By Brian Nambale,
Clinic Manager Medicure Trauma Centre- Nabumali
Introducing Adolescent Reproductive Health Clinic
What can I expect when I attend a Adolescent Reproductive Health?
Registration
When you arrive at a clinic you will have to register. You will be asked for
your name, address, date of birth, contact telephone number and the
name of your GP. This information is treated confidentially. The clinic
will not contact you at home or contact your GP without your permission.
Also, any records from GUM clinics will not go on your main medical
record without your permission.
However, if you have a concern, you do not have to give any details. You can even give a false name. The
important thing is that whatever name you do use, you should use the
same name for any follow-up appointment, to avoid any confusion; for
example, when you return for the result of any tests. To help identify
you as the correct person for any follow-up, you will be given a card
with your clinic number on it, which you should bring back to any
follow-up appointment.
Initial assessment
You will be seen initially by a doctor, a specially trained nurse or a sexual health
adviser. They will ask you some questions to try to assess the situation
and to determine what tests (if any) you may need. You may find some of
the questions quite personal but they are all necessary to ensure the
correct diagnosis and treatment are given.
Examples of questions that you may be asked include:
- What symptoms and/or concerns do you have?
- How many people have you had sex with in the last few weeks and were they male or female?
- What type of sex have you had - vaginal, oral, anal?
- Have you previously had an STI?
- What is the state of your general health?
- Do you take any regular medication?
- Do you have any allergies?
If you are a woman you may be asked about the date of your last period and
whether there is a chance that you may be pregnant, as this might
affect treatment options. You may also be asked about whether you have
had a cervical smear test. This test looks for human papillomavirus (HPV) which is known to be a major factor in the development of cervical cancer. This is sensible as part of a general sexual health check.
After the initial assessment you will be advised what will happen next. You
will normally be examined and at the same time some tests may be taken.
What happens during a sexual health examination?
A doctor will usually examine you. You can ask for a male or female
doctor, but you may have to return at a different time (or even to a
different clinic) if a doctor of a particular sex is not currently
available. The examination includes looking carefully at your genitals
for signs of unusual discharge, redness, lumps or ulcers. The doctor may
also feel the tops of your legs (your groins) to check for enlarged or
tender glands called lymph nodes. If necessary, the doctor may also do a
general examination to check on your general health.
In women, your doctor may also examine your vagina and womb (uterus) by gently inserting a lubricated, gloved finger.
Men may have their testicles (testes) examined.
How are STI tests done?
After the examination is complete your doctor may also take some tests.
Women
The way in which tests are done can vary from clinic to clinic; the following is a general guide.
After the examination of the outside of the genitals the doctor will ask your
permission to insert a speculum. This is a plastic or metal device
which is also used to take a cervical smear when screening for cervical
cancer. It helps the doctor to see the neck of the womb (the cervix) and
allows some samples to be taken.
The doctor will usually warm the speculum if it is metal and cover the tip in lubricating jelly. Once
the speculum has been inserted it is slowly opened and held in place by a
catch. The doctor will then look closely at the walls of the vagina for
any discharge or redness. A swab is usually taken from the vagina and
from the cervix. A swab is a small ball of cotton wool on the end of a
thin stick, used to collect samples. The doctor will then slowly remove
the speculum.
After this has been done a small plastic spatula may be used to take cells from the urethra (the opening which allows urine
to pass from the bladder to the outside of the body). This may feel a
little scratchy. Depending on the information you have given initially
it may also be necessary to take swabs from the back passage (rectum) or
the throat. After all the swabs are taken you will be able to get
dressed. You may be asked to provide a urine sample.
Men
After the examination of the outside of the genitals the doctor will ask for
your permission to insert a swab into the urethra. This may feel a
little uncomfortable but most people do not find it painful. Depending
on the information you have given initially it may also be necessary to
take swabs from the rectum or the throat.
If there is any possibility of infections that may affect the rectum, your doctor may
ask your permission to examine this area more closely. Sometimes this is
done using a proctoscope. This is a small tube, usually made of
plastic, that makes it possible to see inside the rectum. After all the
swabs are taken you will be able to get dressed. You may be asked to
provide a urine sample.
Men and women - blood tests
A sample of blood from a vein may be taken. This is mainly used to test for syphilis, hepatitis B, hepatitis C and HIV. Sometimes you may be advised to delay having a blood test. For example,
following an initial infection of HIV it can take several weeks for a
blood test to become positive. So, for example, if within the previous
few days you had sex with someone who is HIV-positive, you may be
advised to wait several weeks to have a blood test to see if you have
become infected.
How long do STI test results take?
If you are seen at your GP surgery, the swabs and blood tests will be sent
to a laboratory for further testing. Your doctor will advise you about
when the test results will be available; this can take up to a fortnight
and are usually sent to you via text message.
If you are seen in a ARHC clinic some of your results may be available on the same working day of your test.
Your doctor or nurse will take the swabs and smear them on to special
slides. This allows him/her to look at the cells taken from the swabs
under the microscope. Some germs (bacteria) that cause infections can be
seen in the cells you have provided by having swabs done. For example,
the bacteria that cause gonorrhoea can sometimes be identified by
looking through a microscope. This may mean you are given a positive
result on the day, if you have the infection.
However, even though the bacteria can be detected under the microscope, they are not always
seen, even if they are present. To make sure the test result is
reliable, the sample you give is put into a special pot. This pot also
contains a substance that allows the bacteria to grow. The pot, known as
a plate, is then put into an incubator allowing any bacteria present to
grow. The plates are then checked to see if any bacteria which cause
STIs have grown. It takes a while for the bacteria to grow; this is why
you may be asked to check back with the clinic for more results in a few
weeks' time. Trichomonas can also be seen under the microscope.
The results of tests for chlamydia and blood tests for syphilis, hepatitis B
and hepatitis C are usually not available on the same day.
Some clinics offer same-day HIV testing. This means you get the result of the
test on the day your blood sample is taken. Most clinics ask you to
make an appointment for this service, as it may only take place at
certain times.
The swabs that are taken sometimes show other infections which are not considered to be STIs. This includes bacterial
vaginosis and thrush. These infections can also be seen by looking at
the samples you give under the microscope.
What about the results ARHC ?
After your doctor or nurse has checked your samples they will call you back
into the consulting room. They will give you any results available from
checking the cells under the microscope.
You will also be advised about how long it should take to get any other test results back to the
clinic. Each clinic has a different method of giving test results. Some
may ask you to come back or ring the clinic; some work on a 'no news is
good news' policy. It is important you understand how you will get your
results and that the contact information you give is reliable.
My test results show I have a sexually transmitted infection - what now?
If you have a positive test result for an STI on the day of your
attendance at clinic you will be given treatment and advice on the same
day. You will also be asked to speak to a sexual health advisor to help
trace any of your sexual partners who may have come into contact with
the infection.
If the test results come after you have left the clinic you will be given advice about what to do next when you receive
your result.
How are sexually transmitted infections treated?
The treatment that you will be offered depends on what STI is found. For example, a short course of antibiotic medicine can usually clear away chlamydia, gonorrhoea, syphilis and trichomonas. A cream or lotion can clear pubic lice and scabies. Topical treatments can usually clear most anogenital warts. Treatments for genital herpes, hepatitis B, hepatitis C, and HIV are more involved and complex. You
will be given advice about what treatment options you have and given
time to ask questions.
If you are prescribed antibiotics then it is important to finish the full course of tablets, or else the infection
may not be fully cleared. If you develop side-effects then seek advice
from the GUM clinic or from your GP surgery as to what to do. Do not simply stop taking the medication. For some infections you will be asked to return after a course of treatment to check that the infection has gone.
Note: do not have sex again until the time advised by the clinic. Depending on the infection, this may be for a certain length of time
after treatment is finished or it may be until you are given the 'all
clear' from a repeated test. The aim is to prevent you from passing on
the infection to others.
