Teaching in Clinical Practice
Health Promotion & Education -
Module 2/01C
&
Teaching in Clinical Practice
Module 2/08 A
Level 2
Combined Summative Assessment.
Submitted to :
University of Surrey?
European Institute of Health & Medical Sciences
School of Education & Professional Training.
Course Convenors : Chris Willott
Janet Trigg
Word Count : 2695
INDEX.
Page Number.
INTRODUCTION. 1
SEXUAL HEALTH. 3
HEALTH EDUCATION AND PROMOTION :
NEEDS, AIMS, GOALS AND OBJECTIVES. 5
HEALTH EDUCATION AND PROMOTION :
BEHAVIOUR CHANGE AND EDUCATIONAL APPROACHES. 7
HEALTH EDUCATION AND PROMOTION :
EDUCATIONAL TEACHING MODELS. 9
CONCLUSION. 12
REFERENCES. 13
BIBLIOGRAPHY. 15
ANNEX A :
FREQUENCY OF KC 60 DIAGNOSES SOUTH THAMES
(WEST) GUM CLINICS, 1995 - 1997. i
INTRODUCTION.
The author intends to critically analyse a need for safer sex health education, and will demonstrate a teaching strategy to meet this need for the clients attending a Department of Genito-Urinary Medicine (GUM) at a large suburban NHS trust hospital.
Human Immunodeficiency Virus (HIV) and sexually transmitted infections (STI's) are responsible for considerable morbidity and mortality in the United Kingdom (UK), and the incidence appears to be on the increase (Annex A: PHLS CDSC, 1997; DOH, 1996). Therefore the Conservative Government attempted to address this problem with the advent of the "Health of the Nation" document in 1992. This document sets out defined areas for health promotion, included in these are areas relating to sexual health. More recently the present Labour Government set out its document relating to health promotion and education, entitled "Our Healthier Nation" (1998). However, the main criticism levelled at this Green Paper was, it failed to recognise sexual health as an actual or potential problem (HPS, 1998).
The promotion of sexual health is a legitimate role for health professionals and is an essential nursing function (Ingram-Fogel, 1990). With direct client contact, nurses are ideally placed to carry out this vital educational role (Winship and Peachey, 1995), but there is more to this than just giving out leaflets with information about HIV and STI's. There needs to be a coherent plan that can be adapted to meet each individual's needs. Winship and Peachey (1995) state that,
"the education task is not to kill the subject of by making it sterile, or by causing resistance to learning by overstressing the seriousness of the possible consequences of unprotected sex."
(Winship and Peachey, 1995:99)
Preventative health education is the best known approach (Tones, 1981). It is based upon the understanding that prevention is better than the cure and that curative medicines are failing to deal with the present community health problems (Tones, 1981). The present world wide HIV epidemic has provided renewed impetus for the provision of effective sexual health care, education and promotion with departments of GUM and the community (Weston, 1993).
The inability of science to provide a cure or protective measure (i.e. vaccination) has led some health professionals to comment that currently the only means of preventing the spread of HIV and STI's is through behavioural and cultural change (Silverman et al, 1992).
SEXUAL HEALTH.
To look at health promotion and education strategies within this field it is necessary to adopt a usable and appropriate definition of health and more particularly sexual health. Ewles and Simnett (1995:6) summarises health as, "being shaped by the individuals own experiences, knowledge, values, expectations and the fitness they need to fulfil that role."
The author agrees with definition as sexual health is often defined very negatively dwelling on the absence of STI's and unwanted pregnancy, but this definition is a statement allowing flexibility between well being and ill health.
The World Health Organisation (WHO) debated this issue in 1987 and concluded that due to the wide range of individuals, cultures, social differences, lifestyles, sexuality and gender roles, there can be no single absolute definition of a sexually healthy individual. However, Curtis et al (1995) cites the WHO's (1986) earlier description of sexual health, which in the author's opinion suggests a more positive definition of sexual health. This would require a number of components to come together for a person to be considered sexually healthy, these are,
"He or she,
needs a capacity to enjoy and control sexual and reproductive behaviour in accordance with a social and personal ethic.
freedom from fear, shame, guilt, false beliefs and other psychological factors inhibiting sexual response and impairing sexual relationships.
freedom from organic disorders, disease and deficiencies that interfere with sexual and reproductive functions."
(WHO, 1986 cited in Curtis et al, 1995:106)
This appears to be a more workable definition for sexual health, focusing on the positive elements of a sexual being that is a human, though again there is an element of negativity surrounding "disorders and disease."
HEALTH EDUCATION AND PROMOTION :
NEEDS, AIMS, GOALS AND OBJECTIVES.
Working within a Department of GUM is very much like "shutting the barn door, once the horse has bolted." In the main the reasons for attendance are usually linked to the individual either having already exposed themselves to HIV and STI's, or concerns about exposure to the causative organisms. In other words, "the worried well."
Having assessed the need for health promotion and education within this area, and through discussion with the departmental manager and consultant, it was decided that the nursing staff were best placed for this form of health promotion and education. This is supported by Gott and O'Brien (1990), as they have identified two characteristic dimensions of health education as practised by nurses, namely;
"the transmission of information to individuals perceived to live in ignorance of it, and
the creation of trusting relationships with clients, so that they will be more likely to adopt the advice given to them."
(Gott and O'Brien, 1990:90)
To enable the health promoter to develop a coherent plan of health education and promotion, the client, guided by the health promoter will need to consider potential problems and actual problems in their sexual activities. It is important to assess what safer sex means to the client, as it means different things to different people. They may be to embarrassed to confess that they have little knowledge of the correct way to use protection (Sutton and Payne, 1996). This empowers the client to identify their own felt and expressed needs (Bradshaw, 1972 cited by Naidoo & Wills, 1994). ...
This is a preview of the whole essay
To enable the health promoter to develop a coherent plan of health education and promotion, the client, guided by the health promoter will need to consider potential problems and actual problems in their sexual activities. It is important to assess what safer sex means to the client, as it means different things to different people. They may be to embarrassed to confess that they have little knowledge of the correct way to use protection (Sutton and Payne, 1996). This empowers the client to identify their own felt and expressed needs (Bradshaw, 1972 cited by Naidoo & Wills, 1994). Once defined this allows the health promoter to devise ways of meeting these needs (Naidoo & Wills, 1994; Rogers, 1986; Curtis et al, 1995). Armstrong (1982) cited by Naidoo & Wills (1994) suggests that by identifying the clients needs, it enables the health promoter to retain the power and control rather than empowering the client. The author disputes this, as needs are something that the client can benefit from. They are something that they want or demand, rather than something dictated by the health promoter. The client verbalised his needs as wanting to be free from a STI and to be more aware of preventative measures, in other words "safer sex" issues. So from this statement the health promoters can plan the health education by defining an aim, goal and objective (Rogers, 1986).
The aim needs to be a broad statement outlining what the health promoter is trying to achieve. The goal describes the actual purpose of the learning, in general terms and the objective is a statement, which needs to be more defined. It must be obtainable, measurable and relevant (Ewles and Simnett, 1995). Therefore the aim for the health promoter will be to promote sexual health through safer sex practices. The goal of the teaching session to be discussed will be for the client to use safer sex measures. The objective will be for the client to be able to discuss the potential hazards associated with unsafe sexual practices by the end of the counselling session.
To enable the health promoter and client to develop these it is important to identify motivation by stages, this in turn will enable the a health promotion model to be utilised (Rogers, 1986; Naidoo & Wills, 1994). Rogers (1986:63) describes motivation as "internal urges and drives based on needs."
Naidoo & Wills (1994) state that there are five approaches to health promotion and education. Two of these approaches will be discussed in an effort to meet the clients needs. They are the "Behaviour Change" and "Educational" approaches to health education.
HEALTH EDUCATION AND PROMOTION :
BEHAVIOUR CHANGE AND EDUCATIONAL APPROACHES.
These approaches are designed to help the client to change his attitude and behaviour in favour of a healthier lifestyle. Subsequently this will allow the client to have a clearer understanding of safer sex issues, and allow him to explore his own attitudes and beliefs.
The aim of the behavioural change approach is to encourage the client to take up healthier behaviour, this is seen as the means, or key, to improved health (Naidoo and Wills, 1994). An example of this would be to discuss with and demonstrate to the client, the benefits and the correct use of condoms. This approach is well suited to this form of health promotion and education, as It lends itself well to the provision of information from the health promoter to the client in the form of one to one discussions or counselling sessions. This empowers the client to make informed decisions and therefore a behaviour change is hopefully achieved (Ewles and Simnett, 1995). Evaluation of this approach may appear to be quite straight forward, but there are two main problems (Naidoo and Wills, 1994). The first being that change in behaviour by the client may only become self evident after a long period of time, and the second being any changes realised may be difficult to attribute to the health promotion (Naidoo and Wills, 1994).
The aim of the educational approach is to provide the client with enough information and sufficient skills for him to make an informed choice about his health behaviour (Naidoo and Wills, 1994). An example of this would be to discuss with the client the routes of transmission for HIV and STI's. Again, this approach is well suited to this form of health promotion and education. As the health promoter presents the information available to the client, and from this the client is able to explore their own personal values and attitudes. This empowers the client to make his own decisions (Naidoo and Wills, 1994). The health promoter must acknowledge and respect the rights of the client to choose his own health behaviour when using this approach (Naidoo and Wills, 1994; Ewles and Simnett, 1995).
The evaluation of this approach is relatively easy to measure. A question and answer scenario will demonstrate whether the client has understood the information, or has an understanding of the potential risk factors associated with unprotected intercourse. But information alone is not enough to change the behaviour in a client, and other approaches are needed to reinforce the information, (Quinn, 1995; Naidoo and Wills, 1994) such as previously discussed.
To implement these needs, approaches and aims, it is important to bring them together with an educational teaching model suitable for health promotion. These include models by Belbin (1972 cited by Rogers, 1986), Bloom (1968 cited by Rogers, 1986) Gagné (1985 cited by Rogers, 1986: cited by Quinn, 1995) and Tones and Tilford (OL, 1994)
The author will attempt to discuss the implementation of Bloom's Taxonomy (1956 cited by Rogers, 1986: cited by Quinn, 1995: cited by Walkin, 1990) within the field of sexual health.
HEALTH EDUCATION AND PROMOTION :
EDUCATIONAL TEACHING MODELS.
Sexual health education can be defined as "efforts aimed at producing positive changes in attitudes and in health and health seeking behaviours in sexually transmitted disease's and their prevention" (WHO, 1991).
Sutton and Payne (1997) suggest that education and learning in sexual health can be considered under four basic principles, these are,
"Adults learn from one another as well as the educator.
They learn from asking questions and getting answers.
Within a group setting, they learn from other people's questions and answers, especially the shy or inhibited. This may not be practical within the client/professional relationship in the GUM clinic, but can be applied ...., where the aim is the promotion of sexual health.
They learn from talking. By listening to the client talk and encouraging them to disclose their fears, misinformation can be corrected and worries allayed."
(Sutton and Payne, 1997:87)
However, more traditional forms of health education are divided into three main areas, these are the "Cognitive theories," which are theories concerned with an increased level of knowledge. "Behaviourist theories," also known as the "Affective domain" which are theories concerning attitudes and beliefs. "Humanist theories or Psychomotor domain" which are theories concerned with skills acquisition and competence (Roger, 1986; Naidoo and Wills, 1994). These theories are the main stem of Bloom`s Taxonomy, and even the most basic of educational situations will require a complex mix of skills related to addressing each of the theories (Walkin, 1990).
"Safer Sex" is best approached on a one to one basis, in an environment free from distractions and disturbances. The health promoter must be comfortable discussing the subject of sex, often in a frank fashion, with the client (Miller and Bor ,1991). The primary task of the health promoter is to assess the clients current knowledge and understanding of the ways that STI's may be acquired. This situation demands an equal and non-judgmental relationship between the health promoter and client, and is referred to as "androgogy" or the art and science of teaching adults (Knowles, 1973 cited in Nicklin and Kenworthy, 1995). Knowles (1973, cited in Nicklin and Kenworthy, 1995) suggests that this allows the client to learn through experience and accomplishment, and build on existing experience and knowledge. This can be achieved through a basic verbal question and answer scenario. This encourages the thought processes of the client and identifies key factors inherent to the problem of unsafe sexual practices (Walkin, 1990). The client states that the main reasons behind his present attitude towards condoms, and their use is that he feels that they are contraceptives rather than a barrier to infection. This opinion is common among heterosexual adults in this country, and is frequently quoted by clients attending a GUM clinic for the first time (Sutton and Payne, 1997). Once the current level of knowledge is assessed then new information can be added into the discussion. This enables the client to make an informed choice about their sexual health behaviour, at the same time it allows them the opportunity to share and explore their own attitudes and beliefs (Naidoo and Wills, 1994).
Bloom's (1956) three levels of mental performance i.e. analysis, synthesis and evaluation, can be grouped together into one known as "invention" (Walkin, 1990 : Naidoo and Wills, 1994). The client can demonstrate this process by breaking the information down into parts and indicating a clear understanding of the material given (Walkin, 1990). As part of the learning process it is important to introduce condoms and their application to the client, this can be a chance for a "hands on" demonstration by the health promoter. This can then be used as a form of evaluation, by getting the client to repeat the process in front of the health promoter. It is important that during the discussion and demonstration process that the health promoter does not dwell on the negativity of disease and infection as this negative reinforcement can have the opposite effect when discussing issues surrounding sexual health (Miller and Bor, 1991). In that the client may decide that this situation may have nothing to do with them, and therefore "switch off" and ignore any new information given to them.
CONCLUSION.
Over the last twenty years, two events have occurred which have shaped sexual health promotion and education, specifically, the emergence of the HIV epidemic and the change in social attitudes towards sexuality and sexual behaviour (Irwin, 1997). These events are in turn reflected in an increasing emphasis on primary prevention (DOH, 1992).
This assignment has briefly considered an approach to sexual health promotion and education. In order to evaluate the impact of health promotion and its educational outcomes, it would be of benefit to have further discussions about safer sex with the client at subsequent follow-up appointments. However, most behavioural changes take time, and constant reinforcement can have the opposite effect when discussing issues surrounding sexual health. Due to the client's having a tendency to distance themselves from the situation being discussed (Miller and Bor, 1991).
It is clear to the author that health promotion and education are an ongoing processes and that as professionals it is important that we have a clear understanding of the role of the nurse in this activity. It is also a fundamental requirement for the nurse, to have an ongoing process of positive strategies to meet the needs of the client, now and in the future.
REFERENCES.
Curtis H, Hoolaghan T, Jewitt C, 1995, Sexual Health Promotion in General Practice. Radcliffe Medical Press, Oxford.
Department of Health (DOH) 1992, The Health of the Nation : Key Area Handbook : HIV/AIDS and Sexual Health. HMSO, London.
Department of Health (DOH) 1996, Statistical Bulletin 14th July. HMSO, London.
Department of Health (DOH) 1998, Our Healthier Nation. Executive Summary [online] HMSO, London. Available from : http://www.open.gov.uk/doh/ohn/ohnexec.htm [accessed 2nd June 1998].
Ewles L, Simnett I, 1995, Promoting Health : A Practical Guide. Third Edn. Baillière Tindall, London.
Gott M, O'Brien M, 1990, Policy Framework for Health Promotion. Nursing Standard. 5 (1) : 90-92.
Health Promotion Service (HPS) 1998, Towards a Sexual Health Strategy for England : A Working Paper prepared in response to the, Our Healthier Nation Paper. North and Mid Hampshire HPS, Basingstoke.
Ingram-Fogel CI, 1990, Sexual Health Promotion. Saunders, Philadelphia.
Irwin R, 1997, Sexual Health Promotion and Nursing. Journal of Advanced Nursing. 25 : 170-177.
Naidoo J, Wills J, 1994, Health Promotion : Foundations for Practice. Baillière Tindall, London.
Nicklin P, Kenworthy N, 1997, Teaching and Assessing in Nursing Practice : An Experiential Approach. Second Edn. Baillière Tindall, London.
Miller R, Bor R, 1991, AIDS : A Guide to Clinical Counselling. Second Edn. Science Press Limited, London.
Open Learning (OL), 1997, Health Promotion in Professional Practice : Health Promotion Models. Nursing Times Learning Curve. 1 (8) : 9-13.
Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC), 1997, South Thames GUM Clinic Collaborative STD Surveillance. PHLS, London. 8 :12-14.
Quinn FM, 1995, The Principles and Practice of Nurse Education. Third Edn. Stanley Thornes Publishers Limited : London.
Rogers A, 1986, Teaching Adults. Open University Press, Milton Keynes.
Silverman D, Bor R, Miller R, Goldman E, 1992, Obviously the Advice is then to Keep to Safer Sex : Advice Giving and Advice Reception in AIDS Counselling. AIDS : Rights, Risks and Reason. Falmer Press, London. 174-194.
Sutton A, Payne S, 1997, Genito-Urinary Medicine for Nurses. Whurr Publishers Limited, London.
Tones BK, 1981, Health Education : Prevention or Subversion? Royal Society of Health Journal. 101 (3) : 114-117.
Walkin L, 1990, Teaching and Learning in Further and Adult Education. Stanley Thornes Publishers Limited, Cheltenham.
Weston A, 1993, Challenging Assumptions. Nursing Times. 89 (18) : 26-31.
WHO, 1991, Management of Patient with Sexually Transmitted Diseases. Reports of a Working Group Convened by the WHO. WHO, Geneva.
WHO, 1987, Concepts of Sexual Health. Reports of a Working Group Convened by the WHO (EURO). WHO, Copenhagen.
Winship G, Peachey A, 1995, Health Education and Safer Sex. British Journal of Nursing. 4 (17) : 999-1019.
BIBLIOGRAPHY.
Bloxham S, 1996, A Case Study of Inter-agency Collaboration in the Education and Promotion of Young People's Sexual Health. Health Education Journal. 55 : 389-403.
Bright JS, 1997, Health Promotion in Clinical Practice : Targeting the Health of the Nation. Baillière Tindall, London.
Dockrell J, Stockdale J, 1994, Advertising and HIV/AIDS. British Journal of Sexual Medicine. 21 (5) :12-14.
Grigg E, 1997, A Guidelines for Teaching about Sexuality. Nurse Education Today. 17 : 62-66.
Hunt G, 1995a, Sex Education : Are We Only Just Beginning? British Journal of Sexual Medicine. 22 (1) : 26-27.
Hunt G, 1995b, It's Sex Education Next Week : Can I Barrow that Video? British Journal of Sexual Medicine. 22 (5) : 10-11.
Kendall S, Lask S, 1997, Promoting the Health of the Nation. Churchill Livingstone, London.
Kendall S, Lask S, 1997, Promoting the Health of the Nation : Reader. Churchill Livingstone, London.
McManus J, 1995, Promoting Sexual Health : The Local Government Contribution. Health Education Journal. 54 : 251-263.
Piper SM, Brown PA, 1998, The Theory and Practice of Health Education Applied to Nursing : A Bi-polar Approach. Journal of Advanced Nursing. 27 : 383-389.
Rawlins K, 1993, Presentation and Communication Skills : A Handbook for Practitioners. MacMillian Magazines Limited, Bath.
Roger RS, 1998, Sex Education : Does it Work? British Journal of Sexual Medicine. 25 (3) : 12-14.
Staniland S, Newell R, 1996, Adolescent Attitudes to Sex Education. British Journal of Sexual Medicine. 23 (3) : 18-20.
Frequency of KC 60 diagnoses
South Thames (West) GUM clinics
Jan 1997 - June 1997
KC 60
Code
Condition
Persons
Male
Homo-sexual (% of males)
Female
A1, A2
Infectious syphilis
4
4
75
0
A3
Early latent syphilis
5
4
50
A4, A6
Other acquired syphilis
28
21
9.5
7
A9
Epidemiological treatment of suspected syphilis
0.0
0
B1, B2
Uncomplicated gonorrhoea
316
213
21.3
03
B4
Epidemiological treatment of suspected gonorrhoea
61
27
37.0
34
B5
Complicated gonorrhoea
5
0.0
4
C4a, C4c
Post-pubertal uncomplicated chlamydia
896
335
2.7
561
C4b
Other complicated chlamydia
34
2
50.0
32
C4e
Epidemiological treatment of suspected chlamydia
213
12
4.5
01
C4h
Non-specific urethritis (NSU), excluding PID & epididymitis
909
909
4.6
0
C4I
Epidemiological treatment of NSU & related disease
063
279
4.3
784
C1, C2, C3
Chancriod, Donovanosis, LGV
2
2
0.0
0
C5
Complicated non gonoccocal & non specific infection
416
74
.4
342
C6a
Trichomoniasis
69
0
0.0
59
C6b
Anaerobic / Bacterial vaginosis & male infection
698
24
0.0
674
C6c
Other vaginosis / vaginitis / balanitis
618
291
5.3
327
C7a
Anogenital Candidiasis
3235
314
4.9
2921
C7b
Epidemiological treatment of C6 & C7
294
29
.6
65
C8, C9
Scabies / Pediculosis Pubis
54
99
4.3
55
C10a
Anogenital herpes simplex - first attack
576
219
5.5
357
C10b
Anogenital herpes simplex - recurrence
445
73
3.5
272
C11a
Anogentital wart virus infection - first attack
532
810
5.5
722
C11b
Anogentital wart virus infection - recurrence
944
632
5.0
312
C11c
Anogentital wart virus infection persisting >3 months
489
242
8.2
247
C12
Mooluscum Contagiosum
75
23
6.7
52
C13
Antigen positive viral hepatitis B
85
62
33.9
23
C14
Other viral hepatitis
32
7
5.9
5
D2a
Urinary tract infection
432
45
4.5
387
D2b
Other conditions requiring treatment
2959
227
7.4
732
D3
Other episodes not requiring treatment
4366
916
4.6
2450
P1a
Counselling & HIV antibody test done
3865
2081
6.1
784
P1b
Counselling & HIV antibody test not done
532
268
1.2
264
P2
Immunisation against hepatitis B
548
455
53.6
93
P3
Family planning
822
68
4.5
754
P4a
Cervical cytology - minor abnormality
524
2
0.0
522
P4b
Cervical cytology - major abnormality
92
0
0.0
92
P4e
Cervical cytology - other diagnosis
82
0
0.0
81
E1a
Asymptomatic HIV infections - first presentation
58
39
68.6
9
E1b
Asymptomatic HIV infection - subsequent presentation
222
47
77.9
75
E2a
HIV infection with symptoms, not AIDS - first presentation
42
25
64.0
7
E2b
HIV infection with symptoms, not AIDS - subsequent presentation
279
211
78.8
68
E3a
AIDS - first presentation
26
9
52.6
7
E3b
AIDS - subsequent presentation
31
02
72.0
29
E4
AIDS - death
9
9
66.7
0
Total
30387
2744
3.2
7645
Frequency of KC 60 diagnoses
South Thames (West) GUM clinics
Jan 1996 - June 1996
KC 60
Code
Condition
Persons
Male
Homo-sexual (% of males)
Female
A1, A2
Infectious syphilis
9
8
37.5
A3
Early latent syphilis
5
3
0.0
2
A4, A6
Other acquired syphilis
22
2
7.3
0
B1, B2
Uncomplicated gonorrhoea
292
89
2.9
03
B4
Epidemiological treatment of suspected gonorrhoea
32
4
4.3
8
B5
Complicated gonorrhoea
0
0
0.0
0
C4a, C4c
Post-pubertal uncomplicated chlamydia
653
292
3.1
361
C4b
Other complicated chlamydia
38
7
4.3
31
C4e
Epidemiological treatment of suspected chlamydia
212
95
2.1
17
C4h
Non-specific urethritis (NSU), excluding PID & epididymitis
956
956
4.9
0
C4I
Epidemiological treatment of NSU & related disease
927
214
3.3
713
C1, C2, C3
Chancriod, Donovanosis, LGV
0
0.0
C5
Complicated non gonoccocal & non specific infection
456
83
3.3
373
C6a
Trichomoniasis
40
4
0.0
26
C6b
Anaerobic / Bacterial vaginosis & male infection
513
55
0.
458
C6c
Other vaginosis / vaginitis / balanitis
869
498
4.3
371
C7a
Anogenital Candidiasis
2593
302
3.7
2291
C7b
Epidemiological treatment of C6 & C7
16
67
.5
49
C8, C9
Scabies / Pediculosis Pubis
40
07
22.5
33
C10a
Anogenital herpes simplex - first attack
572
221
5.5
351
C10b
Anogenital herpes simplex - recurrence
416
79
2.2
237
C11a
Anogentital wart virus infection - first attack
522
757
4.7
765
C11b
Anogentital wart virus infection - recurrence
921
575
5.9
346
C11c
Anogentital wart virus infection persisting >3 months
441
220
3.3
221
C12
Mooluscum Contagiosum
38
92
1.1
46
C13
Antigen positive viral hepatitis B
36
22
22.7
4
C14
Other viral hepatitis
37
25
28.0
2
D2a
Urinary tract infection
369
61
8.3
308
D2b
Other conditions requiring treatment
2710
952
4.6
758
D3
Other episodes not requiring treatment
4154
871
5.8
2283
P1a
Counselling & HIV antibody test done
3824
999
1.9
825
P1b
Counselling & HIV antibody test not done
633
312
1.6
321
P2
Immunisation against hepatitis B
471
387
56.6
84
P3
Family planning
602
32
0.0
570
P4a
Cervical cytology - minor abnormality
448
2
0.0
446
P4b
Cervical cytology - major abnormality
82
0
0.0
82
P4e
Cervical cytology - other diagnosis
70
0.0
69
E1a
Asymptomatic HIV infections - first presentation
58
41
47.5
7
E1b
Asymptomatic HIV infection - subsequent presentation
59
07
76.9
52
E2a
HIV infection with symptoms, not AIDS - first presentation
38
26
69.2
2
E2b
HIV infection with symptoms, not AIDS - subsequent presentation
54
10
74.5
44
E3a
AIDS - first presentation
23
8
61.1
5
E3b
AIDS - subsequent presentation
08
83
83.8
25
E4
AIDS - death
4
1
72.7
3
Total
28084
2020
1.3
6064
Frequency of KC 60 diagnoses
South Thames (West) GUM clinics
Jan 1995 - June 1995
KC 60
Code
Condition
Persons
Male
Homo-sexual (% of males)
Female
A1, A2
Infectious syphilis
0
0.0
A3
Early latent syphilis
2
0.0
A4, A6
Other acquired syphilis
31
6
2.5
5
A8
Congenital syphilis >2 years of age
0.0
0
A9
Epidemiological treatment of suspected syphilis
2
0.0
B1, B2
Uncomplicated gonorrhoea
203
30
23.1
73
B4
Epidemiological treatment of suspected gonorrhoea
36
22
22.7
4
B5
Complicated gonorrhoea
2
0
0.0
2
C4a, C4c
Post-pubertal uncomplicated chlamydia
491
98
.6
293
C4b
Other complicated chlamydia
6
0
0.0
6
C4d
Chlamydia Opthalmia Neonatorum
0.0
0
C4e
Epidemiological treatment of suspected chlamydia
51
79
.3
72
C4h
Non-specific urethritis (NSU), excluding PID & epididymitis
482
482
3.5
0
C4I
Epidemiological treatment of NSU & related disease
814
277
4.3
537
C1, C2, C3
Chancriod, Donovanosis, LGV
0.0
0
C5
Complicated non gonoccocal & non specific infection
390
70
2.9
320
C6a
Trichomoniasis
41
5
0.0
36
C6b
Anaerobic / Bacterial vaginosis & male infection
231
55
0.0
176
C6c
Other vaginosis / vaginitis / balanitis
864
426
3.3
438
C7a
Anogenital Candidiasis
2203
307
3.6
896
C7b
Epidemiological treatment of C6 & C7
86
11
0.0
75
C8, C9
Scabies / Pediculosis Pubis
36
09
5.7
27
C10a
Anogenital herpes simplex - first attack
407
57
3.2
250
C10b
Anogenital herpes simplex - recurrence
356
61
6.9
95
C11a
Anogentital wart virus infection - first attack
212
587
3.9
625
C11b
Anogentital wart virus infection - recurrence
734
458
4.8
275
C11c
Anogentital wart virus infection persisting >3 months
428
254
4.8
74
C12
Mooluscum Contagiosum
20
83
9.6
37
C13
Antigen positive viral hepatitis B
55
46
30.4
9
C14
Other viral hepatitis
22
6
2.5
6
D2a
Urinary tract infection
326
55
7.4
271
D2b
Other conditions requiring treatment
999
840
0.7
159
D3
Other episodes not requiring treatment
3469
556
4.5
913
P1a
Counselling & HIV antibody test done
3026
551
3.8
475
P1b
Counselling & HIV antibody test not done
385
214
4.4
71
P2
Immunisation against hepatitis B
284
240
64.7
44
P3
Family planning
272
1
0.0
261
P4a
Cervical cytology - minor abnormality
421
0.0
420
P4b
Cervical cytology - major abnormality
48
0
0.0
48
P4e
Cervical cytology - other diagnosis
58
0
0.0
58
E1a
Asymptomatic HIV infections - first presentation
49
30
62.1
9
E1b
Asymptomatic HIV infection - subsequent presentation
08
69
81.8
39
E2a
HIV infection with symptoms, not AIDS - first presentation
37
30
73.3
7
E2b
HIV infection with symptoms, not AIDS - subsequent presentation
01
77
76.6
24
E3a
AIDS - first presentation
21
7
64.7
4
E3b
AIDS - subsequent presentation
84
67
71.6
7
E4
AIDS - death
9
7
85.7
2
Total
22516
9819
0.5
2696
