ABSTRACT
The significance of asymptomatic non-chlamydial non-gonococcal urethritis (NCNGU) is unclear. Organisms associated with NCNGU, e.g. Mycoplasma genitalium, for which there is no widely available test, are linked to reproductive sequelae in women but UK guidance no longer recommends urethral smear microscopy to screen for asymptomatic NCNGU. This case-control study of heterosexual male genitourinary (GU) medicine clinic attenders aimed to identify clinical, demographic and sexual behaviour factors associated with asymptomatic NCNGU so that we could determine whether the presence or absence of symptoms provides a rational basis for deciding to whom we should offer microscopy and whom we should treat. Men with asymptomatic NCNGU were very similar to men with symptomatic NCNGU, except for more consistent condom use. Asymptomatic and symptomatic NCNGU could be different ends of the same clinical syndrome. Until the microbiological basis of NCNGU is understood, we recommend treatment of men with NCNGU irrespective of symptoms.
Subject(s)
Asymptomatic Infections/epidemiology , Heterosexuality , Sexual Partners , Sexually Transmitted Diseases, Bacterial/etiology , Urethritis/etiology , Adult , Case-Control Studies , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Chlamydia trachomatis/isolation & purification , Condoms/statistics & numerical data , Diagnosis, Differential , England/epidemiology , False Negative Reactions , Female , Humans , Male , Multivariate Analysis , Mycoplasma Infections/epidemiology , Mycoplasma Infections/microbiology , Mycoplasma genitalium , Retrospective Studies , Risk Factors , Sexual Behavior , Sexually Transmitted Diseases, Bacterial/epidemiology , Socioeconomic Factors , Urethritis/epidemiologyABSTRACT
UK sexual health services are shifting from hospital-based clinics into primary care, creating a need for high quality clinical sexual health training for non-specialists. Here we describe development, evaluation and costing of a new competency-based training programme, the Sexually Transmitted Infection (STI) Foundation Competency (STIFCompetency) programme, based on the Department of Health's toolkit for delivering more specialized sexual health in primary care. We used an action research paradigm with two iterative cycles. Evaluation was to Kirkpatrick's third level with triangulation of results between trainers and trainees, and different methods, including portfolio evaluation, nominal group technique process, semi-structured interviews, Likert questionnaires and chlamydia testing rates. All 13 primary care clinicians completed the training successfully (median 20 hours) and rated STIFCompetency highly. Trainers needed to reduce their clinical workload to accommodate the training. Average cost per trainee was £1125, reflecting the need for direct observation of competence across a wide range of clinical skills.
Subject(s)
Clinical Competence/statistics & numerical data , Physicians, Primary Care/education , Reproductive Health/education , Clinical Competence/standards , Education, Medical, Continuing/methods , Educational Measurement , England , Female , Humans , Male , Program EvaluationABSTRACT
Partner notification as a public health measure to reduce transmission of sexually transmitted infections (STIs) is a cornerstone of STI control in most countries. The success of any partner notification strategy is conditional on its acceptability and feasibility to both patients and health-care professionals, its compliance with relevant professional and legislative guidance, and its cost-effectiveness.
