sexually transmitted infections: uk national screening and testing guidelines bashh guidelines 2006...

Sexually Transmitted Infections: UK National Screening and

Testing Guidelines

BASHH Guidelines2006

Dr Olwen Williams

Aim of guideline

• To improve access to testing/screening for STIs by tailoring investigations to patients needs

• www.bashh.org

Scenarios

Asymptomatic

low risk

non-invasive tests

Symptomatic

high risk

microscopy

Asymptomatic

• to have no symptoms• exclude contacts?• excludes patients with warts?

Who decides who’s asymptomatic ?• the patient• the receptionist• the triage nurse• the doctor

Definition ‘asymptomatic’

Women

Does not complain of a

vaginal discharge

No abnormal vaginal

discharge on

examination

Men

Does not complain of a

urethral discharge

No urethral discharge

on examination

All patients need risk assessment

• STI• HIV• Contraception

• Intervention strategy• Partner notification

Asymptomatic Heterosexual Men

Site or specimen

GC Chlamydia NSU Syphilis HIV

Urethra Culture NAAT NR NR NR

Rectum NR NR NR NR NR

Oropharynx NR NR NR NR NR

Urine NAAT NAAT NR NR NR

Blood NR NR NR STS EIA

NR: Not recommended

NR

Asymptomatic MSM

Site or specimen

GC Chlamydia

NSU Syphilis HIV

Urethra Culture NAAT NR NR

Rectum Culture NR NR NR NR

Oropharynx Culture NR NR NR NR

Urine NAAT NAAT NR NR NR

Blood NR NR NR STS EIA

NR: Not recommended

NR

Asymptomatic Women

Site or specimen

GC Chlamydia Syphilis HIV

Urethra NR NR NR NR

Cervix Culture NAAT NR NR

Vagina NR NAAT NR NR

Rectum NR NR NR NR

Oropharynx NR NR NR NR

Urine NR NAAT NR NR

Blood NR NR STS EIA

NR: Not recommended

What does this mean?

Women

No HVS

URINE TESTING FOR ALL ???????

Men

No microscopy on

urethral swab

Microscopy

Essential for diagnosis

NSU in men Bacterial vaginosis

Trichomoniasis

Early diagnosis

Gonorrhoea

Immediate results

Who should do the microscopy?

• Experienced

• trained

• Biomedical scientist

• doctor

• nurse

• nursing assistant

• Cost microscope

• training of microscopist

• Consumables

• Time - 4min / slide

The way forward

• All sexual health clinics in Wales to adopt BASHH guideline

• Care pathways between CASH and GUM services for the symptomatic , the high risk and those patients requiring microscopy

• Press for access to NAAT technology (GC & CT) suitable for urine testing