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Purpose
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Identification of women requiring testing for genital tract infections (GTI), sexually transmissible infections (STI) and blood borne viruses (BBV):
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- identification of the presence of GTI and STI prior to insertion of intrauterine contraceptive devices (IUCD)
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- prescription of medications for the treatment of bacterial vaginosis and candidiasis as required
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- referral to medical practitioner / service where positive or indeterminate results for STI / BBV are demonstrated, and monitor attendance at the specified consultation
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Anticipated outcomes
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Women's health nurse practitioners will provide:
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- consistency in assessment, management of results and referral to the medical practitioner
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- optimal care in the management of GTI , STI and BBV and assessment pre IUCD insertion
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- continuity of primary care or secondary referral
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Eligible women
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Eligible women are non pregnant women who are:
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- asymptomatic and identified at risk of STI / BBV through clinical indicators and lifestyle / sexual history assessment
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- asymptomatic and requesting testing for STI / BBV
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- self reporting as asymptomatic but demonstrate signs of STI / GTI on examination
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- asymptomatic on examination but return a Pap smear report noting inflammation and an indicative risk assessment for STI / BBV
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- asymptomatic and identified as suitable for insertion of IUCD
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- asymptomatic and requesting change or removal of IUCD
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Responsibility
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Women's Health Nurse Practitioners are responsible for provision of the primary clinical assessment, notification of test results and referral to Medical Practitioner as per clinical algorithms for STI / BBV / GTI results - management and referral. Refer CPG - Clinical algorithm
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They are responsible for ensuring women attend the identified medical practitioner/service for management of STI/BBV. Following this secondary consultation, responsibility then resides with the medical practitioner/service.
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They are also responsible for establishment of a process for ensuring follow up of women who fail to attend the required secondary consultation.
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Testing
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Eligible women requiring testing for STI and BBV should be tested for:
| - Trichomonas vaginalis, Neisseria gonorrhoea, Chlamydia trachomatis
- Herpes simplex virus as required
- Human Immunodeficiency Virus (HIV), Hepatitis B, Syphilis
- Hep C as indicated
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| Eligible women requiring testing for GTI should be tested for:
| - Bacterial vaginosis
- Candidiasis
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| Prior to insertion of IUCD or other transcervical procedure in eligible women, specimens will be collected for:
| - Bacterial vaginosis
- Chlamydia trachomatis
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| Prior to change over of IUCD in eligible women, specimens will be collected for:
| - Actinomyces
- Bacterial vaginosis
- Chlamydia trachomatis
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| As appropriate, specimens will also be collected for:
| - Cervical cytology
- Rubella
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Treatment
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Refer to Treatment of Chlamydia CPG
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Women's health nurse practitioners will utilise current therapeutics information when prescribing the following medications:
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Treatment of Bacterial vaginosis in symptomatic women or in asymtomatic women prior to insertion of IUCD or other transcervical procedures:
| Metronidazole (eg. Flagyl™) 400mg twice daily orally after food for 5 days, OR 2g stat orally
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| Clindamycin Hydrochloride (eg.Dalacin V™) 2% pack 40g 1 applicatorful (5g) bedtime 7 days
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| Tinidazole (eg. Fasigyn™) 2g stat after food (four 500mg tabs as single dose)
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| Treatment of Candidiasis in symptomatic women:
| Clotrimazole (eg Canesten™) 100mg pessaries or cream 1% (1 applicatorful approx 5g) intravaginally at night for 7 nights or 2% vaginal cream (1 applicatorful intravaginally for 3 nights)
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| | Miconazole nitrate (eg. Monistat Vaginal™) 100mg pessaries or cream 2% (1 applicatorful approx 5g) intravaginally at night for 7 nights |
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Follow up
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Clients will be advised to contact the women's health nurse practitioner if any allergic reactions occur, and if the prescribed treatment is unsuccessful.
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The women's health nurse practitioner will refer to the medical practitioner when women remain symptomatic for candida albicans or bacterial vaginosis following the prescribed course of medication.
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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Please remember to read our disclaimer.
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