Sexual health in the emergency department – what do we need to know?

Abstract

The incidence of sexually transmitted infections in England and Wales is rising. Data from the Public Health Laboratory Service (PHLS 2001) show that cases of gonorrhoea rose by 27% between 1999 and 2000, and the diagnoses of chlamydia increased by 18%. Recent statistics from Genitourinary Medicine (GUM) clinics in England show a rise in infectious syphilis of 43% in men and 36% in women (PHLS 2003). In 2001, the government released its first national strategy for sexual health (Department of Health 2001). One of the main aims of this is to reduce the prevalence of undiagnosed HIV and sexually transmitted infections (STIs). Patients with STIs may present to the emergency department (ED) for treatment and advice either because specialist services such as GUM clinics do not routinely offer a 24-h service or they may not recognise that their problem is related to a sexually transmitted infection. It is fundamental that ED staff are able to recognise common symptoms of STIs, and know when to intervene with treatment and when to refer to specialists. The prevalence of patients attending the emergency departments with STIs may be masked. Patients may complain of symptoms which lead to incorrect diagnoses (for example, a patient with dysuria may be discharged home with the diagnosis of ‘‘urinary tract infection’’) which presents significant