Abstract
BackgroundNational guidelines for sexually transmitted infections (STIs) in primary care exists but their management is uncertain.AimTo assess the management of STIs against national standards in primary care.Design & settingA questionnaire based study in London and Brighton. The survey was conducted in 2015 following reorganisation of sexual health services in England.MethodQuestionnaires were sent to GPs in London and Brighton about testing for STIs, treatment for gonorrhoea, specialist advice, and referral services.ResultsOf 119 GPs who responded, most expressed confidence in treating chlamydia (n = 105/119, 88%), trichomonas (n = 81/119, 68%), and herpes (n = 82/119, 69%) but not gonorrhoea (n = 32/119, 27%). Most referred cases of syphilis (n = 92/119, 77%) and genital warts (83/119, 70%) to genito-urinary medicine (GUM) as per guidance. Most GPs tested for gonorrhoea on patient request (n = 95/119, 80%), in tandem with chlamydia screening (n = 89/119, 75%), because of high risk status (n = 85/119, 71%) and genital symptoms (n = 108/119, 91%). Some GPs (n = 22/119, 18%) sampled urine for culture, 53/119 (45%) provided high vaginal swabs (HVS), and 28/119 (24%) provided self-taken vulvovaginal swabs (STVVS) for culture. These samples are not appropriate for gonococcal culture and not processed in the laboratory. Urethral swabs for men and endocervical swabs (ECS) are recommended for gonococcus culture. Over half (n = 60/102, 59%) of GPs did not treat gonorrhoea but some prescribed cefixime, ciprofloxacin, or azithromycin. Eighty-seven per cent (n = 104/119) sought advice from GUM, and 83/103 (81%) referred gonorrhoea nucleic acid amplification test (NAAT)-positive patients.ConclusionThere is scope for improvement of STIs management in primary care to ensure that patients are optimally investigated, treated, and referred.
Highlights
Patients with STIs are often managed initially by GPs
A questionnaire was developed by collaboration with microbiologists, genitourinary medicine (GUM) physicians, a primary care facilitator, and GPs to investigate the management of STIs in primary care, focusing on confidence in the diagnosis of STIs, indications for sampling, sample types, treatment, accessing clinical advice and GUM referral
Most GPs obtained information on STIs (Figure 1) and clinical advice (Table 4) from the GUM service. This general practice-based scoping survey in London and Brighton provides information on confidence in treating STIs, indications for sampling, sample types, treatment for gonorrhoea, and accessing clinical advice and referral pathways for STIs diagnosed in the community
Summary
Patients with STIs are often managed initially by GPs. Sexual health provision in England has undergone major changes following the implementation of the Health and Social Care Act 2012, resulting in shared commissioning between NHS England, local authorities, and clinical commissioning groups,[1] and commissioning of internet-accessible sexual health services.[2] London and Brighton have the highest and second highest reported rates of sexually transmitted infections in England respectively.[3] National guidance exists for STIs management in primary care.[4] national standards exist for providers of sexual health services.[5] As many patients still access services provided by GPs, it is important to understand how they manage STIs. Wetten et al[6] demonstrated the continued use by some GPs of antimicrobials no longer recommended for gonorrhoea. It is pertinent to assess how primary care clinicians screen patients for STIs, and utilise laboratory and referral services. National guidelines for sexually transmitted infections (STIs) in primary care exists but their management is uncertain
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