SUBSEQUENT VISIT AND POST-TEST COUNSELLING Reason for the consultation:
Patient identification
Sexually transmitted and blood-borne infections (STBBI) Preventive intervention
Follow-up on screening and vaccination
Safer behaviours
r Go over the tests that were performed, infections for which tests were done, and STBBI not included in screening
r Go over risk factors identified (former and new ones):
r Give the results
r Go over preventive counselling: m systematic condom use m safer sexual activities m risk reduction linked to drug addiction m circumstances that encourage risk taking
r Go over meaning of the results and limits of the tests r If result is negative: m Be cautious of the false sense of security a negative result can provide (window period, limits of the tests, possibility of infection with subsequent exposure, result does not apply to all STBBI) m Assess the need to repeat testing
Not ready to change or totally failed: m The pros:
r If result is positive, discuss based on the infection or infections detected: m treatment (free prescription medication program for the treatment of STD) m clinical presentation and evolution of the infection, symptoms to watch for and possible complications m modes of transmission and duration of contagious period m partners to contact so they can also be treated m support for partner notification m reminder of notifiable disease status m pertinence of referring to a medical specialist m pertinence of referral for psychosocial support
Achieving or maintaining: m Go over objectives agreed upon m List the successes and failures m Discuss current difficulties
m The cons: m Discuss solutions
m Transmit a clear message and offer support
r Follow-up on vaccination
m Negotiate rediscussion
m Congratulate for results achieved and reiterate your confidence and support m Reassess action plan
r Notify the Direction de santé publique (form AS-770)
Physical examination: Diagnostic impression:
Plan for follow-up r Review of documentation: r Follow-through on partner notification: r Referral to a regional service for preventive intervention with partners (IPPAP) r Verification of the pertinence of post-treatment follow-up testing (indications limited to certain infections and contexts. See the Canadian Guidelines on STI): r Evaluation of the need for periodic screening (agreement with the patient regarding optimal interval): r Agreement on process for follow-up without breach of confidentiality: r Follow-up on adoption or maintenance of safer behaviours
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