Infectious Diseases and Travel Health

Infectious diseases and travel health cover a broad range of AKT content including common infections managed in primary care, notifiable diseases, HIV, hepatitis, travel medicine, and antimicrobial stewardship.

HIV testing is recommended in areas with high prevalence (more than 2 per 1000) and for all new GP registrations in those areas. Indicator conditions for HIV testing include herpes zoster in under-65s, unexplained lymphadenopathy, oral candidiasis, unexplained weight loss, and any STI. Fourth-generation tests detect both HIV antigen and antibodies and have a window period of approximately 4 weeks. Post-exposure prophylaxis (PEP) should be started within 72 hours of exposure.

Hepatitis B is notifiable and has defined markers for interpretation. HBsAg positive indicates current infection. Anti-HBs indicates immunity (from vaccination or past infection). Anti-HBc IgM indicates acute infection. HBeAg indicates high infectivity. Vaccination is offered to at-risk groups including healthcare workers, household contacts of cases, and men who have sex with men.

Hepatitis C is curable with direct-acting antiviral therapy. Screen high-risk groups including people who inject drugs, those who received blood transfusions before 1991, and people from high-prevalence countries. Refer all HCV-positive patients to hepatology.

Antimicrobial stewardship is a major theme. Principles include avoiding antibiotics for self-limiting viral infections, using narrow-spectrum antibiotics where possible, prescribing the shortest effective course, and following local antibiotic guidelines. Delayed prescribing is recommended for many respiratory tract infections, UTIs in young women (with back-up prescription), and acute otitis media.

Notifiable diseases that GPs must report to Public Health include measles, meningitis, tuberculosis, food poisoning, whooping cough, scarlet fever, and hepatitis (A, B, C, E). Notification is a statutory duty and does not require patient consent.

Travel health consultations include risk assessment based on destination, itinerary, and individual patient factors. Yellow fever vaccination is required for entry to some countries and is only available at designated centres. Malaria prophylaxis depends on the destination: atovaquone-proguanil, doxycycline, or mefloquine. Travellers' diarrhoea is usually self-limiting; standby antibiotics (azithromycin) may be appropriate for high-risk travellers.