Sexual health at risk of becoming ‘Cinderella’ service, say GPs

Sexual and reproductive health is at risk of becoming a ‘Cinderella’ service thanks to red tape, and financial and training hurdles facing GPs and their practice teams, the Royal College of GPs (RCGP) has warned.

These issues risk undoing years of improvement in the quality of sexual and reproductive healthcare being delivered to patients – including a halving of teenage pregnancy rates over the past decade and steadily increasing uptake of long-acting reversible contraceptives (LARCs), it says.

The findings of a College consultation, published in a report, Time to Act, show that GPs fear rates of teenage pregnancy and transmission of sexually transmitted diseases will rise – reversing current trends – as vulnerable patients are being excluded from accessing the most appropriate forms of contraception, and widening  health inequalities as a result.

Full report: Sexual and Reproductive Health: Time to Act

Story via OnMedica

Deaths linked to Aids have halved in a decade

A report by the Joint United Nations Programme on HIV/Aids (UNAids) showed deaths had fallen from a peak of 1.9 million in 2005 to 1 million last year | BBC News

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Image source: UNAIDS

The condition, which is caused by HIV, used to be one of the top 10 causes of death worldwide. It said the “scales have tipped”, with more than half of people getting drug treatment for the first time. An HIV infection cannot be cured – it can only be contained with daily doses of antiretroviral therapy.

Unchecked, it destroys the immune system, causing Aids. At this point people tend to die from other “opportunistic infections” such as tuberculosis. Worldwide, 36.7 million are living with HIV and 53% of them are getting the therapy that gives a near-normal life expectancy.

Contraceptive Method Choice and Initiation in Adolescents and Young Women

The purpose of the study was to identify factors associated with uptake of contraceptive implants or intrauterine devices (IUDs) by adolescents and young women | Journal of  Adolescent Health

Methods: For this prospective cohort study, we recruited English-speaking female contraceptive initiators aged 14–24 years attending a Title X-supported, youth-focused clinic. Immediately prior to their visits, participants completed surveys assessing demographic and reproductive characteristics and awareness of, interest in, and intent to initiate specific contraceptive methods. Participants also answered questions about their social contacts’ contraceptive experiences. Following the visit, participants reported the method initiated and the perceived importance of provider counseling. We used a multivariable regression model to ascertain factors associated with initiation of an IUD, an implant, or a short-acting reversible method.

Results: We enrolled 1,048 contraceptive initiators: 277 initiated short-acting methods, 384 IUDs, and 387 implants. High previsit personal acceptability of the method was associated with choosing that method for both implants and IUDs. Knowing someone who uses a specific method and likes it was predictive of personal acceptability of that method (IUD adjusted odds ratio: 10.9, 95% confidence interval: 3.8–31.1; implant adjusted odds ratio: 7.0, 95% confidence interval: 2.3–21.0). However, 10.4% of those initiating IUDs and 14.2% of those initiating implants had never heard of the method before their appointment. Even women with previsit intent to initiate a specific method found importance in contraceptive counseling.

Conclusions: Previsit personal acceptability, which was associated with social contacts’ experiences, was the strongest predictor of specific method uptake in our study. However, counseling informed the decisions of those with low previsit awareness and supported patients with formed intent.

Full reference: Cohen, R. et al. (2017) Factors Associated With Contraceptive Method Choice and Initiation in Adolescents and Young Women. Journal of  Adolescent Health. Published online: 13 July 2017

 

Cuts to sexual health services are putting patients at risk, says King’s Fund

Cuts to sexual health services in parts of England are placing the care of patients at risk, a new report has warned.

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The research by the healthcare think tank the King’s Fund concluded that budget cuts of more than 20% to genitourinary medicine (GUM) services in some parts of the country had led to service closures and staffing cuts that have harmed patient care. Experts said that the findings were particularly worrying given that numbers of diagnoses of sexually transmitted infections such as syphilis and gonorrhoea were rising.

Current pressures on services were also having a negative effect on staff morale and leading some staff to consider alternative careers, the report warned.

Problems identified in the Genitourinary medicine services:

  • Public health budgets were cut by £200m (6.7%) in 2015-16

  • Around a quarter of local authorities cut GUM spending by more than 20% between 2013-14 and 2015-16. Around one in seven increased spending by this amount

  • The commissioning of sexual health, reproductive health, and HIV services has been split between local authorities, CCGs, and NHS England, resulting in fragmentation

  • New attendances at clinics rose from 1.6 million in 2011 to over 2.1 million in 2015

“You give a blank sheet of paper to local government to do something really exciting, and then you take the money away”—consultant

Read the full article here

Read the original King’s Fund report here

Screening for Chlamydia trachomatis Infections in Women

Wiesenfeld, , H.C. (2017) New England Journal of Medicine. 376:765-773

Chlamydial infection may result in pelvic inflammatory disease, infertility, and ectopic pregnancy. Chlamydia screening is recommended in sexually active women younger than 25 years of age and other women at increased risk and can be performed on vaginal swabs or urine samples.

Read the full abstract here

Associations Between Sex Education and Contraceptive Use

Jaramillo, N. et al. Journal of Adolescent Health. Published online: 26 January 2017

Purpose: This study examined associations between reports of receiving education on topics commonly included in sex education (e.g., abstinence only, comprehensive) prior to age 18 years and contraceptive use at the last sex among heterosexually active, 15- to 20-year-old males in the United States.

 

Conclusions: Exposure to a larger number of sex education topics is associated with young men’s report of dual contraception use at the last sex. Comprehensive sex education, focusing on a range of topics, may be most effective at promoting safer sex among adolescent males.

Read the full abstract here

Sexually transmitted infections: managing outbreaks

Guidance for managing STI outbreaks and incidents | Public Health England

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This guidance revises previous guidance produced by the Health Protection Agency, now Public Health England (PHE). Development of the guidance has been informed by a stakeholder consultation workshop and the many outbreak investigations supported by PHE and its predecessor organisations since 2001.

Guidance is given on:

  • planning a STI outbreak prevention and control strategy
  • investigating an outbreak