8. Sceening and prevention of STI Flashcards
Blood tests check for which sexual disease?
HIV 1+2 antibodies and p24 antigen
Hep B antigen
Syphilis
Swabs and urine tests check for which sexual disease?
- 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
Chlamydia causative agent`?
Chlamydia tachomatis
Effect of chlamydia?
Damage to woman’s reproductive organs e.g. irreversible infertility
Discharge from the penis of infected man
Incidence of chlamydia?
In europe: 10 million new cases per year
Typical developed country prevalence rate for 15-25yr olds:
-9% for females
-Slightly less for males
Transmission of chlamydia?
Vaginal, anal or oral
Also passed from infected mother to baby during vaginal childbirth
Why are sexually active teenage girls and young women at risk of chlamydia?
As their cervix isn’t fully matured
Symptoms of chlamydia?
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
Serious complications of chlamydia in women?
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
Serious complication of chlamydia in men?
Rare
Infection sometimes spreads to the epididymis
Causes pain, fever and rarely sterility
Testing for chlamydia?
Traditional method: Physical examination for collection of samples from urethra/
Urine testing immunoassays e.g. Home testing kits
What is the importance of partner notification?
- 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
What are the different approaches to behaviour change in screening?
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
What are the Prochaska and DiClemente stages of change?
Pre-contemplation Contemplation Preparation Action Maintenance
Correlates of patient change talk
Change talk
- -> Clinician listen
- -> Clinician reframe
Correlates of patient resistance
Clinician confront
- -> Patient argue
- -> Patient interrupt
- -> Patient negative
- -> Patient off-task
Issue of sex communication between adolescents and doctors?
Many adolescents want to discuss sex-related topics but don’t trusts doctors discretion.
What is the Carey et al., 1997 study into HIV risk?
Results showed…
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
What is the flow of change
Motivational interviewing
- -> Desire, ability, reasons, need
- -> Commitment
- -> Change
What is the Carey et al., 2001 study into HIV risk?
Results showed…
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
Organisers of screening programmes are seen to be…
What is the answer?
PATERNALISTIC
Solution:
• Give people information to make an informed choice
• Provide pros and cons
• Effects of decisional aids are unknown and controversial
