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\listoverridecount0\ls5}{\listoverride\listid487091440\listoverridecount0\ls6}{\listoverride\listid367222327\listoverridecount0\ls7}}{\info{\title Notes for CSA + Sexual health}{\author Peter}{\operator Chris}{\creatim\yr2008\mo9\dy12\hr15\min18}
{\revtim\yr2008\mo9\dy12\hr15\min18}{\version2}{\edmins1}{\nofpages4}{\nofwords656}{\nofchars3742}{\*\company TOSHIBA}{\nofcharsws4595}{\vern8283}}\paperw11906\paperh16838\margl1440\margr1440 
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{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang{\pntxta )}}{\*\pnseclvl5
\pndec\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang
{\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}\pard\plain \qc \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 
\fs22\lang2057\langfe1033\loch\af28\hich\af28\dbch\af28\cgrid\langnp2057\langfenp1033 {\fs36 \hich\af28\dbch\af28\loch\f28 Notes for CSA + Sexual health
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b \hich\af28\dbch\af28\loch\f28 Part 1: \hich\af28\dbch\af28\loch\f28 Oral Progesterone only preparations
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 5 trade names available:
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard\plain \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0 
\fs22\lang2057\langfe1033\loch\af28\hich\af28\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af28\dbch\af28\loch\f28 Cerazette (desogestrel)
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}\hich\af28\dbch\af28\loch\f28 Femulen (etynodiol: metabolised to norethisterone)
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Micronor  and Noriday (norethisterone)
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Norgeston (levonorgestrel)
\par }\pard\plain \ql \li360\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 \fs22\lang2057\langfe1033\loch\af28\hich\af28\dbch\af28\cgrid\langnp2057\langfenp1033 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 Effect on ovu\hich\af28\dbch\af28\loch\f28 lation: Cerazette inhibits ovulation in 97% cycles, compared with 40-60% other 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 But insufficient evidence overall \hich\af28\dbch\af28\loch\f28 to show \hich\af28\dbch\af28\loch\f28 
more effective (one study designed primarily to look at vaginal bleeding patterns\hich\af28\dbch\af28\loch\f28  had pregnancy rate figures, but sample size not big \hich\af28\dbch\af28\loch\f28 enough to be statistically significant). 
\par \hich\af28\dbch\af28\loch\f28 Ref Drugs and therapeutics bulletin Vol 41 No 9 September 2003
\par 
\par \hich\af28\dbch\af28\loch\f28 Missed pills: If one or more progesterone only contraceptive tablets are missed or taken more than 
\par \hich\af28\dbch\af28\loch\f28 3 hours late (12 hours for Cerazette) and unprotec\hich\af28\dbch\af28\loch\f28 ted sexual intercourse has occurred before 2 tablets correctly taken emergency contraception is recommended. 
\par \hich\af28\dbch\af28\loch\f28 Ref\hich\af28\dbch\af28\loch\f28 :\hich\af28\dbch\af28\loch\f28   }{\field\fldedit{\*\fldinst {\hich\af28\dbch\af28\loch\f28 HYPERLINK "http://www.bnf.org"}}{\fldrslt {\cs16\ul\cf2 \hich\af28\dbch\af28\loch\f28 www.bnf.org}}}
{
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }{\b \hich\af28\dbch\af28\loch\f28 Part 2: Emergency contraception (EC)
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard\plain \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0 
\fs22\lang2057\langfe1033\loch\af28\hich\af28\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af28\dbch\af28\loch\f28 Oral hormone method: Levonorgestrel (LNG)
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}\hich\af28\dbch\af28\loch\f28 Copper bearing \hich\af28\dbch\af28\loch\f28 intrauterine device (IUD)
\par }\pard\plain \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs22\lang2057\langfe1033\loch\af28\hich\af28\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af28\dbch\af28\loch\f28 Judicial review: pregnancy starts at 
\hich\af28\dbch\af28\loch\f28 implantation;\hich\af28\dbch\af28\loch\f28  EC is not considered an abortifacient
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard\plain \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin720\itap0 
\fs22\lang2057\langfe1033\loch\af28\hich\af28\dbch\af28\cgrid\langnp2057\langfenp1033 {\hich\af28\dbch\af28\loch\f28 LNG should be given as a single 1.5mg dose as son as possible after \hich\af28\dbch\af28\loch\f28 unprotected sexual intercourse (
\hich\af28\dbch\af28\loch\f28 UPSI\hich\af28\dbch\af28\loch\f28 )\hich\af28\dbch\af28\loch\f28  and within 72 hours
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 LNG may be cons\hich\af28\dbch\af28\loch\f28 idered between 73  and 120 hours after UPSI but women should be informed of limited evidence of efficacy, that such use is outside product licence and the alternative of an IUD

\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}\hich\af28\dbch\af28\loch\f28 Women can be advised that LNG EC can be used more than once in a cycle if clini
\hich\af28\dbch\af28\loch\f28 cally indicated
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 An IUD should be offered to a; women attending for EC even if presenting within 72 hours
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Ideally an emergency IUD should be offered at first presentation, but can be offered later at the woman\hich\f28 \rquote \loch\f28 s convenience. In this case LNG EC should be gi\hich\af28\dbch\af28\loch\f28 
ven in the interim
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 A copper IUD can be inserted up to 5 days after the first episode of UPSI. If the timing of ovulation can be estimated insertion can be beyond 5 days of UPSI, as long as it does not occur beyond 5 days after ovulation
\par {\listtext\pard\plain\s15 \fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \s15\ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Ref J Family Planni\hich\af28\dbch\af28\loch\f28 ng and \hich\af28\dbch\af28\loch\f28 Reproductive\hich\af28\dbch\af28\loch\f28  Health Care 2006: 32(2) 121-128, available at }{\field\fldedit{\*\fldinst {
\hich\af28\dbch\af28\loch\f28 HYPERLINK "http://www.ffprhc.org.uk"}}{\fldrslt {\cs16\ul\cf2 \hich\af28\dbch\af28\loch\f28 www.ffprhc.org.uk}}}{
\par }\pard\plain \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs22\lang2057\langfe1033\loch\af28\hich\af28\dbch\af28\cgrid\langnp2057\langfenp1033 {
\par }\pard \ql \li0\ri0\sa200\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\page 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b \hich\af28\dbch\af28\loch\f28 Part 3:\hich\af28\dbch\af28\loch\f28  \hich\af28\dbch\af28\loch\f28 Common \hich\af28\dbch\af28\loch\f28 
Sexually Transmitted infections
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b \hich\af28\dbch\af28\loch\f28 Commonest STIs (GUM new cases in UK)
\par }\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \cell 
}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 2006\cell \hich\af28\dbch\af28\loch\f28 1997\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd 
\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl
\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 
\clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 Chlamydia\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
{\b \hich\af28\dbch\af28\loch\f28 113 585\cell \hich\af28\dbch\af28\loch\f28 42 668\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl
\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 
\clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 Genital\hich\af28\dbch\af28\loch\f28  warts\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 83 745\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh
\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb
\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 Genital Herpes\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 21 698\cell 
\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh
\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb
\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 Gonorrhoea\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 19007\cell 
\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh
\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb
\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\trowd 
\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b 
\hich\af28\dbch\af28\loch\f28 Syphilis\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b \hich\af28\dbch\af28\loch\f28 2 766\cell \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh
\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb
\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\pard 
\ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b \hich\af28\dbch\af28\loch\f28 Chlamydia is now the commonest STI, having taken over from genital warts\hich\af28\dbch\af28\loch\f28  in the last 10 years.}{

\par }\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\hich\af28\dbch\af28\loch\f28 Commonest age group of Chlamydia detection at GUM\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cell \hich\af28\dbch\af28\loch\f28 Rate per 100 000 of\hich\af28\dbch\af28\loch\f28 
 age specific\hich\af28\dbch\af28\loch\f28  \hich\af28\dbch\af28\loch\f28 UK population\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl
\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl
\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\hich\af28\dbch\af28\loch\f28 Boys\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\hich\af28\dbch\af28\loch\f28 20-24 yrs\cell \hich\af28\dbch\af28\loch\f28 1 070/ 100 000\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh
\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb
\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\trowd 
\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\hich\af28\dbch\af28\loch\f28 Girls\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\hich\af28\dbch\af28\loch\f28 16-19 yrs\cell \hich\af28\dbch\af28\loch\f28 1 359/ 100 000\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\trowd \trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf1 \trbrdrl\brdrs\brdrw10\brdrcf1 \trbrdrb\brdrs\brdrw10\brdrcf1 \trbrdrr\brdrs\brdrw10\brdrcf1 \trbrdrh
\brdrs\brdrw10\brdrcf1 \trbrdrv\brdrs\brdrw10\brdrcf1 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb
\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3080 \cellx2972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth3081 \cellx6053\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3081 \cellx9134\row }\pard 
\ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 www.hpa.org.uk
\par 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 
Test of choice for Chlamydia: Nucleic acid amplification test (NAAT) of which the polymerase chain reaction (PCR) is the commonest.
\par \hich\af28\dbch\af28\loch\f28 50% of Chlamydia is now diagn\hich\af28\dbch\af28\loch\f28 osed outside of GUM clinics
\par \hich\af28\dbch\af28\loch\f28 Over 40% of pelvic inflammatory disease has been shown to be due to Chlamydia infection.
\par \hich\af28\dbch\af28\loch\f28 Infection can last as long as 6 years
\par \hich\af28\dbch\af28\loch\f28 50% of cases spontaneously resolve within 15 months
\par \hich\af28\dbch\af28\loch\f28 A single episode of unprotected sex has a risk of\hich\af28\dbch\af28\loch\f28  10% for transmission
\par \hich\af28\dbch\af28\loch\f28 Condoms give approximate 40% transmission reduction
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\field\flddirty{\*\fldinst {\hich\af28\dbch\af28\loch\f28  HYPERLINK "http://www.gumnewcastle.nhs.uk" }}{\fldrslt {\cs16\ul\cf2 \hich\af28\dbch\af28\loch\f28 
www.gumnewcastle.nhs.uk}}}{
\par 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 Opportunistic testing should be considered in:
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Women < 25 yrs and sexually active
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}\hich\af28\dbch\af28\loch\f28 Women with 2 or more partne\hich\af28\dbch\af28\loch\f28 
rs in the last year or a new partner in the last year
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\field{\*\fldinst {\hich\af28\dbch\af28\loch\f28  HYPERLINK "http://www.sign.ac.uk" }}{\fldrslt {\cs16\ul\cf2 \hich\af28\dbch\af28\loch\f28 www.sign.ac.uk}}}{
\hich\af28\dbch\af28\loch\f28  
\par 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b \page \hich\af28\dbch\af28\loch\f28 Part 4: HIV\hich\af28\dbch\af28\loch\f28  and Primary Care
\par }{
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 Who should be\hich\af28\dbch\af28\loch\f28  offered \hich\af28\dbch\af28\loch\f28 HIV test:
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Patient request
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}\hich\af28\dbch\af28\loch\f28 Identified risk
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\hich\af28\dbch\af28\loch\f28 Symptoms and signs
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Screening groups
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par \hich\af28\dbch\af28\loch\f28 Patients reque\hich\af28\dbch\af28\loch\f28 sting a HIV test will have a reason, you may be reassuring but avoid being discouraging and take care before you decline a test.
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 Be flexible some people with HIV will have no apparent risk
\par 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 They do not need to be willing to discuss their risk with you, as\hich\af28\dbch\af28\loch\f28 
 long as they know about the 3 month window and what constitutes a risk
\par 
\par \hich\af28\dbch\af28\loch\f28 What constitutes a risk?
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\hich\af28\dbch\af28\loch\f28 Current or former partner HIV positive
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Anal or oral sex between men
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}\hich\af28\dbch\af28\loch\f28 From area of high prevalence
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Multiple sexual partners
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Sexually transmitted infections
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}\hich\af28\dbch\af28\loch\f28 Inje\hich\af28\dbch\af28\loch\f28 cting drugs
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Rape
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0 {
\hich\af28\dbch\af28\loch\f28 Blood transfusion or transplant in country that has not been testing vigorously
\par {\listtext\pard\plain\fs22\lang2057\langfe1033\loch\af3\hich\af3\dbch\af28\langnp2057 \loch\af3\dbch\af28\hich\f3 \'b7\tab}\hich\af28\dbch\af28\loch\f28 Occupational exposure
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\field{\*\fldinst {\hich\af28\dbch\af28\loch\f28  HYPERLINK "http://www.neli.org.uk" }}{\fldrslt {\cs16\ul\cf2 \hich\af28\dbch\af28\loch\f28 www.neli.org.uk}}}
{\hich\af28\dbch\af28\loch\f28  (National electronic library of \hich\af28\dbch\af28\loch\f28 infection) HIV in Primary Care.pdf
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 Prevalence HIV\hich\af28\dbch\af28\loch\f28  in UK:  73 000
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 Incidence HIV in UK (2006): 7000
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\hich\af28\dbch\af28\loch\f28 Heterosexual new case rate higher than homosexual since 1998
\par 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\field{\*\fldinst {\hich\af28\dbch\af28\loch\f28  HYPERLINK "http://www.hpa.org.uk" }}{\fldrslt {\cs16\ul\cf2 \hich\af28\dbch\af28\loch\f28 www.hpa.org.uk}}}{
\hich\af28\dbch\af28\loch\f28 \hich\f28  \'93\loch\f28 \hich\f28 Testing times\'94
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par 
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }\pard \ql \li0\ri0\sl276\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {
\par }}