Sexual Health

Sexual health questions in the AKT cover STI diagnosis and management, HIV prevention, sexual dysfunction, and inclusive healthcare for LGBTQ+ patients.

Chlamydia is the most common bacterial STI in the UK. It is often asymptomatic. The National Chlamydia Screening Programme offers testing to sexually active under-25s. Diagnosis is by NAAT (nucleic acid amplification test) on a vulvovaginal swab or first-catch urine sample. Treatment: doxycycline 100mg twice daily for 7 days (first-line, changed from azithromycin due to evidence of superior cure rates). Partner notification and treatment are essential.

Gonorrhoea presents with purulent urethral or vaginal discharge. Diagnosis by NAAT and culture (culture is needed for antibiotic sensitivity testing). Treatment is a single dose of IM ceftriaxone 1g. Dual therapy with azithromycin is no longer routinely recommended. A test of cure is required 2 weeks after treatment.

Syphilis has resurged in the UK. Primary syphilis presents with a painless chancre. Secondary syphilis presents with a widespread non-itchy rash, condylomata lata, and systemic symptoms. Diagnosis by syphilis serology (EIA screening, RPR/VDRL for monitoring). Treatment is IM benzathine penicillin. Refer to GUM services.

PrEP (pre-exposure prophylaxis) with tenofovir/emtricitabine is available on the NHS for people at high risk of HIV. This includes men who have sex with men (MSM) with recent STIs, condomless sex, or partners with detectable HIV, and other groups at substantial risk. GPs may be involved in monitoring (renal function every 3-6 months, STI screening, HIV testing).

Sexual dysfunction is common but underdiscussed. Erectile dysfunction: assess cardiovascular risk (ED is an independent cardiovascular risk factor), check testosterone, glucose, and lipids. First-line treatment is PDE5 inhibitor (sildenafil). Contraindicated with nitrates. Female sexual dysfunction includes low desire (consider psychosocial factors, medication effects, hormonal factors), pain (vaginismus, vulvodynia), and arousal disorders.

LGBTQ+ healthcare involves understanding specific health needs: higher rates of mental health conditions, substance misuse, and certain cancers in MSM. Trans healthcare in primary care includes respectful use of pronouns, understanding of gender-affirming hormone therapy side effects and monitoring, and cervical screening for trans men who retain a cervix.