bluuebunny/crossref_metadata_2025 huggingface dataset:
P218 Safetxt: a randomised controlled trial of an intervention delivered by mobile phone messaging designed to reduce infection with chlamydia and gonorrhoea- recruitment methods
Authors: Free Caroline , Swinson Rebecca , Potter Kimberley , McCarthy Ona , Knight Rosemary , Baraitser Paula , Hickson Ford , French Rebecca , Michie Susan , Wellings Kaye , Palmer Melissa , Bailey Julia
Published: May 2024

Introduction

Trial recruitment is one of the most important trial tasks as full recruitment provides trials with sufficient power to detect intervention effects. Yet, two thirds of randomised controlled trials fail to fully recruit. The NIHR safetxt trial is a single blind randomised controlled trial to evaluate the effect of a safer sex intervention delivered by text message on Chlamydia and Gonorrhoea infection at 12 months. 5000 people aged 16–24 are being recruited from UK GU and Sexual and Reproductive Health services. We describe the methods used to facilitate recruitment.

Methods

Mixed methods informed by evidence from behavioural science including: monitoring recruitment, feedback, rewards, identifying barriers to recruitment, shared learning between recruiting clinics and staff, development of materials to address barriers to recruitment and evaluation of materials developed.

Results

34 GU and Sexual and Reproductive Health Services across the UK are involved in the recruitment endeavour. A further 13 sites are due to start recruitment. Over 1100 participants have been recruited, ahead of current recruitment targets. Telephone and face-to-face meetings with staff in recruiting services generated ideas to increase recruitment, enabled services new to trial recruitment or research nurses new to Sexual Health to learn from experienced recruiters, facilitated mutual learning and resulted in the development of materials to support staff in recruitment.

Discussion

The safetxt trial is recruiting ahead of schedule. It will be a major achievement if the safetxt collaboration between GU and Sexual and Reproductive Health services and the trial management team recruit 5000 participants on time.
P219 Vaccinating against human papillomavirus is not associated with risky sexual behaviours among men who have sex with men in australia
Authors: Chow Eric , Aung Ei , Chen Marcus , Bradshaw Catriona , Fairley Christopher
Published: May 2024

Introduction

A recent systematic review has concluded that vaccinating against human papillomavirus (HPV) does not lead to risky behaviours among females but there has been no studies examining this association among men who have sex with men (MSM). We aimed to examine the association between sexual behaviours and HPV vaccination status among men who have sex with men.

Methods

We analysed MSM aged 16–40 years attending a sexual health centre in Australia for their first visit in 2016. Chi-squared test was used to examine the differences in sexual behaviours (e.g. number of male partners and condom use in last 3 and 12 months) between vaccinated and unvaccinated MSM.

Results

A total of 1332 MSM were included in the analysis with a median age of 27 (IQR 23–31). Six percent (n=81) of MSM had been vaccinated against HPV. The median number of male partners in the last 3 and 12 months was 2 (IQR 1–5) and 5 (2–10), respectively. The proportion of men used condoms always in the last 3 and 12 months was 39.2% (n=797) and 36.5% (n=774), respectively. There were no significant differences in number of partners and always condom use in both last 3 and 12 months between vaccinated and unvaccinated MSM (p>0.05).

Discussion

Vaccinating against HPV is not associated with increased sexual activity and condomless anal sex practice among MSM, particularly among sexually-active men attending a sexual health service.
P222 Bisexual men – twice the fun or double the risk?
Authors: Dearing Nicola , Lamont Callum
Published: May 2024

Introduction

Men who have sex with men and women (MSMW) are a group with unique sexual health needs, increased risk of STI’s and the potential to bridge homosexual and heterosexual populations. Information is lacking regarding sexual health behaviour among this group.

Aims

Investigate STI testing behaviour of MSMW attending a sexual health clinic, recent sexual behaviour and STI diagnosis.

Methods

Retrospective review of sexual health clinic electronic case notes of men attending with a new episode whose sexual orientation was recoded as bisexual from 1/4/2016 to 31/6/2016. Information was obtained on demographics, recent sexual partners, STI testing performed and diagnosis.

Results

78 MSMW attended during the audit period. Uptake of STI screening was high (95% genital Chlamydia and Gonorrhoea testing, 87% HIV and Syphilis testing). Extra genital site testing was performed in 70% patients. 79% had all appropriate sites tested according to their sexual history (oropharyngeal testing lacking in 12%, anal testing lacking in 1%, 8% unclear from documentation). In the previous 3 months 61% reported multiple sexual partners, 40% reported sex with both male and female partners and 66% reported unprotected sex with a new partner. Forty men reported a current regular female partner of which 29 also reported a recent male partner (27 unprotected). 23% were diagnosed with an STI following their clinic attendance.

Discussion

MSMW showed high risk sexual behaviour and prevalence of STI’s. Concordant male and female partners highlight the need to encourage regular screening in this group, record a detailed sexual history and offer all appropriate tests.
P227 Factors associated with sexually transmitted infections in <16’s attending a gum clinic
Authors: Evans Megan , Dore Eoin , Prime Katia
Published: May 2024

Introduction

We established whether number of sexual partners and vulnerability factors were associated with sexually transmitted infections (STIs) in <16 year olds.

Methods

Data was captured on <16’s attending a GUM clinic 01/01/15–31/12/15, using a standardised electronic proforma. Data collected: Demographics, appointment type, postcode, STIs, pregnancy, contraception, number of sexual partners and vulnerability factors (mental health, drug use, history of abuse, known to outside agencies, gang involvement).

Results

236 attendances by 124 patients; 89/124 (72%) new, 35/124 (28%) rebook. 50/124 (40%) <16s resident in GUM clinic borough, 59/124 (48%) from neighbouring boroughs. 107/124 (86%) female. Ethnicity: 54/124 (43%) White British, 32/124 (30%) Caribbean, 15/124 (12%) African. Median age at first attendance 14.6 years (range 12–15). 447/88 (53%) patients using contraception and 23/107 (21%) females had pregnancy test; 2/23 (8.7%) positive. 31/124 (25%) were diagnosed with or were contact of an STI (Chlamydia n=22, Gonorrhoea n=5, PID n=2, HSV n=2, HIV n-1), of whom 9/31 (29%) reported ≥ one vulnerability factor. Average number of sexual partners in this group was 3.45 (Range 0–15). 93/124 (75%) were not diagnosed with an STI, of whom 27/93 (29%) reported ≥ one vulnerability factor. Average number of sexual partners was 1.75 (Range 0–20).

Discussion

29% of patients (36/124) attending the clinic had ≥ one vulnerability factor. <16s diagnosed with an STI were not significantly more likely to have a vulnerability factor than those who were not. However, those diagnosed with an STI had a greater number of sexual partners than those without a diagnosis.
P230 Sexual health workers are at higher risk of poor sexual health: a pilot study
Authors: Woodroffe Tamara , Davies Julia , Richardson Daniel
Published: May 2024

Introduction

The effects of occupation on personal heath have been described, but there is a paucity of literature on how working in sexual health affects an individual’s sexual behaviour.

Methods

We gained informed consent from a focus group of 6 female and 2 male sexual health workers in 2010. The focus group was tape recorded, anonymised and transcribed. We used thematic analysis to generate themes.

Results

Sexual health workers feel confident in making an assessment of their own sexual behaviour; yet acknowledge that this self-assessment is not consistently reliable. Access to medication (including antibiotics and emergency contraception) leads to an increase in sexual risk taking in this group. Self-medication occurs for unplanned risks rather than pre-planned. There is reluctance on the part of sexual health workers to consult colleagues due to concerns about lack of anonymity, confidentiality and how positive results will be managed. Sexual health workers feel that these behaviours are a barrier to good sexual health. They also feel that both patients and sexual partners expect them to be more sexually experienced; this can lead to discord in personal relationships. Sexual health workers feel that due to the nature of their work, they have a greater and more realistic insight into sexual relationships; in particular monogamy. They also have greater confidence in their ability to discuss sex with their children and families.

Discussion

This pilot study suggests that sexual health workers may be at risk of poor sexual health and have specific sexual health needs not currently addressed.
P231 Understanding sexual practices, attitudes and sexual health service provision in the over 50s
Authors: Vracar Sandra , Taylor Ruth
Published: May 2024

Introduction

Since 2011 STI incidence has increased in the over-50 population in the UK.

Higher divorce rates, lack of awareness, poor service provision and low pregnancy risk have all been suggested as contributing to these changes.

We examined sexual practices and attitudes of >50s in our city centre clinic, and assessed service accessibility.

Methods

Anonymous questionnaires distributed opportunistically to 50 attendees (23 male 27 female), examining sexual practices, STI awareness and attitudes towards service provision.

Results

Almost half had divorced previously. 50% men never used condoms, 67% women; reasons given included ‘married’, ‘no pregnancy risk’, ‘too old’, ‘don’t like it’. 60% used at least one regular medication and 10% were using >6 drugs. 37% of women and 20% of men were ‘too embarrassed’ to discuss sex with GP. 44% women, 26% men were first-time attenders. All the women in our sample were white heterosexual. There was more ethnic diversity in men, and 30% MSM. There was good awareness of STIs and safer sex, and 70% felt that current services met their needs.

Discussion

Reassuringly, many were attending for the first time suggesting ease of access. However, a lack of diversity in female attendees may indicate unmet needs in some groups. Despite being aware of good sexual health, there was low condom use and a lingering embarrassment to discuss problems with family doctor. This survey suggests unmet needs still exist, even in those who already access services. A similar project in primary care is planned to further assess this.
P232 Somewhere over the rainbow: establishing acceptable locations for sti screening and support for MSM
Authors: Turner Kevin , Priestley Cecilia , Clarke Billy
Published: May 2024

Introduction

Over the Rainbow is a community based LGBT support service and level 3 GUM clinic in Bournemouth, currently under threat due to funding cuts. In May 2016, a patient consultation was undertaken to explore alternative options for service provision.

Methods

A survey was distributed online and in clinic to capture views on the provision of local sexual health services for MSM.

Results

96 people responded to the survey after visiting the service for STI screening (60%) or one to one support (40%). 40% of these would not be happy attending a mainstream GUM or CASH clinic, or GP for STI screening. 34% would not be happy to access STI screening on-line. One third would be unwilling to attend alternative agencies for counselling or support.

80% of the 86 online respondents had attended Over the Rainbow in the past. Responses indicated that even fewer (44-56%) would be happy to attend a mainstream GUM or CASH clinic or GP for STI screening, with a similar proportion reluctant to attend other community settings.

Comments highlighted that service users valued a dedicated LGBT service, in the heart of the gay community. It was described as a safe haven.

Discussion

Future service design and provision must consider community need. Patients expressed a preference for LGBT specific community based services, able to accommodate their sexual health needs within a holistic framework. Many value a face-to-face consultation rather than accessing STI screening on-line.
P233 Sexual dysfunction: primary, secondary or a by-product of secret issues?
Authors: Hamilton Rochelle
Published: May 2024

Introduction

To explore the referral diagnosis of sexual dysfunction from a psychosexual basis.

Methods

A retrospective analysis of 50 women who were referred to a clinical sexologist for varying aspects of sexual dysfunction during January 2016 – December 2016.

Results

Although 100% of women exhibited a variety of sexual dysfunction, 44% displayed variables of sexual abstinence due to real and perceived problems that directly impacted on their ability to participate in sexual intimacy. Factors not explored or discussed by the referring Health Care Professional (HCP) included urinary incontinence, religious/spiritual beliefs, perception of guilt relating to previous sexual behaviours and ill health of the partner.

Discussion

Sexual Dysfunction referrals encompass a broad range of issues. These fall into sub-categories being further classified as primary and secondary. It is identified that a reasonable proportion is still incorrectly identified by the HCP, missing the underlying true reason for sexual abstinence. The ability to ask/frame questions within the assessment is significant to unlocking the contributing or causal problem. Incorporating specific questions assists in decreasing/removing any sense of guilt the woman may have around this.
P237 Are the over 50s being let down by sexual health clinics? – an audit of sexual history taking in over 50s
Authors: Ladipo Zana
Published: May 2024

Introduction

Ageing and Human Immunodeficiency Virus (HIV) has been very topical for a long time but not much has been said of ageing and sexually transmitted infections (STI). The Public Health England STI 2015 update indicates there has been an increase in the rate of STIs in the over 45s since 2011.

Methods

50 random case notes of patients over 50, seen between April 2015 and March 2016 in Sefton Sexual Health Clinic, Southport, North West England. These cases were audited against the 97% target in Sexual History taking 2013 guidelines.

Results

There were 31 men (62%), 4 of whom were homosexual, and 19 (38%) women, all heterosexual. Patients were aged between 50 to 75 years old. 78% were symptomatic. 16% had casual partners, 38% of these used commercial sex workers. 44% were asked about previous STIs and 60% of patients were offered STI screening and off these 13% declined. 82% of patients were asked if they had ever had an HIV test and of these 44% had. Of the 56% that said they had never had a test, 100% were offered a test and 87% accepted. The commonest diagnosis was the first episode of herpes and herpes reoccurrence (both 12%), then first episode of warts (10%) and wart reoccurrence (8%). No patients tested positive for Chlamydia or Gonorrhoea.

Discussion

STI and BBV screening at any age should be guided by an accurate sexual health history and not an assumption. It is a disservice to simply assume low risk due to age.
P246 An audit of the diagnosis and the management of genital herpes in an integrated sexual and reproductive health service
Authors: Heanue Johanna , Kumar Vinod
Published: May 2024

Introduction

The psychological impact of genital herpes simplex virus (GHSV) can be significant but appropriate antiviral therapy and counselling can reduce anxiety and improve quality of life during recurrences. We evaluated the management of GHSV in our integrated sexual health clinics.

Methods

Retrospective case notes audit of patients who were clinically diagnosed with first episode of GHSV, or managed with suppressive therapy for recurrent herpes, between March 2016 and May 2016. The case notes were identified from GUMCADv2 dataset (code C10a/C10b). The data were collected using a standard audit record sheet, developed using BASHH guidelines.

Results

Of 103, 58% were female. The median age was 26 years (range 16 – 59 yrs). A HSV PCR swab was obtained in all patients presenting with a first episode of GHSV (n = 73). Type 1 and Type 2 HSV were typed in 52% and 38% of cases respectively. Syphilis testing was offered to 84% patients. Aciclovir was given to 85% patients. Verbal information giving was good (78%), whereas provision of written information was poor (19%). In patients (n=30), who were managed with suppressive therapy for recurrences, Type 2 HSV was typed in 83% cases. A reason for commencing suppressive therapy was recorded in 77% cases. A clear plan regarding duration of suppressive treatment and follow-ups were recorded 23% and 67% cases respectively.

Discussion

This audit demonstrated many areas of good practice but also identified potential gaps between national recommendations and current clinical practice. Recommendations are made to reach the standards set by BASSH.
P249 Audit of adherence to referral pathway for pregnant women with history of genital herpes booked at a tertiary referral maternity hospital, aug 2015 – aug 2016
Authors: Cunningham Orla , Deegan Nikita , O’Connell Michael
Published: May 2024

Introduction

Genital Herpes Simplex Virus (HSV) can be transmitted in the perinatal period with the potential for serious and devastating consequences for the fetus/infant. Transmission from mother to infant most commonly occurs due to exposure during delivery (85 – 90%). Early 2014, the team caring for women with Infectious Diseases in pregnancy identified that women, with a history of genital HSV or an outbreak in pregnancy, were an at-risk group without a specific care pathway, often with differing clinical decisions regarding their care.

Methods

A retrospective audit was undertaken to ascertain adherence to a newly introduced referral pathway for pregnant women who gave a history of genital herpes booking into a tertiary referral Maternity Hospital, August 2015 – August 2016.

Results

Our initial audit over a 9 month period demonstrated that there was an overall deficit in knowledge regarding the new referral pathway. The 9 month audit showed that only 13 of 49 (26%) of women were referred to specialist services at any time during their pregnancy. Our subsequent audit showed 54% of women were referred for specialist consult in the period following re-education; a large improvement in awareness of our referral pathway.

Discussion

Audit of practice and in particular following an introduction of a new care pathway, is an essential tool for demonstrating compliance as well as highlighting gaps which require addressing. Education targeting the team of midwives who ascertain women’s history on booking into the maternity services, has improved referrals as per our 4 month follow-up audit.
P250 An audit of the care and monitoring of patients co-infected with HIV and hepatitis C in gum in edinburgh: need for better documentation identified
Authors: Pollitt Helen , Raha Durba
Published: May 2024

Introduction

Hepatitis C (HCV) in HIV patients increases risk of cirrhosis and hepatocellular carcinoma (HCC).

Methods

We used the BHIVA guidelines on co-infection to formulate our data fields to audit our compliance with these guidelines. We gathered information from 4 different IT systems used locally and paper notes; looking back over 5 years. Data fields include: Dates of HIV and HCV diagnoses, GP contact, transmission risk, latest CD4 count, ARV regimen, date ARV started, CD4 at ARV start, was HCV diagnosed when ARV started?, HCV treatment regimen, if acute HCV was treatment started within 6-12 months, referral to specialist, transplant, drug, alcohol and mental health services, HEV screening, HAV and HBV serology and vaccine, fibroscan, LFTs, liver biopsy, risk reduction discussion, cirrhosis on liver ultrasound, AFP, endoscopy, if no HCV treatment do they have annual fibrosis assessment?

Results

Abstract P250 Table 1

Number of patients identified under GUM with HCV-HIV co-infection = 16

Patients referred to speciality12/16Patients treated6/16Mode of transmission documented2/16Discussion of risk of transmission documented1/16Cirrhosis3/16Ever had fibroscan5/16Patients referred to speciality12/16Patients treated6/16Mode of transmission documented2/16Discussion of risk of transmission documented1/16Cirrhosis3/16Ever had fibroscan5/16AFP in last year2/3Endoscopy documented2/3HCV treated2/3Non-treated patients (10)Annual fibrosis assessment0/10Cirrhotic patients (3/16)

Discussion

In our HIV patients documentation of HCV care is spread over four IT systems and paper notes. The collation of data to ensure each patient is receiving appropriate care and monitoring is time-consuming and unwieldy, probably the main cause for incomplete monitoring. This audit identifies a need for a cohesive way of documentation for these patients.
O30 Treatment failure in mycoplasma genitalium among gum clinic attendees
Authors: Ovens Katie , Cross Elizabeth , Rickwood Lucinda , Reynolds-Wright John , Hassan-Ibrahim Mohammed Osman , Soni Suneeta
Published: May 2024

Introduction

Macrolide resistance inMycoplasma genitalium(MG) is of growing concern in countries where azithromycin is used to treat non-gonococcal urethritis(NGU) but UK data is lacking. Patients with NGU or pelvic inflammatory disease (PID) are routinely tested for MG at our clinic and offered test of cure (TOC) 4 weeks post-treatment. We aim to determine rates of MG-positivity 4 weeks after treatment and their associations.

Methods

Notes of MG-positive cases between December 2015 and November 2016 were reviewed and data collected on management.

Results

114 cases of MG were identified. 91(80%) were symptomatic and 12(11%) were MG contacts. Should be 52/339(15%) men with NGU and 15/160(9.4%) women with PID were MG-positive.

80/114(78%) were given an azithromycin regimen first line. 59/114(53%) returned for TOC and 24/59(40%) were positive (23 following azithromycin; 1 following moxifloxacin). 19 returned for a second TOC and 14 were negative (1 following azithromycin and 13 following moxifloxacin second line). 5/19(26%) were positive (3 following azithromycin and 2 following moxifloxacin second line). One male patient with confirmed resistance to macrolide and quinolone therapy achieved microbiological cure with pristinamycin.

Having a positive TOC was significantly associated with risk of reinfection (p=0.01) and being symptomatic at TOC (p<0.001), but not significantly associated with gender, sexual orientation, HIV status, concurrent STI (p=0.053) and azithromycin use.

Discussion

MG-positivity rates at 4 week TOC are high raising concerns of treatment failure although re-infection may also contribute. As commercial assays are imminently available, diagnoses of MG will increase and where possible should be accompanied by antimicrobial resistance testing.
O38 The contraception choices interactive decision-aid: development, content and design
Authors: Bailey Julia , Gubijev Anastazia , Walton Lisa , Blandford Ann , D-Souza Preethy , Oliver Sandy , Rait Greta , Stephenson Judith
Published: May 2024

Introduction

Women have many concerns about contraception which can put them off using reliable methods, and their worries may not surface in consultations with health professionals. An online intervention can offer convenient help with decisions. We describe the design and development of the Contraception Choices website which addresses myths and misconceptions about contraception, and provides tailored recommendations for contraceptive methods.

Methods

We gathered several sources of evidence: 1) A qualitative synthesis of systematic reviews of factors influencing contraceptive choice; 2) Views on contraception expressed on YouTube (35 videos); 3) A meta-analysis of randomised controlled trials of interactive digital interventions for contraceptive decision-making; 4) A narrative synthesis of reviews of interventions for contraceptive decision-making; 5) Seven focus groups with 75 women aged 15 to 30 recruited in clinical settings, to explore beliefs and concerns about contraception and suggestions for website content.

YouTube videos and qualitative data were analysed thematically. Themes from the qualitative field work and findings from the evidence reviews were tabulated, and implications for the design of the Contraception Choices website were debated.

Results

The most common myths and misconceptions about contraception were worries about hormones being unnatural, weight gain, altered bleeding patterns, cancer and future infertility. The Contraception Choices website addresses women’s concerns through videos, information which highlights contraception benefits, and an interactive tool which gives tailored suggestions for contraceptive methods.

Discussion

The role of digital decision-aids for contraception will be discussed. The website will be tested in a pilot randomised controlled trial starting in March 2017.
O39 Improving the evidence-base to understand sti risk reduction capacity: the feasibility and acceptability of linking online behavioural survey data to genitourinary medicine clinic records
Authors: Blomquist Paula , Wayal Sonali , Mercer Catherine , Weatherburn Peter , Reid David , Hughes Gwenda
Published: May 2024

Introduction

Behavioural surveys provide insight into the context associated with STI risk, but interpretation is hampered by using self-reported STI history. We aimed to determine the feasibility and acceptability of linking patients’ online survey data on STI risk factors with the national surveillance dataset on STI diagnoses (GUMCADv2).

Methods

Between May-September 2016, attendees at 16 GUM clinics across England were invited to complete an online survey on knowledge, attitudes, and behaviours around STI risk, using a clinic tablet or personal device. Clinic staff recorded respondents’ patient IDs, which we used to link surveys to GUMCADv2 (as well as age, gender, and clinic attendance date). We examined recruitment and linkage success and used Z-test for proportions to assess selection bias.

Results

6283 attendees agreed to participate, and 73.6% (4626) did so, with survey completion higher in those who completed the survey in clinic vs. those who did so at home (87.3% vs 16.8%). 95.9% (4437) of survey respondents were eligible, which was 59.2% of our recruitment target. 91.2% (4046/4437) of participants consented to data linkage, and of these 88.9% (3596) were linked to GUMCADv2. Consent did not differ by age or gender but was higher among MSM than heterosexual men (95.5% vs. 88.4%; p<0.01), and lower among black Caribbean than white participants (87.1% vs 93.8%; p<0.01).

Discussion

Online behavioural surveys distributed in GUM clinics with linkage to GUMCADv2 are both highly acceptable to attendees and technically feasible. Staff should encourage survey completion on clinic tablets to maximise recruitment and linkage success.
UG4 The predictive value of triage questionnaires in a sexual health clinic
Authors: Coles Rebecca , Hegazi Aseel , Prime Katia
Published: May 2024

Introduction

To assess the effectiveness of self-completed triage forms in eliciting symptomatic status and predicting subsequent diagnoses.

Methods

Consecutive patients attending a GUM clinic 3/10/16–7/10/16. Data from self-completed patient triage forms were extracted and correlated with clinician findings documented in electronic patient records at the visit. Fisher’s Exact was used to calculate association.

Results

339 patients were included of whom 56.6% were female. Median age was 29 years (14–84) and 86.4% identified as heterosexual (n=293). 54.6% of patients (n=185) indicated symptoms on the triage forms c.f. 58.7% (n=199) documented as symptomatic by clinicians. Clinicians and patients agreed on symptomatic status in 85.3% (289/339) of cases. 57.7% (n=71) of symptomatic women reported lower abdominal pain (LAP), inter-menstrual/post-coital bleeding (IMB/PCB) or dyspareunia on triage forms which were subsequently documented by clinicians on 66.2% (41/71) of occasions. These symptoms were not significantly associated with a diagnosis of PID, or other infections, when documented by clinicians or patients (p<0.05). Patient and clinician documented ‘change in vaginal discharge’, ‘lumps on genitals’ and ‘genital blisters or sores’ were significantly associated with candidiasis and bacterial vaginosis (p<0.05), genital warts (p<0.05), and genital herpes (p<0.05) respectively. Patient and clinician reported dysuria was significantly associated with NSU in men and UTI in women (p<0.05).

Discussion

There was a high level of concordance between patients and clinicians regarding symptomatic status. Specific symptoms, when included in triage, are effective predictors of associated diagnoses with the exception of LAP, IMB/PCB and dyspareunia which appear to be non-specific.
UG6 A retrospective cohort study of treatment outcomes among HIV positive individuals with early syphilis at a single HIV clinic
Authors: Hobbs Emily , Lawrence David , Dean Gillian , Creswell Fiona
Published: May 2024

Introduction

Guidelines for the treatment of early syphilis recommend benzathine penicillin G (BPG) for all patients regardless of HIV status. Concerns of HIV-positive patients developing asymptomatic neurosyphilis have prompted some to prescribe a neuropenetrative regimen of procaine penicillin (PP) with probenecid. There is heterogeneity in prescribing and the debate surrounding this issue is amplified by the global probenecid shortage. One centre in the UK has historically treated patients with PP regardless of syphilis stage. We compared serological response, adherence and tolerance among these patients compared with those receiving alternative regimens.

Methods

A retrospective analysis of HIV positive individuals with early syphilis infection. Response to treatment was defined by ≥4-fold decline in VDRL titer within 13 months.

Results

197 patients were diagnosed with primary(24%), secondary(50%) or early- latent(26%) syphilis between 2012-2015. 102(52%) received PP, 26(13%) BPG, 38(19%) doxycycline for 28 days and 4(2%) amoxicillin plus probenecid. For 27(14%), treatment regimen was unknown. Of those who completed PP, 91% had serological response, BPG 65%, doxycycline 79%. Four patients on PP switched due to non-adherence. Of the PP patients median age 42, CD4 576 and 80% were on antiretroviral therapy. This did not differ greatly between those who achieved serological response and those who did not.

Abstract UG6 Table 1

Demographics and follow up of patients divided by treatment regimen

PP (%)BPG (%)DOXY (%)AMOX+P (%)No. of patients started treatment102 (52)26 (13)38 (19)4 (2)No. of patients completed treatment94 (92)26 (100)34 (89)4 (100) Serological Response86 (91)17 (65)27 (79)3 (75) Serological Failure3 (3)1 (4)3 (8)1 (25) Lost to Follow up <13 months5 (5)8 (31)4 (11)0No. of patients did not complete treatment8 (8)04 (11)0 Serological Response7 (88)3 (75) Serological Failure1 (12)1 (25)Switched Treatment Regimen4 (4)01 (3)0 BPG1 (25)01 (100)0 Doxycycline3 (75)000 Serological Response4 (100)01 (100)0Age Median42443854 Range25–4629–6827–5840–63Syphilis Infection Primary24 (24)9 (35)7 (18)1 (25) Secondary47 (46)12 (46)25 (66)1 (25) Early Latent31 (30)5 (19)6 (6)2 (50)CD4 at Diagnosis Median576654534728 Range126–1223170–2384274–847404–1146On ART at Diagnosis Yes82 (80)21 (81)30 (80)4 (100) No20 (20)5 (19)8 (20)0

PP=procaine penicillin plus oral probenecid; BPG= benzathine penicillin G; DOXY= doxycycline; AMOX+P= amoxicillin plus oral probenecid; HART=HIV antiretroviral therapy

Discussion

We demonstrate good adherence and tolerance of PP. There was a superior serological response to treatment in this group but a large loss to follow up among those treated with BPG. Further statistical analysis may identify factors associated with serological failure. Prospective studies exploring co-infection are required.
P008 A year of proctitis: aetiology and management in an urban gum clinic
Authors: Hanna Luke , Brusov Anton , Stockwell Sarah , Soni Suneeta , Richardson Daniel
Published: May 2024

Introduction

Chlamydia trachomatis (CT), including Lymphogranuloma venereum (LGV), Neisseria gonorrhoeae (NG), syphilis and herpes simplex (HSV) all cause proctitis in MSM. Local guidance recommends testing and treating for these organisms. We examined the aetiology and management of cases of proctitis at our sexual health clinics.

Methods

Clinical records were reviewed of all men coded for proctitis between January and December 2016. Clinical presentation, microbiology results, and treatments issued at initial clinic visit were recorded and data analysed.

Results

46 MSM were correctly coded as having proctitis. The median age was 38.5(19–75) years. 21/46(45.7%) were HIV-positive. Presenting symptoms included: rectal discomfort(69.6%), discharge(47.8%), bleeding(39.1%), altered bowel habit(23.9%), and tenesmus(17.4%). 7/46(15.2%) had anorectal ulceration.

All patients were tested for CT and NG. NG was detected in 11/46(23.9%) and CT in 10/46(21.7%), including 4 with LGV. 27/46(58.7%) were tested for HSV, which was positive in 8/27(29.6%). 1 Mycoplasma genitalium and 4 Syphilis were diagnosed. Co-infections with >1 organism were identified in 8(17.4%). In 22/46(47.8%) no cause was identified. 41/46(89.1%) MSM received antibiotics for CT. In 30/46(65.2%) MSM this included anti-microbial cover for NG and 17/46(37.0%) had an extended course of doxycycline for LGV. Aciclovir was given to 12/46 MSM (26.1%).

Discussion

NG was the commonest pathogen identified, however only 65% of MSM were treated. HSV testing rates were low despite one third of those tested being HSV positive. This indicates a need to better educate clinicians of the multi-pathogen, syndromic, approach to proctitis management to ensure that relevant pathogens are not missed.
P009 Risk of chlamydia/gonorrhoea naat contamination from clinic surfaces – need for patient and staff awareness in self-swabbing and pooling areas
Authors: Wallace Harriet , Daley Sharon , Loftus-Keeling Michelle , Wilson Janet
Published: May 2024

Introduction

A self versus clinician Chlamydia/gonorrhoea (CT/NG) NAAT swab trial, with pooling of self-taken samples, recruited January 2015–September 2016. There was concern that nucleic acid contamination of clinic surfaces could be a source of false-positive samples during the pooling process.

Aim(s)/objectives

To ascertain levels of environmental nucleic acid contamination within clinic environments. To determine number of false positive pooled samples throughout study.

Methods

Environmental samples of clinic rooms, sluices and toilets were performed and tested using Aptima Combo 2 throughout duration of study. In November 2015, the clinic relocated from old premises to a newly renovated site.

Results were disseminated to staff throughout to raise awareness and to reduce risk of contamination during sampling/pooling. Posters in self-swab areas highlighted risk of contamination, importance of handwashing and no surface contact for swabs.

Results

Of 41 environmental sampling episodes over 12 months, 17 (41%) were CT/GC positive/indeterminate. These were distributed throughout the whole 12 months. Positive results were obtained from surfaces in all clinical examination rooms at the old site and toilets and sluices (where urines were pipetted) at both sites. 3/4 clinic rooms regularly used for examination at the new site remained contamination free. There were 7 false positive pooled samples (6 female, 1 male); all were in the first 6-months of the study.

Discussion

Nucleic acid contamination was repeatedly found throughout the clinic despite regular cleaning/decontamination. Raising staff and patient awareness did not reduce contamination but it did reduce false positive pooled samples, with none occurring after the first 6-months.
O06 Hepatitis c transmission in hiv negative men who have sex with men (msm) who do not inject drugs
Authors: Fitzpatrick Colin , Pinto-Sander Nicolas , Williams Deborah , Richardson Daniel
Published: May 2024

Introduction

Since 2000 there has been an increase in reported acute hepatitis C in HIV infected men who have sex with men which is associated with injecting drug use (IDU), condomless anal sex, pre-exposure prophylaxis (PrEP) use and sexual practices including fisting. There have been very few reports of acute Hepatitis C in HIV negative MSM who do not inject drugs. Locally we have been screening all MSM and IDUs per year for Hepatitis C since 2005.

Methods

We looked at cases of hepatitis C diagnosed in our sexual health/HIV service per calendar year from 2012 – 2016 and looked at HIV status, injecting drug use and sexual behaviour.

Results

We saw 37,012 attendances for sexually transmitted infection testing by MSM in the study period: There were 9 diagnoses of hepatitis C in HIV negative MSM in the study period. (2012:3, 2013:3, 2014:1, 2015:2, 2016:0). 5/9 HIV negative MSM diagnosed with hepatitis C gave a history of IDU. 4/9 HIV negative MSM diagnosed with (incident) Hepatitis C had no documented history of IDU, all had a recent history of condom-less anal sex at chem-sex parties; 2/4 had engaged in fisting and none were using PrEP at the time of diagnosis.

Discussion

There appears to be a very small amount of hepatitis C transmission in HIV negative MSM who do not inject drugs associated with condom-less anal sex at chem-sex parties and fisting. Screening for hepatitis C could be rationalised to these groups of MSM.
P017 Managing mycoplasma genitalium in clinic: don’t forget the partners
Authors: Cross Elizabeth , Ovens Katie , Reynolds-Wright John , Trotman Sarah , Soni Suneeta
Published: May 2024

Introduction

There is increasing UK interest in Mycoplasma genitalium(MG) testing of clinic attendees where indicated. Partner notification(PN) is a crucial part of STI management but as yet no national performance standards specific to MG have been defined.

Methods

Case note review of all MG cases at our clinic from December 2015 to November 2016. Data collected on the four PN outcomes outlined in the 2012 BASHH statement on PN for STIs.

Results

114 cases were identified. Mean age 28.5, 82(71.9%) male of whom 36(43.9%) MSM. The proportion of cases with a PN discussion documented (83.3% [95% CI 75.2–89.6]) and the proportion of cases with an outcome of agreed contact action(s) documented (78.1% [95% CI 69.4–85.3]) were both lower than the national standard of 97.0% (p<0.0001).

There were 0.22 (95% CI 0.17–0.28) contacts per index case whose attendance at a sexual health service for treatment was reported by the index case and 0.19 (95% CI 0.14–0.24) contacts per index case in which a healthcare worker verified treatment. Performance was lower than the national standard of 0.60(p<0.0001), and inferior to local chlamydial and gonorrhoeal PN data, 0.6 and 0.5 contacts per index case reported treated respectively. Performance across all PN outcomes was worse for men than for women.

Discussion

PN for MG at our clinic falls below local and national standards for other STIs. Contributory factors may include poor documentation, absence of national guidance for MG PN performance standards and lack of patients’ appreciation of the importance of MG as an STI.
P018 Universal treatment – should we review?
Authors: Merali Shermin , Hourihan Martin , Higgins Sarah
Published: May 2024

Introduction

Guidelines recommend epidemiological treatment of patients presenting as a contact of infection. This potentially reduces the prevalence of infection, reducing infectivity and reduces patient visits. Over prescription of antibiotics poses a threat of future resistance development and exposes the patient to unnecessary treatment. An audit was carried out to determine if any themes could be identified to indicate a likely positive result in contacts.

Methods

We audited asymptomatic contacts of chlamydia and gonorrhoea (PNC/PNG) attending GU services at BartsHealth (February 2016 for 3 months). Data on gender, sexual orientation, contacts (regular or casual), infection site, time since sex with contact, HIV status, STI in previous year were collected. Testing by Aptima NAATS for chlamydia/gonorrhoea and gonorrhoea culture.

Results

Chlamydia75 asymptomatic contacts (55 male/20 female). All treated as contacts. 25 had a positive result (34%). No factors could be associated with predicting a positive result, except a suggestion that a regular partner v casual partner. Gonorrhoea: 85 asymptomatic contacts (76 male/9 female). All treated as contacts. 27 had a positive result (32%). Being male >24years old/MSM/>5 partners (in 3m) and contact being a regular partner were suggestive of predicting a positive result.

Discussion

The audit reinforces epidemiological treatment. Drawbacks of not treating include failure to return, onward STI transmission and inconvenience of re-attending. However, over 60% had potentially unnecessary treatment and with rapid turnaround of results (<2d), future universal treatment may need to be revised.
P026 Neisseria gonorrhoeae (GC): changing pattern of antibiotic sensitivity and persistence of DNA detection 2007 – 2016
Authors: Young Sarah , Bopitiya Shyamalie , Allan Sris
Published: May 2024

Introduction

Nucleic acid amplification testing (NAAT) is used in GUM clinics to diagnose GC infection; however its in-built sensitivity potentially detects DNA from non-viable organisms following successful treatment. BASHH guidelines stipulate that test of cure with NAAT (TOC) should take place 2 weeks post-treatment.

This study aims to determine whether this is an adequate time interval to perform TOC. We also analysed the changing pattern of antibiotic sensitivity between 2007 – 2016.

Methods

All GC cases at our clinic between 01/01 and 30/06 in 2007–2016 were identified, assessed for antibiotic sensitivity and analysed for TOC data from 2013–2016.

Results

Of 131 cases in 2016, culture and sensitivities were available for 80, with TOC in 63.

Abstract P026 Table 1Susceptibility to Antibiotic groups2007 (%)2009 (%)2011 (%)2012 (%)2013 (%)2014 (%)2015 (%)2016 (%)Fully sensitive to antibiotic testing panel4667594979594355Reduced susceptibility to 12715203810202323Reduced susceptibility to 215101686132115Reduced susceptibility to 3122532856Reduced susceptibility to 41

TOC was performed between 6 and 77 days post-treatment with mean, median and mode of 18, 14 and 14 days respectively.

Discussion

No cultures were resistant to ceftriaxone. This is the first year a case has shown reduced susceptibility to 4 antibiotic groups. From 2015-2016 there has been an increase in GC fully sensitive to the antibiotic testing panel.

Our data supports BASSH guidelines for TOC 2 weeks post-treatment.
P031 Epidemiological study on syphilis diagnoses at a local genitourinary clinic (guc)
Authors: Padovese Valeska , Gamoudi Donia , Farrugia Alexandra Gauci , Muscat Katya , Abela Maria , Carabot Philip , Scerri Lawrence
Published: May 2024

Introduction

In 2015 our country reported 11.5 confirmed syphilis cases per 100 000 population, which is one of the highest rates in Europe. The objective of our study was to analyse the epidemiological characteristics of patients diagnosed with syphilis.

Methods

A retrospective analysis of medical records of patients attending the local GUC with a diagnosis of syphilis from 2002–2015 was carried out. Data concerning patient demographics (age, gender and sexual orientation), year of diagnosis, syphilis stage, treatment regime, HIV/STIs co-infections, partner notification and follow up were recorded.

Data collected was inputted in an excel database.

Results

In the study period a total of 291 patients were diagnosed with syphilis. 82.6% were males (n=238); 48.6%( n=143) were MSM and 5.2% (n=5) bisexual men. Syphilis was diagnosed in the primary stage in 11.3% of patients, secondary in 9.6%, early latent in 30.9% and late latent in 47.4%. All patients with syphilis were tested for HIV and 16.1% (n=147) resulted HIV positive, 74.5% of them (n=35) were MSM. Partner notification was not possible and/or not reported in 40.5% (n=118) of patients. In 21% (n=61) of cases, it was not possible to establish whether the treatment was successful because these were lost to follow up.

Discussion

As the syphilis rates continue to rise so rapidly, it is very important to have robust mechanisms in place to limit spread such as proactive recall for treatment and follow up and education and support regarding safer sexual practices.
P034 Association of mycoplasma genitalium and persistent abdominal pain- what srh doctors undertaking ultrasound need to know?
Authors: Aziz Najia
Published: May 2024

Introduction

The 2016 European guideline on Mycoplasma Genitalium (MG) states that significant association is found between MG and pelvic inflammatory disease (PID). MG is diagnosed through nucleic acid amplification testing. The aim of this study was to find out about the importance of testing for MG in patients with persistent abdominal pain.

Methods

It was a retrospective analysis of patients who were tested for MG in Sexual and Reproductive healthcare (SRH) consultant ultrasound clinic over a period of 17 months. The inclusion criterion for testing was persistent symptoms after PID treatment.

Results

9 patients were tested for MG in consultant led SRH ultrasound clinic. All were initially treated by other clinicians for PID with standard treatment but did not respond and were referred to SRH ultrasound clinic to exclude other pathology. Ultrasound for all of the patients was normal with no adnexal masses or free fluid. Pregnancy test was done in all cases and it was negative; all patients were also negative for chlamydia and Gonorrhoea. MG testing was done in all 9 cases and 2 came back positive (22%). Both were treated with Moxifloxacin 400mg OD for 10 days.

Discussion

This small study shows that there can be an association between persistent abdominal pain and MG. SRH doctors who are undertaking ultrasound on a routine basis should consider possibility of MG testing in patients with persistent abdominal pain. More research is needed in this area to establish a routine testing for MG in a patient with abdominal pain.
P035 Quick starting hormonal contraception after using oral emergency contraception: a systematic review
Authors: Murphy Lauren , Chen Zhong , Warner Valerie , Cameron Sharon
Published: May 2024

Introduction

Unprotected intercourse after oral emergency contraception (EC) significantly increases pregnancy risk. This underlies the importance of promptly starting effective, ongoing contraception – known as ‘quick starting.’ However, theoretical concern exists that quick starting might interact with EC or hormonal contraception (HC) potentially causing adverse side effects.

Methods

A systematic review was conducted, evaluating quick starting HC after oral EC (levonorgestrel 1.5mg [LNG] or ulipristal acetate 30mg [UPA]). PubMed, EMBASE, The Cochrane Library, ICTRP, ClinicalTrials.gov and relevant reference lists were searched in February 2016. A lack of comparable studies prevented meta-analysis.

Results

Three randomised controlled trials were identified. Two biomedical studies suggested HC action was unaffected by quick starting after UPA; one study examined ovarian quiescence (OR: 1.27; 95% CI 0.51 to 3.18) while taking combined oral contraception (COC). Another assessed cervical mucus impenetrability (OR: 0.76; 95% CI 0.27 to 2.13) while taking progestogen-only pills (POP). Quick starting POP reduced the ability of UPA to delay ovulation (OR: 0.04; 95% CI 0.01 to 0.37). Side effects (OR: 1.22; 95% CI 0.48 to 3.12) and unscheduled bleeding (OR: 0.53; 95% CI 0.16 to 1.81) were unaffected by quick starting COC after UPA. Another study reported higher self-reported contraceptive use at eight weeks among women quick starting POP after LNG, compared with women given LNG alone (OR: 6.73; 95% CI 2.14 to 21.20).

Discussion

Limited evidence suggests quick starting HC after UPA does not reduce HC efficacy, however it reduces UPA efficacy. Consequently, women should delay starting HC after UPA.