22 Jun 2010
Pharmacists participating in a scheme to offer chlamydia screening to young women requesting emergency contraception (EC), did not offer it comprehensively. They were less likely to offer testing to women who were married, in a long-term relationship or who had recently been tested. 'The pharmacists surveyed here undertook specific training in sexual health and chlamydia screening in their own time and offered the service free of charge to their customers and for this they are to be commended.However, that screening was offered preferentially implies that at times they were acting expediently and at others were making value judgements. The tendency to decline to offer screening to girls under 16 is an opportunity missed. It could be argued that some screening is better than none but it does highlight the need for proper training and adequate resources if inroads into chlamydia infection are to be realised.'
22 Jun 2010
A study of internet STI testing sites from the United States has found that the quality is variable and often poor.The authors state their concern that the quality of STI testing services was often poor and called for national regulatory control of quality to protect customers from receiving inaccurate results. However, they do not dismiss entirely the advantage of properly regulated internet-based STI testing services in a broader strategy to encourage more testing for thoseat risk. 'it is of course desirable that the public are using the internet not just to source information regarding STIs but also that they are choosing to test for STIs, especially those who are too embarrassed or unwilling to attend their GP or sexual health clinic. Internet sites that offer STI testing services and advice may be available but they are not free and are not regulated. In UK practice, it is entirely possible for patients to use internet-based services for DIY testing at home. We should advise caution if patients choose to use these services and also if they have received test results that are negative.'
22 Jun 2010
The widespread availability of OTC azole antifungals does not appear to have increased the incidence of resistant candida species, according to a study from the North of England. A total of 18 patients with non-albicans vaginal candidiasis were prescribed amphotericin and flucytosine vaginal cream; all were clear of their initial yeast isolate but two had persistent symptoms and had positive cultures for C. albicans which cleared with azoles.'In practice, we may see women with recurrent thrush or thrush resistant to treatment. We may treat syndromically (without any investigations) for simple cases. However, with recurrent or resistant cases, getting at least one swab that demonstrates candida and possibly another swab requesting testing specifically for Candida glabrata may help to support treatment with non-azole antifungals.'
18 May 2010
'While the POPI study does not prove beyond doubt the effectiveness of a chlamydia screening programme, it does prove there is some evidence that it can reduce incidence of PID. Also of interest is that it helps clinicians not to dismiss taking a sexual history in a woman who has had a chlamydia test as she might have been exposed to risks since the last test.'
01 Oct 2009
Current UK national guidelines recommend an increase in HIV testing in primary and secondary care settings to improve early diagnosis. However, I think for this to be successfully rolled out in primary care, there need to be adequate incentive structures in place to encourage uptake, and effort should be concentrated in areas of high HIV prevalence such as London, Brighton and other urban areas.
= Paid-up subscribers