the age of 16 can consent to medical treatment if they have sufficient maturity and judgement to enable them fully to understand what is proposed. This was clarified in England and Wales by the House of Lords in the case of Gillick vs West Norfolk and Wisbech AHA & DHSS in 1985

  13. Fraser Guidance • the young person will understand the professional's advice • the young person cannot be persuaded to inform their parents • the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment • unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer • the young person's best interests require them to receive contraceptive advice or treatment with or without parental consent

  14. Take a sexual history from a maleor female patient in a way • that is • Private and confidential • Non-judgemental • Responsive to the reactions of the patient • Avoid assumptions about • Sexual orientation • Gender/age of the partner(s) • Disability • Ethnic origin

  15. The initial greeting to the patient • Maintain eye contact (if culturally acceptable) • Use appropriate body language • Initiate consultation with open questions followed by exploration of initial concerns and more closed questions as the consultation continue • Explain the rationale for some of the questions asked • Sexually explicit language • Use language that is clear and understandable • Both clinician and patient are comfortable • Possibility of anxiety and distress from the patient • Recognise non-verbal cues

  16. Sanjit who is 44 is referred by the GP for triple swabsShe has had a horrible smelling discharge for the past 2 monthsShe is feeling very itchy and sore.She believes that this is due to her IUDShe has been treated with a canestan pessary twiceIt helped for a short while, but comes back

  17. What should you ask? • Medical history • Medicines • Allergies • Menstrual history • Contraception • LMP • Other symptoms

  18. Other symptoms? • Consistency of discharge • Nature of odour • Urinary problems • Pain • Bleeding • Lumps,rashes,ulcers

  19. Blood Born Virus risks • Number of Partners last 3/6/12 months • Hepatitis B vaccianation • Previous HIV test • MSM or contact with MSM • IVDU or contact with IVDU • Snorting drug use • Chemsex

  20. SI with people from high risk countries • Paid for sex • Been paid for sex • Sex with HIV+ person • History of coercive or non-consensual SI • Non-professional tattoos or piercings • Blood transfusion / medical procedures abroad

  21. Recognise sexual health emergencies • CSE • Emergency contraception • Post-exposure prophylaxis (PEP) in HIV prevention, • Hepatitis B vaccinations • Responding to early presentation of rape and sexual assault

  22. Window periods Chlamydia/Gonorrhoea: 2 weeks HIV: 4 weeks Syphilis: 12 weeks Hepatitis B/C: 3-6 months

  23. Change in Vaginal Discharge • Candida or thrush • Bacterial vaginosis (BV) • Trichomonas vaginalis (TV) • Herpes • Gonorrhoea • Chlamydia • Physiological • Retained condom, tampon or foreign body

  24. Bacterial vaginosis

  25. Signs & Symptoms • Offensive “fishy” smelling vaginal discharge. • More noticeable following sex. • Not associated with soreness or irritation.

  26. Bacterial Vaginosis • Commonest cause of abnormal discharge in women of child bearing age. • Caused by an imbalance in vaginal ecology. • Risk factors include: • Vaginal douching • Using highly perfumed washing products • Recent change of sexual partner • Smoking

  27. Treatment • Metronidazole 400mg orally bd for 5 days. • Intravaginal Metronidazole gel - once daily for 5 days. • Intravaginal Clindamycin 2% cream – once daily for 7 days. • Balance Activ gel (various regimes) • Avoidance of highly perfumed washing products.

  28. Vulvovaginal Candidiasis • Thrush

  29. Signs & Symptoms • Vulvitis • Vulval itching • Superficial dyspareunia • Dysuria • “Curdy” white, non offensive vaginal discharge. • Fissuring

  30. Treatment • Clotrimazole 500mg pv stat pessary. • Clotrimazole 1% cream, topically. • Daktacort cream, topically (if severe erythema). • Oral fluconazole or itraconazole. • Avoidance of highly perfumed washing products.

  31. Chlamydia

  32. Signs & Symptoms • Dysuria • Vaginal or urethral discharge • Abdominal pain • PCB/IMB • Up to 80 % Asymptomatic

  33. Chlamydia Trachomatis • Epidemiology • 3-5% of all women attending GP surgery • 10% Under 25s • Risk Factors • Under 25 • New partner • > 1 partner in previous year • Contraception • TOP

  34. Complications • Pelvic Inflammatory Disease (PID) • Adult or neonatal conjunctivitis • Sexually Acquired Reactive Arthritis (SARA) • Epididimytis • Orchitis

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