The specialty is officially called Genitourinary Medicine (GUM) but is also referred to as Sexual Health and HIV Medicine. GUM is a medical specialty encompassing the prevention and management of STIs including HIV, long-term care of people living with HIV, and the promotion of sexual health and well-being. The speciality also includes the provision of standard and emergency contraception.

Whilst sexual health and HIV care is predominantly delivered in an outpatient setting, GUM clinicians also work across inpatient HIV care. They contribute to on-call rotas and spend some time working in general internal medicine

GUM and Community Sexual and Reproductive Health (CSRH) are two different specialties with separate training programmes. GUM and CSRH have been independently recognised by the General Medical Council (GMC) and NHSE as distinctive yet complementary specialties, whose training curricula are highly fit for purpose. The simplest way to explain the difference between the two specialties is that GUM is a physicianly specialty and CSRH is a gynaecological specialty.

Most sexual health services have both GUM and CSRH doctors working closely together.

The main differences between GUM and CSRH are:

GUM	CSRH
Complex STI care	Basic STI care
Basic contraception care	Complex contraception care
Specialist HIV prevention	Abortion Services
Specialist HIV care	Menopause/PMS care
Internal Medicine	Medical gynaecology

More information about GUM and GUM/GIM training

GUM involves the investigation, prevention and management of sexually transmitted infections and HIV. It is mostly outpatient based but does include inpatient care of HIV infection. It can also include more specialised services. These include young people's clinics, genital dermatoses, sexual function and well being, psychosexual medicine and outreach services for sex workers and people who inject drugs.

GUM clinicians deliver complex STI care (e.g. syphilis, disseminated gonococcal infection, Mpox, LGV, genital ulcers, systemic and extra-genital manifestations of STIs, STIs in pregnancy), basic contraception care, specialist HIV prevention (e.g. PEP & PrEP) and the majority of HIV outpatient and inpatient care nationally. In addition, the new dual GUM/GIM  training programme means that GUM trainees are now also training and working in internal medicine.

GUM training is a 4-year training programme commencing at ST4 after trainees have completed their ST1-3 years of stage 1 GIM training which includes passing their MRCP. During the 4-year GUM/GIM training programme trainees spend 12 months WTE training in GIM spread out across the 4 years. GUM trainees need to pass the DipGUM and DipHIV exams to complete specialty training.

More information about CSRH and CSRH training

Community Sexual and Reproductive Health (CSRH) doctors deliver sexual and reproductive healthcare throughout the life course. This includes managing the whole sphere of contraception, which involves contraceptive provision for all people including those with medical or social complexities and managing complex specialist contraception. Additionally, they provide medical gynaecology, abortion services, menopause/PMS and basic STI care.

CSRH specialty training is a six-year run-through training programme commencing at ST1, which means that doctors can enter this training programme at the end of FY2. CSRH trainees are not, therefore, required to do any further general medical training after their FY2 year. In the first three years of CSRH training, trainees need to achieve competencies in SRH and gynaecology, and basic competencies in STI care. CSRH trainees have to pass the MFSRH (Membership of the Faculty of Sexual and Reproductive Healthcare) exam to complete specialty training.

Other sexual health service staff

A proportion of sexual health medical staff (non-training grades) have not undergone bespoke specialist training. Despite  often being highly skilled and experienced within sexual health services, they take up non-trading grade posts.

Increasingly many sexual health services are delivered via nurse-led clinics with support from GUM and CSRH consultants. These clinics also involve input from allied health professionals, sexual health advisers, administrative and clerical staff and healthcare scientists. Additionally, some clinician assistant and assistant practitioner roles are also emerging. The treatment and management of STIs and complex contraception, however, requires access to, and support from, specialist staff.

The potential breadth and depth of opportunities open to people specialising in GUM are vast. These opportunities span public health, outpatient, and inpatient care, primary, secondary, and tertiary care, as well as research and academia. It also has links with infectious diseases, gynaecology, dermatology, and other key areas of medicine.

HIV Medicine varies from:

• The management of acutely unwell patients with opportunistic infections
• The management of inpatients with HIV as one of many medical conditions
• Routine outpatient care of people living with HIV
• Management of viral hepatitis B/C co-infection
• Complex antiretroviral resistance, drug interactions
• Management of chronic co-morbidities such a renal, bone, liver, and cardiovascular disease.

It also includes the management of specialist groups such as antenatal HIV infection and adolescents with perinatally acquired HIV.

Research is an integral part of the specialty and trainees are encouraged to participate in this. The specialty provides the opportunity participate in innovative, dynamic, and impactful research, including (but not limited to):

• Novel HIV treatments
• Ageing with HIV
• STI treatment and prevention including HIV PrEP
• Epidemiology
• Public health research
• Social research.

Trainees are supported to take out-of-programme experiences including to undertake MScs, PhDs and MDs if desired.

GUM trainees will experience a mixture of GUM blocks and IM blocks. When working on their GUM block, the kind of activities trainees will be involved with include:

• Weekly complex GUM and simple contraception clinics
• HIV clinics
• HIV in-patient ward rounds
• Audit/QI and research
• Multidisciplinary HIV meetings
• Diagnostics groups to discuss local STI trends, diagnostic tests
• Viral load meetings/discussion of complex HIV/ARV cases
• Specialised clinics: Psycho-sexual, GU dermatology, Syphilis clinic, sexual assault, HIV-joint specialty clinics (lipid, renal, antenatal, hepatitis), Commercial Sex Worker clinics
• Safeguarding meetings
• Weekly teaching: Guideline updates, conference feedback

A GUM consultant’s job is very varied, and the sort of work you will be involved with depends on your role, seniority and special interests. The GUM consultant job plan involves clinical, managerial, teaching, and special interest allocation, with a split of roughly 80% clinical, 20% non-clinical.

To learn more about the typical day of a GUM/GIM Consultant, please watch the video below:

For information on pay scales for various grade doctors, please refer to the BMA website.

GUM has an attractive work-life balance, with less anti-social hours and on-call shifts than other medical specialties, while remaining stimulating and rewarding. Our LoveGUM survey highlighted that 82% of those who had chosen their specialty most enjoy that GUM offers a good work-life balance (Survey conducted by BASHH in November 2023).

Teamwork is integral to GUM. Specialising in GUM provides the opportunity to work within a diverse multi-disciplinary team from specialist nurses, specialist pharmacists, health advisors and psychologists to peer support workers daily, and also with a diverse patient population. This means communication skills, a non-judgemental attitude and an empathetic nature are integral for GUM clinicians. You’ll also consult with healthcare professionals from other allied specialties.

Throughout their training GUM trainees work mostly in outpatient services which may be community or hospital based or a mixture of the two. GUM trainees spend their first two years of training:

• Accumulating experience in the management of STIs and their complications
• Gaining knowledge in basic contraception
• Learning about STI and HIV prevention
• Acquiring skills in basic HIV care

This is achieved through mostly working in outpatient settings across sexual health and HIV services either in hospital or in the community.

During the first two years trainees will also spend some of their total 12 months of GIM training time working and training in GIM which will be hospital, and mostly inpatient based. GUM trainees usually also contribute to hospital on-call rotas e.g. HIV, infectious diseases or internal medicine during some or all of their training time. During the second two years of training trainees build on their STI experience and accumulate experience in more complex HIV care including HIV inpatient care. This entails working in both outpatient and inpatient settings across community and hospital services. During the second two years trainees will also spend some of their total 12 months of GIM training time working and training in GIM. At least three months of IM training needs to take place in the final year of training. This training will be hospital-based, and mostly inpatient based. Of the 12 months of GIM training that GUM/GIM trainees are required to do, 3 months of this can be based on an HIV inpatient / Infectious diseases ward vs on a general medical ward.

Once trainees are approaching or have completed their GUM/GIM training they are able to apply for GUM, GUM/GIM or GIM Consultant posts. This is because they will be on the specialist register for both specialties. Most GUM Consultant posts don’t include GIM and will be mostly outpatient based (community / hospital / both), with or without an HIV inpatient on-call requirement. GUM/GIM Consultant posts involve a mixture of GUM, mostly outpatient (community / hospital / both) based work and GIM, mostly inpatient hospital-based work. Having a CCT in both GUM and GIM means that GUM doctors are able to provide enhanced care to patients presenting with complex STIs and our aging cohort of people living with HIV. Additionally, it provides them with more career choice / options than single-accredited colleagues. Dual GUM/GIM training, therefore, benefits both patients and clinicians.

There is plenty of opportunity to travel working in GUM, with international out of programme experiences on offer alongside courses abroad and the ability to attend international conferences.

If you’d like to learn more about GUM, the Student and Trainee Association for Sexual Health and HIV (STASHH) is a great place to start: Get Involved in GUM. STASHH arrange taster days, offer teaching and leadership roles and arrange bi-yearly career events. If you are a junior doctor, we can also help you arrange some local taster days – see BASHH’s GUM training page for the details of our trainee reps and SAC Chairs. If you contact them, they will be able to put you in touch with your local GUM Training Programme Director who will be able to help arrange a training day(s) for you. We also run an annual national GUM taster day which is usually held in October each year. If you Google ‘National GUM taster day’ and the year you are interested in attending you should be able to find the details of this course online a few months before the course runs.

This will depend on the individual consultant. NHS Trusts are responsible for creating consultant posts and job plans to meet the needs of their local population. Once you reach consultant level, it’s your choice what jobs you apply to.