Health-anxious patients in genitourinary clinics

Genitourinary medicine is as much about prevention of infection as it is about its detection and treatment. Patients who may have put themselves at risk of infection are encouraged to come forward for testing as many sexually transmitted infections, especially in the early stages, may be asymptomatic. Usually, there is a delay between contracting a sexually transmitted infection (STI) and the relevant test becoming positive. This can be as short as up to 2 weeks for gonorrhoea and chlamydia, and as long as 3 months for HIV and syphilis. So a patient attending for a check-up 3 weeks after an episode of unprotected sex, with negative screening, including that for HIV and syphilis, will have to re-attend 9 weeks later for the blood tests to be completed. This can be a very anxious time, particularly if they are in another relationship, as during this time they should practise safe sex or abstain.

There still remains a degree of stigma around sexual health and this can make it hard, if not impossible, for patients to talk about their worries with others, and very often this extends to health professionals too. In addition, unlike most other diseases that people fear, such as cancer, there is the issue of transmission and guilt is often a major issue that needs to be addressed in therapy. What is more, all this occurs within the context of intimate relationships, where trust can be seriously undermined and relationships potentially permanently damaged. Occasionally, test results can be equivocal and need repeating, and occasionally false–positive and false–negative results may be obtained. One person in a couple may test positive for an infection, but their partner may not, further adding to the confusion.

There is also the question of confidentiality and partner notification (contact tracing for the partners of infection). Patients are given clinic numbers and these, coupled with the patient's date of birth, are used to replace names on all biological specimens. You are not allowed to discuss any aspect of a patient's care with their partner unless they have given their express permission (ideally, clearly documented and signed). This can cause frustration for patients, even if you explain that it is official legislation and that you would be breaking the law, but there are ways of couching these issues in sensitive terms, so patients feel listened to and understood.