Triage in a public outpatient sexual health clinic

Sexual Health ◽  
2006 ◽  
Vol 3 (2) ◽  
pp. 87 ◽  
Author(s):  
Vickie Knight ◽  
Anna McNulty
Keyword(s):  
Sexual Health ◽  
Waiting Times ◽  
Health Centre ◽  
Wait Time ◽  
Health Clinic ◽  
Average Wait Time ◽  
Survey Tool ◽  
Time Flow ◽  
Sexually Transmissible Infections ◽  
Nurse Triage

Background:The increasing prevalence of sexually transmissible infections in Australia, coupled with a NSW Health Department requirement to target services to those most in need, has led many services to investigate patient triage as a way of better using scarce resources.2 In October 1997, a Triage Nurse position was trialled that aimed to facilitate the optimal flow of patients through the Sydney Sexual Health Centre (SSHC) clinic in an efficient and patient-focussed manner. A pre and post implementation time-flow study was conducted to analyse the effect. A staff survey was also completed to ascertain staff acceptance of the Nurse Triage system. Methods:A time-flow data survey tool was developed and placed in the medical record of every person attending the SSHC in one month in 1997 and again in 1999. The staff survey was an 11-item likert scale questionnaire administered to all centre staff. Data were analysed and average visit and waiting times were generated. Results:When comparing 1997 with 1999 data, the main results of note were that the length of consultation had been stable or decreased, the average wait time had remained stable or decreased and the wait time in the medical and nursing unbooked clinic had decreased. The average wait time for the unbooked clinic had decreased from ~24 minutes in 1997 to ~12 minutes in 1999. Conclusions:Since the introduction of Nurse Triage, the average overall waiting times for those who attend without an appointment has halved and the wait to see a doctor and a nurse has decreased. The majority of staff felt that the triage process had improved patient flow.

Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic

Sexual Health ◽  
2010 ◽  
Vol 7 (1) ◽  
pp. 55 ◽  
Author(s):  
Elizabeth A. Sturgiss ◽  
Fengyi Jin ◽  
Sarah J. Martin ◽  
Andrew Grulich ◽  
Francis J. Bowden
Keyword(s):  
Human Papillomavirus ◽  
Sexual Health ◽  
Health Centre ◽  
Health Clinic ◽  
Newly Diagnosed ◽  
Anogenital Warts ◽  
Human Papillomavirus Vaccination ◽  
Anogenital Wart ◽  
Screening Programs ◽  
Sexually Transmissible Infections

Background: Anogenital warts are a common initial presentation to the Canberra Sexual Health Centre. It is anticipated that the introduction of human papillomavirus vaccination will reduce the incidence of anogenital warts. The present study determines the prevalence of other sexually transmissible infections in patients newly diagnosed with warts who may not have presented for screening without the impetus of a genital lump. Methods: The prevalence of other sexually transmissible infections in new patients presenting to the Canberra Sexual Health Centre diagnosed with anogenital warts was determined from a retrospective clinical audit from 2002 to 2007. Results: A total of 1015 new patients were diagnosed with anogenital warts. Of this total cohort, 53 (5.2%) were found to be co-infected with either chlamydia and/or gonorrhoea. Only 13.2% of co-infected patients reported symptoms other than genital lumps. Of co-infected patients 11.3% reported contact with a partner with chlamydia and/or gonorrhoea. Not all patients were screened for other sexually transmissible infections: 762 (75.1%) were screened for chlamydia and 576 (56.7%) were screened for gonorrhoea. Of those tested, 6.8% of men and 6.9% of women were positive for chlamydia highlighting the importance of offering full sexually transmissible infection screening in those newly diagnosed with anogenital warts. Chlamydia was more common in younger patients who reported a higher number of sexual partners. Conclusions: It is anticipated that human papillomavirus vaccination will lead to a decline in anogenital wart incidence as well as other human papillomavirus associated disease. Although one opportunity for testing for other sexually transmissible infections may be lost in this population, the decrease in anogenital warts will leave clinicians with more time to pursue other screening programs. Education and screening campaigns should continue to focus on the asymptomatic nature of the majority of sexually transmissible infections.

Transgender people attending a Sydney sexual health service over a 16-year period

Sexual Health ◽  
2007 ◽  
Vol 4 (3) ◽  
pp. 189 ◽  
Author(s):  
Victoria L. Hounsfield ◽  
Eleanor Freedman ◽  
Anna McNulty ◽  
Christopher Bourne
Keyword(s):  
Health Service ◽  
Sexual Health ◽  
Sex Work ◽  
Health Centre ◽  
Health Clinic ◽  
Risk Behaviours ◽  
Retrospective Case ◽  
Transgender People ◽  
Sexual Health Service ◽  
Sexually Transmissible Infections

Background: Previous studies have concluded that transgender people are a marginalised and stigmatised group, with high rates of sexually transmissible infections (STI), sex work, injecting drug use and multiple sexual partners. To our knowledge, this is the first study in Australia to focus on the sexual behaviour and sexual health needs of transgender people attending an urban sexual health clinic. Methods: A retrospective case note review was undertaken of the transgender attendees of the Sydney Sexual Health Centre between 1990 and 2006. Demographics, gender characteristics, risk behaviours, sexual health morbidity, psychosocial information and other significant features of the transgender population were assessed. Results: Forty clients were identified as transgender, of whom 36 (90%) were male-to-female and four (10%) were female-to-male. Seventeen (43%) had a history of sex work, 16 (40%) had injected drugs, 14 (35%) had had unprotected anal or vaginal sex in the past 3 months. Twenty (50%) clients had histories of a STI, including three (7.5%) that were HIV positive, and two were co-infected with hepatitis C. Genital warts and chlamydia were the most common diagnoses made during the study period. Physical examination was inadequately documented in 53% of first visits. Psychosocial morbidity was common. Conclusions: Transgender clients presented infrequently at this clinic. Although half reported few risks, the other half reported multiple risk behaviours and had most STI. These findings suggest that there needs to be improved sexual health service for transgender clients at our clinic.

Low yield of anogenital examination among asymptomatic clients of an urban sexual health clinic

Sexual Health ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 90 ◽  
Author(s):  
Jun Yong Ma ◽  
Nathan Ryder ◽  
Lynne Wray ◽  
Anna McNulty
Keyword(s):  
Sexual Health ◽  
Physical Examination ◽  
Diagnostic Yield ◽  
Health Centre ◽  
Cross Sectional Study ◽  
Health Clinic ◽  
Cross Sectional ◽  
Heterosexual Women ◽  
Sexually Transmissible Infections ◽  
Sexual Health Clinics

Background: The use of self-collected specimens to test for sexually transmissible infections (STI) has reduced the opportunity for physical examination. Physical examination has been found to be of limited value in asymptomatic heterosexual women and men; however, prior studies have excluded higher risk populations. We performed a retrospective cross-sectional study to determine the diagnostic yield of physical examination among all clients attending our sexual health service. Methods: The Sydney Sexual Health Centre database was used to identify asymptomatic clients attending for the first time between January and June 2009. Demographic and behavioural data were extracted from the database for all clients. Medical records were then manually reviewed to determine the number and nature of diagnoses related to the examination and whether this varied by sex and sex of sexual partners. Results: Of the 590 clients included, 450 (76%) received anogenital examinations. Ten (2.2%; 95% confidence interval 1.1–4.1%) STI were found, including four cases of cervicitis, four of anogenital warts and two of molluscum. Nineteen (4.2%) other non-STI conditions were detected, mostly in heterosexual women and men who have sex with men (MSM). Conclusion: Physical examination of asymptomatic clients attending our sexual health clinic was of limited value, even among higher risk individuals such as MSM. Sexual health clinics should direct resources currently used to examine clients towards increasing the STI testing rate.

Prevalence of rectal Mycoplasma genitalium and macrolide resistance in men who have sex with men attending Sydney Sexual Health Centre

Sexual Health ◽  
2020 ◽  
Vol 17 (2) ◽  
pp. 114
Author(s):  
Isabella Bradley ◽  
Rick Varma ◽  
Vickie Knight ◽  
Dimitra Iliakis ◽  
Leon McNally ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Sexual Health ◽  
Rectal Swab ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Macrolide Resistance ◽  
Cross Sectional ◽  
Screening Guidelines ◽  
Sexually Transmissible Infections ◽  
Sex With Men

Background Sexually transmissible infections (STIs) have been increasing in men who have sex with men (MSM) in recent years; however, few studies have investigated the prevalence or antimicrobial resistance in rectal Mycoplasma genitalium in this group. This study aimed to determine the prevalence and predictors of rectal M. genitalium in MSM attending an urban sexual health service in Sydney, Australia, namely the Sydney Sexual Health Centre (SSHC), as well as estimate the rate of macrolide resistance. Methods: A prospective cross-sectional analysis was conducted of rectally asymptomatic MSM having a rectal swab collected as part of their routine care. Participants self-collected a rectal swab to be tested for M. genitalium and completed a 14-item questionnaire that provided information on behavioural risk factors. The prevalence of rectal M. genitalium was determined and multivariate analysis was performed to assess the associations for this infection. Positive specimens then underwent testing for macrolide-resistant mutations (MRMs) using the ResistancePlus MG assay (SpeeDx, Eveleigh, NSW, Australia). Results: In all, 742 patients were consecutively enrolled in the study. The median age was 31 years (interquartile range 27–39 years), with 43.0% born in Australia. Overall, 19.0% of men were bisexual, 22.9% were taking pre-exposure prophylaxis (PrEP) and 4.3% were HIV positive. The prevalence of rectal M. genitalium was 7.0% (95% confidence interval (CI) 5.3–9.1) overall and 11.8% in those taking PrEP. On multivariate analysis, PrEP use was significantly associated with having rectal M. genitalium (odds ratio 2.01; 95% CI 1.09–3.73; P = 0.01). MRMs were detected in 75.0% (36/48; 95% CI 60.4–86.4%) of infections. Conclusion: Rates of rectal M. genitalium infection were high among asymptomatic MSM attending SSHC and MRMs were detected in 75% of infections. PrEP use was found to be significantly associated with rectal M. genitalium infection. These data contribute to the evidence base for screening guidelines in MSM.

49. SYPHILIS SCREENING PROFILE AT SEXUAL HEALTH CLINIC, ST GEORGE HOSPITAL & SUTHERLAND HOSPITAL

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 303
Author(s):  
H. Tran ◽  
P. Konecny ◽  
C. Carmody
Keyword(s):  
Sexual Health ◽  
Health Centre ◽  
Health Clinic ◽  
Sexual Health Information ◽  
Presenting Symptoms ◽  
Information Program ◽  
Syphilis Screening ◽  
Behavioural Factors ◽  
Syphilis Serology

A retrospective analysis was conducted to describe the cases of Syphilis identified and managed at Short Street Centre and The Sutherland Sexual Health Centre, in South Eastern Sydney and Illawarra Area, from January 2000 to June 2007. Syphilis serology is routinely offered as part of an STI screen to new and follow-up patients as appropriate. Information on the diagnoses, demographic and other variables was extracted from the clinical database Sexual Health Information Program (SHIP) and analysed in SPSS v11. Information on age, gender, relationship status, country of birth, presenting symptoms, stage of Syphilis, type of treatment and subsequent RPR levels were confirmed from patient records. An analysis of the relative frequency of the stages of Syphilis from over 130 patients will be presented and their relationship to a number of demographic and behavioural factors.

Introduction of screening guidelines for men who have sex with men at an STD clinic, the Melbourne Sexual Health Centre, Australia

Sexual Health ◽  
2005 ◽  
Vol 2 (4) ◽  
pp. 241 ◽  
Author(s):  
Nichole A. Lister ◽  
Anthony Smith ◽  
Christopher K. Fairley
Keyword(s):  
Sexual Health ◽  
Health Centre ◽  
Health Clinic ◽  
Chlamydia Screening ◽  
Screening Guidelines ◽  
Computer Reminder ◽  
Sex With Men ◽  
New Guidelines ◽  
One Year ◽  
The Impact

Background: A recent audit indicated that a substantial proportion of men who have sex with men (MSM) were not screened for rectal gonorrhoea and chlamydia at the Melbourne Sexual Health Clinic, Melbourne, Australia. In response, screening guidelines for MSM were introduced at the clinic using a computer reminder. The aim of this study was to evaluate the impact of the guidelines and alert on screening MSM for gonorrhoea and chlamydia. Methods: The medical records of MSM were reviewed for gonorrhoea and chlamydia screening by site (pharyngeal, urethral and rectal), four months before the implementation of the guidelines and alert (July to October 2002), and one year thereafter (beginning November 2002). Results: After the introduction of the guidelines there was a significant increase in rectal chlamydia testing (55% to 67%, P < 0.001), and significant reduction in pharyngeal chlamydia and gonorrhoea testing (65% to 28%, P < 0.001, and 83% to 76%, P = 0.015 respectively). The proportion of tests that were positive by any site did not change (7% to 7%). Conclusions: The introduction of a computer reminder for new guidelines was temporally associated with screening that conformed more closely to clinical guidelines.

Fuckbuddy partnerships among men who have sex with men – a marker of sexually transmitted infection risk

2017 ◽  
Vol 29 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Vincent J Cornelisse ◽  
Christopher K Fairley ◽  
Tiffany Phillips ◽  
Sandra Walker ◽  
Eric PF Chow
Keyword(s):  
Sexual Health ◽  
Health Centre ◽  
Romantic Attachment ◽  
Sexual Partners ◽  
Health Clinic ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Hiv Prevention Strategies ◽  
Sex With Men ◽  
Exposure Prophylaxis

‘Fuckbuddies’ are a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment. We surveyed 989 men who have sex with men (MSM) at the Melbourne Sexual Health Centre, Australia, with the aim of determining the frequency of ‘fuckbuddy’ partnerships among sexual health clinic attendees and assessing their sexual risk. The majority (60%) of 1139 regular partnerships were described as ‘fuckbuddies’. Most MSM (63%) with a ‘fuckbuddy’ had multiple ‘fuckbuddies’. MSM with ‘fuckbuddies’ were more likely to also have casual sexual partners (odds ratio [OR] 5.7; 95% confidence interval 3.6–8.9) and had more casual sexual partners (median of 4 versus 1, p < 0.001) and more rectal chlamydia (12.4% versus 5.7%; adjusted OR 2.3; p < 0.05) than MSM without ‘fuckbuddies’, and this risk persisted after adjusting for total numbers of sexual partners. Our findings suggest that patients with ‘fuckbuddies’ are at particular risk of sexually transmitted infections. We argue that clinicians should specifically ask about ‘fuckbuddy’ partnerships as part of their risk assessment during patient interviews, as these patients may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP).

Cervicitis: limited clinical utility for the detection of Mycoplasma genitalium in a cross-sectional study of women attending a New Zealand sexual health clinic

Sexual Health ◽  
2013 ◽  
Vol 10 (3) ◽  
pp. 263 ◽  
Author(s):  
Jeannie Oliphant ◽  
Sunita Azariah
Keyword(s):  
Sexual Health ◽  
Trichomonas Vaginalis ◽  
Clinical Utility ◽  
Clinical Symptoms ◽  
Mycoplasma Genitalium ◽  
Cross Sectional Study ◽  
Health Clinic ◽  
Sectional Study ◽  
Cross Sectional ◽  
Sexually Transmissible Infections

Background Although multiple studies have confirmed Mycoplasma genitalium as a cause of nongonococcal urethritis in men, there is less evidence of its pathogenicity in women. Our aims were to determine the prevalence of M. genitalium in a sample of women attending a sexual health clinic and to assess whether there was any association between the detection of M. genitalium and a diagnosis of cervicitis in this population. Methods: A cross-sectional study recruited women who required screening for sexually transmissible infections. Endocervical swabs to detect the presence of M. genitalium were taken in addition to routine testing for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Data were collected on demographics, sexual behaviour, clinical symptoms and the presence of clinical or microscopic cervicitis. Results: The prevalence of M. genitalium was 8.4% (n = 22, 95% confidence interval (CI): 5.4–12.5%) in the study sample of 261 women. There was an association between the finding of cervical contact bleeding (odds ratio OR): 5.45; 95% CI: 1.93–15.42, P = 0.001) and microscopic cervicitis (OR: 2.64; 95% CI: 0.95–7.34, P = 0.06) and the presence of M. genitalium when compared with women with no diagnosed infection; however, the latter finding was not statistically significant. Conclusions: Although the prevalence of M. genitalium was high at 8.4%, the overall lack of any association between the findings of cervicitis and the detection of M. genitalium support the conclusion that cervicitis has poor clinical utility as an indicator for the presence of M. genitalium infection.

Follow-up of renal impairment results among attendees taking HIV Pre-Exposure Prophylaxis at a Sydney Sexual Health Clinic

2020 ◽  
Vol 31 (7) ◽  
pp. 689-693
Author(s):  
NB Comninos ◽  
R Foster ◽  
R Varma ◽  
C Bourne
Keyword(s):  
Renal Impairment ◽  
Sexual Health ◽  
Service Provision ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Health Centre ◽  
Health Clinic ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Renal monitoring is recommended for Pre-Exposure Prophylaxis (PrEP) users. We aimed to explore follow-up and outcomes among PrEP users with renal impairment (defined as estimated glomerular filtration rate <65 mL/min/1.73 m2) attending Sydney Sexual Health Centre. Time to follow-up was analysed for impairment results over a 12-month period (January–December 2018); 48/2504 (1.9%) tests among 1700 attendees showed impairment. Follow-up occurred in 39/48 (81.3%) impairment results after a median of 42 days. PrEP was ceased in 3/6 cases of non-resolving/persisting impairment, with one case of subsequent human immunodeficiency virus infection. Maintaining engagement and follow-up of those with renal impairment are important aspects of PrEP service provision.

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