Consultant physicians working with patients - Royal College of ...

2 Specialties Genitourinary medicineGenitourinary medicineDr Jackie Sherrard FRCP Consultant genitourinary physician1 Description of the specialtyGenitourinary medicine (GUM) is the medical specialtyconcerned with the screening, diagnosis and managementof sexually transmitted infections (STIs) and relatedgenital medical conditions. In the past 30 years, thescope of clinical work has broadened to include humanimmunodeficiency virus (HIV) diagnosis and acquiredimmune deficiency syndrome (AIDS) management.STIs, including HIV, are currently of major public healthconcern. This has been recognised by the Departmentof Health (DH) and 48-hour access to GUM serviceswas an NHS priority in England from 2008 to 2011.A distinctive feature and strength of GUM clinics is theholistic approach whereby STIs and HIV diagnosis andmanagement, contraceptive advice/emergencycontraception, health promotion/risk reduction adviceand partner notification, are all provided in the sameclinic. However new commissioning arrangements fromApril 2013 mean GUM services including HIVprevention and diagnoses will be commissioned by localauthorities and HIV management by the NationalCommissioning Board. It is hoped that this split will notlead to fragmentation of care.The British Association for Sexual Health and HIV(BASHH) is the GUM national specialist society and isaffiliated with the Royal College of Physicians (RCP). Itprovides the specialty with a framework for education,clinical governance and audit.Who are the patients?GUM is primarily outpatient based. The largest groupof patients are those with STIs and a range of othersexual health conditions. Much activity is related tosexual health advice-seeking and screening which formsan important part of the prevention and public healthrole of the specialty. STIs affect all sections of thepopulation; however, case finding by screening at-riskgroups and the identification of sexual partners ofpersons with STIs are necessary components to controlthe spread of infection. Approximately 50% of patientsare under 25 years of age. The service sees adisproportionate number of vulnerable people, egyoung people, immigrants, drug users, commercial sexworkers and offenders.Main disease patternsThe impact of poor sexual health is greatest in youngadults and in men who have sex with men (MSM). Overthe past 10 years, increased transmission through unsafesexual behaviour, especially among MSM, hascontributed to a substantial increase in STI diagnoses.Untreated STIs can lead to serious costly sequelae.Management of STIs is important in the control of HIVinfection because evidence indicates that STIspredispose to the transmission of HIV.Patients with HIV infection form a rapidly increasingand time-consuming group with a wide variety ofmedical, social and other problems. Newly diagnosedHIV infections continue to increase. Highly activeantiretroviral therapy (HAART) has improved survival,further adding to caseloads.2 Organisation of the service and patternsof referralA typical serviceHistorically, clinics provided an open access walk-infacility. Recently, higher numbers of patients and limitedresources have led to increased use of appointmentsystems. Patients attend the clinic of their choice – thismay or may not be near where they live or work becauseof travel or concerns about confidentiality. Sevices areworking increasingly with contraceptive services todeliver more integrated sexual health services.Sources of referralMost patients self-refer but a proportion are referredfrom general practice, family planning, accident andemergency (A&E) departments and other providers.Locality-based and/or regional servicesSpecialist services in GUM provide primary level STImanagement, particularly in urban areas and to thosewithout easy access to health services. They also providesecondary and tertiary level referral and referenceC○ Royal College of Physicians 2013 111