Young people are still embarrassed to talk about using condoms, so STIs remain high in this age group, but pharmacy can help

Prevalence of sexually transmitted infections (STIs) is high among young people, so last December’s launch of the Government’s first sexual health campaign in eight years aimed at encouraging more under-25s to use condoms to prevent STIs is good news. 

Headed by Public Health England (PHE), the ‘Protect Against STIs’ digital advertising campaign launch coincided with a YouGov survey of 2,007 young people that revealed almost half (47 per cent) of 16-24-year-olds have never used a condom with a new partner, and one in 10 have never used one at all.

This reluctance to use one of the best – and simplest – methods of protecting against STIs is alarming, according to Gwenda Hughes, PHE’s head of STI surveillance, who says: “Rates of STIs among young people continue to be too high and it is concerning that many sexually active young people are not using condoms with new partners. Six in 10 chlamydia and gonorrhoea diagnoses are in those under 25 years of age, so we need to remind young people of the importance of using condoms with a new or casual partner to help prevent infection.”

The medium is the message

As the survey revealed that one in three (32 per cent) young adults said they have never seen a condom mentioned in sex scenes on TV or in films, the main aim of the ‘Protect Against STIs’ campaign is to normalise and encourage condom use by utilising the kinds of digital communications that the target audience is most familiar with. 

Backed by a range of partners including the Family Planning Association (FPA) and British Association for Sexual Health and HIV (BASHH), the campaign aims to raise awareness of the serious consequences of STIs and features real people talking about their own personal experiences of having an STI, but with their identities animated by emojis. It also directs young people to the FPA’s Sexwise website for further information and support.

A challenging topic 

Worryingly, it seems that embarrassment is also a hurdle to be overcome. The YouGov survey revealed that sexual health is a challenging topic to discuss, with 56 per cent of men and 43 per cent of women saying they found it difficult to talk about STIs with friends. Furthermore, 58 per cent said that if they had an STI they would find it difficult to talk to their sexual partner about it.

If customers want to talk to someone in the pharmacy team about STIs then it’s useful to have some basic information to pass on. For example, STIs pass from one person to another through unprotected vaginal, anal or oral sex, by genital contact and through sharing sex toys, and you don’t need to have lots of sexual partners to get an infection. 

If a customer requires more specific information, pharmacy staff can offer information on the most prevalent STIs, their symptoms, risks and treatment.

STIs explained

Chlamydia 

Chlamydia is one of the most common STIs, but more than two in three women and one in two men won’t have any obvious symptoms. For women, symptoms include bleeding between periods and/or heavier periods (including in women who are using hormonal contraception), bleeding during or after sex, unusual vaginal discharge and pain when passing urine. Men can experience a white, cloudy or watery discharge from the tip of the penis, pain when passing urine, and pain in the testicles.

The only way to confirm chlamydia is with a test, and it’s currently very easy to treat and cure with antibiotics. If left untreated it can cause painful complications and serious health problems such as infertility.

Gonorrhoea

Gonorrhoea is a bacterial STI that can cause pain when passing urine, as well as white, yellow or green discharge in men and women. Around half of women and one in 10 men with genital gonorrhoea won’t have any obvious signs or symptoms.

In women, gonorrhoea can spread to other reproductive organs and cause pelvic inflammatory disease (PID). This can lead to long-term pelvic pain, blocked fallopian tubes, infertility and ectopic pregnancy. In men, gonorrhoea can result in a painful infection in the testicles and possibly reduce fertility.

A simple test can diagnose gonorrhoea, and early treatment with antibiotics can avoid painful complications and serious health problems. However, there is concern that gonorrhoea is becoming increasingly resistant to antibiotics, and may become untreatable in the future.

Genital herpes

Genital herpes is a common STI caused by the herpes simplex virus. Most people won’t have any visible signs, but they can include flu-like symptoms followed by stinging, tingling or itching in the genital or anal area; vaginal or urethral discharge; and small, fluid-filled blisters in the genital or anal area, on the buttocks, or at the top of the thighs.

Treatment is a five-day course of antiviral tablets to relieve the pain and prevent the virus from multiplying. People who have repeated outbreaks (usually more than five in a year) may be given a long course of tablets – known as suppressive therapy – to reduce the number of outbreaks. As genital herpes is caused by a virus and not bacteria, antibiotics won’t help. 

Treatment is not essential, as genital herpes will clear up by itself, but prompt treatment at the start of an outbreak can reduce the duration of the outbreak and reduce the risk of passing the virus on to someone else. 

Genital warts 

Genital warts are the most common viral STI. They are caused by the human papilloma virus (HPV), which can be passed on during sexual contact. 

Most people with HPV infection won’t develop visible warts and the virus will go away on its own, however treating visible warts may reduce the risk of passing them on to someone else.

It’s rare for genital warts to cause long-term health problems, and it’s worth reassuring customers that the types of HPV that cause genital warts (6 and 11) do not cause cancer – although some other types of HPV can cause cell changes that may lead to cancer. The HPV vaccine offered to girls aged 12-13 years as part of the National HPV Vaccination Programme protects against HPV 16 and 18 (the types that can cause cell changes that lead to cancer) as well as HPV 6 and 11. The programme is showing a continued reduction in genital warts in adolescent girls.

Sildenafil switch

The Medicines and Healthcare products Regulatory Agency (MHRA) has approved Viagra Connect (containing sildenafil 50mg) to be formally reclassified from a POM to P medicine later this year, making it available without prescription for use by men over 18 who have erectile dysfunction (ED). But what does this mean for pharmacy teams and customers?

  • It is up to the pharmacist to determine whether treatment is appropriate for the patient 
  • The pharmacist must give advice on erectile dysfunction, usage of the medicine, potential side effects, and decide if further consultation with a general practitioner is required
  • The product will not be sold to men with severe cardiovascular disorders; those with high cardiovascular risk, liver failure or severe kidney failure; or those taking certain interacting medicines. Use in these groups must be under the supervision of a doctor
  • Fast access to quality, legitimate care will help direct men who might not otherwise seek help into the healthcare system and away from the risks of buying unlicensed and counterfeit products from websites operating illegally.

Recommending condoms

With prevention better than cure, condoms remain highly effective first-line protection against STIs. PHE’s campaign highlights the increased likelihood of contracting an STI if having sex without a condom, but the YouGov survey found that almost twice as many young people say that the main reason for using condoms is to avoid pregnancy (58 per cent), rather than to avoid getting an STI (29 per cent).

In addition, many young people still don’t know how to access condoms, or are embarrassed to do so – which is where community pharmacy can help. Pharmacy teams can signpost young people to local services and get involved in services like the C-card scheme that offers registered users aged between 13 and 24 free condoms from a variety of venues, such as pharmacies and clinics.

Talk about testing

Pharmacy staff can signpost sexual
health clinics for STI testing and
treatment

As well as improving customers’ risk awareness and encouraging safer sexual behaviour through consistent and correct condom use, community pharmacy has a role in talking about STI testing. 

If a pharmacy doesn’t offer STI testing, staff can signpost GUM or sexual health clinics, GP practices, contraception clinics, and some young people’s services providers for tests and treatment.

As it is possible to have more than one sexually transmitted infection at the same time, it’s a good idea recommend customers consider a check-up for other infections if:

  • They or a partner have a new diagnosis of genital warts
  • They or a partner have, or think they might have, any other symptoms
  • They’ve recently had unprotected sex with a new partner
  • They or a partner have had unprotected sex with other partners
  • A sexual partner has a sexually transmitted infection
  • They’re pregnant or planning a pregnancy.

If a customer is reluctant to get tested, then home tests for STIs such as chlamydia, gonorrhoea, syphilis and HIV are available to buy online. It’s important to stress that all home tests should carry a CE mark and be licensed for use in the UK. The customer should be encouraged to come back to the pharmacy once they have done the test to talk about the results and what to do next.

Because of pharmacy’s position on the front line of health advice pharmacy teams are ideally placed to help young people prevent and deal with STIs in a tactful and sensitive way, which may increase patient loyalty.

Emergency contraception

TM spoke to Clare Newins, marketing manager at HRA Pharma, manufacturer of emergency contraceptive pill EllaOne (ulipristal acetate), about her advice on emergency contraception provision in pharmacy

Pharmacy is the first port of call for emergency contraception (EC) for the majority of women (77 per cent), which means pharmacy team members should be up to date with the latest guidance from the Faculty of Sexual and Reproductive Healthcare (FSRH). 

Key facts

Women should be given information regarding all methods of EC methods and signpost them to services that can provide them, where necessary

The copper intrauterine device (Cu-IUD) is recognised as the most effective method
of emergency contraception

Where the IUD is not immediately available, EllaOne (ulipristal acetate) is recognised to be a suitable alternative for the majority of women regardless of weight, with the FSRH guidance noting that EllaOne should be considered as the first-line oral treatment for women.

Barriers to access

EC products are most effective when taken as soon as possible after unprotected sexual intercourse or contraceptive failure so it is important that there are no barriers to accessing it. Although both women and pharmacy staff may feel uncomfortable, it is important to ensure women feel supported and not judged when coming in for help and/or advice. The best way of doing this is to remain objective, yet understanding. 

There has been much debate in the press recently relating to the price of EC resulting from the ongoing British Pregnancy Advisory Service (BPAS) campaign seeking to improve access to this important treatment. Although EC pricing is set at the discretion of the retailer, this price includes the fee for the pharmacy consultation and it is during this consultation process that the pharmacy team ensures that the most suitable method of EC is provided. It is of upmost importance that women in need of EC are provided access to the most suitable and efficacious product for their individual needs. The latest guidance on EC reinforces this by outlining the role of the pharmacy in educating women on the differences in efficacy among the treatments that exist.

Pharmacy teams are ideally placed to help young people prevent and deal with STIs in a tactful and sensitive way

Originally Published by Training Matters

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