Sexual health is topical with many factors impacting upon its concept and hence provision. In 1995 the Sexual Health Service in East Berkshire was formed by the integration of the clinical services of Family Planning, Genitourinary Medicine and HIV with Sexual Health Promotion. The philosophy of the service is to provide holistic sexual healthcare in one visit, on one site by one clinical team. This article outlines the practical developments and the strengths and weaknesses of this model of service.

There has long been interest in the possible relationship between oral contraceptive (OC) use and diabetes mellitus. In 1991, we reported our findings (in this Journal) on 45 women who had been referred to hospital for diabetes during follow-up in the Oxford-Family Planning Association (Oxford-FPA) contraceptive study. No association was found with OC use. 1 We nonetheless thought it would be of interest to comment briefly on the findings for this disease up to the time that individual follow-up of the study participants ceased in July 1994 (follow-up of cancer registrations and death notifications is still continuing).The Oxford-FPA study methods have been described in detail elsewhere. 2 In brief, the study includes 171032 white women who, when recruited between 1968 and 1974, were married and aged between 25 and 39 years. At entry, 56% were using OCs, 25% a diaphragm and 19% an intrauterine device. These women (save for certain subgroups -see Vessey and Painter 3 ) were followed up annually and information was collected about changes in contraceptive methods, pregnancies and their outcome, hospital referrals and deaths. Women who at entry to the study reported that they were suffering from diabetes were excluded from the present analyses. There were 81 cases remaining. Only the first hospital referral (inpatient or outpatient) was taken into account in the analyses.As expected, hospital referral was strongly positively related to age and body mass index (BMI). In addition, referral was three times as common in women of lower social class (IV-VI) as in women of upper social class (I-II), a difference only partly explained by BMI. Analyses of hospital referral rates in relation to OC use were therefore adjusted for age, BMI and social class.Our first analysis compared women ever using OCs with those never doing so. The rate ratio was 0.8 with a 95% confidence interval (CI) ranging from 0.5 to 1.3. Rate ratios for hospital referral in relation to total duration of OC use were as follows (95% CIs are given in parentheses): never used, 1.0 (reference category); 1-48 months, 0.9 (0.3-2.1); 49-96 months, 0.7 (0.3-1.7); 97-144 months, 0.9 (0.5-1.7); 145 months or more, 0.6 (0.2-1.6). Corresponding rate ratios in relation to interval since last use of OCs were as follows: never used, 1.0 (reference category); current-48 months, 0.7 (0.3-1.4); 49-96 months, 0.7 (0.3-1.7); 97-144 months, 0.6 (0.2-1.5); 145 months or more, 1.5 (0.7-2.8). The data were too few to enable analyses to be done by type of OC, but it should be noted that preparations containing 50 µg oestrogen made up 67% of OC exposure. OCs containing a greater amount of oestrogen provided only 2% of exposure.We recognise the shortcomings of our data, which include the small number of affected women and the associated fact that only those referred to hospital with diabetes were identified. Nonetheless we believe that our case finding has been unbiased with respect to OC use. Furthermore, as we have pointed out previously, 1 if such a bias existed it might be...

Sexual health is topical with many factors impacting upon its concept and hence provision. In 1995 the Sexual Health Service in East Berkshire was formed by the integration of the clinical services of Family Planning, Genitourinary and HIV Medicine with Sexual Health Promotion. The philosophy of the service is to provide holistic sexual healthcare in one visit, on one site by one clinical team. This article outlines the practical developments and the strengths and weaknesses of this model of service.

An audit of chlamydia treatment and contact tracing in a sexual health serviceSir: White and Wardropper's audit of chlamydia treatment and contact tracing in a genitourinary medicine (GUM) setting highlights the importance of immediate referral of chlamydia-infected women attending other services to eliminate re-infection/ potential re-infection and the need for re-treatment 1 . However, research has shown that the uptake of such referrals is poor and default is common 2 . We write, therefore to express our concern that this weakness in the process must be highlighted and every effort made to improve protocols for referral and follow up.To improve the ef® cacy of any chlamydia screening policy there must be close working alliances between family planning clinics, general practices, and GUM services.At the Sexual Health Service in Slough, we aim to provide full care for our patients in one visit. We recently evaluated the success of contact tracing in chlamydia-positive women who attended the service for contraception. Women were screened if symptomatic, pre-procedure (termination of pregnancy or for intrauterine device insertion), opportunistically or on request. From a retrospective case note audit we identi® ed 22 such women over a one-year period from September 1997 to August 1998 and compared them with 79 chlamydia-positive women attending with GU needs over the same time period. Sixteen (72.7%) of the 22 women attending with family planning (FP) needs and 60 (75.9%) of the 79 GU women were seen by a health adviser on site. There was no signi® cant difference between the 2 groups (P > 0.5). Fourteen (63.6%) of the index FP women were successfully contact traced for their most recent partner, compared with 57 (72.2%) in the GU group. Again there was no difference between the groups (P > 0.25). All except one GU patient (whom we were unable to contact) were treated.The success of contact tracing in the women attending for contraception is likely, at least in part, to be due to the fact that they did not have to attend another clinic for treatment and contact tracing. We feel that the model of care offered by sexual health services such as ours goes a long way towards minimizing the opportunity of default in providing screening, treatment, contact tracing and health education to all patients under one roof and usually in a single visit.