Table 2.
Changes along the (walk-in) male patient pathway
| Before rapid STI service | Rapid STI service | ||
| Registering at reception | All walk-in patients allocated an appointment in order of queue—may have to come back later that day | Receptionist triages each patient to appropriate pathway referring to guide/pathway | |
| Patients not eligible for rapid STI service are given an appointment for later that day and continue on old pathway | Rapid STI service-eligible patients wait after registering to be called up | ||
| Triage form used to register patients | Triage form amended to be gender neutral and to make categories clearer | ||
| Seeing a clinician/ health adviser | At first appointment | First appointment very brief—reduced history taking. Unless uncomplicated vaginal discharge | |
| MSM and all patients needing partner notification/risk reduction/safer sex advice see health adviser | High-risk patients (MSM or new to service) see health adviser at initial appointment | ||
| Symptomatic men see doctor/trained nurse only at follow-up not drop-off, usually on same day | |||
| Providing samples | Urine and swabs: taken at time of consultation. Self-taken if asymptomatic. If symptomatic: clinician taken swab for microscopy (to detect NGU* and gonorrhoea) and gonorrhoea culture; NAAT self-taken | Self-sample drop-off—urine and swabs NAAT self-sampled in toilets, putting samples through a hatch to the laboratory. Instructions are on posters in the toilet and from nursing staff/NAs. Gonorrhoea culture taken by clinician on return only if NAAT positive. Swab for microscopy to detect NGU if NAAT-negative (see text above) | |
| Blood samples taken by doctor/nurse/nursing assistant (NA) | Blood samples taken by doctor/nurse/NA | ||
| Tests results | All STI test results in 2–3 weeks | Chlamydia and gonorrhoea processed on Panther—results within 48 hours. Others still 2–3 weeks | |
| If negative, text sent | Results by text if asymptomatic and negative | ||
| If positive, HA phones patient to discuss result and arrange treatment (unless already received presumptive treatment) | Results given at follow-up appointment with clinician if symptomatic or asymptomatic positive | ||
| Treatment | Treat presumptively | Wait for results before treating | |
| Treat at first (only) appointment | Treat at follow-up appointment | ||
| Notified partners | Treated immediately | Only treat on positive results (if sexual contact was >2 weeks; otherwise treat immediately) | |
*NGU (Non-Gonococcal Urethritis) is an infection of the urethra caused by pathogens (germs) other than gonorrhea.
MSM, men who have sex with men; NA, Nursing Assistant.; NAAT, nucleic acid amplification test; STI, sexually transmitted infection.