Modules
- Year 1
- Year 2
- Introduction to Year 2 and Year Outcomes
- Cardiorespiratory 2
- Metabolism 2
- Brain and Behaviour 2
- Human Development 2
- Human Sciences and Public Health 2
- Locomotor 2
- Cancer Week
- Moving and Handling Training
- Year 2 Lifesaver Programme
- Clinical Communication Skills
- Medicine in Society 2
- Extended Patient Contact
- Student Selected Component (SSC)
- Year 3
- Introduction to Year 3 and Year Outcomes
- Clinical Science and Professionalism (Weeks 1-3)
- Cardiovascular, Respiratory and Haematology (CR3)
- Gastroenterology and Cancer (MET3A)
- Public Health
- Endocrinology and Renal Medicine (MET3B)
- General Practice and Community Care
- Student Selected Component (SSC)
- Clinical and Communication Skills
- Year 4
- Introduction and Year 4 Outcomes
- Obstetrics and Gynaecology
- Child Health
- HIV & Sexual Health
- Musculoskeletal
- Health Care of the Elderly
- Neuroscience
- Dermatology
- General Practice and Community Care
- Psychiatry
- Ear, Nose and Throat
- Global Health and Ethics
- Ophthalmology
- Clinical & Communication Skills
- Student Selected Component (SSC)
- Year 5
- Introduction to Year 5 and Year Outcomes
- Teaching Week 1
- Teaching Week 2
- Anaesthesia & ITU (AN & ITU)
- Breaking Bad News
- Clinical Pharmacology & Therapeutics
- Community Care
- Doctors as Teachers and Educators (DATE)
- Emergency Medicine (EMERG MED)
- General (Internal) Medicine (G(I)M)
- Immediate Life Support (ILS)
- Student Assistantship
- Simulation
- Surgery
- Student Selected Component (SSC)
- Year GEP 1
Year 4 I&I 4: HIV & Sexual Health
- Dr Claudia Estcourt
- c.s.estcourt@qmul.ac.uk
Teaching Material for this Module
Introduction
The aims of the HIV and Sexual Health Module are to:
Help students develop a sensitive, non-judgemental attitude to people (patients) regardless of their race, gender and sexual preference and the student’s own personal prejudices.
Equip all graduating doctors to function effectively as a potential Level 1 Provider of sexual health care (National Strategy for Sexual Health and HIV, 2001) as a minimum.
Enthuse students to pursue further learning in sexual health, e.g. by additional optional sexual health modules.
Index
- General Outcomes for Sexual Health & HIV
- Contraception
- HIV Infection
- Genital Discharge
- Genital Ulcers and Lumps
- Pelvic Pain
- Testicular Pain
- General Outcomes for Sexual Health & HIV
- Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
-
Sexually Transmitted Infections - General
- Understand the pathogenesis, diagnosis and management of Herpes Simplex Virus, Syphilis, Lymphogranuloma Venereum,
- Understand the pathogenesis, diagnosis and management of Human Papilloma Virus, Molluscum contagiosum and Sarcoptes scabiei
- Understand the pathogenesis, diagnosis and management of Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, Trichomonas Vaginalis, Bacterial Vaginosis and Non-Specific Urethritis
- List the major routes of transmission of HIV
- General Outcomes for HIV and AIDS
- Sources of Infection and Routes of Transmission
-
Sexually Transmitted Infections - General
- Medical knowledge: PHARMACOLOGY (TD 8.10)
-
Contraception and HRT
- Describe to a patient methods of emergency contraception, indications and guidance for use
- Demonstrate basic knowledge of currently available contraceptive methods and be able to communicate to patients the mechanisms of action and failure rate
- Manage under supervision or refer as appropriate the contraceptive needs of a patient presenting with a medical condition which may contraindicate the method s/he is currently using
-
Contraception and HRT
- Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
- HIV Infection
-
Sexual Assault
- Understand the management of male and female victims of sexual assault
- To know where to refer patients who have been possible survivors of sexual assault
- Identify symptoms and presentations that may indicate that patients have been survivors of sexual assault
- Recognise presentations of Domestic Abuse and be able to refer appropriately
- Identify and understand Female Genital Mutilation and be able to refer appropriately
- Be aware of non-consensual sexual intercourse in male and females and appropriate referral pathways for further management and support
-
General Outcomes for Sexually Transmitted Diseases
- Understand the pathogenesis, diagnosis and management of Herpes Simplex Virus, Syphilis, Lymphogranuloma Venereum
- Recognise common presentations of patients with psychosexual factors affecting sexual function and / or relationships and know where to refer them.
- Understand the pathogenesis, diagnosis and management of Human Papilloma Virus, Molluscum contagiosum and Sarcoptes scabiei
- Understand the pathogenesis, diagnosis, management and prevention of the following in the context of HIV: Pneumocystis jiroveci, Cryptococcus neoformans, Candidia albicans, Toxoplasma gondii, Cryptosporidium parvum, Mycobacterium tuberculosis
- Understand the pathogenesis, diagnosis and management of Chlamydia trachomatis, Neisseria gonorrhoea, Candida albicans, Trichomonas Vaginalis, Bacterial Vaginosis and Non-Specific Urethritis
- Recognise the clinical presentations of primary HIV infection (seroconversion) and describe the management of a suspected case
- Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
- HIV/AIDS and Sexually Transmitted Infections
- Medical knowledge: PSYCHOLOGY (TD 9 a-g)
-
Bio-Psycho-Social Issues
- To appreciate the concerns a patient may have attending a GUM clinic and list three ways you might put patients at ease
- Describe the stresses and psychological reactions associated with actual or perceived HIV infection, Hepatitis B and C or STDs, and the buffering effects of adaptive coping skills and social support
-
Bio-Psycho-Social Issues
- Clinical skills: HISTORY (TD 13 a-b)
-
General
- List the required competencies in The Fraser Ruling
- Be able to obtain an appropriate sexual history, to assess risk for sexually transmitted infections and pregnancy and to communicate this risk to individual patients in a sensitive, non-judgemental manner
- Understand causes of genital warts and difference between low-risk and high-risk HPV types
- Understand some of the difficulties patients might have in discussing issues regarding sex, sexuality and sexual practices and problems
- To understand how to take a sexual history
- Take a brief alcohol and recreational drug history and understand the relevance to high risk sexual behaviours
- To gain an appreciation of some of the different types of sexual practices
- Take a sexual history with regard to sexual preference, practice, and problems that is respectful of individual lifestyles and sensitive to social and cultural issues
- Be able to obtain an appropriate sexual history, to assess risk for sexually transmitted infections and pregnancy and to communicate this risk to individual patients in a sensitive, non-judgmental manner
-
General
- Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
- Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
- Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
-
General Outcomes for Sexual Health Diagnosis
- Understand the pathogenesis, diagnosis and management of Herpes Simplex Virus, Syphilis, Lymphogranuloma Venereum,
- Understand the pathogenesis, diagnosis and management of Human Papilloma Virus, Molluscum contagiosum and Sarcoptes scabiei
- Understand approach to diagnosing genital sores (history and examination)
- Understand the pathogenesis, diagnosis and management of Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, Trichomonas Vaginalis, Bacterial Vaginosis and Non-Specific Urethritis
- List the diagnostic tests used for genital sores (Dark ground, PCR)
- List a differential diagnosis for a male and female patient presenting with genital ulceration, focussing on Herpes Simplex and Syphilis infection
- Recognise the clinical presentations of non-infective genital ulceration (eg Bechet’s disease)
- With reference to HIV, Hepatitis B and C and STDs the student should be able to: a) Identify the skills, roles and responsibilities of the health care team; b) To understand that a patient needs to give consent for an HIV test and that pre-test/post-test counselling are no longer performed routinely in order to reduce the stigma associated with HIV.
- Be able to explain asymptomatic shedding of HSV
- Be able to explain incubation periods and transmission
- Understand the pathogenesis, diagnosis and management of HIV infection
- Explain other aspects of management – e.g. Patient Information, Partner Notification issues, condom use
- To have an introduction to Sexually Transmitted Infection (STI) and their treatments
-
General Outcomes for Sexual Health Diagnosis
- Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
-
Management Sexual Health Disorders (Inc. HIV) - General
- Understand the management of psychosexual disorders in male and female patients.
- List treatment options for genital warts
- List treatments for NGU, Chlamydia, Gonorrohea and LGV
- With reference to HIV, Hepatitis B and C and STDs the student should be able to: a) Identify the skills, roles and responsibilities of the health care team; b) To understand that a patient needs to give consent for an HIV test and that pre-test/post-test counselling are no longer performed routinely in order to reduce the stigma associated with HIV.
- To understand the efficacy, side effects, drug interactions and contraindications of drugs used in the management of STIs
- Offer STI & HIV testing as part of genital wart management
- Offer STI & HIV testing as part of management
- List treatments for HSV and Syphilis
- Explain other aspects of management – eg Patient Information, Partner Notification issues, condom use
- Offer STI & HIV testing as part of genital sores management
- Understand the pathogenesis, diagnosis and management of HIV infection
- Explain other aspects of management – eg Patient Information, Partner Notification issues, condom use
- To have an introduction to Sexually Transmitted Infection (STI) and their treatments
- To appreciate the importance of contact tracing and partner notification
- Management of general O&G problems
-
Management Sexual Health Disorders (Inc. HIV) - General
- Clinical skills: SUPPORTING PATIENTS and IDENTIFYING ABUSE and NEGLECT (TD 14 h-i)
- General Outcomes for Integrated Health
- Clinical skills: INTERACTION WITH PATIENTS (TD 15 a-b)
- Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
- Pharmacological Therapy - Sexual Health (General)
- Professional issues: WORKING IN TEAMS (TD 22 a-c)
- Professional issues: ETHICS and LAW (TD 20 a-g)
- Legal, Moral, Ethical Responsibilities of Patient Care
- Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
- Human Factors
- Principles of Risk Management
- Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
- Contraception
- General Outcomes for Contraception
- Be able to obtain a contraceptive and reproductive health history to assess contraceptive need and to discuss contraceptive choices to enable patients to make informed decisions on those choices
- List the reasons for high teenage pregnancy rates or rises in STI prevalence
- Understand and be able to explain the principles of Fraser Competency for under 16s and vulnerable young people and adults
- Demonstrate correct condom technique
- General Outcomes for Contraception
- HIV Infection
- General Outcomes for HIV Infection
- Understand the pathogenesis, diagnosis, management and prevention of the following in the context of HIV: Pneumocystis jiroveci, Cryptococcus neoformans, Candidia albicans, Toxoplasma gondii, Cryptosporidium parvum, Mycobacterium tuberculosis, atypical My
- Describe the spectrum of clinical problems associated with HIV infection: primary HIV infection, asymptomatic HIV infection, persistent generalised lymphadenopathy, symptomatic HIV infection and Acquired Immunodeficiency Syndrome
- To understand the basic epidemiology of STIs and HIV and public health issues for control of spread of infection locally and globally
- Engage in relevant HIV pre-test discussions to assess relative risk of infection and enable patients to make an informed decision on testing (both in GU setting and outside of GU)
- Recognise the significance and list possible causes for the following symptoms in an HIV infected person: Generalised seizures; Loss of consciousness; Focal neurological deficit; Change in affect; Shortness of breath; Rash; Fever
- Recognise the major clinical presentations of neurological complications of HIV
- Recognise the clinical presentations of primary HIV infection (seroconversion)\and describe the management of a suspected case
- Recognise the clinical presentations of primary HIV infection (seroconversion)\and describe the management of a suspected case
- Understand the pathogenesis, diagnosis and management of HIV infection
- Demonstrate knowledge of the CDC classification system for HIV infection
- Explain the functions of the various parts of the HIV virus particle
- To describe principles of partner notification for STIs and HIV
- Understand the concept of opt-out testing and the settings in which opt-out testing are conducted.
- Understand the changing significance neurological complications of HIV, in particular, HIV-associated neurocognitive disease
- Assess risk of HIV transmission in individual presenting after occupational and non-occupational potential exposure to HIV
- Correlate the degree of immunosuppression of an individual patient with the likely clinical problems
- Describe the genome of HIV with reference to the regulatory proteins produced and their functions.
- Identify barriers to testing (from patients and healthcare professionals)
- Identify neurological clinical presentations that may indicate undiagnosed HIV infection
- Describe the tests used in the diagnosis and monitoring of HIV infection including: tests for antibodies to HIV-1 and HIV-2; Tests for the virus itself (viral antigen, viral DNA and RNA, viral subtypes and genetic analysis for resistance mutations); Tests of the immune system (lymphocyte subsets)
- Describe available PEP regimens and how best to access these regimen
- Understand a range of testing methods
- Formulate a plan for the treatment and prevention of neurological disease in HIV
- Critically evaluate the utility of individual tests in specific clinical situations including: Diagnosis in chronically infected individual; HIV seroconversion; pregnancy; neonates and children less than 2 years old; patients on antiretroviral therapy
- Understand the circumstances in which HIV testing can be performed with out the patient’s consent
- Demonstrate the events that occur at a cellular level during acute HIV infection
- Describe the management of a person who has sustained a needlestick injury from a known HIV positive source
- Be able to explain the events within the immune system which result from HIV infection
- Describe the specific immune responses to HIV
- Correlate the changes in the immune system at a cellular level with the clinical consequences for the patient with HIV infection
- Explain the factors that may confer resistance to HIV
- Define the term long-term non progressor
- Describe the potential uses of vaccination and immunotherapy in HIV
- Infections and Disorders Associated with HIV
- Describe the spectrum of clinical problems associated with HIV infection: primary HIV infection, asymptomatic HIV infection, persistent generalised lymphadenopathy, symptomatic HIV infection and Acquired Immunodeficiency Syndrome
- List the fungi and protozoa that commonly cause clinical disease in the context of HIV infection
- Describe the epidemiology and natural history of Hepatitis A, B, C and D
- List the bacteria and viruses that commonly cause clinical disease in the context of HIV infection
- Understand the effect of co-infection with HIV and Hepatitis B and C on the natural history of HIV and Hepatitis B and C
- Recognise the major clinical presentations of: Pneumocystis jiroveci; Cryptococcus; Candidiasis; Toxoplasmosis; Cryptosporidium; Herpes viruses (Herpes Simplex, Herpes Zoster, Cytomegalovirus); Human papilloma virus; Papovavirus; Salmonella; Mycobacteria; Haemophilus; Pneumococcus
- Describe the methods of diagnosis and monitoring of Hepatitis B and C infection
- Describe the investigation of abnormal liver function tests / hepatomegaly in an HIV-infected individual
- Describe the treatment of Hepatitis B and C and how this differs in the context of HIV co-infection
- Describe prevention strategies, including vaccination, for Hepatitis A, B and C
- Describe the spectrum of renal disease in HIV
- Describe the investigation and management of abnormal renal function in an HIV-infected individual
- Treatment of HIV Infection
- Understand the pathogenesis, diagnosis and management of HIV infection
- Recognise the clinical presentations of primary HIV infection (seroconversion)\and describe the management of a suspected case
- Recognise the clinical presentations of primary HIV infection (seroconversion)\and describe the management of a suspected case
- To describe the basic principles of anti-HIV therapy, including major side-effects and interactions of therapy
- Describe the management of a person who has sustained a needlestick injury from a known HIV positive source
- Describe the different groups of antiretroviral drugs and their mode of action
- Explain the rationale for risk assessment and the use of antiretroviral agents for prophylaxis following sexual intercourse with a known or suspected HIV positive person
- Describe examples of the most commonly prescribed antiretroviral drugs including major side-effects and interactions of therapy
- Describe why adherence to ARVs is important
- Demonstrate the life cycle of HIV, with particular reference to the areas that have implications for therapeutic interventions
- Describe the principles of diagnosis, management and prevention of opportunistic fungi and protozoa
- Review the specific details of development of ARV resistance
- Describe the principles underpinning the diagnosis, management and prevention of opportunistic bacterial and viral infection in HIV infected patients
- Consider specific difficulties associated with ARVs that have an impact on adherence and resistance including: bioavailability; side-effects (short and long-term); confidentiality; interactions
- Formulate a plan for the treatment and prevention of opportunistic bacterial and viral pathogens
- Describe how antiretroviral therapy may be used to prevent HIV transmission including: Mother to child transmission; Post-exposure prophylaxis (PEP / PEPSE); Pre-exposure prophylaxis (PrEP); Treatment as Prevention (TAsP) strategies including “test and treat” initiatives in high prevalence settings
- Describe the potential uses of vaccination and immunotherapy in HIV
- Malignancies Associated with HIV Infection
- Explain why HIV infection predisposes to certain malignancies
- Understand the relationship between HHV8, EBV and HPV in the etiology of malignancy
- List the presenting clinical features of Kaposi’s sarcoma, non-Hodgkin’s B cell lymphoma and squamous cell carcinoma in HIV infection
- Consider appropriate differential diagnoses for each condition
- Discuss potential management strategies for each type of malignancy
- General Outcomes for HIV Infection
- Genital Discharge
- General Outcomes for Genital Discharge
- Understand approach to diagnosing dysuria & discharge (history and examination)
- Understand approach to diagnosing vaginal discharge (history and examination)
- List the diagnostic tests used (microscopy, culture, urinalysis)
- List diagnostic tests used (eg microscopy, culture, NAATs)
- List a differential diagnosis patient presenting with urethral or rectal discharge and/or dysuria (including NGU and LGV)
- List a differential diagnosis for a female patient presenting with vaginal and/or rectal discharge
- Offer STI and HIV testing if appropriate
- General Outcomes for Genital Discharge
- Genital Ulcers and Lumps
- Pelvic Pain
- General Outcomes for Pelvic Pain
- Understand approach to diagnosing female pelvic pain (history, examination, pregnancy test)
- List the diagnostic tests used (microscopy, culture, urinalysis, pregnancy test)
- List differential diagnoses (eg ectopic pregnancy, PID, UTI)
- Understand referral pathway for urgent management of ectopic pregnancy
- Offer STI & HIV testing as part of management
- Explain other aspects of management – eg Patient Information, Partner Notification issues, condom use
- General Outcomes for Pelvic Pain
- Testicular Pain
- General Outcomes for Testicular Pain
- Epididymitis
- Testicular Torsion