Sexual health: Hot topics. Anne Connolly Vice President FSRH

Transcription

1 Sexual health: Hot topics Anne Connolly Vice President FSRH

2 To cover Contraception choices Contraception safety Sexual history taking Relevant tests

3 We don t do great % pregnancies are unplanned One in five pregnancies end in abortion every year >184,500 abortions were performed in % of women attending for an abortion were using contraception when they became pregnant Increased risks to mother and pregnancy outcome if inter-pregnancy interval is < 12 months

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5 Doc I want the pill

6 Contraceptive choices

7 IUD IUS Implant Injection The Fit and forget methods (LARC)

8 CHOICE study They chose LARC methods Contraceptive method choices after counselling (N=2,500) 1 Long-acting Shorter-acting 33% 67% LARC=long-acting reversible contraceptive. 1. Secura GM et al. Am J Obstet Gynecol. 2010;203:115.e1 115.e7 2. Mestad et al. Contraception 2011;84: % of year-olds chose a LARC with 63% of these choosing an implant 2

9 Proportion of women, % They liked it after 12 months... Contraceptive CHOICE project Mirena (n=1,809) Cu-IUD (n=434) Implant (n=522) DMPA (n=313) Pills (n=478) Patch (n=99) Ring (n=431) Peipert et al LARC Short-acting reversible contraception

10 .and they work Pill Patch Ring Winner et al. N Eng J Med 2012

11 Doc I want the pill Vicky is aged 21 She gets headaches Her Mum had migraines with flashing lights and couldn t take the pill She remembers vomiting and having to go home from school with her headaches when she was younger. Can she?

12 UKMEC It does: Provide guidance on safety of contraceptive methods using numerous medical conditions and patient characteristics. It does not: Address the use of contraceptives for non-contraceptive benefits Consider the efficacy of methods Replace clinical judgment

13 Definition of categories

14 Contraceptive risks VTE CVD Others

15 . Migraine

16 Cardio-vascular disease

17 More cardio-vascular disease

18 Rheumatic diseases

19 MEDSCAPE

20 MEDSCAPE

21 Doc we ve had an accident

22 This is an opportunity Assessment of pregnancy risk Emergency contraception choices Assessment of STI risk Ongoing contraception

23 When in the cycle is the risk highest? Max risk

24 Emergency Contraception IUD EllaOne Levonelle

25 It hurts Doc Molly is a 45 year old teacher who you have provided primary health care for her and the extended family for many years. She has recently noticed a change in discharge and she is having pain during sex.

26 Causes of vaginal discharge

27 Why is taking a sexual history so hard..?

28 Why is taking a sexual history so hard..? Treat like any other medical enquiry or history A warning shot may make it easier to open discussions. Make no assumptions Ask routine questions Use words that they understand Remember: an embarrassed healthcare professional leads to an embarrassed patient

29 Sexual history assessment of symptoms What are the symptoms: Discharge Dysuria Bleeding Pain Itching Rash/lumps

30 Sexual history taking core components Last sexual intercourse (LSI) Partner gender/sites of exposure*/condom use Repeat for other recent partners Women: LMP/contraception/cytology BBV risk history Any safe-guarding concerns? How are they going to get their results?

31 Sexual history taking BBV risk assessment Current/past use of injecting drugs, personal history or that of partners From/sexual contact with someone from a high risk country MSM or SI with bisexual partner Medical treatment abroad including transfusions SI with HIV positive partner Paid for/been paid for sex History of HIV/hepatitis testing *tattoos

32 HIV in 2014 Approximately 103,700 people living with HIV Estimated HIV prevalence in the UK 1.9/ % were unaware of their infection and diagnosed late. Most people with HIV who died were diagnosed late. 1/2 new diagnoses probably acquired infection in the UK, 2/3 were MSM

33 HIV time course

34 HIV is a long-term condition

35 I need checking Lauren is bovvered She went to a party on Saturday and her mate said her ex had slept with her ex-best mate who she knew had chlamydia.

36 Vaginal discharge Infective causes Non STI Bacterial Vaginosis (BV) Candida STI Chlamydia trachomatis Neisseria gonorrhoeae Trichomonas vaginalis Herpes simplex virus (HSV)

37 STI rates

38 STIs Chlamydia trachomatis ASYMPTOMATIC in up to 70% women Treatment of lower genital tract infection with azithromicin 1g stat Gonorrhoea ASYMPTOMATIC in 50% women Refer all positives to GUM for treatment due to increasing antibiotic resistance So presence of discharge is not a sensitive indicator of an STI Both can give similar symptoms to candida/bv/tv

39 Resources

40 Sexual and reproductive health The planning of the family is important to improve medical, social and psychological outcomes LARC methods are superior Emergency contraception consultations are an opportunity The new UKMEC is published STIs are common and often asymptomatic HIV is important to diagnose early