Home' Australian Pharmacist : Australian Pharmacist July 2012 Contents 558 Australian Pharmacist July 2012 I ©Pharmaceutical Society of Australia Ltd.
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
to target people who are less likely to
self-refer to health services. It can be
based on specific criteria to identify those
at higher risk or may be offered routinely
Screening to detect asymptomatic
infection is generally only recommended
when it is possible to decrease
transmission, or where early intervention
will reduce morbidity and mortality.5
Timely screening and risk assessment for
STIs can increase a consumer’s awareness
on sexual health issues, assist in
identifying undiagnosed symptoms, and
reduce the risk of serious complications.13
Screening for STIs in
Screening and risk assessment for STIs
in Australian pharmacies is largely
‘opportunistic’. Typically STIs will not be
the primary reason the person has visited
the pharmacy, however, pharmacists can
gather information to identify those at
increased risk of STIs and refer them for
Pharmacists will be familiar with
providing sexual health services in
relation to contraception (and emergency
contraception) and pregnancy tests.
They will also be familiar with people
presenting with genital symptoms
for advice on treatment (e.g. vaginal
discharge and itching suggestive of
thrush; or itch from suspected pubic
lice). These interactions all provide
opportunities for pharmacists to
discuss safe sexual health practices,
raise awareness of the risk of STIs,
provide targeted and essential health
promotion information, and refer
for testing. However, sexual health
promotion is not limited to genital
and reproductive health. Services such
as travel health advice also provide
opportunities to raise awareness of the
risk of STIs.
Identifying those at risk
Consultation about STIs must occur in a
private, non-judgemental manner. It can
also be helpful to explain to the person
why you are asking certain questions:
‘In order to establish.. [the possible
cause of your symptoms, your risk
of complications, etc] ...I will need
to ask you some personal and
Open-ended questions allow an
unrestrained and free response,
and may result in a broad range of
information being provided by the
person. Examples of open-ended
• What do you do to protect yourself
• What do you think I need to know
about your sexual practises to ensure
I consider all the potential causes of
However, some people will be reluctant
to disclose information about their sexual
practises and may need prompting with
direct closed questions in order to gather
the information needed to assess risk.
Examples of closed questions include:5
• Are you in a sexual relationship
at the moment? With a male or
• Have you had any other partners?
• Have you had a change in partner?
• When were you last tested for STIs?
• What percentage of time do you use
condoms for sex?
• Have you ever had sex with someone
from overseas? What country were they
from? (as countries have different rates
Sex workers and men having sex with
other men are at higher risk of STIs and
require regular STI testing. Other groups
of people who are at risk and should be
routinely referred for testing include
• Are sexually active and aged <29 years
(especially for chlamydia screening)
• Have engaged in unprotected sex
• Have multiple sexual partners
• Have had a recent change in
• Have had sexual contact with anyone
with an STI
• Are from Aboriginal and Torres Strait
Pregnant women should also be
routinely tested for STIs due to the risk to
If a pharmacist feels uncomfortable
discussing sexual health-related issues,
then referral to a sexual health centre
would be appropriate. Pharmacists
can also refer people to an online tool
developed by the Melbourne Sexual
Health Centre (see: www.checkyourrisk.
org.au). The tool assesses a person’s risk
of STIs and recommends appropriate
screening. It does not, however, provide
information on safe sex practices.
Providing education and
Once it has been identified that a person
may be at risk of an STI, sensitive and
non-judgemental communication of the
need for referral for testing is required.
This may involve stating that:
• Many STIs do not cause any symptoms,
especially in the beginning.
• Even if no symptoms are present, the
infection can still be transmitted to
other people through unprotected sex.
• Unless tested:
you will not know if you have an STI
your sexual partner will not know
if they have an STI (and so will not
know if there is a risk of passing the
infection onto you).
• A full STI check-up may involve blood,
genital and urine tests
• If you test positive:
Most common STIs can be treated
easily with antibiotics. This will
prevent you from developing any
promotion is not
limited to genital and
Services such as travel
health advice also
to raise awareness of
the risk of STIs.’
This content is for information purposes only. The clinical information
presented should not be used to guide clinical advice/decisions without
reference to the complete section of the APF.
What can I find out about...
You can find all this and more in the complete
palliative care manuscript in your APF.
See pages 212–217.
Visit www.psa.org.au to purchase your copy.
What is the role of the community pharmacist in palliative care?
Pharmacists can play an important role in optimising the use of medicines at the
end-of-life phase by providing advice on the management of symptoms, medication
supply, medication management and provision of support to patients, their family and carers.
When can medicines be withdrawn?
Decisions about which drugs to cease should be made by considering the likely prognosis
from the palliative care diagnosis and the short-, medium- and long-term risks associated
with stopping medications for managing co-morbidities.
Are opioids necessary for all palliative care patients?
Opioids are generally regarded as the‘gold standard’for treating moderate to severe pain and for
managing pain in the terminal stages. Morphine and oxycodone are the opioids of first choice.
Accreditation number: CP120040a
This activity has been accredited for 0.25 hours of Group 2
CPD (or 0.5 CPD credits) suitable for inclusion in an individual
pharmacist’s CPD plan.
What is the recommended treatment for nausea and vomiting?
Joe (89 years old) has bowel cancer with liver metastases and is experiencing
troublesome nausea and vomiting (gastrointestinal cause).
He also has Parkinson’s disease.
Based on the information in APF22, what is the recommended
symptom management for his nausea and vomiting?
Enter your answer and claim 0.5 Group 2 CPD credits.
Visit www.psa.org.au and click submit answers.
Health information and resources
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Provision of Pharmacist Only medicines
Counselling guides for common ailments
Complementary medicines monographs
Clinical monographs of commonly used medicines
Principles of drug therapy
Compounding and dispensing
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