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GPs must play a bigger role in the fight against sexually transmitted infections, and ministers should be prepared to pay them for it, experts said this week.
Jackie Cassell, an epidemiologist at Brighton and Sussex Medical School, told a meeting organised by the Science Media Centre, an independent body working to promote the voice of the scientific community in the national news media, that thousands of people with a sexually transmitted infection were visiting their GP each year only to be turned away without diagnosis or treatment—and in some cases without any advice at all.
As result many people were waiting on average another six days before receiving a diagnosis and treatment at their genitourinary medicine clinic.
Her study of 3184 patients attending four clinics in England found that around half of the 801 patients who had been to their GP before attending the clinic continued to have sex between the visits, 7% with a new partner (Sexually Transmitted Infections doi: 10.1136/sti.2006.024554). A tenth of these patients had received no treatment from their GP and had not been advised to attend a genitourinary medicine clinic.
“In most areas, GPs should be doing a lot more of the treatment and the testing,” said Dr Cassell.
She said much more funding was needed to equip primary care to diagnose and treat sexually transmitted infections and that GPs should be paid more for the extra work this would entail.
Her claims came just a week ahead of new figures from the Health Protection Agency, figures that are expected to show further significant rises in the incidence of sexually transmitted infections across the United Kingdom.
Cliodna McNulty, head of the agency's primary care group, agreed that primary care should play a bigger part in sexual health.
She said: “QoF [quality and outcomes framework] targets will be needed to raise the profile of sexual health in primary care.
“One of the problems is that traditionally all GUM [genitourinary medicine] problems were seen in a GUM clinic. GPs have not been trained for it, and they have been very nervous about discussing STIs [sexually transmitted infections].”
However, Dr Cassell's research also showed serious problems in the services provided by the clinics, with many reducing the availability of “walk-in” services. She said that lack of access to genitourinary medicine doctors, combined with primary care's inability to diagnose and treat sexually transmitted infections, was “likely to be a major determinant of rising STI transmission rates in the UK.”
Also at the meeting, Lisa Williamson, of the Medical Research Council's Social and Public Health Sciences Unit in Glasgow, presented new data indicating that 4.4% of gay men in Edinburgh and Glasgow were infected with HIV. Just under half of these were unaware that they were infected.