nmrcgp for consultants

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Sexual Health

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

1. PRIMARY CARE MANAGEMENT

• Manage primary contact with patients who have sexual health concerns and problems.
• Work in partnership with members of the Practice’s team including the receptionists to ensure accessibility of the services for patients and practice nurses and health visitors in providing coordinated services with respect to sexual health.
• Co-ordinate care and make timely appropriate referrals on behalf of patients to specialist services, especially to appropriate gynaecologists, sexual and reproductive health specialists, genito-urinary specialists, urologists and specialists in infectious diseases.
• Promote sexual health well-being by applying health promotion and disease prevention strategies appropriately.
• Describe strategies for early detection of sexual health problems that may already be present but have not yet produced symptoms.

The knowledge base

Symptoms
Key issues in the diagnosis of sexual health problems will be eliciting of the appropriate signs and symptoms and subsequent investigation and treatment or referral of people presenting with:
• Genital skin conditions including rashes, ulcers and lichen atrophicus
• Lumps
• Abnormal genital smell
• Vaginal or penile discharge
• Pain on passing urine
• Lower abdominal pain in women
• Testicular pain
• Pain on intercourse

Common and/or important conditions in men and women
• Urinary Tract Infection
• Bacterial vaginosis
• Candidiasis
• Group B Haemolytic Streptococcus
• Chlamydial infections
• Gonorrhoea
• Genital Ulcers and Warts, Syphilis, Chancroid, Herpes Simplex
• HIV / AIDS and the presentations / complications including Pneumocystis pneumonia, Candidiasis, Cryptococcus, Kaposi’s sarcoma, Toxoplasmosis, Lymphoma, Hepatitis, tuberculosis
• Sexual dysfunction

Investigation
• Pregnancy testing
• Urinalysis
• Blood tests for the common conditions including HIV/AIDS
• Microbiology and virology swabs
• Secondary care investigations e.g. colposcopy

Treatment / Management
• Contraception – effectiveness rates of all methods and how to provide short term methods including oral contraception and emergency contraception
• Contraception – knowledge and availability of long term methods, including natural family planning, implants, intrauterine methods and sterilisation
• Termination of pregnancy – methods and the legal procedures relating to referral for termination of pregnancy
• Principles of treatment for common conditions managed largely in primary care (see above)
• Principles of antiretroviral combination therapy for HIV/AIDS, potential side effects and the role of the GP in their management in primary care

Emergency care
• Emergency hormonal contraception
• Emergency intrauterine contraception

Prevention
• Health education and prevention advice – safe sex and risk reduction
• National screening programmes – cervical screening, Chlamydia, antenatal HIV testing
• Hepatitis B immunisation programme
• Occupational risks – exposure to needle stick injuries

2. PERSON CENTRED CARE

• Take a sexual history (from a male or female patient) in a way that is non-judgemental, avoids assumptions and is responsive to the reactions of the patient.

3. PROBLEM SOLVING SKILLS

The knowledge base

Investigation
• Pregnancy testing
• Urinalysis
• Blood tests for the common conditions including HIV/AIDS
• Microbiology and virology swabs
• Secondary care investigations e.g. colposcopy

Emergency care
• Emergency hormonal contraception
• Emergency intrauterine contraception

Specific problem-solving skills
• Understand the functional anatomy of the male and female genital systems and the female reproductive physiology to aid diagnosis.
• Ability to take an appropriate sexual history and apply the information gathered during the history taking and examination, generate a differential diagnosis and formulate a management plan
• Recognise common presentations of sexual dysfunction, and of sexual violence and abuse, including covert presentations such as Somatisation.
• Be able to counsel patients with sexual problems including issues related to contraception, sexually transmitted infection, pre-test HIV counselling, and for patients who have an unwanted pregnancy
• Understand the best practice guidance on the provision of advice and treatment to young people under 16 years.
• Understand when urgent intervention is needed in sexual health and if necessary, to refer appropriately, e.g. in provision of emergency contraception or in severe pelvic inflammatory disease, or in serious infections in the immune-compromised patient
• Understand that many sexually transmitted infections may present early and in an undifferentiated way or may be present without symptoms.
• Understand the limitation of ‘watching and waiting’ because some serious infection e.g. Chlamydia and HIV may also lapse back into being asymptomatic, whilst still causing harm to the patient.

4. COMPREHENSIVE APPROACH

• Use the sexual history (including partner history and information on sexual practices including condom use) and other relevant information to assess risk of sexually transmitted infection, unwanted pregnancy and cervical cancer.
• Use risk assessment to tailor advice and care accordingly, including advice on safer sexual practices and Hepatitis B immunisation.
• Be aware of factors which may indicate that a woman is at high risk of cervical cancer and the value of an opportunistic approach to screening in this group.
• Be aware of when to refer a patient with cervical smear abnormalities, and what is involved in secondary care management.
• Aware of specific interventions for HIV prevention such as post-exposure prophylaxis and the prevention of mother to baby transmission.
• Understand the screening programmes in use in the UK and the benefits, limitations and need for informed consent.

5. COMMUNITY ORIENTATION

• Understand the epidemiology of sexual health problems and how it is reflected in their local community.
• Recognise that the prevalence of sexual health problems, including HIV, will be affected by the make-up of the local population.
• Be aware of local sexual health services, including services which provide specialist contraceptive care; termination of pregnancy; STI diagnosis and management; HIV management and services for relationship problems and sexual dysfunction.
• Be aware how to access local sexual health services, for their patients. They should also be aware how to obtain specialist expertise through their local cytology and microbiology laboratories.
• Understand the principles of partner notification and contact tracing

6. HOLISTIC APPROACH

• Understand that sexual health problems may impact on the physical or mental health of the individual, or the well being of the relationship or family.
• Understand and take into account cultural and existential factors which affect the patient’s risk of having sexual health problems and also their reactions to them.
• Understand the social stigma that may be associated with sexual health problems.

All these 6 domains have a

7. Contextual Aspect

• Recognise the central role of general practitioners and their primary care teams in prevention, diagnosis and management of sexual health problems.
• Be aware of the availability of sexual health services in the local health community and how their practice contributes to that local network.
• Be aware of the legal aspects relating to sexual health including termination of pregnancy and the methods used in the UK.

8. Attitudinal Aspect

• Take a sensitive, non-judgmental and person-centred approach to dealing with sexual health problems
• Describe the ethical principles involved when treating patients who have sexual health concerns e.g. contraception and abortion
• Understand the importance of confidentiality and informed consent
• Ensure that the doctor’s own beliefs, moral or religious reservations about any contraceptive methods or abortion do not adversely affect the management of a patient’s sexual health.

9. Scientific Aspect

• Understand and implement the key national guidelines that influence sexual healthcare provision