Dawn Wilkinson

You’re Welcome quality criteria: making health services young-people-friendly

You’re Welcome (YW) is a Department of Health (DH) initiative to improve the quality of adolescent healthcare.1 It is endorsed and supported by a number of key professional bodies.2 3 The first edition of YW was produced in 2005, revised and piloted in 2007; a national support programme began in September 2008. The latest version with a self-assessment toolkit is available on the DH website.4 YW addresses the need for services to be friendly to young people (YP) who are under the age of 20, providing holistic care and “joined up working” at a local service level. Evidence-based criteria lay out key principles applicable to all health services, both in the community and in acute hospital settings. Criteria include the acceptability, accessibility, quality and choice of services for YP. These have the potential to contribute to the national indicator set and vital signs for local priorities in PCTs,5 which include achieving the target for teenage pregnancy under-18 conception6 and ensuring good-quality services and best practice. The concept of setting standards for YP sexual-health services is not new. Genitourinary medicine (GUM) services recognise that YP with or at risk of sexually transmitted infections (STIs) often have other high-risk behaviours and vulnerability factors when compared with their non-infected peers and, additionally, have …

UK National Guideline on the Management of Sexually Transmitted Infections and Related Conditions in Children and Young People (2009)

This guideline is appropriate for use in genitourinary (GU) medicine/sexually transmitted infections (STIs) clinics, and by other National Health Service (NHS) or other services providing sexual health advice, management or treatment to young people, e.g. sexual health clinics, young person’s clinics, contraceptive clinics, gynaecology/antenatal services, termination services, Sexual Assault Referral Centres (SARCs), paediatric services and general practice in the UK. The principles apply wherever young people are seen for sexual health care or where there are concerns about child sexual abuse (CSA) or where a STI has been detected. It includes recommendations on the assessment, examination, diagnostic tests, treatment regimens and prophylaxis for the effective management of children and young persons under 16 at risk of, or who have, an STI. It offers guidance on consent and confidentiality on children and young people presenting to health-care professionals working in sexual health services. It is also applicable to young people aged 16–18 who have learning difficulties or who are ‘vulnerable’. Some parts of the guidelines are relevant to all those providing sexual health services, but other parts are only relevant to Level 3 service providers. Prevention of STIs through health education and one-to-one interventions as recommended by the National Institute of Health and Clinical Excellence (NICE) is an integral part of sexual health care of young people but is outside the scope of the guidelines. Stakeholder involvement, rigour of development, levels of evidence and grading of recommendations are available online only in the full version of this guideline at http://ijsa.rsmjournals.com/cgi/content/full/21/4/229/DC1 This guideline is laid out in specific sections: Part 1: Introduction and discussion of issues concerning consent, confidentiality, child protection and basic principles of care. Part 2: The diagnosis and management of specific STIs and related conditions in the under 16s. Correspondence to: K Rogstad

Uptake of the HPV vaccination programme in England: a cross-sectional survey of young women attending sexual health services

Objectives The UK human papilloma virus (HPV) vaccination programme requires 80% uptake to have a significant impact on cervical cancer rates. Uptake in the first three years of the programme was 66%. We report the results of a cross-sectional survey of young women attending sexual health services (SHS) in England, reviewing HPV vaccination uptake and prevalence of HPV-related risk factors. Methods An anonymous questionnaire surveyed women aged 13–19 attending 19 hospital-based and 13 community-based SHS across England, March–August 2011. Data were analysed using multiple logistic regression. Results 2247 questionnaires were completed. Compared with national data, respondents had higher smoking rates (48% vs 14% of 15 year olds), coitarche under-16 (52% vs 38%), previous sexually transmitted infections (STIs) (25% vs 4%) and a higher proportion not in education, employment or training (NEETs) (8% vs 2% of 16 year olds). Seventy-four per cent had been offered the vaccination, with significantly lower offer rates in London, non-white ethnicities, 17–19 year olds, NEETs, smokers and those with previous STIs (all p<0.05 in multivariate analysis). Sixty-five per cent of those offered, completed, with significantly lower completion rates in London, non-white ethnicities, 17–19 year olds, NEETs, smokers and those with previous STIs (all p<0.05 in multivariate analysis). Overall completion rate was 47%. Conclusions We observed lower vaccination offer and completion rates and higher prevalence of HPV-related risk factors compared with national data. The highest risk individuals were the least likely to have been offered or to have completed the course. This survey highlights an opportunity for primary prevention by routinely offering the HPV vaccine to eligible women attending SHS.

Sexually transmitted infections in children as a marker of child sexual abuse and direction of future research.

Purpose of review This review considers recent evidence on sexually transmitted infections (STIs) as a marker of child sexual abuse (CSA), when diagnosed after the neonatal period. It also aims to identify if there are specific areas where additional research is required. Recent findings An evidence-based systematic review using strict inclusion criteria shows that CSA is a major cause of STIs in children. In children 12 years and below, 36–83% of Neisseria gonorrhoeae and 75–94% of Chlamydia trachomatis infections are due to CSA; for children 14 years and younger, 31–58% of anogenital warts are due to CSA. In child genital sampling, genital human papillomavirus (HPV) types were more common in those considered abused (13.7%) than nonabused (1.3%). HPV typing of genital warts in children were all of genital type 6. Subsequent research, into N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis and syphilis in children including ophthalmic infection, found that 13 of 15 cases were confirmed/likely due to CSA. Recent data indicate that bacterial vaginosis and Mycoplasma genitalium are related to sexual activity in adults but did not assess children. Summary STIs in children under 13–14 years may indicate CSA. Genital HPV types are associated with CSA. Research is required of sufficient standard to contribute to the evidence base.

An evaluation study of the Becton-Dickinson ProbeTec Qx (BDQx) Trichomonas vaginalis trichomoniasis molecular diagnostic test in two large, urban STD services

Objectives The BASHH guidelines recommend molecular tests to aid diagnosis of Trichomonas vaginalis (TV) infection; however many clinics continue to use relatively insensitive techniques (pH, wet-prep microscopy (WPM) and culture). Our objectives were to establish a laboratory pathway for TV testing with the Becton-Dickinson Qx (BDQx) molecular assay, to determine TV prevalence and to identify variables associated with TV detection. Methods A prospective study of 901 women attending two urban sexual health services for STI testing was conducted. Women were offered TV BDQx testing in addition to standard of care. Data collected were demographics, symptoms, results of near-patient tests and BDQx results for TV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Women with any positive TV result were treated and followed up for test of cure (TOC). Results 901 women had a TV BDQx test. 472 (53%) were white, 143 (16%) black and 499 (55%) were symptomatic. Infections detected by BDQx were: 11 TV (1.2%), three GC (0.3%) and 44 CT (4.9%). Of the 11 BDQx-detected TV infections, 8 (73%) were in patients of black ethnicity. Of these, four of seven cases (57%) were WPM-positive. All patients received treatment and nine of nine (100%) were BDQx-negative at TOC. In univariate analysis, only black ethnicity was associated with likelihood of a positive TV BDQx result (relative risk (RR) 10.2 (95% CI 2.15 to 48.4)). Conclusions The use of the BDQ enhanced detection of TV in asymptomatic and symptomatic populations. Cost-effective implementation of the test will rely on further work to reliably detect demographic and clinical variables that predict positivity.

Spotting the Signs: a national toolkit to help identify young people at risk of child sexual exploitation

It has been widely reported in research and inquiries that child sexual exploitation (CSE) is both under-reported and unrecognised by statutory and voluntary sector organisations.1–3 A report by the Office of the Childrens Commissioner found that at least 16 500 children were identified as being at risk of CSE each year by gangs and groups.1 Between 5% and 17% of children under 16 (between 650 000 and 2 million children) experience sexual abuse, and more than one in three do not tell anyone during childhood.2 CSE has been defined by the National Working Group for Sexually Exploited Children and Young People3 as the involvement of those aged <18 in exploitative situations, contexts and relationships where the young people (or a third person) receive something (eg, affection, gifts) as a result of them and/or others engaging in sexual activities. It is an abuse of power by those exploiting by virtue of their age, gender, intellect, and physical strength and/or economic or …

New tool to aid detection of child sexual exploitation

Thomas and Humphery highlighted the challenges inherent in safeguarding young people against child sexual exploitation (CSE).1 Consultations with young people within sexual health services routinely entail detailed exploration of risk and vulnerability, placing sexual health as key services to identify those at risk of CSE. In response to emerging understanding about the prevalence and nature of CSE,2 the …