Family Practice Vol. 19, No. 5, 572
© Oxford University Press 2002
Book review |
Sexual health matters in primary care.
Gill Wakley, Ruth Chambers. (214 pages, £19.95.) Radcliffe Medical Press Ltd, 2002. ISBN 1-85775-414-X.
Clinical Research Fellow, Department of General Practice and Primary Care, University of Birmingham
In 1990, the WHO estimated that unsafe sex accounted for 2% of worldwide adult mortality and 3.5% of morbidity. The seemingly inexorable advance of most sexually transmitted infections since then means that these proportions are now likely to be underestimates. The UK tops the league in Europe for unplanned pregnancy. In the UK, NHS costs estimated at £100 million annually have prompted the government to consider a population screening and treatment programme for Chlamydia trachomatis.
Sexual health is clearly an important issue, particularly for primary care. Genito-urinary physicians and other tertiary care specialists have developed considerable expertise—since HIV pushed their clinical constituencies into prominence in the early 1980s. But these experts only ever see a small atypical fraction of the sexually active population. Only primary care sees a proportion of the public large enough to give a realistic opportunity to influence population sexual health. However, few primary care workers have specific, relevant experience. This practical manual, by Ruth Chambers and Gill Wakley, is therefore timely. Each chapter deals with a particular clinical or organizational issue and encourages incorporation of these, as appropriate, into a personal or workplace development plan. All chapters—covering topics including clinical governance, talking about sex, contraception, management of sexually transmitted infection and sexual dysfunction—conclude with exercises to facilitate consolidation of the message conveyed.
There are minor criticisms. The book may be less relevant to those working in settings in the less developed world, particularly those where syndromic management is still the norm and access to diagnostic technology, specialist support and more expensive drugs is limited. The book is probably most relevant to those working within the UK. National primary care-based population screening and treatment for Chlamydia have been proposed in the UK, so the chapter devoted to the—particularly topical—issue of C.trachomatis is highly relevant. The authors provide their own practice guidelines for the opportunistic screening of young women, although this may be superseded by a national campaign. Most of the important questions related to Chlamydia screening—whether it should involve men, whether it should be universal or targeted, the most appropriate specimen and test, and how best to trace and treat contacts—remain to be answered. A particular criticism is that Wakley and Chambers advocate azithromycin as treatment in pregnant women; in the UK, it is not currently licensed for this indication and an alternative such as erythromycin or amoxycillin should be used.
Some aspect of sex matters to the physical, psychological and social well being of most people attending for primary health care. Using this book as a practical resource, interested primary care teams should be able to help these people better.
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