bluuebunny/crossref_metadata_2025 huggingface dataset:
P164 Which aspects of stigma are most important in an integrated sexual health service?
Authors: Sauer U , Singh A , Pittrof R
Published: May 2012

Background

The stigma of sexual health services is pervasive and affects all user groups. It is likely to affect access to and satisfaction with the service. Reducing stigma has to be an essential aspect of improving sexual healthcare. Stigma has four domains: disclosure concerns, negative self-image, public attitudes and positive (non-stigmatising) aspects. It is currently not known which of these domains is perceived as most relevant by service users.

Objective

To determine which aspect of stigma of the service was felt most intensely by service users in a level 3 integrated sexual health service (ISHS).

Method

Application of a validated 15 item quantitative tool to assess stigma among 200 unselected patients attending an ISHS in outer London.

Results

A total of 77 strong agreement with a statement describing stigma of the service were recorded. Of them nearly half were given in response to two statements: statement (S) 5: “I am careful whom I tell that I have been in this clinic” (14) and S 10 “I am concerned that I bump into someone I know when I am at this clinic” (16). No other statement attracted >6 positive strong responses. Of the 171 responses indicating a moderate stigma of the service 24 were given to the S1 “I won't tell anyone that I came to this clinic because I am concerned about their reaction”. Statement 5 and S10 received 22 moderate agreements each while S6 “I worry that people who know that I have been here tell others that I have been to this clinic” attracted 17 moderate positive responses.

Discussion

Our research indicates that disclosure concerns are the key source of stigma for the ISHS. Other aspects like self-image or public attitudes were less relevant. The high level of concerns expressed in S10 throws a new light on the issue of time spent in the waiting room. It suggests that waiting can be very stressful as stigmatising encounters are anticipated.
P166 Increasing screening frequency in men who have sex with men (MSM): impact of explicit guidance on risk profiling on UK service
Authors: Baker A , Fleury C , Foley E , Samraj S , Rowen D , Patel R
Published: May 2012

Background

STI and HIV diagnoses are increasing among MSM. Mathematical modelling shows increasing screening frequency can reduce STI prevalence, especially targeting MSM engaging in risk behaviours. International guidelines from both the CDC and Australasian Society for HIV Medicine clearly define risk behaviours with adapted screening intervals—contrary to the UK where NICE guidance is vague.

Objectives

To investigate impact of applying stricter international screening guidelines for MSM, on service workload and earlier STI diagnosis in a UK level 3 service [L-3S].

Methods

A validated risk questionnaire distributed to MSM attending a large provincial L-3S over a 3-month period explored their actual screening frequency, STI diagnoses and risk behaviours in the prior 12 months. Australian screening guidelines were applied to the data to identify MSM needing more frequent screening. Projections to the larger MSM population attending over 12 months were modelled, based on the demographics of the respondents.

Results

126/357 completed the questionnaire, 89 were identifiable. There was no statistically significant difference between STI rates (p=0.18) and HIV diagnoses (p=0.62) between identifiable questionnaire respondents and other MSM clinic attendees. Demographic analysis showed the sample group was representative of the larger cohort. In 2011, applying Australasian Society for HIV Medicine risk profiling for the 793 MSM who attended the unit, 26% would require one additional 6-monthly attendance for HIV screening, while 6% would require two visits. Additional STI screening visits would be needed by 25% (1 visit) and 10% (2 visits). 29% of STI diagnoses were in infrequent attendees.

Conclusions

Stricter UK screening guidelines for MSM defining and weighting risk behaviours explicitly in line with other international guidelines, would increase L-3S MSM visits by 30% and potentially diagnose a large proportion of disease earlier. In light of the results UK guidelines may benefit from review.
P168 Acute generalised exanthematous pustulosis induced by pneumocystis carinii pneumonia (PCP) prophylaxis with dapsone
Authors: Vas A , Laws P M , Marsland A M , McQuillan O
Published: May 2012

Background

Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction. Most cases are drug related, however the condition has been associated with viral infections.

Objective

AGEP in the setting of HIV is uncommon. We report a case of AGEP induced by PCP prophylaxis with dapsone.

Results

A 34-year-old HIV-infected Nigerian woman was admitted to hospital with a 2-week history of a progressing pustular skin rash. CD4 count 1 month prior to admission was 176 cells/mm3and she had not been taking antiretrovirals since 2008. Three weeks prior to presentation she had commenced Dapsone for PCP prophylaxis. Admission to hospital revealed a fever of 40°C, tachycardia, hypotension and a widespread erythematous papular eruption with overlying pustules. Laboratory investigations revealed; haemoglobin 7.6 g/dl, raised oeosinophils of 0.67×109/l, C reactive protein 144 mg/l and Direct Coombs test was positive. A venous metheamoglobin level was raised at 3.5% and chest radiography revealed subtle consolidation at the left base. Broad spectrum antibiotics and fluids were initiated and Dapsone was withdrawn. Dermatology review raised the clinical suspicion of drug rash with oeosinophilia and systemic symptoms (DRESS) or AGEP. Skin biopsy supported the clinical diagnosis of AGEP. She remained systemically unwell and intravenous hydrocortisone was commenced. Subsequent infective screen for viral and bacterial pathogens was negative. Over the following week the pustular rash began to desquamate with significant improvement. She made a full clinical recovery and subsequently started antiretroviral therapy and atovaquone for PCP prophylaxis.

Discussion

Drug reactions in the setting of HIV and its treatment are common. AGEP in the setting of HIV has rarely been reported. This case illustrates a less common but important severe cutaneous adverse reaction to recognise in our HIV cohort.
P169 Don't whip it out until syphilis is ruled out
Authors: Teo S Y , Fairley I
Published: May 2012

Introduction

Discrete syphilitic lesions mimicking testicular tumours are reported in the literature but usually diagnosed after removal of the testes in conjunction with positive syphilis serology. We present the first case, to our knowledge, in which a discrete testicular mass in the context of positive syphilis serology has been spared surgery and resolved both clinically and on serial ultrasound scans following antibiotic therapy.

Case

A 47-year-old gentleman attended GUM clinic with inflammation under his foreskin and was found to have painless testicular lump on examination. Initial ultrasound revealed a 2 cm well defined, hypoechoic mass within the right testes. He was referred to urology on suspicion of malignancy. Subsequent Syphilis serology was positive and the penile lesion and testicular mass were felt to be consistent with syphilis. After liaising with the urology department, and in view of negative tumour markers (LDH, AFP and HCG) and known penicillin allergy, he was managed conservatively with doxycycline. Follow-up ultrasound scans at 1 month and 4 months revealed good resolution of the testicular mass. The last scan performed at 10 months after treatment revealed complete resolution.

Conclusion

The case illustrates that syphilis needs to be considered in the differential diagnosis of testicular lumps and that conservative management with close follow-up can spare the patient radical orchidectomy.
P170 A clinical case study of the use of motivational interviewing (MI) to address a HIV+ gay man's sexual risk taking and recreational drug use
Authors: Yap S Y
Published: May 2012

Background

There is an increased prevalence of many sexually transmitted infections (STIs) among HIV+ gay men. In addition, the increase of the use of recreational drugs within this population is associated with increased sexual risk taking. There is a need for specific services to address sexual risk taking within this population. A clinic was set up to deliver an MI based intervention to gay men who engage in “high risk” sexual activity, including unprotected anal intercourse. This is a case study of one of the patients referred to this clinic.

Aims

The patient is a 47-year-old gay man with a long standing diagnosis of HIV; he has had a number of other STI's in the past. He was engaging in a high frequency of unprotected anal intercourse (both single partner and group sex) with partners he met on the internet. He reported always using recreational drugs during sex sessions. The aim of the intervention was to reduce the frequency of the patient's unprotected sex, thereby reducing patient's risk of acquiring and/or transmitting STIs.

Methods

Intervention consisted of five individual sessions of MI with a Clinical Psychologist over a period of 3 months.

Results

After five sessions, the patient reported discontinuation of all recreational drugs, a reduction in the volume of sexual encounters, an improvement in mood and increased satisfaction with his sex life.

Discussion

This clinical case study provides preliminary data to support the value and the appropriateness of MI for sexual risk reduction coupled with recreational drug use. Despite the level of complexity of the patient's presenting problems, MI proved to be an effective intervention. Further research is needed to investigate the efficacy of MI for sexual risk reduction with this population.
P171 A case of extensive oral and penile ulceration
Authors: Hartley A , Paige D , Buchanan J , Hourihan M , Adlington R
Published: May 2012

A 35-year-old Indian man was referred to the genitourinary clinic with a 3-month history of progressive, painful oral and penile ulceration. He had lost 10 kg in weight. He was anorexic secondary to mucosal pain but was otherwise well, with no reported rashes or eye problems. He had no significant medical history and took no regular medication. Last sexual intercourse was protected vaginal intercourse with a commercial sex worker 10 weeks earlier. On examination of the mouth, extensive ulceration was seen on the buccal mucosa and tongue; genital examination revealed superficial erosions on the glans penis and prepuce. Examination of the eyes, skin and joints was unremarkable. The differential diagnosis included: erosive lichen planus, aphthous ulcers, pemphigus vulgaris, cicatricial pemphigoid, Behçet's disease and secondary syphilis. Swabs from the oral ulcers were positive for Herpes simplex virus (HSV) type 1 DNA but penile swabs were negative for both HSV type 1 and 2. Hepatitis B, C, and syphilis serology, HIV antibody, and autoimmune profile were negative. Indirect immunofluorescence for epithelial intercellular cement was positive at a titre of 1:160. Biopsy of the oral lesions showed marked suprabasal acantholysis with prominent Tzank cell formation, in keeping with pemphigus vulgaris (PV). The patient was maintained on oral prednisolone with gradual improvement. Azathioprine will be used as a long-term steroid sparing agent. PV is a potentially fatal autoimmune blistering disorder of the skin and mucous membranes, more common in Indians. Cutaneous lesions are often absent. HSV can both mimic immunobullous disorders and cause superinfection. Therefore, positive HSV swabs must be taken in context and interpreted carefully. Patients may present to the GUM clinic with a history of mucosal ulceration and PV should be included in the differential of such cases.
P172 Transmitted drug resistant HIV presenting as severe encephalitis
Authors: Singh S , Fox J , Teague A
Published: May 2012

Background

Selection of the K103N mutation is associated with a small but significant reduction in viral replicative fitness. Therefore it could be hypothesised that transmission of this strain could be associated with minimal symptoms and low level viraemia at HIV seroconversion.

Case

We present the case of a 41-year-old MSM who was admitted with fever, confusion and agitation following unprotected anal sex 6 weeks earlier with a man of unknown HIV status. He required intubation due to the level of agitation. Admission CT and MRI brain were unremarkable. The first test HIV test was weakly antibody positive; a repeat 6 days later showed a stronger antibody response consistent with HIV seroconversion. His baseline CD4 count was 138 (18%); HIV viral load was 929 000 copies/ml. CSF analysis showed 4 white blood cells, elevated protein at 1.2 g/dl, and a normal CSF to plasma glucose ratio. There was insufficient CSF sample for HIV viral load testing. A diagnosis of encephalitis secondary to HIV seroconversion was made and antiretroviral therapy (ART) with five drugs was started on day 3 of admission. The patient remained agitated for several days. By day 21 the seroconversion symptoms had fully resolved, and by day 28 the plasma HIV viral load was undetectable. Viral genotyping showed the K103N mutation only. The patient remains on ART; now simplified to Kivexa, Darunavir and Ritonavir. This is to continue for 48 weeks at which point a decision will be made to either stop treatment or to continue lifelong ART.

Conclusion

Transmitted drug resistant HIV can cause severe seroconversion illness and high levels of viraemia despite lower viral fitness. To our knowledge, this is the first report of viral encephalitis at HIV seroconversion caused by drug resistant HIV. The role of entry inhibitors and integrase inhibitors for the treatment of severe seroconversion symptoms to prevent viral entry into cells and aid rapid decline in viraemia are currently under evaluation.
P174 The tangled mesh of lymphogranuloma venereum
Authors: Okpaluba I , Dunham R J C , Evans A
Published: May 2012

Introduction

The HPA report an epidemic of lymphogranuloma venereum (LGV) among men who have sex with men in the UK since 2003. Untreated LGV may lead to chronic or irreversible complications with disabling anatomic defects. Reports suggest surgical intervention is rarely required.

Case

45-year-old man who has sex with men, diagnosed HIV positive in 1995, not on antiretroviral therapy due to patient reluctance, following intolerance to several previous regimens. He had spent the summer in Egypt and on return to the UK had a brief spell as an inpatient with campylobacter and norovirus diarrhoea. He presented to the GUM clinic reporting multiple high risk partners and was treated as a gonorrhoea, chlamydia and syphilis contact; STI screen negative. He re-presented a month later with severe proctitis; pain and blood per rectum and frequent small volume stool. Rectal chlamydia was positive and subsequently LGV serovars confirmed. He tested positive for hepatitis C, retrospective sampling of stored blood samples suggested that this had been recently acquired. Hepatitis C treatment was unsuccessful due to lack of virological response and he suffered acute psychosis likely secondary to pegylated interferon. Despite 3 weeks of doxycyline and negative chlamydia retesting he persisted with severe proctalgia and constipation and was referred to gastroenterology. Flexible sigmoidoscopy showed a single ulcer in the upper third of the rectum with the remainder of the colon looking normal. He received empirical retreatment of LGV, rectal predfoam and laxatives. Symptoms worsened and a defecating proctogram (video of proctogram available) identified marked ano-rectal intussusception. This was surgically managed with a mesh support inserted laparoscopically.

Conclusion

Despite early recognition, treatment and apparent clearance of LGV infection complications can occur. This is the first report of complicating anorectal intussusception requiring surgical intervention with a mesh support.
P175 The great pretender strikes again
Authors: Moby T , Mwirigi A , White J
Published: May 2012

Background

An epidemic of syphilis persists in UK men who have sex with men (MSM), often with unusual manifestations. We report a case of syphilis mimicking a lymphoproliferative disorder.

Case

A 29-year-old previously well MSM was admitted with 3 weeks of generalised painless lymphadenopathy. He reported malaise, night sweats and joint pain while travelling recently in the Middle East. He was apyrexial and routine bloods were normal apart from mildly raised liver enzymes. Paul Bunnell and HIV antibody tests were negative. His GP screened for STIs but did not include syphilis serology despite the patient describing penile lesions. Clinicians felt that the presentation was highly suggestive of lymphoma. A CT scan showed multiple enlarged lymph nodes in the neck and small bowel mesentery. An open cervical lymph node biopsy was performed. Histopathology showed suppurating granuloma in a reactive lymph node with no evidence of lymphoma. Stains for HIV p24, acid-fast bacilli and fungi were negative. The suggested differential included lymphogranuloma venereum (LGV), cat scratch disease and melioidosis. At GU medicine review he reported sex with multiple partners in the preceding 6 months. He had a blotchy maculopapular rash on his penis and scrotum, though this was treated as “fungal” by junior staff. Molecular tests for chlamydial and gonococcal infections were negative, including throat swabs. Treponema pallidum (TP) antibodies were positive, RPR = 1:256. He was recalled and started on doxycycline for both secondary syphilis and possible LGV. Two weeks later his lymphadenopathy had greatly reduced in size. His original lymph node biopsy was retrieved and TP immunostaining was performed, which revealed a profuse infiltrate of spirochetes.

Conclusion

This case highlights the need for clinicians from all specialities to be alert for the many clinical manifestations of syphilis currently prevalent in MSM. Wider use of TP immunostaining in relevant specimens is warranted.
P176 Scars of venus…and aesculapius
Authors: Stockwell S , van der Walt J , White J A
Published: May 2012

Background

The lymphogranuloma venereum (LGV) epidemic continues unabated in UK men who have sex with men (MSM). Whatever its presentation, prompt recognition of LGV can be challenging.

Aim

We describe a case of LGV inguinal syndrome identified too late to prevent major surgery.

Case report

A 46-year-old HIV-positive MSM presented to A&E on a Saturday with a 3-day history of a painful left groin lump. He was stable on Atripla with CD4 count 400 cells/ml. He had a tender left inguinofemoral mass and the surgical team took him to theatre for suspected incarcerated femoral hernia. At operation they found instead a large necrotic lymph node and excised it. The patient self discharged the next day. Two weeks later he presented to the GU clinic as a syphilis contact. He mentioned his recent surgery and review of the histology report from the excised node showed “appearances consistent with LGV or cat scratch disease…also a vigorous periadenitis and syphilis should be considered.” Abdominal examination revealed a 25 cm recent surgical scar in the left iliac region. There was penile oedema with sclerosing lymphangitis. A small round subpreputial ulcer was found; it was non-tender and had a rolled edge. There was no perianal or anal lesion. Dark ground microscopy from the ulcer was negative. Rectal and urethral swabs showed no pus cells. The patient was treated with 21 days doxycycline for suspected LGV as well as to cover early syphilis.Chlamydia trachomatis: RNA was detected from the ulcer, first catch urine and rectal specimens. The ulcer tested negative for herpes simplex and TP DNA. All gonococcal tests were negative. LGV-specific DNA was detected from the ulcer but not the rectal swab. TP antibodies were positive with an RPR titre of 4. TP immunostaining of the node biopsy was negative. All clinical signs had resolved by the end of the 3-week doxycycline course.

Conclusion/Learning points

This case highlights that LGV may still evade detection in both A&E and surgical departments. Awareness of LGV remains poor outside of GUM.
P177 Investigating the cost-effectiveness of integrated prenatal HIV/syphilis screening to prevent adverse pregnancy outcomes in China
Authors: Owusu-Edusei K , Tao G , Gift T L , Tun Y , Kamb M L , Wei X , Wang L M , Bulterys M
Published: May 2012

Background

The need to scale-up integrated prenatal HIV/syphilis screening in China has increased in the last decade owing to recent increases in syphilis and HIV cases.

Objectives

In this study, we assess the health and economic outcomes of integrated HIV/syphilis screening to prevent adverse pregnancy outcomes in China.

Methods

A Markov cohort decision analysis model was used to examine the health and economic outcomes of pregnancy using data from published literature and local data. Adverse pregnancy outcomes examined included miscarriage, induced abortion, congenital syphilis, stillbirth, low birth weight, mother-to-child HIV transmission and neonatal death. We examined four screening strategies; No-Screening, HIV-Only, Syphilis-Only and HIV-and-Syphilis. We estimated Disability-adjusted life years (DALYs) for all health outcomes. The life expectancy of the child and mother were the analytic horizon.

Results

Preliminary results indicated that for a cohort of 10 000 pregnant women (0.07% prevalence for HIV and 1.5% for syphilis; 20% of HIV+ had syphilis), the HIV-Only strategy prevented 1 case of mother-to-child HIV transmission and resulted in 2 induced abortions; the Syphilis-Only strategy prevented 3 stillbirths, 2 miscarriages, 15 cases of congenital syphilis, 6 cases of low birth weight and 1 neonatal death, but resulted in 35 induced abortions. The HIV-and-Syphilis strategy prevented the sum of the outcomes prevented by the HIV-Only and Syphilis-Only strategies. Estimated costs per DALYs prevented were: Syphilis-Only, $38; HIV-and-Syphilis, $122; HIV-Only, $5806.

Conclusions

Integrated prenatal HIV/syphilis screening is more cost-effective than HIV-Only screening. This is largely due to the relatively higher prevalence of syphilis and the substantially lower cost of treatment.
P178 Is punishment and criminalisation of HIV transmission justified?
Authors: Phillips M D , Clegg S
Published: May 2012

Aim

To examine why it may be acceptable to punish HIV positive individuals for unintentionally transmitting HIV through consensual sex.

Method

Key issues for criminal punishment include deterrence, retribution, rehabilitation and incapacitation. This framework was applied to the justification of criminal prosecution for non-intentional transmission of HIV through consensual sexual intercourse.

Results

Retribution

This includes pain inflicted or rights removed (such as freedom) in response to an action. Criminal law is retributive. However, in England and Wales, prosecution occurs for “reckless transmission” not reckless endangerment. It is legal to take a chance, but illegal if a certain outcome occurs.

Deterrence

A threatened legal sanction may prevent crime through fear of retribution. Criminalising transmission of HIV to an unknowing partner may increase disclosure. This approach is flawed. (1) The charge of reckless transmission needs the HIV positive person to know they are probably or definitely infected: criminalisation may prevent testing. (2) Criminalisation is counterintuitive to placing responsibility for an individual's sexual health with themselves, not with someone else. (3) Criminalisation stigmatises the HIV positive community.

Rehabilitation

Rehabilitation in prisons is not perfect, with 39.3% of those with convictions being re-convicted of crime in 2009. Any change in behaviour in the absence of specialised programmes may be due to deterrence.

Incapacitation

It is difficult to practise safer sex in prison as there may be a higher risk of coercion, sex work and covert sex. Sexual healthcare in the prison setting is unlikely to be equal to community sexual healthcare. Incapacitation cannot justify criminalisation in this case.

Conclusion

Prosecution for non-intentional transmission of HIV through consensual sexual intercourse satisfies few of the justifications for punishment. The case for criminal sanctions should be reconsidered.
P179 Life-time and recent recreational drug use is more common among men who have sex with Men compared to others attending sexual health clinics
Authors: Dargan P I , Hunter L , White J A , Benzie A , Wood D M
Published: May 2012

Background

Data on the frequency of recreational drug use (RDU) are collected at a population level through representative national surveys (eg, British Crime Survey). Anecdotally it appears that RDU is more common in men who have sex with men (MSM), but there are few systematic data to prove this. The aim of this study was to investigate the pattern of RDU in patients attending a sexual health clinic and to determine whether drug use was greater among MSM.

Methods

We administered a questionnaire to all patients attending the sexual health clinics at two inner-city London teaching hospitals over a 3-month period (July 2011–September 2011). The questionnaire was self-completed by patients while waiting to see a clinician. Data were collected on age, gender, gender of sexual partner(s) and previous/current RDU (type and frequency of drugs used).

Results

1328 questionnaires were completed (mean±SD age 30.5±8.5 years, 54.9% female); 254 (19.1%) were MSM. Life-time use of all drugs, except cannabis, was more common in MSM; last-month use of all drugs, except cannabis, cocaine powder and amphetamine, was more common in MSM (abstract P179 table 1).

Abstract P179 Table 1

Frequency of lifetime and last month use among the men who have sex with men (MSM) and non-MSM respondents

Lifetime useLast-month useMSM (%)Non-MSM (%)p ValueMSM (%)Non-MSM (%)p ValueCannabis62.758.40.2310.29.20.62Cocaine (powder)48.632.8<0.0014.32.60.14MDMA (pill)40.830.80.0022.70.90.02Mephedrone23.912.2<0.0013.10.1<0.001Ketamine33.717.3<0.0013.50.5<0.001Volatile nitrites71.426.9<0.00118.40.4<0.001Sildenafil (Viagra)43.515.7<0.00111.80.5<0.001Amphetamine29.821.20.0030.80.30.23Gamma-hydroxybutyrate (GHB)22.711.1<0.0012.40.1<0.001Gamma-butyrolactone (GBL)16.18.8<0.0013.10.1<0.001Methamphetamine16.99.0<0.0011.20.20.02

Conclusion

Sexual health clinics provide an ideal forum to identify individuals using recreational drugs and to implement behavioural interventions and education programmes to promote safer RDU, reduce drug-related harm and, in view of the association between RDU and high risk sexual behaviours, to decrease the risk of subsequent STIs. Our data show that both life-time and last-month use of most recreational drugs are more common in MSM and therefore interventions should be targeted to this population.
P182 Is it useful to perform a full physical examination in asymptomatic patients with late syphilis?
Authors: Dabis R , Radcliffe K
Published: May 2012

Background

In late and congenital syphilis a thorough physical examination should be undertaken for signs of syphilis as per British Association for Sexual Health and HIV guidelines. This should include examination of skin and mucosal surfaces, lymph nodes, the cardiovascular and neurological systems.

Aims

To audit all cases of late syphilis at our centre to see if a full cardiovascular and neurological examination was documented and also to see if a full examination contributed to the management of asymptomatic patients.

Methods

A total of 648 notes were identified as late syphilis from KC60 codes from our local database. Records were from the period 1994 to 2010.The following information was extracted from the clinical records: age, ethnicity, gender, sexuality, symptomatic/asymptomatic, cardiovascular and neurological examination findings and further action taken where applicable. 148 notes were unavailable. 20 notes were excluded. Therefore 480 notes in total were audited.

Results

Of the 480 patients, 262 (55%) were of Black Caribbean ethnicity, 75 (16%) White British, 68 (14%) Black African and 75 (16%) others. 240 (50%) were heterosexual males, 206 (43%) heterosexual females, 31 (6%) men who have sex with men. Information on sexual orientation was not available in 3 (1%). 295 patients were asymptomatic of which 288 (98%) had normal physical examinations. Seven asymptomatic patients had positive clinical findings but these did not lead to a diagnosis of cardiovascular or neurological syphilis. In 99 cases a full examination was not documented and in 21 cases patients declined or defaulted further follow-up. There were 65 symptomatic patients all had abnormal physical findings.

Conclusion

In view of the absence of significant clinical examination findings in asymptomatic patients with late syphilis we believe that a physical examination is not a necessary element in the management of such cases and should be omitted.
P183 How likely is environmental contamination ofChlamydia trachomatisDNA to lead to false positive results in patients attending our clinic?
Authors: Chan S Y , King R , Borgulya G , Pakianathan M , Sadiq S T , Hay P , Planche T
Published: May 2012

Background

Environmental contamination with DNA fromChlamydia trachomatis(CT) has been reported from GUM clinics, suggesting the possibility of cross contamination of specimens during sample processing or the environment. If it does occur, contamination is likely dependent to some degree on how busy patient throughput is in a clinic. Our GUM clinic sees over 29 000 patients a year.

Aims

To investigate whether diagnostic samples could become contaminated from the environment in our clinic.

Methods

We investigated the potential for contamination in two ways. (1) A dummy run of 60 sterile water samples, as surrogates of urine and 10 sterile swabs during routine clinic times. (2) A patient throughput study using logistic regression analysis to see if patients positive for CT were associated with attendance numbers. We hypothesise that possible contamination increases after each infected patient and drops off to zero over the weekend. Our clinic is open from Monday to Friday and cleaned daily. Toilets are not cleaned between patients. Results were analysed for walk in clinics.

Results

None of the dummy urine or swabs tested positive for CT over 6 months. In a year, 24 115 patients attended the walk in clinics with 2860 (11.9%) testing positive for CT. A logistic regression analysis was done on CT positivity on Mondays compared to Tuesdays to Fridays. This was adjusted for age, gender, sexuality and type of clinic. Rates of CT were 5% higher on Tuesdays through Fridays than on Mondays but the difference was not significant (95% CI 0.95 to 1.16).

Conclusion

There was no evidence of dummy sample contamination during our study period. We found weak association between CT positivity and clinic attendance although it was not significant at the 5% level. Further studies with a larger sample size and analysis on within day trends could explore this in depth. Environmental CT is unlikely to lead to false positive results in our clinic.
P184 Peyronie's disease presenting to a sexual health clinic
Authors: Draeger E M , Dharmaratne S D , Goh B T
Published: May 2012

Background

Peyronie's disease (PD) is an acquired inflammatory condition of the corpus cavernosum of unknown aetiology. This can lead to formation of a plaque within the tunica albuginea of the penis leading to curvature and pain of the erect penis and erectile dysfunction. Medical treatment options are with colchicine or pentoxifyline.

Aim

To characterise the patients who were seen between 1998 and 2011 with a diagnosis of PD.

Method

Retrospective case notes review of 18 identified cases with history and signs consistent with PD.

Results

The mean age of the 18 patients was 42 (range 20–63); six were Caucasians, six were from Indian subcontinent, five Africans and one Caribbean. All except one gave a history of change in penis shape during erection: six had upward curvature, seven bent to the left, one to the right, two had shortening of penis/distal flaccidity and one had no change. Seven had pain on erection, 10 had history of a penile lump, five had erectile dysfunction and two had difficulty in penetration. The mean duration of symptoms before presentation to the clinician was 64.1 months (range 3 weeks to 264 months), none had a history of penile trauma, intracavernosal injection or Dupuytren's contracture. Of four who had an ultrasound scan of the penis, two were confirmed to have lumps consistent with PD. Of 12 who had primary treatment with colchicine for 2–12 months; three showed improvement in symptoms, three no change and six unknown outcome. Of two who had primary treatment with pentoxifyline for 1–11 months one showed improvement in symptoms and one unknown. Of three who failed to respond to colchicine and were then treated with pentoxifyline, a further one showed improvement.

Conclusion

(1). 28% of cases had ED. (2). Overall, 33% of the patients had symptomatic improvement with treatment and none had worsened post treatment which is consistent with the findings of other studies.
P186 Should nursing staff in sexual and reproductive health (SRH) clinics wear a uniform?
Authors: Cunningham C , Stewart V , Emslie L , Davis T
Published: May 2012

Background

The NHS Scotland dress code policy was implemented in 2008 with the introduction of a national uniform in 2010. Historically nursing staff within SRH clinics have chosen not to wear a uniform to create a less formal environment. Within the policy it is stated that boards should conduct a full risk assessment to ensure that local policy is appropriate for different categories of staff.

Aim

To gather opinions from both patients and nursing staff about the impact of the introduction of the national uniform policy within the SRH service.

Methods

A patient (n=224) and nursing staff (n=13) survey was undertaken over a 10-day period in January 2012.

Results

The patient survey revealed that a minority (7%) of patients preferred that nursing staff wore their own clothes with the majority (54%) having no preference on staff dress code. The nursing staff surveys revealed that the majority work within a community health centre setting (46.2%) and were moderately happy with wearing a uniform (30.8%). Convenience was identified as a very important factor when choosing to wear a uniform (53.8%). The majority of staff agreed or strongly agreed that wearing a uniform made them more approachable (46.2%) and their role more identifiable to patients (71.6%) but they neither agreed or disagreed that it increased a patient's perception of their competency (46.2%) or enhanced professionalism (30.8%).

Discussion

Although there was concern that the introduction of uniforms for sexual health nursing staff might interfere with the nurse–patient relationship this has not be realised.
P187 Workforce planning and SAS Doctors: a crisis in waiting
Authors: Lee J , Carlin E , Robinson A
Published: May 2012

Background

The importance of medical workforce planning is well recognised but it is an inexact science and has usually concentrated on consultant and trainee numbers. The difficulties in planning are complicated by a lack of information on specialty and associate specialist (SAS) doctors.

Aims

We sought to aid workforce planning by collecting data from the SAS workforce to enable broader sexual health service planning.

Methods

A survey monkey questionnaire was devised and sent to all SAS doctors in sexual health who were known to the British Association for Sexual Health and HIV (BASHH) or its members. The survey was open for completion for 3 months from March 2011.

Results

In total, 227 SAS doctors (78% female, 22% male) completed the survey, 74% were on the new SAS contract, 44% as specialty doctors, 30% as associate specialists. Uptake was estimated at 40% on local assessment. According to the data in abstract P187 table 1, 1049–1253 genitourinary medicine (GUM) sessions/week are done by the respondents. Numbers are likely to be much higher given the estimated response rate. Significant numbers of HIV and sexual and reproductive health (SRH) sessions are also undertaken. Respondents indicated that 63% planned to retire within the next 15 years; 11% by 2013, 18% between 2014 and 2016, 20% between 2017 and 2022, 21% between 2022 and 2026, 29% were unsure when in the next 15 years they would retire.

Abstract P187 Table 1

Number of sessions performed by SAS doctors

% of SAS doctors working these sessionsNumber of GUM sessions/week 1–220 3–420 5–617 7–815 9–1018 ≥103Number of HIV sessions/week None74 1–219 3–42 5–62 7–82 9–100.5Number of SRH sessions/week None49 1–224 3–410 5–67 7–84 9–105

Conclusion

SAS doctors provide a major contribution to sexual health service work and given that 63% plan to retire within the next 15 years this is a crisis in waiting. Failure to take this data into account when planning for the future may mean that the crisis will become a reality.
P193 A mixed-method study of how to increase STI screening among young people
Authors: Loades N , de Visser R
Published: May 2012

Background

STIs are a considerable problem, with diagnoses concentrated among young people. Although the Theory of Planned Behaviour (TPB) predicts many health behaviours, there is a lack of research into how well it explains STI testing. The original TPB emphasised the importance of intentions as the ultimate influence on behaviour. Subsequent research focuses on implementation intentions—people who make explicit plans for how to implement their intentions are more likely to do so. Although some studies have analysed barriers and facilitators in STI testing, no published research has examined what impact developing implementation plans has. This study was designed to address this knowledge gap.

Objectives

To assess an extended TPB and implementation intention interventions on STI testing; to carry out a qualitative study of barriers and facilitators in those who intend to test.

Methods

371 participants completed an online baseline questionnaire and were randomly allocated to a control, information or implementation plan condition to examine differential effects on intentions to undergo STI testing. 172 completed a 6-week follow-up questionnaire to assess actual testing behaviour. In-depth interviews were conducted with a purposive selection of the sample and analysed using interpretative phenomenological analysis.

Results

Multivariate analysis revealed that TPB variables explained 20% of the variance in past testing behaviour (p<0.01) and 17% of variance in intention (p<0.01). No significant difference between intervention arms was found (p=0.90) (the intervention did not significantly strengthen intentions). Qualitative analysis revealed multiple perceived barriers to STI testing.

Conclusion

Results provide support for the utility of an extended TPB in predicting past behaviour and intentions to undergo STI testing. Although the implementation plan intervention was ineffective, qualitative data helped explain why a significant intervention effect was not found.
P195 Asking about sex in general health surveys: it can be done! Comparing data collected by the 2010 Health Survey for England with Natsal
Authors: Mercer C H , Robinson C , Craig R , Nardone A , Johnson A M
Published: May 2012

Objectives

The HSE is administered annually to a probability sample of people in England. In 2010, the HSE included, for the first time, questions about sexual health, which previously were considered too sensitive for a general health survey. This paper compares the reporting of sexual behaviours by people aged 16–44 in HSE2010 with Natsal-2, Britain's national probability survey of sexual behaviour.

Methods

HSE2010 interviewed 8420 people aged 16–69, of whom 2911 were 16–44. Natsal-2 interviewed 12 110 people aged 16–44 in 1999/2001. HSE2010 used pen-and-paper self-completion questionnaires for the sexual health questions, while Natsal-2 used computer-assisted self-interviews for the more sensitive questions.

Results

Collecting sexual behaviour data were acceptable to HSE2010 participants with low item non-response (5%–10%), albeit slightly higher than in Natsal-2 (<5%). Reported age at 1st intercourse was comparable in the two surveys: medians of 17 (men) and 16 (women) aged 16–24. However, for some very sensitive questions there were lower levels of reporting in HSE2010 than in Natsal-2: while the proportion reporting same-sex in the last 5 years was similar (2%–3%), reporting of ever having same-sex was lower in HSE2010 for men (2% vs 5% in Natsal-2). Similarly, the mean number of opposite-sex partners reported in HSE2010 was a little lower than in Natsal-2, particularly for men: 9.5 vs 12.7, respectively; (5.4 vs 6.5 for women, respectively). Men were also slightly less likely to report STI diagnoses in HSE2010 vs Natsal-2: 8.7% vs 11.1%, respectively; but this was reported by similar proportions of women (12%).

Discussion

Sexual behaviour data can be successfully collected by the HSE, albeit in less detail than in Natsal. HSE2010 has demonstrated the feasibility and utility of including such questions in general health surveys, providing a useful vehicle for monitoring sexual risk behaviour more frequently than is possible with decennial Natsal surveys.
P197 Young Asian sexual health: what can young Indian, Pakistani and Bangladeshi people tell us about their beliefs, attitudes and behaviours regarding sexual health and sex and relationships education?
Authors: Reynolds-Wright J , Alice N , Michelle M , Kanabar H
Published: May 2012

Introduction

Young people's sexual health in the UK has been a concern for public health policy and, despite falling teenage pregnancy rates, sexually transmitted infections (STIs) among young people have shown an increase. The numbers of Asian teenagers engaging in sexual intercourse is reportedly lower than their Black counterparts, however, there is some evidence that Asian young people are more likely to report “regretful intercourse”, “unequal willingness” and higher rates of anal intercourse, and so are still at risk of STIs through their behaviour.

Methods

16–25-year-old South Asian people were recruited from schools, universities and community organisations to participate in focus group (FG) or individual interviews. The Topic guide was developed following a literature review, steering group discussions and pilot FG. Following each FG or interview, emergent themes were explored in subsequent discussions. Ethical Permission was granted by NHS South Yorkshire Research Ethics Committee.

Results

NVivo 8 software was used to code, organise and support thematic analysis. A total of five FGs and six interviews have been completed and analysis indicates five over-arching themes: (1). Formal sex and relationships education (SRE) (2). Informal SRE (3). Relationships (4). Barriers to access of SRE and sexual health services (5). Future development

Conclusion

South Asian young people have distinct health education needs that are underpinned and informed by their ethnic, religious and cultural background. In order to deliver the best level of care to this group, awareness of these needs is essential.
P2 Audit of clinical stage at presentation and factors contributing to antiretroviral therapy delay, in HIV patients in rural Kenya
Authors: Hussey R
Published: May 2012

Background

The 2010 WHO guideline, “Antiretroviral Therapy for HIV Infection in Adults and Adolescents” states that those with HIV and CD4 counts ≤350 cells/mm3, should start antiretroviral therapy (ART), regardless of symptoms. Those with WHO clinical stage 3/4 should start ART irrespective of CD4 count. In a small hospital north west of Nairobi, an HIV clinic, which is fully funded, provides ART to over 4000 patients. Patients are assessed on WHO clinical stage and CD4 count for ART eligibility.

Aim

To audit a random sample of 100 patients attending the clinic and determine the WHO clinical stage at diagnosis, the number eligible for treatment at diagnosis and factors causing delay in ART initiation.

Method

Retrospective audit of 100 case notes. Recording patient gender, age, date of diagnosis, WHO stage, CD4 count, length of time from diagnosis to ART initiation and reasons for delay of treatment. “Counselling” is compulsory pre-treatment, usually over 3 weeks. “Patient default” is defined as patient non-attendance.

Results

82/100 patients were eligible for treatment at diagnosis. WHO clinical stage at diagnosis: 1–26, 2–17, 3–34, 4–5. Length of time between diagnosis and treatment: <28 days: 21/82, >28 days: 61/82, range: 4–861 days, mean: 102 days. Reasons for delay in those >28 days: TB diagnosis/treatment: 21, counselling: 18, patient default: 23 (see abstract P2 table 1).

Abstract P2 Table 1

WHO clinical stage of HIV infection at diagnosis

WHO clinical stage at diagnosisNumber of patients12621733445

Conclusion

82 of 100 HIV positive patients chosen at random were eligible for treatment at presentation, as per WHO guidelines. The majority of these patients were WHO stage 3 at presentation (41%). Length of time from diagnosis to ART initiation varies greatly and this is likely multifactorial. A significant number of patients (74%) did not commence ART within 4 weeks of diagnosis. The most common reason for this was patient non-attendance. In this setting, stigma attached to HIV diagnosis, extreme poverty and lack of education contribute to both late presentation and a delay in treatment initiation.
P20 Potential impact of updated UK guidelines for use of post exposure prophylaxis following sexual exposure in a London sexual health service
Authors: Snell L , Edwards S G , Benn P D
Published: May 2012

Background

Updated UK guidelines for post exposure prophylaxis following sexual exposure (PEPSE) outline new thresholds for when PEPSE is recommended (R), considered (C) or not recommended (NR).

Aim/Objective

We compared practice and outcomes according to 2006 and 2011 guidelines.

Methods

Retrospective review of electronic patient records between 20 January 2011 and 7 November 2011. Information regarding presentation, recommendations and outcomes were collected. Risk estimates were compared with guidelines. Blood abnormalities were classified grades I-IV. Data were analysed using Microsoft Excel.

Results

Of 325 requests to a London sexual health service, PEPSE was issued on 281 occasions to 268 patients. Gender: male n=258, female n=10, median age: 32 years, sexual orientation: men who have sex with men n=236, heterosexual n=25, not recorded n=7. Risk exposure: unprotected anal (n=263) and vaginal (n=26) intercourse. Source details: HIV+ n=112 (40%), on antiretroviral therapy n=31, viral load known 40 (14%) (<50 n=26, >50 n=14). 71 (26%) reported taking PEPSE ≥ once (range 1–5) previously. 99% commenced PEPSE within 72 h (median 30). Comparing those classified as R (n=258) and C (n=21) according to 2006 guidelines, 27 (10%) were reclassified NR using 2011 guidelines. Completion of 28 days PEPSE was reported in 59% cases, 100% adherence in 87%. Eight stopped early due to side effects (n=4) or the source tested HIV- (n=4). 148/268 (55%) had ≥1 blood abnormality, grade I-II (n=196) and grade III-IV (n=29). 1 patient developed acute interstitial nephritis. 196/268 (73%) underwent ≥1 screen for sexually transmitted infections; chlamydia (n=27), gonorrhoea (n=17), syphilis (n=4) and hepatitis B (n=1). Of 243 due 4-month follow-up, 52% have tested HIV− (n=122) and HIV+ (n=4).

Conclusions

We report high rates of repeat PEPSE, side effects/blood abnormalities and poor completion rates. Updated guidelines may result in a modest reduction in the use of PEPSE.