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When should patients access STI testing ? If a patient complains of a change in discharge or other symptoms described above , and they are sexually active or have been in the past – including contact such as touching and use of sex toys – it is important to check if they have been screened for STIs recently .
If there is a high suspicion of an STI , a screen should be performed . A patient may still be at risk if they have been with the same partner for years or have not changed partners since their last test , or even if they have been recently tested .
Many regions of the UK now offer online testing , which means your patient can order a postal kit from their local sexual health service to test for STIs including gonorrhoea and chlamydia at home . If a patient gets a negative result with an at-home test , but is still experiencing symptoms , they will need to go to a sexual health clinic or their GP for further tests .
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Why is it important to ask about washing ? Washing can often be the cause of thrush , BV or dry and itchy skin . Washing inside the vagina or washing with strong soaps , shower gels or intimate feminine hygiene products can all cause a change in the natural pH balance of the vagina and cause irritation , soreness , or other symptoms of thrush or BV .
Using strong soaps or products can also cause dryness and soreness on the internal and external skin . The vagina is self-cleaning , and genitals should be washed with plain water or very mild soap . Patients should be advised never to wash or douche inside the vagina .
Tight clothing such as tights or leggings and washing detergents that are perfumed or biological can also cause thrush or BV . If external skin is dry or sore , using an emollient wash cream can help .
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BV should be treated with antibiotics , such as metronidazole . If someone is prone to BV , however , they may use OTC lactic acid gels , particularly around or after their period , to prevent the infection .
Sexually transmitted infections If the vaginal discharge is yellow or green , or of unusual consistency , or if the patient is experiencing other symptoms such as pain or discomfort when urinating , this could indicate an STI .
Common STIs include gonorrhoea and chlamydia ( both bacterial infections ), trichomoniasis ( caused by the protozoan Trichomoniasis vaginalis ) and genital herpes simplex ( a viral STI that can cause genital ulcers ). The patient will need to undergo testing to guide treatment .
How are infections diagnosed ? GPs and practice nurses can often diagnose thrush or BV based on clinical assessment . If symptoms are atypical , recurrent or not responding to treatment , they may take a high vaginal swab to test for BV , thrush or trichomoniasis infections , or refer the patient to a sexual health or genitourinary medicine ( GUM ) clinic for further testing .
Sexual health or GUM clinics will usually use microscopy to confirm thrush , BV or trichomoniasis , and ‘ NAAT ’ ( nucleic acid amplification test ) endocervical swabs to test for infections like gonorrhoea and chlamydia . 2
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References 1 BNF . Vaginal and vulval infections : Recurrent vulvovaginal candidiasis . bit . ly / 35k4Ow1 2 RCGP Sex , Drugs , HIV and Viral Hepatitis Group and British Association for Sexual Health and HIV ( BASHH ) guideline : Sexually transmitted infections in primary care , 2013 . bit . ly / 35jM7Zq |
Why is antibiotic use relevant ? It is important to ask if the patient has taken a course of antibiotics recently . Antibiotics can trigger thrush , as they diminish levels of the ‘ good ’ bacteria that keep a natural , healthy balance of different microorganisms – enabling a yeast infection to develop .
How does contraception affect vaginal and vulval health ? Hormonal contraception can change vaginal discharge , and both hormonal and non-hormonal intrauterine devices can also cause BV in some people . If a patient who has a coil fitted is regularly getting BV , their threads will need to be checked . A thread that gets too long can trigger BV and will need to be cut shorter . If the threads have been checked and all other causes have been ruled out , a change of contraception method may be required .
What if symptoms persist despite treatment ? If the patient has received treatment for thrush or BV but is still complaining of symptoms , check how long ago they took the medication . Symptoms can often take one to two weeks to clear up . If they experience recurrent thrush or BV and treatment is not working , they will need to speak to their GP or local sexual health clinic . Similarly , if a patient is complaining of unusual discharge but thrush and BV have been ruled out , they are washing correctly and their STI screens come back negative , they will need to be seen in a sexual health clinic where they will be fully assessed .
Helen Burkitt is a senior sexual health nurse at the non-profit online sexual health services SH : 24 ( sh24 . org . uk ) and Fettle ( fettle . health )
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