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Preventing sexually transmitted infections and under-18 conceptions

Short Text

This pathway covers sexually transmitted infection (STI) prevention for the whole population and the prevention of under-18 conceptions.

Introduction

This pathway covers recommendations on how to prevent sexually transmitted infections among the whole population and how to prevent under-18 conceptions. It focuses on the provision of one-to-one interventions as part of the routine care provided by primary care, sexual health and contraceptive services. The recommendations are aimed at the NHS, local authorities and the wider public, voluntary, community and private sectors.

Source guidance

The NICE guidance that was used to create the pathway.

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Pathway information

Updates to this pathway

27 January 2014 minor maintenance updates
11 June 2013 minor maintenance updates
21 May 2013 minor maintenance updates
25 October 2011 minor maintenance updates

Supporting information

Glossary

People who are at risk of getting a sexually transmitted infection (STI) include:
  • men who have sex with men
  • people who have come from or who have visited areas of high HIV prevalence.
Behaviours that increase the risk of STIs include:
  • misuse of alcohol and/or substances
  • early onset of sexual activity
  • unprotected sex and frequent change of and/or multiple sexual partners.
Primary care is healthcare delivered outside hospitals. It includes a range of services provided by GPs, nurses, health visitors, midwives and other healthcare professionals and allied health professionals such as dentists, pharmacists and opticians. It includes community clinics, health centres and walk-in centres.
Vulnerable young people aged under 18 may include thoseDepartment for Education and Skills [2006] Teenage pregnancy: accelerating the strategy to 2010. London: Department for Education and Skills:
  • from disadvantaged backgrounds
  • who are in – or leaving – care
  • who have low educational attainment.

Preventing STIs and under-18 conceptions

Preventing STIs and under-18 conceptions

Commissioning and coordinating sexual health services

Commissioning and coordinating sexual health services

Commissioning and coordinating sexual health services

Ensure that sexual health services, including contraceptive and abortion services, are in place to meet local needs. All services should include arrangements for the notification, testing, treatment and follow-up of partners of people who have a sexually transmitted infection (STI) (partner notification).
Define the role and responsibility of each service in relation to partner notification (including referral pathways).
Ensure staff are trained.
Ensure there is an audit and monitoring framework in place.

Implementation tools

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Source guidance

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Providers of sexual health advice

GPs, nurses and other clinicians providing sexual health advice in healthcare settings, school clinics, outreach centres, voluntary, community and other non-healthcare settings

People at risk of STIs

Identifying people at risk of sexually transmitted infections and providing advice

Identifying people at risk of sexually transmitted infections and providing advice

Who should take action?

Health professionals working in: general practice, genitourinary medicine, community health services (including community contraceptive services), voluntary and community organisations and school clinics.

Identifying those who need one-to-one help

Identify individuals at high risk of sexually transmitted infections (STIs) using their sexual history. Opportunities for risk assessment may arise during consultations on contraception, pregnancy or abortion, and when carrying out a cervical smear test, offering an STI test or providing travel immunisation. Risk assessment could also be carried out during routine care or when a new patient registers.

One-to-one discussions

If trained in sexual health, have one-to-one structured discussions with individuals at high risk of STIs. If not, arrange for these discussions to take place with a trained practitioner. The discussions should be structured on the basis of behaviour change theories. They should address factors that can help reduce risk-taking and improve self-efficacy and motivation. Ideally, each session should last at least 15-20 minutes. The number of sessions will depend on individual need.
For details of a range of behaviour change theories see Conner and NormanConner M, Norman P, editors (2005) Predicting health behaviour. Maidenhead: Open University..

Source guidance

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Vulnerable young people under 18

Giving sexual health advice to vulnerable young people aged under 18

Giving sexual health advice to vulnerable young people aged under 18

One-to-one sexual health advice

Who should take action?

GPs, nurses and other clinicians working in healthcare settings such as primary care, community contraceptive services, antenatal and postnatal care, abortion and GUM services, drug/alcohol misuse and youth clinics, and pharmacies.
GPs, nurses and other clinicians working in non-healthcare settings such as schools and other education and outreach centres.

What action should be taken?

Where appropriate, provide vulnerable young people with one-to-one sexual health advice on:
  • how to prevent and/or get tested for sexually transmitted infections (STIs) and how to prevent unwanted pregnancies
  • all methods of reversible contraception, including long-acting reversible contraception (LARC) in line with the NICE pathway on long-acting reversible contraception
  • how to get and use emergency contraception
  • other reproductive issues and concerns.
Provide supporting information on the above in an appropriate format.

Young women who are pregnant or have children

Who should take action?

Midwives and health visitors who provide antenatal, postnatal and child development services.

What action should be taken?

Regularly visit vulnerable women aged under 18 who are pregnant or who are already mothers.
Discuss with them and their partner (where appropriate) how to prevent or get tested for STIs and how to prevent unwanted pregnancies. The discussion should cover:
  • all methods of reversible contraception, including LARC in line with the NICE pathway on long-acting reversible contraception, and how to get and use emergency contraception
  • health promotion advice, in line with the NICE pathway on postnatal care
  • opportunities for returning to education, training and employment in the future.
Provide supporting information in an appropriate format.
Where appropriate, refer the young woman to the relevant agencies, including services concerned with reintegration into education and work.

Source guidance

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People with an STI

Helping people with a sexually transmitted infection to get their partners tested

Helping people with a sexually transmitted infection to get their partners tested

Who should take action?

Health professionals, including those with a responsibility for helping to contact, test and treat partners of patients with a sexually transmitted infection (STI) and including those working in school clinics.

What action should be taken?

Help patients with an STI to get their partners tested and treated (partner notification), when necessary. This support should be tailored to meet the patient's individual needs.
If necessary, refer patients to a specialist with responsibility for partner notification. (Partner notification may be undertaken by the health professional or by the patient.)
Provide the patient and their partners with infection-specific information, including advice about possible re-infection. For chlamydia infection, also consider providing a home sampling kit.

Source guidance

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Paths in this pathway

Pathway created: August 2011 Last updated: January 2014

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.

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