Siam Care Conference January 2008

DAY 1

What a privilege it was to have Khunying Kobchitt Limpaphayom, from the Thai College of Obstetrics and Gynae to open the conference today and contextualise for us the specific sexual health issues of Thailand. Then Adrienne Blomberg, Siam Care's Director in Thailand did an offical welcome with a presentation which highlighted the contrasts in health, welfare and the economy of Thailand.

Angela Robinson, Member of the UK Department of Health's Chlamydia Screening Programme, who is a GUM consultant for Camden PCT, and Honorary Senior Lecturer at University College London presented next and gave a global context. The messages I took from this were firstly that there are 120 million people that we know of worldwide who do not want another child yet are not using contraception, and secondly that of the 33.2 million people infected with AIDS worldwide, 22.5 million of them are in sub-saharan Africa.

Khun Mechai Viravaidya presented next. A legend in Thai Sexual Health Care - who has had his first name, Mechai, adopted on the streets as slang for condom, gave an overview of sexual health Thai Style, including advice to get down there with the population and create events of interest and with some form of attraction for the people. He spoke of Cops and Rubbers, Vasectomy Days, Condom Nights, peer education projects, the use of the Restaurant Codoms and Cabbages, and Birds and the Bees Events, and demonstrated how all of this proactive work resulted in changes in behaviour and attitude.

Emile Morgan, Clinical Director of Bolton PCT, then delivered an interactive session GUM live raw and uncut, in which he highlighted how straightforward it should be for G.Ps and Primary Care to take sexual histories and to manage genital herpes, genital warts, discharge and HIV. He presented a case study of a patient presenting with genital warts and asked what three GP delegates would do. The answer was for straightforward warts to prescribe self applied Warticon (least expensive) and later Aldara (more expensive) for up to 16 weeks. If warts are intra meatal however they should be referred early for cryosurgery. If there is no response after 16 weeks then refer to GUM for either diathermy or liquid nitrogen treatment. Keratotic warts should always bereferred to GUM. Differential diagnoses - moluscum contagiosum need not be treated, although it is up to the patient, as they will go on their own. Skin tags are sometimes confused with warts, and can be removed in minor surgery - sometimes tags do have warty changes.
The point was made that warts can have a long incubation period of 12 months, and this can be difficult to explain in relationships, and threatens trust about faithfulness if not fully explained.

Next came Dr Will Ford - Young, GP in Macclesfield who presented an overview of where primary care can work well, where it has to be autious and where mistakes can be made and rectified.

Anne Greenwood,Clinical Director for Sexual Health and Family Planning in Lancashire ave an overview of the effects different contraceptives have on HIV acquisition, transmission and progression, plus interactions between hormonal contraception and anti-retroviral therapy. She presented facts, charts and evidence for each method of contraception (UKMEC1,2 AND 3)

The WHO has identified that male circumcision may reduce the acquisition and spread of HIV. In this session Christine Evans controversially presented a number of papers, some contradicting the WHO, some concurring, and raised the issue of whether it is ethical to violate a child too young to consent.

During the afternoon we heard from Dr Sris Allan on the key issues related to HIV and Vertical Transmission - the key mesaages were around childbirth and breastfeeding, and the necessity for Caesarean delivery, as tranmission rates are 30-40% if breastfeeding, 15-20 for non breast feeding, 8% during pregnancy and 15% during labour.

Kathy French spoke about the extended role of the nurse within the specialist field of sexual health and how these skills can be best utilised to provide quality services.

Paddy Horner presented on Urethritis, its aetiology, cause and management.

Nuntawun Yuntadolik, a Social Scientist who is deputy director of the AIDS division of the Thai Ministry of Public Health presented her research on the sexual health issues surrounding Thai Seafarers.

Anthony Pryce's first session was entitled Theorising the Pox, drawing on recent research on the social construction of male sexualities in the field of GM, the notion of the active patient providing the basis for identifying how a systematic sociology of sexual health and disease might be constructed.

DAY 2

Tuesday 15th January’s morning session had the theme Sexual Health and Uro-Gynaecology and was chaired by Paddy Horner and Anne Greenwood .

The session covered Genital Dermatology with Jyoti Dhar, who gave an excellent and comprehensive overview on genital dermatoses, pitfalls and advice on how to pragmatically manage these conditions.


Sex and the Heart by Walter Rhoden, a consultant cardiologist examined the effect of sex on the heart, especially the weakened heart, with a particular focus on managed erectile dysfunction. He showed how although Testosterone was once thought to be responsible for cardiac conditions, it is now known not to be the case. Another misconception is that having sex is responsible for many cardiac deaths, whereas in reality coital death accounts for only 0.6% of all sudden deaths , and sexual activity is a likely contributor in 0.9% of Myocadial Infarctions’s. Although sex can trigger MI the increased relative risk is 2.5
And regular exercise greatly reduces risk of triggering MI. Walter also spoke of some misconceptions about the dangers of Viagra, and showed which people would be at risk, and the drugs it adversely reacted with.


Sex Management in Elderly Men with the media Dr Love Pansak Sugkraroek, who discussed the fact that men also have hormones, as they approach maturity may need help with maintaining these, and learning about a different kind of intimacy which comes with maturing . He focussed on the importance of staying well and good communication between couples.


HPV and Cervical Cancer prevention with Nikki Seddon, gave a very comprehensive view of cervical cancer and looked positively at the new vaccine, with debate about its introduction and reach.


Lower Genital Tract and use of Ultrasound by Ahmos Ghali looked at the advantages of this non-invasive technology in both man and women, and how it is very useful in the diagnosis of many genital tract conditions presenting in GUM. He highlighted how it can be a great reassurance of the absence of significant pathology for patients with chronic pelvic pain.

Managing Vesico-Vaginal Fistula with Dr Christine Evans finished the morning sessions with a global view of this condition and some case studies from her work in Iraq, Kurdistan and Ethiopia.

Tuesday afternoon focussed on Marginalised Groups. It was chaired by Olwen Williams and Barbara Hastings-Asatourian

The first session was presented by Sue Reed a nurse practitioner in Kent, but is also very interested in all things complementary, and is training in homeopathy. She spoke of how PMS affects 85-97% of women of reproductive age from 2-14 days before a period starts. Symptoms may be severe enough to disrupt daily life for 3-5% of women.

Physical symptoms include breast tenderness, fluid retention, appetite changes, carbohydrate cravings,weight gain, swelling or bloated sensation (swollen face, abdomen, fingers), acne or skin rashes, headaches, constipation or diarrhoea, changes in sleep patterns – often insomnia, palpitations, muscular stiffness or aches & pains, abdominal pains or cramps, pelvic heaviness, backache, exacerbation of epilepsy, migraines, asthma, rhinitis and urticaria

Psychological changes include anxiety, irritability, violence, clumsiness or poor co-ordination, difficulty concentrating, forgetfulness and changes in sexual interest.

Sue went through all of the conventional treatments before discussing in depth some small but noteable trials of the following homeopathic treatments. Lachesis mutus, Natrum muriaticum, Nux vomica, Pulsatilla pratens, Sepia officinalis, Calcarea carbonica and Chamomilla

Mala Morjaria is a specialist practitioner/midwife and Nurse Practitioner specialising in Primary Care Sexual Health. She is responsible for developing and supporting practice based interventions in general practices, supporting practice nurses and primary care professionals. Mala gave a deeply painful session on Female Genital Mutilation, coving its prevalence and the impact it has on sexuality and childbirth. She showed some very disturbing but necessary video footage to demonstrate the effects of the practice on young women in many parts of Africa.


Justin Gaffney then introduced his newly launched charitable organisation Soho Boyz

Anthony Pryce,our resident Sociologist, then delivered his second session of the conference, Suede Shoes

Anne Greenwood delivered her second session on Managing Rape and Sexual Assault in GUM. She focused her excellent session on Initial presentation to the services, Screening for sexually transmitted infections, Antibiotic prophylaxis, Immunisation for hepatitis B, HIV prophylaxis Emergency contraception, Psychological support and Forensic issues

DAY 3

Wednesday 16th January was the final day of the Bangkok leg of the conference and study tour. The morning was devoted to working with adolescent sexual health. Chaired by Emile Morgan and Brian Whitehead it kicked off with an interactive session - Adolescent health overview and Ten Teasers, delivered by Kathy Phipps, who then showed example consultations from the new “HEAR” video.

Olwen Williams gave an illustrated overview of HIV in primary Care, including how adolescents with HIV are an increasing group that require care, time and management, much of which can be delivered in primary care. Members of the audience shared their experiences on HIV testing and adolescents.

On a slightly alternative note,Brian Whitehead then showed a video produced by young people in London entitled the Blueberry Condom. The video is just 10 minutes long but shows many of the issues about condoms, what condoms protect against and how, and how unsafe sex impacts on individual relationships. There are some graphics which illustrate STI’s.

Hilary Piercy then presented “Coming to do the Sex Talk” in which she described how school based education although an important aspect of children’s education, is highly politicised and controversial and a matter of concern to a wide number of stakeholders. She presented findings from a qualitative study undertaken with school nurses in a single geographical area. In particular it focused on what were deemed to be inappropriate questions, the basis upon which the label was applied and the strategies employed in the management of such questions.

The final session of the morning was “Poke Someone Now” – a look at sex education and the web by Barbara Hastings-Asatourian. She outlined how on-line Social Networking sites have received quite a lot of bad press but not a lot of good press considering their capability of reaching vast numbers of young people in a really user friendly and attractive way. Although caution is necessary, to protect privacy and avoid abuse, Barbara Hastings-Asatourian showed examples of how sites like Myspace, You Tube and Facebook have great education potential. She also reported on a session she delivered in the on-line virtual world of Second Life, a medium with huge potential for attracting a different group of learners.