Date: | HCP: |
Appointment given: | Telephone/walk-in patient |
Score
|
Tick
|
Condition
|
14 | | Untreated chlamydia, gonorrhoea, syphilis, unmanaged HIV infection |
14 | | Male discharge (rectal/urethral)/dysuria |
14 | | Genital ulceration |
14 | | STI risk with recent low abdominal pain |
14 | | Sexual assault within past 12 weeks |
14 | | Review HIV patient with new symptoms |
14 | | Severe acute genital pain (or advise A and E assessment if more appropriate) |
14 | | Acute testicular pain/swelling |
14 | | Adverse drug reaction (patient on medication provided by us). |
12 | | Contact of HIV or syphilis |
8 | | Sexual contact of gonorrhoea, chlamydia, trichomoniasis, hepatitis A/B |
6 | | Needlestick/trauma infection concern >4 weeks. If earlier advise A&E assessment. |
5 | | HIV infection (new/transferred in) or appointment for routine review |
5 | | Leaving UK unable to return (use discretion) |
5 | | Phone call from HCP/youth worker (<16 year old) |
4 | | Genital lumps and bumps (warts/molluscum contagiosum) |
4 | | Vaginal discharge/irritation—eg, candidiasis/bacterial vaginosis |
4 | | Perigenital spots/rash or irritation (balanitis, lice, scabies) |
4 | | Extreme distress/distance travelled/school timetable, etc |
0 | | Worried well/STI risk |
−2 | | Patient unable to wait (walk in only) |
| | Clinic capacity (yes or no) |
Total | | |
Comments: (contact no, etc) |