There are relatively few studies available on the effectiveness of sexual health promotion in the context of STIs other than HIV/AIDS. While such studies may be relevant, it cannot be assumed that sexual health promotion effective in the context of a predominantly fatal virus can be automatically transferred to a treatable bacterial infection such as chlamydial infection.

Studies have been undertaken to evaluate the effectiveness of a range of intervention programmes, for example to promote condom use.^{164,165,166,167} Community interventions to increase awareness of chlamydial infection and other STIs, promote prompt treatment seeking, and reduce high-risk sexual behaviours have also been reported.^168,169 However, few of the studies reviewed meet the required methodological standards, and the effects of the interventions on subsequent behaviour are inconclusive. It is therefore not possible to recommend any particular intervention.

One of the most important components of any educational effort will be the reduction of stigma associated with chlamydial infection, STIs in general, and GUM services.¹⁷⁰

While there is a lack of evidence about educational interventions that will alter behaviour, some general points can be ascertained from the social science literature. There are three distinct groups to which education should be targeted: patients, the general public, and health professionals.

6.1 Patients

6.1.1 PRIMARY PREVENTION

Sexual health promotion should be an integral part of contraception provision. Risk of STIs should be discussed where non-barrier contraception is being offered as well as possible condom use in addition to other contraceptive methods.¹⁷¹ It is important that sexual health education in primary care is also targeted at men, for example, when attending for new patient checks or for travel advice.¹⁶⁹ Evidence level IV

Sexual health promotion should be an integral part of contraception provision wherever this is offered.

6.1.2 PREVENTION OF REINFECTION

Successful treatment and control of STI involves a complex set of behaviours: prompt seeking of health care, compliance with therapy, referral of sexual partners, return for follow up and prevention of re-exposure.¹⁵⁹ The educational needs of patients are likely to vary according to age, gender, social class, social vulnerability, sexual orientation and ethnicity.¹⁷² Evidence level III

All patients with chlamydial infection should receive appropriate health education, including relevant reading materials.

Valuable information for patients is contained in the leaflets "What is chlamydia?", produced by the Family Planning Association and "What do you know about Chlamydia and NSU?" produced by the Health Education Board for Scotland (see Annex 2).

6.2 General public

An essential precondition for any screening strategy would be education of the general public, to increase awareness of chlamydial infection and reduce stigma.

Knowledge of chlamydial infection among the general population and among GUM clinic attenders has been found to be low.¹⁷³ Education campaigns that have used multimedia advertising to increase awareness about other sensitive issues (e.g. HIV/AIDS, Zero Tolerance of Violence Against Women campaign) have proved successful.^174,175 It is the translation of increased awareness into behaviour change that is problematic. Evidence Level III

Opportunities should be taken to deliver education in a wide variety of non-health care settings e.g. youth clubs, community centres, schools. Education about chlamydial infection should be integrated with other sexual health education and condom promotion initiatives.

6.3 Health professionals

The communication skills needed to discuss sexual health and to elicit a sexual history have traditionally been awarded relatively little attention in undergraduate curricula.¹⁷¹ The educational needs of staff providing care outwith specialised sexual health centres therefore requires attention.¹⁷⁶ Specific issues to be addressed include strategies to initiate and discuss sexual health issues within a consultation, especially when the consultation is unrelated to sexual health. ¹⁷¹

Medical educators should include sexual history skills as an essential part of undergraduate education. The skills required for sexual history taking should also form part of postgraduate medical training, as well as training for practice nurses and health advisers.