Experts call for review of the sexual health service

“The 2014 review was a perfect case study of what not to do – it was a disaster,” says Massimo Giola, president of the Australasian Chapter of Sexual Health Medicine at the Royal Australasian College of Physicians. Dr Giola says there has been a 500 per cent increase in referrals from primary to secondary care since the review.

A report in the New Zealand Medical Journal on Friday, by Te Whatu Ora Toku Tumai sexual health physician Sunita Azariah, compares three Auckland districts (former DHBs) in relation to how each provides sexual healthcare.

It finds large inequities in access to the sexual health service for people living in Counties Manukau district, with disproportionate numbers young people, Māori and Pacific people, and men who have sex with men, which are groups considered to be a sexual health priority.

A new review is needed to first assess the needs of the community, and then resource it adequately, Dr Giola says.

President of the New Zealand Sexual Health Society Anne Robertson says strong referral guidelines and a better-resourced specialist system would alleviate pressure on both primary and secondary care.

Dr Robertson says sexual health is often wrongly considered simple to manage and easily cared for in primary care.

The current model's confused and patchy referral system means patients are not seeing specialists when they need to be, resulting in further spread of STIs, the sexual health clinician says.

When syphilis is not managed in the community correctly, there tend to be higher levels of congenital syphilis, which further deepens the inequity, she says.

Dr Giola says plenty of sexual healthcare, such as STI swabs and condom promotion, is best delivered in primary care. But primary care doesn’t have the resources for all sexual healthcare, particularly with the rise of complex STIs, and increased use and access to HIV Pre-Exposure Prophylaxis medication and gender-affirming care.

Syphilis and gonorrhoea cases have increased and are best managed in specialist care, he says.

Another barrier to accessing sexual healthcare within primary care is that not everyone is comfortable with receiving this care from their GP, Dr Giola says.

Up to 50 per cent of gay, bisexual and other men who have sex with men have not disclosed their sexuality to their GP.

Dr Giola says the health system must take responsibility for providing free and safe specialist care in ways that work for the populations disproportionately affected by STIs.