8. Sceening and prevention of STI

Question 1

Blood tests check for which sexual disease?

Answer 1

HIV 1+2 antibodies and p24 antigen
Hep B antigen
Syphilis

Question 2

Swabs and urine tests check for which sexual disease?

Answer 2

• chlamydia ** ( most commonly sexually transmitted disease)
• HIV **
• gonorrhoea,
• mycoplasma,
• ureaplasma,
• candida (thrush),
• streptococci,
• staphylococci and
• haemophilus.
• NSU (non-specific urethritis),
• bacterial vaginosis (BV),
• trichomonas and
• cystitis.
• Genital wart and HPV

Question 3

Chlamydia causative agent`?

Answer 3

Chlamydia tachomatis

Question 4

Effect of chlamydia?

Answer 4

Damage to woman’s reproductive organs e.g. irreversible infertility
Discharge from the penis of infected man

Question 5

Incidence of chlamydia?

Answer 5

In europe: 10 million new cases per year
Typical developed country prevalence rate for 15-25yr olds:
-9% for females
-Slightly less for males

Question 6

Transmission of chlamydia?

Answer 6

Vaginal, anal or oral

Also passed from infected mother to baby during vaginal childbirth

Question 7

Why are sexually active teenage girls and young women at risk of chlamydia?

Answer 7

As their cervix isn’t fully matured

Question 8

Symptoms of chlamydia?

Answer 8

Silent disease
Symptoms tend to only occur 1-3 weeks after exposure

Female symptoms:

• Abnormal vaginal discharge
• Burning sensation when urinating
• Lower abdominal pain
• Low back pain
• Fever
• Pain during intercourse
• Bleeding between menstrual periods

Male symptoms:

• Discharge from penis
• Burning sensation when urinating
• Burning / itching around opening of the penis
• Pain and swelling in the testicles are uncommon

Question 9

Serious complications of chlamydia in women?

Answer 9

PID:

• Untreated infection can spread into the uterus or fallopian tubes. Leading to pelvic inflammatory disease (PID)
• 40% of untreated female cases
• Leads to: Permanent damage to the fallopian tubes, uterus and surrounding tissues
• Damage leads to chronic pelvic pain, infertility and dangerous ectopic pregnancy
• 5 x more likely to be infected with HIV

Question 10

Serious complication of chlamydia in men?

Answer 10

Rare
Infection sometimes spreads to the epididymis
Causes pain, fever and rarely sterility

Question 11

Testing for chlamydia?

Answer 11

Traditional method: Physical examination for collection of samples from urethra/
Urine testing immunoassays e.g. Home testing kits

Question 12

What is the importance of partner notification?

Answer 12

• More than half of the partners of +ve patients are themselves +ve.
• Found that partner notification was important to notify partners for testing. Huge saving in treatment costs if both partners are tested.
• But GPs prefer specialist partner notification

Question 13

What are the different approaches to behaviour change in screening?

Answer 13

Motivational interviewing: Process of increasing motivation when people are not thinking of change
Problem-focused counselling: Identifies causes of problems that prevent change
Modelling and rehearsal of change: Improves skills and self-efficacy to achieve change

Question 14

What are the Prochaska and DiClemente stages of change?

Answer 14

Pre-contemplation
Contemplation
Preparation
Action
Maintenance

Question 15

Correlates of patient change talk

Answer 15

Change talk

• -> Clinician listen
• -> Clinician reframe

Question 16

Correlates of patient resistance

Answer 16

Clinician confront

• -> Patient argue
• -> Patient interrupt
• -> Patient negative
• -> Patient off-task

Question 17

Issue of sex communication between adolescents and doctors?

Answer 17

Many adolescents want to discuss sex-related topics but don’t trusts doctors discretion.

Question 18

What is the Carey et al., 1997 study into HIV risk?

Results showed…

Answer 18

Randomised control trial of 102 women at risk of HIV in the US.
Motivational interviewing in 4 group MET sessions
Comparison group: Waiting list group
Follow up: 3 months

Results showed..
MI group showed greater:
-HIV knowledge
-Perception of HIV risk
-Intention to protect
-Communication with partner
MI group showed lower rates of:
-Unprotected intercourse
-Substance abuse before sex

Question 19

What is the flow of change

Answer 19

Motivational interviewing

• -> Desire, ability, reasons, need
• -> Commitment
• -> Change

Question 20

What is the Carey et al., 2001 study into HIV risk?

Results showed…

Answer 20

Randomised control trial of 102 women at risk of HIV in the US.
Motivational interviewing in 4 group MET sessions
Comparison group: Educational group
Follow up: 3 and 12 weeks

Results showed…
MI group showed greater:
-HIV knowledge
-Intention to protect
MI groups showed lower rates of…
-Unprotected intercourse among women with imperfect intentions
MESSAGE: Use of motivational interviewing approaches are more successful than education

Question 21

Organisers of screening programmes are seen to be…

What is the answer?

Answer 21

PATERNALISTIC
Solution:
• Give people information to make an informed choice
• Provide pros and cons
• Effects of decisional aids are unknown and controversial