Clearer GUM referral advice needed in primary care

By Emma Wilkinson

Patients with sexually transmitted infections are being missed in primary care due to a lack of clear referral protocols, say UK researchers.

Their study of 1,000 patients attending a GU clinic in South-West England found 35% had gone to their GP initially.

Chlamydia testing had been done in 27% of female and 6% of male patients.

Of those patients with genital warts, most had been diagnosed correctly already but only 9% offered treatment.

The researchers writing in Sexually Transmitted Infections said there was a lack of clarity on who should be doing what investigations and there was a danger that people could fall through the cracks before they received treatment.

Dr Rachel Neale, study leader and specialist registrar in the department of GU medicine, Royal Cornwall Hospital, Truro said at the very least everyone should be getting Chlamydia tests in line with government strategy.

"There's variation and there doesn't seem to be set boundaries or protocol. Some patients will just be signposted on while others will have had full history, tests done and being treated – it's inconsistent.

But Edinburgh GP and chair of the RCGP sex, drug and HIV working group Dr Ewen Stewart said: ‘It seems that the majority of patients are being directed to GUM for diagnosis and management which is often the most appropriate course of action for patient presenting with symptoms suggestive of an STI.

‘The important issue for primary care is that a proper sexual history is taken and symptoms are recognised - appropriate management can then be determined which may or may not include referral to GUM.'