1 Recommendations

This document constitutes the Institute's formal guidance on one to one interventions to prevent sexually transmitted infections (STIs) and under 18 conceptions. The recommendations in this section are presented without any reference to evidence statements. Appendix A repeats the recommendations and lists their linked evidence statements.

Recommendation 1

Who is the target population?

Key groups at risk of STIs including:

  • men who have sex with men

  • people who have come from or who have visited areas of high HIV prevalence.

Behaviours that increase the risk of STIs include:

  • misuse of alcohol and/or substances

  • early onset of sexual activity

  • unprotected sex and frequent change of and/or multiple sexual partners.

Who should take action?

Health professionals working in:

  • general practice

  • genito-urinary medicine (GUM)

  • community health services (including community contraceptive services)

  • voluntary and community organisations

  • school clinics.

What action should they take?

  • Identify individuals at high risk of STIs using their sexual history. Opportunities for risk assessment may arise during consultations on contraception, pregnancy or abortion, and when carrying out a cervical smear test, offering an STI test or providing travel immunisation. Risk assessment could also be carried out during routine care or when a new patient registers.

  • Have one to one structured discussions with individuals at high risk of STIs (if trained in sexual health), or arrange for these discussions to take place with a trained practitioner.

Recommendation 2

Who is the target population?

Key groups at risk of STIs including:

  • men who have sex with men

  • people who have come from or who have visited areas of high HIV prevalence.

Behaviours that increase the risk of STIs include:

  • misuse of alcohol and/or substances

  • early onset of sexual activity

  • unprotected sex and frequent change of and/or multiple sexual partners.

Who should take action?

Health professionals trained in sexual health who work in:

  • general practice

  • GUM

  • community health services (including community contraceptive services)

  • voluntary and community organisations

  • school clinics.

What action should they take?

  • Have one to one structured discussions with individuals at high risk of STIs. The discussions should be structured on the basis of behaviour change theories. They should address factors that can help reduce risk-taking and improve self-efficacy and motivation. Ideally, each session should last at least 15–20 minutes. The number of sessions will depend on individual need.

  • For details of a range of behaviour change theories see 'Predicting health behaviour' (Conner and Norman 2005).

Recommendation 3

Who is the target population?

Patients with an STI

Who should take action?

  • Health professionals working in general practice, GUM and community health services (including community contraceptive services), voluntary and community organisations and school clinics. (However, they may need to refer the patient to a specialist.)

  • Specialists with responsibility for helping to contact, test and treat partners of patients with an STI (partner notification). They may be sexual health advisers, general practitioners (GPs) or practice nurses providing enhanced sexual health services, chlamydia screening coordinators or GUM clinicians.

What action should they take?

  • Help patients with an STI to get their partners tested and treated (partner notification), when necessary. This support should be tailored to meet the patient's individual needs.

  • If necessary, refer patients to a specialist with responsibility for partner notification. (Partner notification may be undertaken by the health professional or by the patient.)

  • Provide the patient and their partners with infection-specific information, including advice about possible re-infection. For chlamydia infection, also consider providing a home sampling kit.

Recommendation 4

Who is the target population?

Population served by a PCT

Who should take action?

PCT commissioners

What action should they take?

  • Ensure that sexual health services, including contraceptive and abortion services, are in place to meet local needs. All services should include arrangements for the notification, testing, treatment and follow-up of partners of people who have an STI (partner notification).

  • Define the role and responsibility of each service in relation to partner notification (including referral pathways).

  • Ensure staff are trained.

  • Ensure there is an audit and monitoring framework in place.

Recommendation 5

Who is the target population?

Vulnerable young people aged under 18. This may include young people:

  • from disadvantaged backgrounds

  • who are in – or leaving – care

  • who have low educational attainment.

For a more detailed definition of vulnerable young people see Department for Education and Skills (2006) 'Teenage pregnancy: accelerating the strategy to 2010'.

Who should take action?

  • GPs, nurses and other clinicians working in healthcare settings such as primary care, community contraceptive services, antenatal and postnatal care, abortion and GUM services, drug/alcohol misuse and youth clinics, and pharmacies.

  • GPs, nurses and other clinicians working in non-healthcare settings such as schools and other education and outreach centres.

What action should they take?

  • Where appropriate, provide one to one sexual health advice on:

    • how to prevent and/or get tested for STIs and how to prevent unwanted pregnancies

    • all methods of reversible contraception, including long-acting reversible contraception (LARC) (in line with NICE clinical guideline 30)

    • how to get and use emergency contraception

    • other reproductive issues and concerns.

  • Provide supporting information on the above in an appropriate format.

Recommendation 6

Who is the target population?

Vulnerable young women aged under 18 who are pregnant or who are already mothers. This may include young women:

  • from disadvantaged backgrounds

  • who are in – or leaving – care

  • who have low educational attainment.

For a more detailed definition of vulnerable young people see Department for Education and Skills (2006) 'Teenage pregnancy: accelerating the strategy to 2010'.

Who should take action?

Midwives and health visitors who provide antenatal, postnatal and child development services

What action should they take?

  • Regularly visit vulnerable women aged under 18 who are pregnant or who are already mothers.

  • Discuss with them and their partner (where appropriate) how to prevent or get tested for STIs and how to prevent unwanted pregnancies. The discussion should cover:

    • all methods of reversible contraception, including LARC (in line with NICE clinical guideline 30), and how to get and use emergency contraception

    • health promotion advice, in line with NICE guidance on postnatal care (NICE clinical guideline 37)

    • opportunities for returning to education, training and employment in the future.

  • Provide supporting information in an appropriate format.

  • Where appropriate, refer the young woman to the relevant agencies, including services concerned with reintegration into education and work.