Monday, October 27, 2014

RE: Less questions, more testing

Dear Ottawa Public Health,

I'm writing in regards to STI (sexually transmitted infection) testing in the city of Ottawa. To increase testing rates, I propose the that Ottawa Public Health facilitate a hassle free/no questions asked option for the standard set of HIV, gonorrhea, chlamydia, and syphilis screenings.

I applaud Ottawa's availability of anonymous HIV testing, but bacterial STIs also compromise public health by appearing asymptomatically and spreading rapidly. Increasing testing rates for bacterial STIs would mean more effective treatment and containment.

If the purpose of gathering sexual histories is to track how infections are spread, then this inquiry is more efficiently placed within the processes of treatment. Collecting sexual histories post-diagnosis, cuts paperwork and creates and impetus for more accurate data collection.

If you've contracted an STI, your previous partners need to be contacted. This point in the process is where sexual histories should be collected. STI transmission data would be sourced from those with a vested interested (the health of their sexual partners) in accurately disclosing their sexual histories. Further, public health authorities already provide third party services to anonymously inform sexual partners or diagnosed patients of their risk and testing options.

So many people lie during the collection of sexual histories. I definitely glossed over some details of a particularly promiscuous Summer.. Imagine the disincentive to give an accurate sexual history if you were a closet-case or sex worker (or both).

The fewer questions asked, the more people will get tested. A no questions asked STI testing option reduces social barriers to testing and re-positions the collection of sexual history in a way that improves the quality of data on STI transmission.

1 comment:

Unknown said...

Hello Devyn,

At the Sexual Health Clinic, we gather information about a client’s sexual history but it is not for the purpose of tracking how infections are spread. It is to determine their risk to specific STIs, whether they are in the incubation period and need re-testing, if vaccinations are needed and what sites of the body need to be tested which depend on the type of sexual contact. The number and type of questions depend on whether a client has symptoms or not. We follow best practice guidelines in determining what questions to ask. We continue to look at new research and innovative ways to make STI testing easier and quicker while meeting the client’s needs.

Ottawa Public Health has a few options available for STI testing. The Get Tested Why Not (GTWN) website provides a downloadable requisition form for chlamydia and gonorrhea testing. This is an option for individuals who do not have symptoms. They can download the requisition and go to a lab in Ottawa to submit a urine sample.

Another option available at the Sexual Health Clinic is Express Testing. If a client does not have symptoms, he/she has the choice of having a quicker visit by completing a short self-assessment questionnaire, reading some information, having minimal pre-test counselling and seeing a public health nurse for the collection of their blood and urine sample with no physical exam.

However, if the client is having symptoms then further questions need to be asked. Diagnosis and treatment are based on a client’s sexual and health history, physical exam as well as the selection of appropriate laboratory tests and specimens. When a client is symptomatic, we may treat based on their sexual health history and not wait for the STI testing results so we need the information at that time to make that clinical decision rather than waiting to a later visit as proposed. If they do not have symptoms then we offer the client a choice regarding the amount of information they would like to provide regarding their sexual history (GTWN, Express Testing or full assessment including complete sexual health history and physical exam).

Thank-you for writing to us in regards to STI testing in Ottawa and sharing your perspective with us. We have nurses available Monday to Friday if you would like to speak with a Public Health Nurse in more detail: 613-580-6744 (TTY: 613-580-9656).

Barb, Clinic Director/Nurse Practitioner, Ottawa Public Health