There is an appreciable overlap between genitourinary (GU) medicine and gynecology, urology and dermatology, which sometimes leads to difficulties when deciding to whom to turn for further advice or a specialist opinion. The following should be considered as general guidelines: if in doubt to whom to refer, give your local GU medicine clinic a call.
Many consultants in GU medicine have specific interests and the services available from individual clinics may vary accordingly. A large number of clinics provide expertise in vulval disease, genital dermatology, psychosexual medicine, colposcopy, and sexual assault assessment and management. Getting to know your local department of GU medicine or sexual health is to be strongly recommended: GU medicine clinicians are usually very approachable and are delighted to have general practitioners (GPs) and practice nurses attend clinical sessions and learn more about the specialty.
1.1 CONSIDER URGENT REFERRAL
Men with
• Urethral discharge or dysuria
• Acute epididymitis.
Men and women with
• Primary genital herpes
• Genital ulceration: Previously unconfirmed diagnosis.
1.2 REFERRAL STRONGLY RECOMMENDED
Men and women with
• Concern (patient or doctor) regarding sexually transmitted infection
2 SEXUAL HEALTH AND GENITAL MEDICINE IN CLINICAL PRACTICE
• Concern regarding human immunodeficiency virus (HIV) infection
• Any of the following infections (proven or suspected):
- chlamydial infection
- non-gonococcal urethritis
- gonorrhea
- trichomoniasis.
• Sexual partners of patients with
- chlamydial infection
- non-gonococcal urethritis
- gonorrhea
- trichomoniasis.
• Positive syphilis serology.
1.3 REFERRAL RECOMMENDED
Women with
• Persistent/recurrent vaginal discharge
• Persistent/recurrent vulval irritation/soreness/burning
• Chronic pelvic pain
• Dysuria/frequency with sterile urine culture.
• Young women with post-coital bleeding (possibly prior to referral to gynecology)
• Painful sexual intercourse (superficial or deep).
Men with
• "Testicular"/intrascrotal discomfort
• Symptoms suggestive of prostatitis/chronic pelvic pain syndrome
• Balanoposthitis.
Men and women with
• Genital warts
• Genital molluscum contagiosum
• Genital "lumps" of uncertain etiology
• Pubic lice
• Genital rashes (diagnosis uncertain or unresponsive to treatment).
1.4 CONSIDER REFERRAL
Women with recurrent candidiasis or recurrent bacterial vaginosis.