A multi-district audit of the management of syphilis in genitourinary medicine clinics in Yorkshire

An audit against standards and guidelines of a representative sample of syphilis cases managed in genitourinary medicine clinics in Yorkshire was carried out. Satisfactory serological endpoints could be determined for about two-thirds of treated early and less than one-third of treated late syphilis cases. HIV antibody testing was obtained for less than half of all cases. Recently available national guidelines suggest inadequacy of both the dose and duration of treatments with procaine penicillin of asymptomatic late syphilis cases where lumbar puncture was not carried out. The diagnosis and management of syphilis is complex, and this audit demonstrates the importance of the systematic approach developed by genitourinary medicine clinic and laboratory services.     

Contraceptive provision in genitourinary medicine clinics in the UK

The objective of this study was to assess current and future contraceptive provision in genitourinary (GU) medicine clinics in the United Kingdom. Questionnaires were sent to 18 British Co-Operative Clinical Group regional representatives for distribution to clinical leads. Of 185 clinics, 124 (67%) responded. All clinics provided condoms, 116 (94%) the 'morning after' pill and 31 (25%) would fit an intrauterine contraceptive device (IUCD) for emergency contraception. Twenty-three (18.5%) regarded their clinic as already providing a comprehensive service and most of these could provide a wide range of contraceptive methods. Of all clinics, which included eight (34%) clinics already providing a comprehensive service, 69 (56%) anticipated developing their contraceptive provision within the next five years. In conclusion, contraceptive provision varies between clinics. A reduction in unwanted pregnancies and sexually transmitted infections (STIs) would most likely be achieved if clinics expanded their provision of contraceptive services.     

A national audit on the management of pelvic inflammatory disease in UK genitourinary medicine clinics

The prompt and effective treatment of pelvic inflammatory disease (PID) may reduce the risk of complications such as infertility, ectopic pregnancy and pelvic pain. We conducted a national audit to investigate the treatment of women diagnosed with PID and associated rates of partner notification in genitourinary (GU) medicine clinics during 2008 and compared our results with the British Association of Sexual Health and HIV (BASHH) 2005 national guideline. Among a total of 1,105,587 female attendees, national data showed 18,421 cases of PID diagnosed in GU medicine clinics, giving an incidence of 167 cases per 10,000 attendences. We audited a national sample of 1132 PID cases for review. Of those, 504 (44.5%) received a recommended treatment regimen and 447 (39%) of named male contacts were treated. Adherence to recommended treatment and partner notification did not reach national standards.     

Sexual dysfunction service provision in UK genitourinary medicine clinics in 2007

Sexual difficulties are common in people attending genitourinary (GU) medicine/HIV services and many would like professional help. Here, we report the results of the BASHH Special Interest Group in Sexual Dysfunction (SD) survey on the level and type of SD service provision within UK GU medicine services in 2007. Many clinicians expressed an interest in SD, however, only 25% of GU medicine clinics provide a designated SD service. Marked regional variation in the level of service provision was highlighted. Lack of resources and other pressures on GU medicine services, notably 48-h access, are barriers to SD service development. In spite of these constraints, we argue that GU medicine clinics are a highly appropriate place to treat SD.     

Management of recurrent genital herpes: a survey of UK genitourinary medicine clinics in 2003

We carried out a survey of all UK genitourinary (GU) medicine clinics, via postal questionnaire, in order to evaluate the current management of recurrent genital herpes (RGH) in the GU medicine setting. Respondents were invited to answer questions regarding various aspects of herpes simplex virus (HSV) management. There was a 62% response rate. Analysis of the returned surveys revealed that the vast majority of clinics (96%) provided drug treatment for RGH, with 81% having a clinic policy for the management of genital herpes (GH). A majority (64%) of clinics had access to some type of counselling or psychological therapy and 47% encouraged collaboration with primary care for follow-up prescribing. Of the clinics providing drug therapy for RGH, 80% used aciclovir alone with smaller numbers having access to aciclovir, famciclovir and valaciclovir. While many clinics are meeting the British Association of Sexual Health and HIV (BASHH) guidelines, improvements can be made to increase the availability of psychological support to patients with HSV and improve links with primary care.     

A multidistrict audit of the management of chlamydial PID in genitourinary medicine clinics in Yorkshire

In response to recent reviews of practice of pelvic inflammatory disease (PID) management, a multidistrict audit involving eight genitourinary clinics within the Yorkshire region was carried out. This audit reports the referral patterns of patients, physical signs and microscopy findings at the first genitourinary medicine (GUM) clinic attendance, antibiotic treatment and follow-up data as well as health adviser involvement and partner participation for 68 patients diagnosed with chlamydial PID. Twenty-eight (41.2%) patients presented with symptoms of less than or equal to four weeks duration, partner notification was recorded as being carried out for all patients and at least one partner was documented as having been treated in 57 (83.8%) patients. There is, however, a wide variation in the antibiotic regimens used for treatment and their duration.     

Management of under-16-year olds in UK genitourinary medicine clinics: British Co-operative Clinical Group

In 2004, the management of under-16-year olds in UK genitourinary (GU) medicine clinics was surveyed. Questionnaires were sent to 185 lead GU medicine consultants. A total of 111 questionnaires were returned (60%). Ninety-eight percent of respondents managed young people aged 13-16. Fifty percent managed under 13-year-olds. Twenty-nine percent of respondents ran dedicated young people's clinics. Ninety-eight percent were aware of the National Guidelines, and 74% had adopted them. Fifty-seven percent had a named departmental child protection lead. Thirty-seven percent of consultants had received training specific to child protection issues in GU medicine. Improvements had been made since a similar survey published in 2001, but the need for further training was still apparent.     

Screening colposcopy in genitourinary medicine.

A prospective study of new female patients attending the Genitourinary Medicine Department in Doncaster was carried out to look at the value of colposcopic examination at their first attendance. Of the 100 randomized patients studied 41 showed evidence of colposcopically detected cervical abnormality. Twenty-seven patients had colposcopically directed biopsies. These showed evidence of cervical intraepithelial neoplasia (3 cases), flat condyloma (16 cases), exophytic wart (2 cases), chronic inflammation (2 cases) and normal epithelium (4 cases). Colposcopic cervical abnormalities were significantly associated, with a history of anogenital warts, sexual contact with anogenital warts and the presence of anogenital warts at presentation. Despite this, less than half the group showing colposcopic abnormalities had an association with anogenital warts. Demonstration of cervical abnormalities by colposcopy resulted in a greater patient compliance during follow-up. Screening or primary colposcopy may be incorporated into a genitourinary screen at the first visit. The procedure is both acceptable and beneficial to the patient, facilitating the detection of a range of cervical disease and enhancing the doctor-patient relationship.     

The management of Chlamydia trachomatis in genitourinary medicine clinics: a national audit in 2004

The first national audit of the management of Chlamydia trachomatis was undertaken by non-consultant career grade doctors working in genitourinary (GU) medicine clinics in the UK. During the audit period of January--March 2004, 1670 data collection forms were completed (from 830 men and 840 women with chlamydia). In all, 99% (1647) were treated appropriately; 76% (1261) were followed up, of which 12% (154) required re-treatment; 71% (1186) were managed appropriately within four weeks and 942 partners (0.56 per index case) were managed satisfactorily within four weeks of the initial partner notification interview. Partner notification outcomes were significantly more successful when the index patient was followed up (P<0.0001). Outcome standards were not associated with age, gender or sexuality, but were significantly associated with ethnicity (P<0.004). GU medicine clinics are delivering high-quality care and evidence-based national outcome standards are being met.     

Triage clinics: a way forward in genitourinary medicine

Our objective was to evaluate the effectiveness of a nurse-led triage clinic in genitourinary medicine (GUM). A prospective study was made of 200 consecutive patients attending the triage clinic in the GUM Department, Portsmouth. These patients were seen by the triage nurse and treated according to clinic guidelines. The consultants reviewed the case notes to assess the appropriateness of management. During the 6-week study period, 3009 patients were seen in the department. Of the 200 patients seen in the triage clinic, 38 were referred to a doctor during the initial visit. One or more sexually transmitted or associated infections were found in 61 female and 58 male patients. Six female and 4 male patients were not treated according to the clinic guidelines. Given appropriate education and training and working within a supportive framework the nurse undertaking a triage role in GUM can provide a highly effective and high-quality service to patients.     

Time to use text reminders in genitourinary medicine clinics

Faced with a national 48-hour waiting time target and high non-attendance rates for booked appointments, our sexual health service sought patient preferences for appointment reminders. Questionnaires were distributed to 350 consecutive genitourinary medicine clinic attendees. Eighty-eight percent of respondents approved of appointment reminders, with text messaging being the preferred option. Automated voicemail reminders to mobile phones were acceptable to 84%. Patients would generally choose a voicemail reminder to their mobile phone as opposed to home or work phone, and this preference was more pronounced in younger patients (P = 0.03). The majority of patients considered reminders two or three days in advance sufficient notice, with 98% owning a mobile phone. Text or voicemail reminders may significantly reduce non-attendance rates and their associated costs, improve accessibility and reduce waiting times.     

Prevalence and service implications of health anxiety in genitourinary medicine clinics

A comparison of the prevalence of health anxiety in genitourinary medicine (GUM) clinics in two UK centres was carried out using a new rating scale, the Health Anxiety Inventory (HAI). The relationship of health anxiety to demographic and clinical variables, and its impact on service contacts, was also examined in one of these centres. 694 patients were assessed and significant health anxiety was identified in 8-11%. HAI scores were stable over time and high levels persisted in the absence of treatment. Attenders with sexually transmitted infections had significantly lower levels of health anxiety than those with other conditions. Contacts with clinic doctors and health advisors in the nine months before and after assessment were significantly greater in those with high health anxiety, with doctor appointments 37% higher in the high HAI group (P = 0.005). Health anxiety is a source of considerable morbidity in GUM clinics deserving further study.     

Survey of prioritizing/triaging of appointments in genitourinary medicine clinics in the UK: a British Co-operative Clinical Group survey

A questionnaire was circulated to all lead genitourinary (GU) medicine physicians in the UK in November 2003 to obtain data on access, waiting times and triaging. Of the 143 responders, 92.3% departments had limited access to some or all GU medicine clinics. Where access was limited, 5.3% had no identifiable process in place to see urgent patients. The mean waiting times in clinics with an open appointment system only for a routine female and male appointment were 2.9 weeks and 2.8 weeks (range 2 days-10 weeks), respectively, and for an urgent appointment, two days (range same day-14 days), for both sexes. The survey has raised concerns that a number of departments did not consider as urgent for prioritizing, patients with documented untreated gonorrhoea, syphilis, or HIV, or contacts of patients with these conditions. This survey has highlighted a need for the national specialist society to provide guidance on prioritizing patients where access is limited.     

Historical disclosure of rape by women attending genitourinary medicine clinics

In a previous internal audit of women attending the department of genitourinary medicine following rape, we noted that data from diagnostic coding seemed to underestimate the problem and that anecdotally, a number of women had been seen with concerns relating to historical assault. We therefore decided to record attendance following rape prospectively. Between 1 June 1996 and 31 May 1997 staff at the Department of Genitourinary Medicine (GUM) at the Royal Infirmary of Edinburgh completed a data collection form for every female patient aged >15 years who attended the clinic and spontaneously disclosed a history of rape, either recent or historical. Seventy-five women attending GUM disclosed a history of rape. Sixty-six per cent were aged <25 years. Thirty women presented more than 12 months after the incidence, of whom 50% presented to the health adviser requesting HIV antibody testing. The incidence of sexually transmitted infections was low and in no case could be specifically attributed to the rape. None of the 38 HIV antibody tests performed were positive. A number of women present to GUM a long time after an incident of rape, most commonly due to concerns about HIV. They may have endured a great deal of mental anguish before summoning up the courage to seek help. This can have a substantial effect on workload, especially for health advisers.     

The management of first episode genital herpes in genitourinary medicine clinics: a national audit in 2006

A national audit of the management of first episode genital herpes (GH) was undertaken by non-consultant career grade doctors working in genitourinary (GU) medicine clinics in the United Kingdom. In total, 1620 data collection forms were completed (794 men and 826 women). Virus culture is the main detection method (1150, 71%), although polymerase chain reaction (PCR) use is increasing (442, 28%). PCR was significantly associated (P<0.0001) with fewer negative isolates (29/442, 6.6%) compared with virus culture (174/1150, 15%). Herpes simplex virus type 1 was isolated in 552 cases (46%). For 243 cases (15%), there was no evidence of counselling about GH. A total of 1355 (84%) were screened for other sexually transmitted infections. Serological testing for syphilis was undertaken in 72%. GU medicine clinics are managing first episode GH as broadly outlined in the guidelines. Areas identified for improvement are to increase counselling/written information/testing for syphilis towards 100%.     

Factors affecting time to treatment following diagnosis of genital Chlamydia trachomatis infection in Scottish genitourinary medicine clinics

Early treatment of genital Chlamydia trachomatis can reduce complications and transmission. Guidelines have proposed standards for how soon people should be treated following a test. Data from an audit of Scottish genitourinary (GU) medicine clinics was analysed to identify factors associated with a short interval to treatment of chlamydia. A sample of 538 cases of chlamydia diagnosed at 12 Scottish GU medicine clinics between 1 April 2005 and 30 June 2005 was studied. Variables assessed included: age, sex, sexuality, whether a contact, symptoms, whether microscopy was performed, time to lab result and how the result was given. Earlier treatment was associated with: being a contact, having symptoms, being male, performing microscopy (male patients only) and giving the result at a follow-up appointment. Most of these variables (sex, symptoms, etc.) are without the influence of clinic policies and the ones which can be influenced (microscopy and follow-up appointments) are becoming less common. Time to treatment of genital chlamydia might therefore increase in the future.     

Audit on routine HIV testing in patients attending genitourinary medicine clinics

The Sexual Health Strategy was published in 2001. One of the recommendations was that all patients attending genitourinary (GU) medicine clinics for a sexual health screen should be offered an HIV test. This audit was undertaken in the GU medicine clinic at Portsmouth, offering a routine HIV antibody test to patients attending the clinic. This audit shows that patients will accept HIV testing when offered, during a routine GU medicine clinic visit. This initiative is important especially in areas with high HIV prevalence to identify undiagnosed HIV infections. Early diagnosis and intervention are important to reduce the morbidity and mortality of HIV infection.