Are patients aged over 50 years being let down by sexual health clinics? Audit of sexual history taking in patients aged over 50 years in an integrated sexual health clinic in North West England

Sexual history can be neglected in a routine nursing or medical assessment. Sarah Kipps gives tips to assist in making a sexual history taking session as comfortable as possible for both health professional and patient Practitioners in primary care are in a unique position to improve the sexual health of men and women. They can do this by introducing the topic of sexual health into their everyday consultations and thereby normalising the subject as part of routine health for the patient. There is evidence that health professionals find sexual history taking to be one of the more challenging aspects of a consultation. There are a number of different reasons for this: feeling not equipped to ask questions of such a sensitive nature; fear of opening a ‘can of worms’ which cannot be dealt with; and the general social embarrassment and difficulties experienced talking about sex in general. This article will give health professionals some tips and guides to assist in making a sexual history taking session as comfortable as possible for both health professional and patient.

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Changes in the time of COVID-19: a quality improvement initiative to maintain services at a youth sexual health clinic

Sexually Transmitted Infections ◽

10.1136/sextrans-2021-055265 ◽

2021 ◽

pp. sextrans-2021-055265

Author(s):

Andrew C Lim ◽

Meghana Venkatesh ◽

Danielle L Lewald ◽

Patricia J Emmanuel ◽

Lisa Sanders

Keyword(s):

Quality Improvement ◽

Service Delivery ◽

Sexual Health ◽

Urban Youth ◽

Community Outreach ◽

Health Clinic ◽

Quality Improvement Initiative ◽

Reproductive Health Services ◽

Health Clinics ◽

Sexual Health Clinics

ObjectivesAdolescents and young adults (AYAs) face difficulties accessing sexual and reproductive health services. These difficulties were exacerbated for a variety of reasons by the COVID-19 pandemic. We document strategies and outcomes implemented at an urban youth sexual health clinic in Florida that allowed uninterrupted provision of services while protecting against spread of COVID-19.MethodsThe plan–do–study–act (PDSA) model was used to implement COVID-19 interventions designed to allow continued service delivery while protecting the health and safety of staff and patients. This method was applied to clinic operations, community referral systems and community outreach to assess and refine interventions within a quick-paced feedback loop.ResultsDuring the COVID-19 pandemic, changes made via PDSA cycles to clinical/navigation services, health communications and youth outreach/engagement effectively responded to AYA needs. Although overall numbers of youth served decreased, all youth contacting the clinic for services were able to be accommodated. Case finding rates for chlamydia, gonorrhoea, syphilis and HIV were similar to pre-pandemic levels.ConclusionsQuality improvement PDSA initiatives at AYA sexual health clinics, particularly those for underserved youth, can be used to adapt service delivery when normal operating models are disrupted. The ability for youth sexual health clinics to adapt to a changing healthcare landscape will be crucial in ensuring that under-resourced youth are able to receive needed services and ambitious Ending the HIV Epidemic goals are achieved.

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How do UK medical graduates rate their knowledge and skills in sexual health and HIV medicine? A national survey

International Journal of STD & AIDS ◽

10.1258/ijsa.2008.008325 ◽

2009 ◽

Vol 20 (5) ◽

pp. 324-329 ◽

Cited By ~ 7

Author(s):

C Estcourt ◽

N Theobald ◽

D Evans ◽

N Lomax ◽

A Copas ◽

...

Keyword(s):

Sexual Health ◽

Learning Outcomes ◽

Postal Questionnaire ◽

Sexual History ◽

History Taking ◽

Transmitted Infection ◽

Clinical Indicators ◽

Knowledge And Skills ◽

Medical Graduates ◽

Sexual History Taking

The objectives of this study are to determine self-assessed knowledge and skills in sexual health and HIV medicine in preregistration house officers and to explore undergraduate experiences of teaching and assessment in these subjects prior to the launch of National Core Learning Outcomes in Sexual and Reproductive Health and HIV. The study was designed as a postal questionnaire survey. The participants were all UK medical graduates of August 2004. The response rate 1737/4746 (36%). The main outcome measures were Doctors’ views on their preparedness to manage patients with sexual health and HIV-related problems. Since graduation, 90% of respondents had seen at least one patient with a sexually transmitted infection or HIV-related issue. Seventy-six percent felt confident to take a sexual history. In all, 63% and 53% felt competent in male and female genital examination, respectively. Forty-three percent felt they could conduct an appropriate HIV pretest discussion and 59% felt they could recognize clinical indicators suggestive of HIV. Seventy-eight percent had been formally assessed in sexual health and 55% in HIV medicine. Increased confidence in sexual history taking, HIV pretest discussion and recognition of HIV indicators was associated with a longer duration of teaching and formal examination. In conclusion, although the proportion of recent graduates confident in sexual history taking is encouraging, their lack of skill in discussing HIV testing, risk assessment and recognition of possible HIV presentations must be addressed. Integration of National Core Learning Outcomes into all undergraduate curricula is a key step in reducing inconsistencies in undergraduate training.

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Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking: Consensus From the Summits in Medical Education in Sexual Health

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2018.08.008 ◽

2018 ◽

Vol 15 (10) ◽

pp. 1414-1425 ◽

Cited By ~ 4

Author(s):

Elizabeth S. Rubin ◽

Jordan Rullo ◽

Perry Tsai ◽

Shannon Criniti ◽

Joycelyn Elders ◽

...

Keyword(s):

Medical Education ◽

Best Practices ◽

Sexual Health ◽

North American ◽

Sexual History ◽

History Taking ◽

Sexual History Taking

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Unlinked anonymous HIV prevalence among New Zealand sexual health clinic attenders: 2005–2006

International Journal of STD & AIDS ◽

10.1258/ijsa.2008.008153 ◽

2008 ◽

Vol 19 (11) ◽

pp. 752-757 ◽

Cited By ~ 14

Author(s):

S M McAllister ◽

N P Dickson ◽

K Sharples ◽

M R Reid ◽

J M Morgan ◽

...

Keyword(s):

New Zealand ◽

Sexual Health ◽

Health Clinic ◽

Bisexual Men ◽

Sexually Transmitted ◽

Health Clinics ◽

Undiagnosed Hiv ◽

And Bisexual ◽

Sex With Men ◽

Sexual Health Clinics

This unlinked anonymous study aimed at determining the prevalence of HIV among sexual health clinic attenders having blood samples taken for syphilis and/or hepatitis B serology in six major New Zealand cities over a 12-month period in 2005–2006. Overall, seroprevalence was five per 1000 (47/9439). Among men who have sex with men (MSM), the overall prevalence and that of previously undiagnosed HIV were 44.1 and 20.1 per 1000, respectively. In heterosexual men, the overall prevalence was 1.2 per 1000 and in women 1.4 per 1000. HIV remains to be concentrated among homosexual and bisexual men. Comparison with a previous survey in 1996–1997 suggests an increase in the prevalence of undiagnosed HIV among MSM and also an increase in the number of MSM attending sexual health clinics. The low prevalence of HIV among heterosexuals suggests no extensive spread into the groups identified at risk of other sexually transmitted infections.

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Confidentiality and access to sexual health services

Sexual Health ◽

10.1071/sh08078 ◽

2009 ◽

Vol 6 (2) ◽

pp. 153 ◽

Cited By ~ 5

Author(s):

Nathan Ryder ◽

Anna M. McNulty

Keyword(s):

Health Care ◽

Health Services ◽

Sexual Health ◽

Risk Groups ◽

Health Clinic ◽

Sexual Health Care ◽

Health Clinics ◽

Care Workers ◽

English Speaking ◽

Sexual Health Clinics

Background: Confidentiality concerns are often described as barriers to seeking sexual health care. There has been little research describing the relative importance of confidentiality to clients of sexual health clinics, and whether members of high-risk groups have greater concerns. This study aimed to determine the importance of confidentiality and anonymity to clients of a public sexual health clinic, and determine associations with gender and sexuality. Methods: A self-administered questionnaire was offered to consecutive new English-speaking clients in October and November 2007. Participants were asked to describe the reasons for presenting, likelihood of disclosing identifying information, and concern should specific people and agencies become aware of their attendance. Results: Of 350 eligible clients, 270 (77%) participated in the survey. Expert care was included in the top three reasons for choosing a sexual health clinic rather than a general practitioner by over half of participants, while confidentiality and cost were each included in the top three reasons by one-third of respondents respectively. Over 90% of clients reported they were likely to give accurate identifying information to the clinic. Participants were comfortable with disclosure of information to other health-care workers but became increasingly unwilling for information to be shared with services not directly involved in their care. Overall there were few associations with gender or sexuality. Conclusion: Clients choose to attend our clinic for a variety of reasons, with confidentiality and anonymity being of lesser importance than competence and cost. Confidentiality is important to the majority of clients, whereas few desire anonymity. Most clients would accept information being shared with other health services, suggesting that confidentiality may not be a barrier to the use of electronic health records in sexual health clinics.

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The Acceptability and Feasibility of Implementing a Bio-Behavioral Enhanced Surveillance Tool for Sexually Transmitted Infections in England: Mixed-Methods Study (Preprint)

10.2196/preprints.9010 ◽

2017 ◽

Author(s):

Sonali Wayal ◽

David Reid ◽

Paula B Blomquist ◽

Peter Weatherburn ◽

Catherine H Mercer ◽

...

Keyword(s):

Sexual Health ◽

Health Clinic ◽

Bisexual Men ◽

Transmitted Infection ◽

Web Based ◽

Sexually Transmitted ◽

Clinic Staff ◽

Research And Innovation ◽

Health Clinics ◽

Sexual Health Clinics

BACKGROUND Sexually transmitted infection (STI) surveillance is vital for tracking the scale and pattern of epidemics; however, it often lacks data on the underlying drivers of STIs. OBJECTIVE This study aimed to assess the acceptability and feasibility of implementing a bio-behavioral enhanced surveillance tool, comprising a self-administered Web-based survey among sexual health clinic attendees, as well as linking this to their electronic health records (EHR) held in England’s national STI surveillance system. METHODS Staff from 19 purposively selected sexual health clinics across England and men who have sex with men and black Caribbeans, because of high STI burden among these groups, were interviewed to assess the acceptability of the proposed bio-behavioral enhanced surveillance tool. Subsequently, sexual health clinic staff invited all attendees to complete a Web-based survey on drivers of STI risk using a study tablet or participants’ own digital device. They recorded the number of attendees invited and participants’ clinic numbers, which were used to link survey data to the EHR. Participants’ online consent was obtained, separately for survey participation and linkage. In postimplementation phase, sexual health clinic staff were reinterviewed to assess the feasibility of implementing the bio-behavioral enhanced surveillance tool. Acceptability and feasibility of implementing the bio-behavioral enhanced surveillance tool were assessed by analyzing these qualitative and quantitative data. RESULTS Prior to implementation of the bio-behavioral enhanced surveillance tool, sexual health clinic staff and attendees emphasized the importance of free internet/Wi-Fi access, confidentiality, and anonymity for increasing the acceptability of the bio-behavioral enhanced surveillance tool among attendees. Implementation of the bio-behavioral enhanced surveillance tool across sexual health clinics varied considerably and was influenced by sexual health clinics’ culture of prioritization of research and innovation and availability of resources for implementing the surveys. Of the 7367 attendees invited, 85.28% (6283) agreed to participate. Of these, 72.97% (4585/6283) consented to participate in the survey, and 70.62% (4437/6283) were eligible and completed it. Of these, 91.19% (4046/4437) consented to EHR linkage, which did not differ by age or gender but was higher among gay/bisexual men than heterosexual men (95.50%, 722/756 vs 88.31%, 1073/1215; P<.003) and lower among black Caribbeans than white participants (87.25%, 568/651 vs 93.89%, 2181/2323; P<.002). Linkage was achieved for 88.88% (3596/4046) of consenting participants. CONCLUSIONS Implementing a bio-behavioral enhanced surveillance tool in sexual health clinics was feasible and acceptable to staff and groups at STI risk; however, ensuring participants’ confidentiality and anonymity and availability of resources is vital. Bio-behavioral enhanced surveillance tools could enable timely collection of detailed behavioral data for effective commissioning of sexual health services.

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51. PATTERNS OF TREATMENT AND RESOURCE UTILISATION IN THE TREATMENT OF GENITAL WARTS IN AUSTRALIAN SEXUAL HEALTH CLINICS

Sexual Health ◽

10.1071/shv4n4ab51 ◽

2007 ◽

Vol 4 (4) ◽

pp. 304

Author(s):

A. Morrow ◽

J. Chuah ◽

E. L. Conway ◽

C. K. Fairley ◽

J. McCloskey ◽

...

Keyword(s):

Sexual Health ◽

Genital Warts ◽

Quadrivalent Vaccine ◽

Health Clinic ◽

Resource Utilisation ◽

Common Disease ◽

Treatment Practices ◽

Health Clinics ◽

Topical Treatments ◽

Sexual Health Clinics

The introduction of the quadrivalent vaccine (HPV types 6, 11, 16, 18), GARDASIL, in the National HPV Vaccination program has the potential to eliminate a substantial proportion of the health burden of genital warts, currently the most common sexually transmitted viral disease in Australia. Although there are an estimated 10�000 cases per year managed through sexual health clinics in Australia, there is very limited data on treatment practices and resource use in this setting. A clinical audit was undertaken in five sexual health clinics in different states of Australia. A total of 500 cases (100 consecutive cases per clinic) were identified of patients aged 18 to 45 years with a first ever diagnosis of genital warts between 1 January 2004 and 31 December 2004. The average age of cases was 27 years for females and 31 years for males with 43% cases female. There was an average of 2.7 visits per case (range 1-22). Ablative measures (cryotherapy, laser or diathermy) were the most common form of treatment applied in 58% cases (mean per case�=�2.4; range 1-16); topical treatments were prescribed in 44% cases (mean per case�=�1.5; range 1-8) and topical treatments were applied by the health care provider in 22% cases (mean per case�=�1.5; range 1-8). Additional analyses including type of treatment, variation in treatment practices by sexual health clinic and duration of cases will be presented. This study confirms the considerable individual and clinical burden of this common disease.

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Epididymitis and its aetiologies in a central London sexual health clinic

International Journal of STD & AIDS ◽

10.1177/0956462420963879 ◽

2020 ◽

pp. 095646242096387

Author(s):

Venkateshwaran Sivaraj ◽

Azraan Ahamed ◽

Ruslan Artykov ◽

Anatole Menon-Johansson

Keyword(s):

Sexual Health ◽

Trichomonas Vaginalis ◽

Health Clinic ◽

Study Cohort ◽

Scrotal Pain ◽

Sexually Transmitted ◽

Health Clinics ◽

Results Management ◽

Sexual Health Clinics

Epididymitis is a common cause of scrotal pain presentation in sexual health clinics; however, it is unclear what fraction is attributable to transmissible infections. We, therefore, reviewed the aetiologies causing epididymitis. A retrospective data analysis of all cases of epididymitis diagnosed from January 2018 to December 2018 in three sexual health clinics was conducted, collecting demographics, results, management and symptom resolution at two weeks follow up. A total of 127 cases of epididymitis (mean age 32 years, heterosexual 97, MSM 30) were included. Among them 14 cases (11%) were caused by sexual transmitted infections (<35 years n = 9; >35 years n = 5): seven cases of chlamydia, six gonorrhoea, one syphilis and one trichomonas vaginalis. There were three cases of urinary tract infection diagnosed. All cases were treated with antibiotics recommended by the British Association for Sexual Health and HIV (BASHH). At two weeks follow up post-treatment 10 (7%) were symptomatic; 91% did not attend for follow up. Sexually transmitted infections were associated with acute epididymitis in 11% of this study cohort.

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