COMMUNITY pharmacies in Scotland provide around 75,000 doses of emergency hormonal contraception (EHC) every year1 as part of the public health service (PHS) element of the community pharmacy contract. Each of these interactions is an opportunity to provide information and advice about ongoing contraception, and how to reduce the risk of transmission of sexually transmitted infections (STIs).
The service has been ongoing for around 10 years. Yet, so far, pharmacies in Scotland have not been involved in the crucial step of assessing the risk of, and testing for these diseases, despite the fact that the Faculty of Sexual and Reproductive Healthcare (FSRH) recommends that: “All women requesting EC should be assessed as to their risk of sexually transmitted infection and offered appropriate testing or advised as to the testing that is recommended and how to access this.”2
Risk factors for STIs include 3,4:
- Age under 25 years.
- A new sexual partner.
- More than one sexual partner in the last year.
- A high number of lifetime sexual partners.
- Lack of consistent condom use.
- A history of STIs.
- First sexual intercourse at an early age.
Other people at risk include men who have sex with men, and female sexual partners of men who have sex with men.
Involving pharmacies in the assessment and testing of those at risk of STIs would mean infections could be identified and treated, symptoms managed, and the risk of complications and transmission reduced. Moreover reducing transmission would mean prescribing fewer antibiotics, which would help address the threat of antimicrobial resistance.
It seems to be an obvious next step for the development of a more comprehensive EHC service that pharmacists should help address the current gap which these people, who choose pharmacy, are falling through.
Women requesting EHC in pharmacies may be at risk of STIs, so an assessment followed by testing for gonorrhoea, chlamydia, syphilis and HIV may be appropriate. Women who attend pharmacy for EHC should not receive a reduced level of service just because they have chosen to use the convenience of the local pharmacy instead of adding to the time pressures of their GP.
Some pharmacies in England already offer Chlamydia testing kits and treatment alongside EHC consultations. Is it time for Scotland to improve on the existing pharmacy EHC service? I think so.
- NHS National Services Scotland. Dispenser remuneration. April 2015 to March 2016.
- FSRH. Emergency contraception. March, 2017.
- NICE CKS. Herpes simplex — genital.
- NICE CKS. Chlamydia uncomplicated genital.