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The wider availability of hormonal emergency contraception may well
not change a woman's sexual behaviour, but does expose a new group of
health professionals to managing sexual health issues raised in such
consultations.
The complacency about the users of emergency contraceptive services
not being at risk for sexual infection in Bissell et al's letter is
breathtaking. What data do they have to support their assertions? In
Wakefield, an audit of emergency hormonal contraceptive seekers in family
planning clinics found 25% of women chlamydia positive by urine PCR
testing (Dr I Morgan, personal communication). This is at least double the
risk of infection compared with general practice screening pilots. In a
survey of community pharmacists within the catchment area of our GU
medical service (1), 79% of respondents did not know where the nearest GU
medicine service was, and nearly one third admitted they did not feel able
to broach the topic of sexual health with clients with a relevant
symptom.Around half the respondents were already trained in delivering
post-coital contraception.
I am sure Wakefield is not untypical of many areas in the United
Kingdom. Data relevant to local practice and provision must be available
to pharmacists to advise their clients appropriately.
The combination of assuming women in a currently stable relationship
are not at risk from infection (chlamydia is often clinically silent; and
what about infection from a prior relationship, a concurrent partner or
from an unfaithful spouse?)with an assumption that all emergency
contraceptive needs can be met by Levonelle (emergency IUD fittings have
not stopped with its introduction) and ignorance of how to access
treatment service provision is a potential recipe for disaster for the
future reproductive health of those women seeking emergency
contraception.Tubal infertility from unrecognised chlamydial and
gonococcal infections is very expensive form of contraception in both
human and healthcare terms.
The proposed Sexual Health strategy (2) pleads for integrating
services and client-centred care; we must not make assumptions about
client needs and professional competencies.Screening all contraceptive
requesters may reduce the stigma of being checked for an STI, but what
happens if a positive test is found?
Pilot studies often involve well motivated and interested
practitioners from all professional groups; we need be sure that a level
of competence is achieved across all standards of interest and enthusiasm
in a district. Until we can be assured that all community pharmacists have
had access to relevant local information and are fully trained and
confident in discussing sexual health matters I would plead for a
moratorium on the introduction of over the counter provision of hormonal
emergency contraception in the United Kingdom.
Refs
1. Ralph SG Preston A Clarke J Over-the-counter advice for genital
problems; the role of the community pharmacist.
Int J STD & AIDS 2001;12 513-5
2.The national strategy for sexual health and HIV Department of Health
2001
What do pharmacists know about sexual health services?
The wider availability of hormonal emergency contraception may well
not change a woman's sexual behaviour, but does expose a new group of
health professionals to managing sexual health issues raised in such
consultations.
The complacency about the users of emergency contraceptive services
not being at risk for sexual infection in Bissell et al's letter is
breathtaking. What data do they have to support their assertions? In
Wakefield, an audit of emergency hormonal contraceptive seekers in family
planning clinics found 25% of women chlamydia positive by urine PCR
testing (Dr I Morgan, personal communication). This is at least double the
risk of infection compared with general practice screening pilots. In a
survey of community pharmacists within the catchment area of our GU
medical service (1), 79% of respondents did not know where the nearest GU
medicine service was, and nearly one third admitted they did not feel able
to broach the topic of sexual health with clients with a relevant
symptom.Around half the respondents were already trained in delivering
post-coital contraception.
I am sure Wakefield is not untypical of many areas in the United
Kingdom. Data relevant to local practice and provision must be available
to pharmacists to advise their clients appropriately.
The combination of assuming women in a currently stable relationship
are not at risk from infection (chlamydia is often clinically silent; and
what about infection from a prior relationship, a concurrent partner or
from an unfaithful spouse?)with an assumption that all emergency
contraceptive needs can be met by Levonelle (emergency IUD fittings have
not stopped with its introduction) and ignorance of how to access
treatment service provision is a potential recipe for disaster for the
future reproductive health of those women seeking emergency
contraception.Tubal infertility from unrecognised chlamydial and
gonococcal infections is very expensive form of contraception in both
human and healthcare terms.
The proposed Sexual Health strategy (2) pleads for integrating
services and client-centred care; we must not make assumptions about
client needs and professional competencies.Screening all contraceptive
requesters may reduce the stigma of being checked for an STI, but what
happens if a positive test is found?
Pilot studies often involve well motivated and interested
practitioners from all professional groups; we need be sure that a level
of competence is achieved across all standards of interest and enthusiasm
in a district. Until we can be assured that all community pharmacists have
had access to relevant local information and are fully trained and
confident in discussing sexual health matters I would plead for a
moratorium on the introduction of over the counter provision of hormonal
emergency contraception in the United Kingdom.
Refs
1. Ralph SG Preston A Clarke J Over-the-counter advice for genital
problems; the role of the community pharmacist.
Int J STD & AIDS 2001;12 513-5
2.The national strategy for sexual health and HIV Department of Health
2001
Competing interests: No competing interests