Fear of venepuncture as a barrier to testing for blood-borne infection and use of an oral fluid test as an alternative to venepuncture in a genitourinary medicine clinic.

OBJECTIVE: A survey of 505 consecutive patients attending a UK genitourinary medicine clinic (GUM) included a psychometric tool to compute a fear of venepuncture (FOV) score, responses to the offer of venepuncture and to alternative testing. METHOD: An oral fluid test (OFT) was available to test for blood-borne infection (BBI). Completed fear scores were provided by 299 (59%) patients routinely offered venepuncture, of whom 72 (24%) who did not have venepuncture had higher fear scores compared with 227 (76%) who had venepuncture (p<0.001). RESULTS: Both FOV and female sex were independent predictors of not having venepuncture. CONCLUSIONS: FOV is an important barrier to uptake of venepuncture. FOV may not always be recognised by health carers. OFT is an acceptable alternative test for some patients with needle aversion who decline venepuncture.

An evaluation of the applicability of quantitative clinical standards for the management of genital chlamydial infection using an electronic database.

A prototype electronic database was designed for use as a retrospective audit tool to provide data that allowed comparison of genital chlamydial infection management performance with a series of quantitative operational consensus standards. However, some of the terms used by the standards require further definition for translation into database fields to improve accuracy and general application as an audit tool. Construction of the database involved differentiation between prior and clinic diagnostic points, as well as a forward contact trail of specific quantitative indicators of contact tracing. More definition is needed of the meaning of diagnosis and contact in the standards. For clinic-diagnosed patients, the time to treatment was mainly dependent on clinical factors, not on the availability of a chlamydial test result. For about one-third of patients (with prior management), several standards cannot be applied because data are not available, and this raises the issue of data sharing between various agencies involved in chlamydial testing. More data from other clinics may help both to test the appropriateness of, and inform, some of the operational standards. The database could be developed as a real-time audit tool for use with electronic patient records.

Anogenital warts and condom use--a survey of information giving.

OBJECTIVE: To examine information giving by genitourinary medicine (GUM) consultants about the use of condoms for patients with anogenital warts (AGW). METHOD: 228 GUM consultants in the UK and Ireland were sent a questionnaire concerning the information about condom use which they usually discuss with patients with AGW. The survey was carried out in 1994. RESULTS: There was a 46% response rate. Most consultants indicated giving information specifically with regard to the prevention of transmission of human papilloma virus (HPV), and not only in the context of safe sex. With regard to current AGW, consultants were more likely to discuss, than not to discuss, use of condoms with patients with regular sexual partners in terms of benefit, uncertain benefit, or no benefit. However, no significant difference in the likelihood of discussing, or not discussing, these issues was found for current AGW for patients without regular partners. For both groups, benefit of using condoms for current AGW was more likely to be discussed than no benefit. The majority of consultants indicated that they would discuss condom use after disappearance of AGW as being of uncertain benefit. However, many consultants also indicated discussing use of condoms for a specific period or an indefinite period of time, including many of those who specific discussing uncertain beneficial use of condoms after disappearance of AGW. The most common duration of condom use chosen for discussion was until 3 months after disappearance of AGW. CONCLUSION: GUM consultants vary in the information they give about condom use specifically to prevent transmission of HPV. This survey suggests a need for evaluation by GUM physicians of management guidelines relating to information given about condom use for AGW, including utilising the available scientific evidence as well as dealing with issues of uncertainty.

Use of GUM services and information and views held by first time service users in a large UK city: implications for information provision.

The aim of this study was to examine the relationship between information and views held by service users before obtaining help from a genitourinary medicine (GUM) service and the accessibility and use of the service, and to determine potential intervention measures for change. A structured questionnaire was completed by 292 first-time GUM service users in a large UK city in 1994. Overall 94 (57.7%) of 163 male service users and 59 (48.4%) of 122 female service users had some information about the service before seeking help, although this difference was not significant. Only 92 (31.5%) knew the service was open-access. The main source of information was through general practitioners (GPs), with personal contact as the second most common information source. Two hundred and fifteen (73.6%) used the service within 2 weeks of needing help and 104 (35.6%) of these felt there was delay, but reporting delay was not associated with having information about the service. The majority indicated feeling nervous and/or embarrassed about using the service. Female service users were significantly more likely to feel nervous or embarrassed than male service were (P < 0.05). Service users were significantly more likely to feel nervous when they had no information about the service than if they knew something about the service (P < 0.01). Most service users regarded the service as dealing with sexually transmitted infections (STIs), and most intended to use the service for this reason. However, whilst many service users indicated knowledge about non-STI services, including HIV counselling and testing, relatively few intended to use these services. Most service users (269, 92.1%) were in favour of increased availability information about GUM clinics mainly through written media but also through GPs. The results of this study show a clear need to project increased awareness and information about this GUM service so as to encourage use of the range of services available and promote more positive feelings about using the service. Information in written media as well as through other health professionals may be of benefit. Further work is needed to study the effect of information provision in influencing the large number of potential service users to make use of sexual health services.

"Healthy alliances?"--other sexual health services and their views of genitourinary medicine.

OBJECTIVE: To assess health professionals' views of genitourinary medicine (GUM) services in a large UK city and to determine potential intervention measures for change. METHODS: A postal questionnaire was sent to 205 service providers in a range of sexual health services in Glasgow, including GUM specialist doctors, nurses and health advisers. The questionnaire included structured questions about organisation and use of GUM services, assessment of profile and stigma, and asked about factors most likely to influence future service development. RESULTS: 128 questionnaires were returned from areas throughout the city. Non-GUM health professionals had poor factual knowledge about the organisation of GUM services. GUM had a poor profile compared with other sexual health services and stigma was thought to exist about the service. Most non-GUM service providers continue traditionally to regard GUM mainly as a referral centre for a few specific sexually transmitted infections and not as a centre for holistic sexual health care. Genital chlamydial infection and pelvic inflammatory disease were considered low priority for GUM referral by some groups of service providers. These views contrasted with those working in the speciality. There was generally poor professional contact between GUM and other service providers involved in sexual health. Most indicated that greater levels of information and publicity, increased professional contact, and a broader range of services within GUM were important for future service development. CONCLUSIONS: The response to the questionnaire strongly indicates that there is poor awareness of and consequently suboptimal use of the full range of services offered by GUM. Potential interventions to address this need include increased cross-speciality collaboration and targeting of specific groups of service providers involved in sexual health care. Important groups include hospital-based specialists and voluntary agencies as well as general practitioners. There is a clear need to project the broad range of sexual health services offered by GUM, and to emphasise the role of GUM in managing specific sexual health problems including several sexually transmitted infections.