bluuebunny/crossref_metadata_2025 huggingface dataset:
P136 The evaluation of a stepped-care model for providing effective and cost-efficient psychosexual services within sexual health
Authors: Gurney Karen , Bullemor-Day Pip , White Kathy , Yates Michael , Jamieson Rhiann , Kiddy Caitlin , Der Walt Herman Van
Published: May 2024

Introduction

Increasing demand for sexual problems services plus reductions in commissioning have led to a need for high quality services delivered in a low-cost model within sexual health settings. A service redesign utilised a stepped-care model included the use of group therapy interventions as a first line treatment for erectile difficulties and painful sex. These interventions continued alongside existing MDT service provision.

Methods

All patients accessing the service in the first 12 months were given self-report outcome measures at key points of the intervention including quantitative and qualitative aspects of change. Results are compared between those accessing an erection difficulties group, a painful sex group and individual psychosexual therapy sessions.

Results

Abstract P136 Table 1

Psychosexual intervention results

InterventionIndividual
(n=32)Erection Group
(n=23)Pain Group (n=9)% significant change50%30%22%% change38%70%67%% reporting no change12%0%0%

Discussion

Further efforts to utilise group interventions for sexual problems may support the continued provision of psychosexual services in sexual health settings. Groups were evaluated favourably by service users and demonstrated considerable change. Qualitative feedback suggested distinct benefits of a group intervention over individual care. Those receiving a higher stepped intervention (individual sessions) may have been more complex and for others change in the problem in a traditional sense may not have been possible, however change was reported in other ways (i.e. affect in relation to the problem, relationship satisfaction).
P138 Can we reduce time to treatment by naming the infection in a results text?
Authors: Fearnley Nicola , Brady Sophie
Published: May 2024

Introduction

Previously patients testing positive for infections received a text (SMS) asking them to contact clinic. Often this led to missed calls, anxiety and delays in both communicating results and treatment. In June 2016 the wording of the text was changed to include the name of the infection and advice regarding how to access treatment.

Methods

We identified all patients attending our service with chlamydia or gonorrhoea infection between April and December 2016. We excluded those who had received treatment prior to confirmation of their test result (e.g. symptomatic, contacts of infection) and those who did not receive a results text. We reviewed the records of 200 consecutive patients (100 before and 100 after introduction of the new text) and compared time to treatment in the two groups.

Results

Old text recipientsmedian time to treatment was 2 days (d)/mean 3.3 (range 0–24d). New text recipients: median time to treatment was 2d/mean 3.9d (range 0–26d).

Discussion

Naming the infection in texts has not led to a reduction in the time to treatment but the median time to treatment in both groups was short. Our health advisor team report anecdotal benefits following the new text including less time spent answering telephone calls therefore allowing more time for patient contact, beneficial since depletion of the health advising workforce. Additionally patients have been happy to agree to the text change in advance with a reported reduction in anxiety knowing the name of the infection.
P140 A need to reinforce the importance of pregnancy testing and correct antibiotic regimen: a re-audit of pid management against bashh guidelines
Authors: Burridge Joanna , Aziz Najia , Mani Reena
Published: May 2024

Introduction

BASHH guidelines (2011) for the management of pelvic inflammatory disease (PID) recommend one of two antibiotic regimens for outpatient treatment. In addition, patients should be offered a pregnancy test and full screening for sexually transmitted infections (STI).

Aim(s)/objectives

To review PID management across the sexual health clinics, comparing it to the previous year’s audit and BASHH guidelines.

Methods

Data was retrospectively collected from December 2015 until March 2016. Data collected included whether pregnancy was excluded, STI screening, antibiotic regimen used, provision of written information, partner notification, and outcome at any follow up.

Results

51 patients were identified, 2 were excluded due to treatment by their GP. 100% of cases had at least one sign or symptom suggestive of PID. 47/49 (96%) of cases had STI screening; 41/49 (84%) had a HIV screen as part of this. Pregnancy was excluded in 22/49 (45%) of cases. A BASHH recommended antibiotic regimen was used in 28/49 (57%) of cases. Of the 21 of non-compliant cases, only 4/21 had a documented allergy or intolerance that precluded standard treatment.

Discussion

Since the last audit, recommended antibiotic treatment for PID has improved, but remains low at 57%. Pregnancy exclusion was low at 45%, compared with 70% at the last audit. Differences in how healthcare professionals record information on the electronic system could partially account for this. Actions have been taken to improve treatment and pregnancy testing by giving individual feedback to the clinicians, with a re-audit planned to assess the outcome of these interventions.
P141 Management of sexual assault in a nurse-delivered sexual health service
Authors: Funi Rita , Richards Catherine , Obeyesekera Sharmin , Theodore Cecelia
Published: May 2024

Introduction

Comparing April 2014 to March 2015 with the same period in 2013–14, has seen an increase of 32% in the number of serious sexual offences reported to Police in our county.

We audited management of complainants of sexual assault attending our nurse-delivered sexual health service against BASHH auditable outcome measures (guidelines 2011) and other factors relevant to improving the quality of sexual assault aftercare offered.

Methods

Retrospective study November 2014 to November 2015.

50 case notes were identified from two sites within our service – 23 from Site1 and 27 Site2. In addition to BASHH auditable outcomes, we included data such as: Time from assault to attendance, History of previous assault, Disclosure at time of attendance, Police report at attendance & Attitude to reporting at end of consultation, documentation of follow up plan re medical and psychosocial support/referrals.

Results

33/50 (66%) complainants were <25 years. Nearly 40% attended within the first 7 days, half of these within 3 days, 35/50 (70%) within 6 weeks of assault. Compliance with BASHH outcomes reached 100% in baseline STI screening and documentation of child protection needs, 84-92% for essential history components, 90% Hepatitis B offer, 79% Emergency contraception, 74% FME and 70% PEP offer. Self-harm assessment 76%. Documentation of physical injury 20% and offer of prophylactic antibiotics 2%.

Discussion

We have re-designed our proforma to more readily capture poorly documented information. A review use of skill mix, training updates regarding forensic time scales/pathways for early intervention were undertaken, with algorithms included in updated proforma.
P148 Female genital mutilation – when do you call 101?
Authors: Seneviratne Kanch , Boog Katie , Cooper Susan , Munatsi Shereen , Carlin Elizabeth
Published: May 2024

Introduction

Reporting cases of FGM in those aged under 18 years became mandatory in 2015. Protecting those who have been affected and safeguarding those at potential risk is paramount.

Aims

To evaluate staff knowledge of FGM and the volume of FGM seen in two neighbouring sexual health services.

Methods

Clinicians were asked to complete a questionnaire assessing their knowledge and understanding of the FGM care pathway. Case notes of women with a FGM code since its introduction in 2014 were reviewed.

Results

Forty-six clinicians completed the questionnaireTwenty-two women, aged 24–59 years, were identified with a FGM code, 91% were of Black African ethnicity.

Abstract P048 Table 1

Female Genital Mutilation

Do you understand the care pathway/management of FGM?PercentageAction taken if < 18yr with FGMNo13%Unable to provideNo22%Appropriate action describedYes52%Appropriate action describedYes13%Limited understanding of required action

Overall, 74% of staff were aware of the need to ask about other daughters, social services referral and police contact. A quarter were unable to summarise appropriate action plans, of particular concern in this group were those who felt they understood the care pathway. Only a fifth stated that they coded genital piercings as FGM.

Discussion

There is a clear knowledge gap in actions and coding required in relation to FGM. Over 80% staff recognised this and requested training. Plans are underway to deliver this and close the gap as a priority. A flow chart for quick reference has been developed and will be available at the conference.
P149 Patient involvement in sexual health service delivery
Authors: Meyrick Jane , Gray Debra , Jones Abigail
Published: May 2024

Introduction

Sexual and reproductive health and HIV (SRHH) services face unique PPI challenges, as the anonymity and confidentiality required by service users can be a barrier to attracting patient input. PPI could improve sexual health services, through increased trust in services and the ability to tackle sexual health inequalities. However, specific practical guidance on how to address PPI in sexual health and the evidence to support it is sparse.

Methods

This research aimed to begin building an evidence base for PPI in sexual health services through: 1) an audit of PPI in SRHH in the Bristol region; and 2) a parallel survey of potential users of sexual health services about their experiences of PPI. For the audit, 18 SRHH organisations from all those in the region invited complete a short online survey, representing a range of different service providers. For the online survey, 96 sexually active young people were recruited through a convenience sample.

Results

Sexual Health patients are reluctant to get involved in PPI work, often because of embarrassment. PPI work was highly variable with some reliance on customer satisfaction approaches. Patients reported not being asked for feedback and wanted to know what PPI is for. Services cited under-resourcing and a lack of time as barriers to improving PPI work.

Discussion

Improving the use of patient’s voice in sexual health needs through clarity of purpose (measured against outcomes), better communication with patients, and the exploration of flexible methods that respect patients’ needs for anonymity. Next steps will be outlined.
P152 Staff satisfaction improvement work: actively asking, listening and responding to the concerns of our staff
Authors: Hartley Anna , Williams Andy , Symonds Merle , Barter Janet , Apea Vanessa
Published: May 2024

Introduction

Contract tendering and service integration has resulted in great uncertainty for sexual health staff. Our service has recently integrated with sexual and reproductive health (SRH) and is currently under tender. We aimed to review and address the satisfaction of our staff.

Methods

An online survey was disseminated to staff at our sexual health service.

Results

73% of staff responded: 13 doctors, 9 nurses, 6 technicians, 15 health advisors/psychologists, 8 receptionists, 8 administrators, 3 anonymous. On a scale of 1–10, staff rated: feeling valued 5.9; enjoying work 6.4; day-to-day support 5.7. Scores were lower among receptionists (4, 4.1, 3.6 respectively). 61% felt day-to-day issues were dealt with in a timely manner. Cascade of information from management to staff was deemed ‘too little’ by 53%. 34% stated they did not have the opportunity to contribute to decisions affecting them. Staff found it easier to raise concerns with their line manager (6.7/10) than with management (5.7/10). These scores were lower among receptionists (3.6/10, 4/10 respectively).

Discussion

Improvement work is addressing the issues raised by our staff. Initiatives include: Staff Member of the Month Award; Daily team huddle actively including receptionists, addressing day-to-day issues; Psychology session with receptionists to better understand their concerns; Clinic has relocated to be next to reception (rather than on a different floor); A buddying system for incoming SRH staff; Regular integration emails from management and whole team briefings.

Discussion

Our survey demonstrates the need to actively ask, listen and respond to staff’s satisfaction, especially during such uncertain times.
P154 How well are we managing lymphoma in our HIV cohort over 5 years: a regional audit in three main HUBS
Authors: Malik Seema , Porree Mickaela , Patel Raj , Samraj Selvavelu
Published: May 2024

Introduction

Since the introduction of antiretroviral therapy, the life expectancy of HIV infected patients has increased significantly. As the incidence of opportunistic infections accounting for HIV related deaths has declined, malignancies now account for an increasing proportion of these mortalities, with lymphoma presenting second most commonly. In order to determine whether HIV positive patients with lymphoma are receiving best care, patients from three hubs within the region were reviewed.

Methods

Data was collected retrospectively from HIV positive patients with lymphoma from 1stof January 2010 to 31stof December 2014.

Results

Total number of patients in the study was 25 across the three centres with 8,12 and 5 patients from each centre. All patients underwent the recommended diagnostic procedures for diagnosis and 96% received appropriate imaging for staging. Of the 20 patients where documentation was available, 70% were diagnosed with stage IV lymphoma and 50% had the International Prognostic Index (IPI) score of 3 or more. 5-year survival rate was 72% and in those followed up for a minimum of 2 years the 2-year progression free survival rate was 100%. 28% patients died during the study period, 43% of whom had a late diagnosis.

Discussion

Management of lymphoma within three centres in the region is in line with current best practice guidelines. In order to improve the survival further, early diagnosis and treatment of HIV were identified as crucial factors necessitating increased awareness of HIV testing.
P158 Benefits of disintegration of a hiv service from a sexual health service?
Authors: Street Emma , Short Lindsay
Published: May 2024

Introduction

With an imminent split of our HIV service from an integrated sexual health service we felt it a timely opportunity to address anonymised blood testing in the HIV service.

Historically patients have had routine monitoring for HIV under their GUM number unless pregnant or have requested specific bloods under their name. Continued isolation of the HIV service, while complying with HIV patients wish for enhanced confidentiality, can have a negative impact on their care- increasing clinical risk and duplication of tests. As our patient age they require multidisciplinary input to manage comorbidities so integrated working is essential.

Methods

Patients were provided with an information leaflet about the service change and completed a survey/consent form starting in December 2015. If patients agreed to the switch this was implemented for their subsequent bloods.

Results

Our cohort size in 2015 was 394 – 2/3rdare male and over half MSM. So far 301 patient questionnaires have been analysed.

Results show 93% of patients have consented to changing to named bloods with a generally positive feedback to this change. We will present the results looking at the differences between those that consent and those that do not.

Discussion

Results suggest that the majority of patients are not concerned about loss of anonymity through switching to named blood samples. Switching to named blood samples is one small step in reducing the isolation of HIV care.
P163 Haart prescribing and bhiva standards of care for people living with hiv audit
Authors: Holwell Robert , Killeen Dawn , Ladipo Zana
Published: May 2024

Introduction

We audited our service against the BHIVA 2013 Standards of Care for People Living with HIV, BHIVA treatment guidelines for HIV-1-positive adults 2015 and North West 2015 treatment algorithm for HIV-1-positive adults 2015.

Methods

This is a retrospective audit involving the review of all patient notes (84). 64 patients were excluded as they were started on medication before 2013.

Results

40% of all patients had a CD4 count of more than 350 when they were started on medication and 10% had a CD4 count of <200. Only 5% had HIV related symptoms. 15% were started as prevention of transmission.

30% (6 in 20) of patients were started on treatment on/after 2015. Only 17% (1 in 6) of these patients had been prescribed treatment according to the North West 2015 algorithm (The patient was given Kivexa based therapy when they could have had Truvada). First line therapy according to BHIVA 2015 guidance was prescribed in 100% of patients (Standard of care target >75%).

100% of patients adhered to their medication within the first 3 months (Standard of care target >95%). None of the patients who had viral loads done had experienced virological rebound (Standard of care target <2%).

Discussion

We are 100% compliant to the BHIVA treatment guidelines while only 17% compliant to the North West algorithm. To improve our service and make it more viable, we will update our proforma according to the North West algorithm, which reflects the availability of cheaper generic drugs and NHS England guidance.
P167 Pilot feasibility trial of targeted sexual risk reduction interventions within sexual health settings in england – the santé project
Authors: King Carina , Llewellyn Carrie , Anstee Sydney , Clark Laura , Bailey Julia , Pollard Alex , Abraham Charles , Burns Fiona , Rodger Alison , Copas Andrew , Shahmanesh Maryam , Gilson Richard
Published: May 2024

Introduction

There is evidence from RCTs that brief behavioural interventions can have modest but valuable impacts on sexual risk behaviours and STIs in young people and men who have sex with men (MSM). Implementing these nationally could reduce STIs, but has not yet been done. Santé aims to adapt and pilot a package of evidence-based risk reduction interventions, and assess the feasibility of conducting a large-scale effectiveness trial.

Methods

Following a systematic literature review, mixed-methods evaluation of existing practice, and patient and provider preference, a process of Intervention Mapping was used to adapt effective interventions and create an intervention package for MSM and young people. Triage algorithms were developed using routine surveillance data. A pilot cluster trial is running in eight sexual health clinics. Quantitative process data and qualitative interviews with patients and providers will assess feasibility.

Results

The intervention package is a triage algorithm which directs patients into a low-intensity digital intervention or high-intensity one-to-one behaviour change consultation. No identified digital interventions were available for piloting; therefore, patients are directed to suitable health promotion websites. An intervention manual incorporating a Five Step Pathway was developed for the one-to-one consultation, detailing the behaviour change elements. Preliminary pilot results will be available in June 2017.

Discussion

The pilot will identify issues that need addressing to make a large trial feasible. Although intended to be deliverable within existing clinic resources, current service changes threaten the viability of such innovations. Further adaptation and development of digital resources will be needed prior to implementation.
P168 Data analysis of a self-completed questionnaire for patients within a men-having-sex-with-men clinic
Authors: Bayman Philip , Gilson Rebecca
Published: May 2024

Introduction

The questionnaire was created to discover the characteristics of the MSM population attending a clinic dedicated to their sexual health needs. It covered reasons for attendance, risk factors for sexually transmitted infections and blood-borne viruses transmission and usage of post-exposure prophylaxis and pre-exposure prophylaxis. The data would be used for adaptation of the clinic.

Methods

The questionnaire was given to clinic attendees for a 75 day period in 2016 and kept anonymous by a unique client number. The collated data was analysed and reproduced in graph and table form for categories split into reason for attendance.

Results

Acceptability of the questionnaire was high at 99.2%. The data analysis showed a large asymptomatic client population (57%) attending the clinic for sexual health screening. For contacts of infection, HIV and gonorrhoea were the most prevalent. For STI and BBV infection risk factors, 15% of clients did not use condoms, while 49% of clients did not know a sexual partner’s HIV status. Use of PEP was low but showed a majority using it since 2015, while there were 5 users of PrEP.

Discussion

The study showed a majority low-risk MSM population using the dedicated clinic. The survey has influenced clinic redesign with the introduction of test-only clinics for the low risk cohort. However the clinic may not be seeing the high-risk patients who would benefit from senior medical input rather than just a sexual health screen. Data showing usage of PEP and PrEP has given a baseline for comparison in future studies.
O22 Acceptability of HIV self-testing among men who have sex with men attending a sex on premises venue in brighton: a cross sectional survey
Authors: Amlani Aliza , Dean Gillian , Soni Suneeta , Peralta Carlos , Llewelyn Carrie , Vera Jaime
Published: May 2024

Introduction

Interventions to target and test men who have sex with men (MSM) for HIV are crucial to reduce incidence. Accessing traditional healthcare services can act as a barrier to HIV testing. Testing in outreach settings, such as sex on premises venues (SOPV), may be more successful. This study aimed to determine the acceptability of HIV self-testing in MSM sauna clients.

Methods

An anonymous cross sectional, electronic/paper survey was conducted in a male SOPV in Brighton. Results were collated using Survey Monkey.

Results

A total of 281 clients responded. 23% were aged 25–34 years, 16% 35–44 years and 37% 45–64 years. 32% reported never testing for HIV; 56% had not tested in the last 12 months; 44% felt they were not at risk of HIV. 93% would consider collecting a HIV self-test at the sauna with 40% wanting to test there and then, and 53% preferring to test at home.

Discussion

A significant number of MSM attending this SOPV felt they were not at risk of HIV, and had never tested for HIV or not tested for over 1 year. Despite this, most individuals found testing at the SOPV acceptable, and would consider HIV self-testing if it were available. Innovative methods to enable HIV self-testing in venues frequented by high risk MSM are urgently needed.
P177 D2B or not d2b: a regional multicentre survey in level 3 gum clinics of ‘other conditions requiring treatment’
Authors: Sanmani Leela , Priestley Cecilia
Published: May 2024

Introduction

Diagnoses in patients attending GUM clinics are coded using SHHAPT codes. D3 is used for conditions not requiring treatment. It is often taken to mean a negative STI screen; however the code may not reflect the time or expertise required for a consultation with a high risk or anxious individual. The D2b code is used for ‘other conditions requiring treatment’ for which there is no other appropriate SHHAPT code. D2b codes did not attract funding in the SRH tariff.

This survey aimed to identify the range of complex consultations and non-STI work seen in GUM clinics that were not captured by the coding.

Methods

A retrospective case notes review of patients with a D3 or D2b code attending GUM clinics in 2011. Data was gathered on socio-demographic details, SHHAPT codes and other diagnoses, and outcome. The data was analysed using Excel.

Results

594 patients were included (339 D2b, 255 D3). The commonest diagnoses were genital dermatoses 129(22%). Other diagnoses included chronic pelvic and vulval pain (27), other gynaecological and urological conditions (23), prophylaxis of recurrent infections (33), psychosexual and complex consultations including high risk sexual behaviour, sexual assault, and safeguarding referrals (65).

Discussion

Following this survey, a list of D2b sub-codes was developed for use in all the regional GUM clinics. Since then, SRHAD codes have been introduced for complex dermatology, urology, and gynaecology conditions. However the continued use of the D2B sub-codes for high risk patients and complex consultations provides valuable data to support commissioning.
P178 Traumatic recto-vaginal fistula after consensual sexual activity: a case series
Authors: Waite Kathryn , Webster Claire , Karandikar Sharad , Bowley Doug
Published: May 2024

Introduction

Consensual vaginal intercourse may be associated with relatively minor genital injury, such as mucosal abrasions, tears or ecchymoses. More severe genital injury is more likely to be associated with rape or sexual assault by penetration with an object. Conversely, we know that the absence of genital injury does not mean that rape or serious sexual assault did not occur.

Methods

We report a small series of patients presenting with severe and life-threatening genital injury after consensual sexual activity.

Results

An adult woman presented with lower abdominal pain and faeculent vaginal discharge after sexual activity with her intimate partner involving consensual and simultaneous insertion of two sex toys (oneper rectumand anotherper vaginam). She had sustained a 100mm defect in the posterior vaginal and antero-lateral rectal walls. Despite surgery and faecal diversion, she developed severe sepsis that required extended critical care.

A second patient presented with faeculent dischargeper vaginamafter consensual, ‘conventional’ peno-vaginal intercourse. On examination, she was found to have a 30 × 20 mm low recto-vaginal fistula; on this occasion not associated with peritoneal contamination or serious septic response.

Discussion

Traumatic recto-vaginal fistulae are rare with implications for both immediate morbidity and mortality and long-term physical and mental well-being. These cases demonstrate the extreme spectrum of genital injury that may be associated with consensual sexual activity. Recognition that this severity of injury can occur following consensual activity is important and our first patient’s story also highlights some of the public health implications concerning the use and regulation of sex toys.
P180 Unusual causes of genital ulceration presenting to genitourinary medicine clinic – a case series
Authors: Kinghan Emma , Megarity Stephen , McCarty Emma
Published: May 2024

Introduction

Genital ulceration presents frequently at GUM clinics, with herpes simplex (HSV) infection a common aetiology. A diagnosis of HSV is distressing with possible implications for relationships and future pregnancies. It is therefore important to consider other causes if atypical presentation or negative HSV PCR from area of active ulceration.

Method

Case review of uncommon aetiologies of ulceration.

Results

Case 1: 25 year old. Prodromal sore throat and flu-like symptoms. Examination revealed deep ulcers on vulva and oral mucosa without eye or skin involvement. CRP 120, ESR 80, ASOT titre 400, negative autoimmune screen, monospot negative. Developed anterior uveitis and erythema nodosum 24 hours later. Diagnosed with Behcet’s disease requiring prednisolone and mycophenolate mofitil.

Case 2: 28 year old. Prodromal sore throat and headache. Sexual history atypical for HSV. Known Graves’ disease, on propylthiouracil. On examination, patient looked unwell. Shallow vulval ulceration noted. Neutrophils 0.1, ESR 31. Diagnosed with apthous ulceration secondary to neutropenia and admitted for neutropenic-sepsis treatment. Required thyroidectomy with pathology revealing papillary carcinoma.

Case 3: 13 year old referred by SARC. No history of sexual contact or features of child sexual exploitation. Prodromal flu-like illness. Of note, mother Influenza A positive.

No response to empirical acyclovir. HSV PCR negative. Nasopharyngeal swab confirmed Influenza A. Case subsequently closed with SARC and Social Services.

Discussion

This case series highlights less common but important causes of genital ulceration. Full systemic history and clinical assessment remains essential in those where alternate diagnoses to HSV are being considered.
P191 Prevalence and impact of musculoskeletal pain among staff working in a large integrated sexual health service in uk
Authors: Malik Seema , Sundaram Sangeetha , Samraj Selvavelu , Turner Jill , Walker-Bone Karen
Published: May 2024

Introduction

Musculoskeletal pain (MSKP) is common and contributes to sickness absence among people of working age. Little is known about the occurrence of MSKP in staff working in Sexual Health (SH).

Methods

SH staff working in a large integrated service completed a questionnaire exploring MSKP at several different anatomical sites, its severity and impact on work and personal life.

Results

39/80 (49%) questionnaires were completed. One staff member reporting pre-existing MSK problems was excluded. 92% respondents were female. 61% of doctors and 85% of nurses reported MSKP. Low back (LB) pain was more common in nurses (76%) than doctors (27%). However, involvement of single or multiple sites and overall impact were comparable for both groups. Those with/without pain were not significantly different in terms of age, median time working in SH or types of routine procedures. The most common site of pain was LB (54%). Pain intensity was on average moderately severe during the day (29%) and more severe at night (46%). Moderate to fairly severe impact was reported for work/daily routine (34%), social activities/hobbies (29%), sleep (29%), fatigue/low energy (26%) and emotional wellbeing (23%).

In terms of impact including seeking healthcare, using analgesia, missing work and interference with normal/recreational activities the most common sites implicated were LB, neck and hand pain in that order.

Discussion

MSKP is very common among SH staff and causes significant impact professionally and personally. Reassuringly, symptoms were not markedly associated with any particular clinical procedure.
P192 Syndemics among gay, bisexual and other men who have sex with men in the united kingdom and the republic of ireland: empirical evidence of clustered health inequalities
Authors: McDaid Lisa , McAloney-Kocaman Kareena , Flowers Paul , Boydell Nicola , Coia Nicky , Kerr Yvonne , Frankis Jamie
Published: May 2024

Introduction

Gay men experience a multiple burden of ill health in relation to sexual health, mental health and substance use and there is growing recognition that these could cluster assyndemichealth inequalities. Few studies (outside the USA) have addressed the co-occurrence of such negative health outcomes. We examine empirical evidence of syndemic health outcomes in an online cross-sectional survey of MSM.

Methods

Self-report data on sexual, mental and physical health outcomes from the SMMASH2 survey of 3373 MSM in Scotland, England, Wales, Northern Ireland and the Republic of Ireland in 2016 were used to derive a measure of syndemic ill health.

Results

Overall, 68.2% reported at least one sexual health outcome, 60.4% reported at least one mental health outcome, and 61.0% reported at least one physical health outcome. There was significant co-occurrence of outcomes, with 67.0% reporting multiple health outcomes; 42.0% reporting two, and 27.0% reporting all three. There was statistically significant clustering of the behaviours at all levels. When examining all three outcomes concurrently, all were clustered with greater prevalence than expected if the outcomes where independent (O/E Ratio=1.07; 95% Confidence Interval 1.004 –1.14).

Discussion

Clustering of poor sexual, mental and physical health provides evidence of syndemic health inequalities in communities of gay, bisexual and other MSM surveyed online (at levels significantly higher than the nationally estimated prevalence of 8.4%). Current health improvement efforts are often characterised by disjointed services, which should be reconfigured to ensure a holistic approach to addressing the complex, multi-faceted, interrelated issues affecting these communities.
P194 Rolling out the uk’s first regional msm hpv vaccination programme: early evaluation and practical considerations
Authors: McIntyre Michelle , Quah Say , Wilson Yvonne , McCarty Emma , Dinsmore Wallace
Published: May 2024

Introduction

The four countries in the UK had different interpretations of the JCVI HPV vaccination recommendations. We aim to describe our experience to date of the full vaccination programme that commenced in our region in October 2016.

Methods

We conducted a retrospective review of our opportunistically-offered vaccination programme, using both electronic and paper records.

Results

From October 2016 until end January 2017, 827 vaccines were administered to 609 patients. The records of 274 vaccinees were analysed. 59% were HIV negative, 41% positive. 99% were MSM, aged 18 – 67, 12% were over 45, 43% were diagnosed with an STI or had PEP in the preceding 6 months, 74% had no documented history of genital warts. 11% attended solely for the HPV vaccine at their second visit. 91% of HIV positive patients re-attended for their second vaccine at their usual HIV clinic appointment. An estimated completion rate, calculated using those who re-attended as planned at one month and received a second vaccination, was 83%. For the HIV positive cohort, this was higher still at 95%.

Discussion

We found that opportunistically vaccinating this cohort resulted in only 11% of all second attendances being solely for a HPV vaccine, and only 6.5% in the HIV positive cohort. Our completion rate, calculated using data at one month, was high. We aim to present a full six months of data.
P200 Just google it! impact of media coverage of an outbreak of high-level azithromycin resistant gonorrhoea on attendances, and gonorrhoea testing and diagnoses at local sexual health clinics in england
Authors: Smolarchuk Christa , Furegato Martina , Mohammed Hamish , Town Katy , Fifer Helen , Wilson Janet , Nardone Anthony , Hughes Gwenda
Published: May 2024

Introduction

We investigated whether media coverage of an outbreak of high-level azithromycin resistant gonorrhoea in England, dubbed ‘super gonorrhoea’, affected online searches nationally, and attendances and gonorrhoea testing and diagnoses at sexual health clinics (SHCs) in affected areas.

Methods

Google Trends was used to determine Relative Search Interest (RSI) for ‘gonorrh*’ and ‘super gonorrh*’ in England from 2015 – 2016. Using data from England’s national STI surveillance system, an interrupted time series analysis was performed to compare the sex-stratified, weekly rates of attendances, and gonorrhoea testing and diagnoses at 6 SHCs in Leeds and in five other affected areas. The analysis compared rates of events 6 weeks before and after initial media coverage of the outbreak in September 2015.

Results

The RSI peaked during initial media coverage in September 2015 with smaller peaks coinciding with subsequent coverage. The number of SHC attendances by women in Leeds rose after initial coverage (p<0.01) by 36% (from 320 to 435/week), but there was only a 4% increase in attendances (from 326 to 340/week) by men (p=0.70). There was no change in rates of gonorrhoea tests or diagnoses in women (p=0.87 and 0.23) or men (p=0.51 and p=1.00). There were no significant increases in event rates in five other areas with a high RSI.

Discussion

We demonstrate that media coverage can impact health-seeking behaviours during high-profile outbreaks. Further research is needed to inform how best to target these messages to those most likely to benefit from attending and being tested in SHCs.
P202 Increase in diagnoses of early infectious syphilis: local outbreak or following the national trend?
Authors: Goode Deborah , Kennedy Sarah , Evans Amy , Talbot Angela , Page Emma , Cronin Mary , Hughes Gareth , Padfield Simon
Published: May 2024

Introduction

There has been a substantial increase in the incidence of early infectious syphilis (EIS) in our large city clinic, apparent since reconfiguration of services in July 2015.

Methods

A retrospective case note review of electronic patient records was undertaken to investigate whether this was due to a local outbreak or in keeping with recent national trend. A database search for primary, secondary & early latent syphilis identified 78 and 116 cases in 2015 and 2016 respectively. These records were assessed using BASHH audit standards and reviewed for various lifestyle risk factors. We worked with Public Health England to address concerns regarding a possible local syphilis outbreak.

Results

Of 168 patients, 85% were MSM: 34% and 28% were HIV positive in 2015 and 2016 respectively. Of the patients with known HIV, 64% were diagnosed as part of their HIV care. Partner notification reached 0.56 contacts per index case. Of the 89 contacts, over 50% were positive for syphilis. Retrospective analysis of surveillance data identified a breakpoint in July 2014 associated with a monthly increase in cases since then with no observable change in patient demographics.

Discussion

Service reconfiguration focussed on MSM risk groups, coincided with increased EIS diagnoses within 1 year. However, epidemiological analyses indicate a continuum from 2014 following national trend. Routine syphilis screening in HIV care remains an essential tool for early case finding. As 80% were first syphilis infections we are evaluating syphilis point of care testing alongside capillary blood sampling to increase screening in outreach settings.
P205 The functionality of dating applications in sexual relationships and sexual health
Authors: Vojt Gabriele , Smith Matthew , Woode-Owusu Melvina , Mapp Fiona , Flowers Paul , Pothoulaki Maria , Estcourt Claudia , Palermo Amir , Valencia Mario , Ejedenawe Oluwatomilayo , Dankyi Stephanie , Attah Sally-Rae , Levy Noemie , Mercer Cath , Saunders John , Symonds Merle , Wayal Sonali
Published: May 2024

Introduction

Dating apps are an increasing way people meet each other for sex and relationships. Their functionality captures aspects of contemporary sexual culture and reflects the ways relationships are understood. This study systematically assed dating app functionality in relation to sexual relationships and sexual health.

Methods

We examined the top down-loaded 500 dating apps listed on a public platform of dating applications (App Annie). Following screening using inclusion and exclusion criteria, data were systematically extracted from included dating apps (n = 259). Data were collated regarding how the App functionality related to target population, and included links to sexual health interventions. We specifically coded how the Apps defined the kinds of relationship the app-user was in and the kind of relationship the app-user was looking for.

Results

Forty percent of dating apps were designed for specific user populations defined by nationality, religion or sexual orientation and preference. Dating apps varied greatly in the ways their functionality reflected types of relationships (e.g, it’s complicated’, ‘something long term’, ‘friends with benefits’). Only a minority of dating apps (4.2%) provided a link to sexual health information, interventions or referral to clinical service options.

Discussion

This study can help clinicians to better understand the relationships people have, the words used to describe these relationships and the likely impact this has on sexual behaviours, onward transmission and potential partner notification interventions.
P207 Outbreak of hep a affecting msm: the london response
Authors: Mindlin Miranda , Crook Paul , King Michael , Chandra Nastassya , Maimo Mary , Gibson Kenny , Heffernan Catherine , Heathcock Simone Thorn
Published: May 2024

Introduction:

Outbreaks of hepatitis A virus (HAV) have previously been described in men who have sex with men (MSM). BASHH only recommends HAV vaccination for MSM during outbreaks. A UK cluster of HAV cases was identified and, by 27/2/2017, London had 45 probable and confirmed cases in MSM. London sexual health commissioning is in flux with new arrangements imminent.

Methods:

For individual notified cases, Health Protection Teams (HPT) routinely assess source, offer infection control advice to the case and organise vaccination of household and sexual contacts. A London outbreak control team (OCT) comprised epidemiologists, commissioners and providers of immunisation and sexual health services, health promotion partners and communications. The OCT scoped possible additional interventions to control the outbreak.

Results:

The OCT recommended: Awareness raising re risk behaviour:Distribute a nationally commissioned leaflet with safer sex advice to cases and to genitourinary medicine (GUM) clinics, plus relevant content on digital platforms.

Liaison with providers, commissioners: Inform GPs. Survey current practice in GUM for HAV immunisation. Vaccinate MSM opportunistically in GUM clinics (if had a new or casual partner in last 3 months).

Link with existing health promotion networks: Working with gay venues, to get understanding and cooperation.

Set up vaccination clinics near the popular venues

Discussion:

It is challenging to set up an immunisation programme in a large city with complex commissioning relationships at short notice. Consideration should be given to vaccination between outbreaks to reduce the proportion susceptible, or ‘outbreak ready’ plans included in sexual health commissioning arrangements.
P214 The use of anabolic steroids in males attending a sexual health clinic
Authors: Horn Kate , Poore Sophie , Fernandes Arnold
Published: May 2024

Introduction

A 2013 study by Public Health England stated ‘Men who inject anabolic steroids (AS) and tanning drugs are at higher risk of HIV and viral hepatitis’. Injectors of AS are now the biggest client group at many needle and syringe programmes in the UK. The British Crime Survey on AS use among 16–59 year olds in England and Wales found in 2009/2010 0.7% had ever used and 0.2% had used in the last year. There have been no studies looking specifically at prevalence in sexual health clinic attendees and we wondered whether this might represent a different population.

Methods

All male attendees to the sexual health clinic were invited to participate in the survey by self-completing an anonymous questionnaire about use of anabolic steroids, basic demographic details and details of known pre-existing blood borne virus infections.

Results

96 respondents. Age range: 3% <18, 55% 18–25, 42% >25. 82% self-identified as heterosexual. Only 1 patient admitted to having known HIV infection, none to hepatitis and 5 individuals opted not to answer this question. 4.1% admitted previous use of anabolic steroids. All were heterosexual, had injected and had used within the last year.

Discussion

The use of image and performance enhancing drugs has grown substantially, but the risk of exposure to blood borne viruses among those who inject drugs to change body appearance or improve performance has rarely been studied. Although small numbers, our survey identified higher than anticipated use of injected anabolic steroids in males attending our sexual health service.
P217 Syphilis on the rise – implementation of enhanced surveillance
Authors: West Daniel , Emmett Lynsey , Salimee Sultan , Reacher Mark
Published: May 2024

Introduction

Diagnoses of infectious syphilis have risen dramatically in the UK since the late 1990s. This resurgence has been facilitated by a number of outbreaks across the UK, occurring mainly in men who have sex with men but also in heterosexual men and women.

In response, a number of enhanced surveillance initiatives have been developed and implemented across England to collect timely demographic, clinical and risk factor information. These run alongside the routine surveillance system for sexually transmitted infections, the quarterly Genitourinary Medicine Clinic Activity Dataset (GUMCADv2). The system in the East of England is described here.

Methods

Up to 2016 two paper based forms were utilised. A one page ‘surveillance’ form was completed for every case of infectious syphilis, and a more detailed ‘investigation’ form used if an unusual increase required investigation. During 2016 these two forms were merged and information is now entered into an online form. All forms are completed by the diagnosing clinic.

Data collected is used to generate automatic reports, identify and investigate any unusual increases and for audits against GUMCADv2.

Results

Enhanced surveillance has allowed the identification of a number of unusual increases prompting timely and appropriate investigations to be launched; identified opportunities to improve reporting standards. The change to an online system has improved the timeliness and accuracy of reporting and made the system more secure.

Discussion

Ongoing enhanced surveillance complementing GUMCADv2 is important. This information provides timely intelligence on the epidemiology of infectious syphilis across the region.
O26 ‘It just gives you the heebie jeebies’: late middle-aged adults’ engagement with knowledge of sexually transmitted infections
Authors: Dalrymple Jenny , Booth Joanne , Flowers Paul , Hinchliff Sharron , Lorimer Karen
Published: May 2024

Introduction

Rates of sexually transmitted infections (STIs) among adults over 45 are rising in the UK and other Western countries. While STI rates are higher among men who have sex with men and young people, there is increased fluidity of sexual partnerships across the life course, exemplified by mid-life divorce and re-partnering, with sexual activity continuing beyond the age of 80. In order to develop a risk-reducing intervention for this age group, this qualitative study sought to understand the socio-cultural factors influencing late middle-aged adults’ knowledge of STIs.

Methods

Recently sexually active heterosexual adults aged 45–65 (n=31) were recruited from a large city sexual health service and sport and leisure centres. In-depth individual interviews explored how STI-related knowledge was acquired across the life course. Interview data were transcribed and analysed thematically.

Results

Most participants (n=19) lived in areas of high deprivation and most were divorced, separated or bereaved from partners (n=24). Two key themes revealed that STI-related knowledge was acquired over the life course through personal social circumstances and wider cultural influences: 1) early stigmatisation of STIs influenced current understandings and 2) women in particular learned about STIs through parenting their adolescent children. Further themes showed that 3) knowledge of STIs was stated tentatively and 4) current STI knowledge did not necessarily facilitate health-seeking behaviour.

Discussion

Engagement with STI-related knowledge among middle-aged adults is influenced by socio-cultural factors including the enduring stigmatisation of STIs. Interventions tackling stigma should aim to recognise and legitimate changing sexual partnerships across the life course.