Introduction
The last eighteen months has brought numerous issues in sexual health into the public eye in the United Kingdom. Influential publications during this period have included guidelines on testing for HIV, the Department of Health’s review of the national strategy for sexual health and HIV and reviewed NICE guidelines for antenatal care. We have also seen the national roll-out of the national Chlamydia Screening Programme. Other developments such as Best Practice in Testing and Treatment for STIs in women have evolved more gradually but may not be accessible to those not working directly in sexual health. This article will attempt to cover all these issues in enough measure to guide basic practice, with guidance on where further information may be sought.
Sexual health in the United Kingdom was reviewed in the Department of Health (DOH) document on the national strategy for Sexual Health and HIV, published in July 2008.
It reports:
- 14% of people said they would never or rarely, use a condom with a new sexual partner;
- Numbers of new STI diagnoses at GUM clinics have risen steadily over the last 10 years. The highest rates are in young people and men who have sex with men;
- 16-24 year-olds account for nearly half of all STIs diagnosed in GUM clinics;
- 9.5% of women and 8.4% of men aged under 25, test positive for Chlamydia when screened;
- Afro-Caribbeans continue to have a very high incidence of STIs, accounting for 17% of all gonorrhea diagnoses, though they only comprise 1% of the UK population.
The year 2008 also brought the publication of the updated NICE guidelines for antenatal care. Pregnancy may be one of the only times that many otherwise healthy women access medical care, it therefore seems an ideal time to opportunistically screen for Sexually Transmitted Infections.
The new guideline continues to recommend routine screening for certain blood borne infections (HIV & Hepatitis B) and syphilis for pregnant women. A new introduction to the guideline is the recommendation that:
“At the booking appointment, healthcare professionals should inform pregnant women younger than 25 years, about the high prevalence of chlamydia infection in their age group and provide local details for the National Chlamydia Screening Programme”.
It also adds that, although there is no current role for routine chlamydia screening in antenatal care, there is a need for further research into the benefits of screening in these patients. Patients who are 25 and over who are keen to be screened should be advised about where they can be tested.
The implications of Chlamydia in pregnancy are the same as those outside pregnancy: pelvic inflammatory disease, increased risk of infertility and ectopic pregnancy with the increased risks associated with untreated infection in pregnancy of possible preterm delivery, low birth-weight and fetal infection (ophthalmic/pulmonary). By understanding these risks we can help to advise women eligible for screening of the benefits.
Since the NICE publication, there has been a report from Australia looking at antenatal chlamydia screening. It identified those most likely to have the infection in pregnancy.