Sexually Transmitted Infections (STIs)

Please watch our RefTalk on STIs which gives an overview of risk groups, testing, diagnostic and treatment approaches with a focus on Monkey Pox and HIV.

Services

STI and HIV testing and treatment, along with other specialist genitourinary referral services, are provided by the integrated Lothian Sexual and Reproductive Health services team based at Chalmers Sexual Health Centre and ten Sexual Health Local Clinics across Lothian.

The Chalmers ‘where to start’ guidance gives advice on assessment and testing for STIs and related conditions.

Please also see the clinical pathways for individual conditions for help with management in general practice and guidance on the point at which referral is indicated.

Remote STI testing:

Routine check-ups for sexually transmitted infections for those without symptoms can be done with a Self Sampling Kit.
The kit is very simple to use and includes tests for Gonorrhoea, Chlamydia (using swab or urine samples) along with finger prick blood tests for HIV and Syphilis.

At Chalmers:

Diagnosis, treatment and contact tracing (partner notification) of sexually transmitted infections (STI) in patients with or without symptoms
Diagnosis and treatment of genital symptoms that may or may not be due to an STI.
Diagnosis and ongoing care of patients with HIV infection.
Management of adults who have been sexually assaulted – please see Sexual Assault Services.
Management of young adults who may have been sexually abused (seen previously by Community Paediatrics)
Provision of HIV Post-Exposure Prophylaxis following Sexual Exposure (PEPSE)
Provision of Pre-Exposure Prophylaxis for HIV (PrEP).
Vaccination against Hepatitis A & B and HPV for those at risk through sexual contact.
Vaccination against HPV for GBMSM under the age of 45.

At local clinics:

All Local Clinics offer a full range of STI testing services, vaccination and treatments for common STIs as well as contraceptive and reproductive health services.
Formal referrals are required for complex problems, HIV care, PrEP provision and treatment for gonorrhoea and syphilis. Those services are only provided at the Chalmers Centre and the local clinic at Howden.

C.M & S.W 19-12-23

Who to refer:

People with a diagnosis of HIV, Syphilis or Gonorrhoea
Contacts of HIV, syphilis or gonorrhoea
Other rare or uncommon STIs (Trichomonas Vaginalis, Lymphogranuloma venereum, Mycoplasma genitalium).
People who require HIV care, PEPSE or PrEP
People with complex, recurrent or treatment-resistant STIs
People with genital symptoms suggesting an STI of uncertain aetiology
People who require follow up STI screening following sexual assault
People who are HIV positive needing ongoing outpatient care
GBMSM under the age of 45 for HPV vaccination.

GBMSM who require routine testing for STIs and HIV can be tested in general practice: please see the Primary Care Management section. However, GP staff are welcome to refer for testing and support at any of the services for GBMSM.

If you are not sure whether referral is required, please see the Primary Care Management section. There is also detail on the individual condition pages and please ask the service if you are not sure (see below for email and phone contacts)

Who not to refer:

People without symptoms who require tests for STI and HIV – this can be done in Primary Care or via Self Sample Kits.
People with a new presentation of genital warts or uncomplicated Chlamydia
People diagnosed with hepatitis B or C (refer hepatology or Infectious Diseases)
People who require STI/BBV testing or Hepatitis vaccination for employment or visa purposes (refer to occupational health or a private provider).
People who require supplies of PrEP or PEPSE for potential occupational exposure (eg medical student electives) – refer to the Travel Clinic at the Regional Infectious diseases unit
Men with urinary tract infection, urinary flow or prostatic symptoms (please refer to Urology)

How to refer:

The service offers several referral routes including self-referral by phone or online booking for ‘phone back’ consultations. All referrals to the service, including SCI gateway referrals are triaged.

For positive STI results please contact the Health Advisor Team on

chalmershealthadvisors@nhslothian.scot.nhs.uk

Please let the patient know of the positive result and to expect contact from the HA team.

Patient self- referral:

Direct patients to Lothian’s Sexual Health website for information where they can self-refer for many services. Some services can be booked online.

Direct patients to dial 0131 536 1070 Monday to Friday 09.00 – 15.00. Initially they may be offered a Phone Back appointment.

Patients who are already taking PrEP and require a follow up appointment, or who require an appointment to discuss starting PrEP, can call 0131 536 1138. There is a waiting list for PrEP assessment appointments.

GP phone line:

Health professionals only can dial 0131 536 1070 and press button ‘9’, for advice from a senior clinician. This line is open from 09.00-15:00 Mon – Fri. Please leave a message if the service is unable to answer immediately.

Email advice line:

Chalmers.ClinicalAdv@nhslothian.scot.nhs.uk offers a 48-hour turnaround for clinical queries relating to ANY of our services. This is for use by Health Care Professionals via an NHS email account only. Direct enquiries from public and patients cannot be answered.

SCI Gateway: Please refer for any of the listed services, other than for urgent problems, to Chalmers Sexual Health Centre. In all cases, but especially those who have already had treatment e.g. with antibiotics for a STI, or are complicated in any way, a referral letter is helpful.

SCI gateway referral is essential for patients with chronic, intransigent or complex problems, including those relating to vaginal discharge and warts where an expert opinion is sought.