bluuebunny/crossref_metadata_2025 huggingface dataset:
P119 Integrated care in sexual health: a novel training programme to engender culture change for trainees in primary and secondary care specialties
Authors: Bradbeer C , Mears A , Kulasegaram R
Published: May 2012

Background

Changes in the NHS dictate that staff in general practice (GP), public health (PH), SRH and GUM work closely together. This integration cannot be achieved by processes and structures alone. It requires a substantial change in attitude and understanding between the protagonists.

Aim

To develop a training programme to increase trainees' understanding of the philosophy and ways of working of other disciplines involved in delivering sexual health care, so as to facilitate collaboration and integrated working.

Methods

The day-long programme, first held in February 2011, was delivered to 21 specialist trainees reaching the end of their training in GUM, SRH, PH and GP. The London Deanery funded the innovation and invited participants from among its trainees. Each day was structured to cover: understanding population health; an update on the future of the NHS; workforce planning; involving patients and public; developing services, financial considerations and examining patient pathways. There was humorous stereotyping of specialties followed by group work to dispel misconceptions and understand each other's viewpoint. Speakers represented all invited disciplines and included a senior manager, a third sector leader and a member of the government's Listening Forum. A detailed evaluation of the day included an interval questionnaire after 4–8 months.

Results

Two training days have now taken place; a third is oversubscribed for February 2012. Trainees said it was excellent, they found it inspiring and thought provoking. They requested more workshops which have been incorporated. Interval evaluations showed trainees had undertaken joint working and used their learning to prepare for consultant interviews. The model has now been used by London Deanery in related generic training programmes for other professionals and other disciplines.

Conclusion

This model programme delivers effective training in leadership and culture change.
P125 The association between condom proficiency, condom problems and STI risk among Scottish MSM
Authors: Goodall L , Clutterbuck D , Flowers P
Published: May 2012

Background

The effectiveness of condoms in preventing sexually transmitted infections (STI) including HIV depends on consistent and correct use.

Aims

To examine associations between demographics, STI risk, condom proficiency, condom problems and STI acquisition among MSM and to direct discussion and debate towards thinking about how and why it might be important to improve condom use skills.

Methods

Cross-sectional surveys of MSM were conducted in GUM clinics and commercial gay venues in Summer 2010. The self-completed, anonymous questionnaires recorded data on socio-demographic variables, numbers of unprotected anal intercourse (UAI) partners in the preceding year, STIs diagnosed over the previous year and self-reported condom problems and condom proficiency.

Results

792 respondents provided data with an overall response rate of 70% (n=459 clinic sample, n=333 community). Number of UAI partners was the strongest predictor of self-reported STI acquisition over the previous 12 months. Demographic characteristics were not associated with self-reported STI diagnosis. However, condom proficiency score was associated with self-reported STI acquisition in the previous 12 months. Condom problem score was also associated with self-reported STI diagnosis in the clinic but not community sample. Condom problem score remained associated with STI diagnosis after adjusting for number of UAI partners with logistic regression.

Discussion

This study identified a measure of condom use associated with likelihood of STI diagnosis when controlling for number of UAI partners. Targeting those who experience condom problems may improve overall frequency and consistency of condom use among MSM; in turn reducing likelihood of STI acquisition. This could involve developing condom problem scales into screening tools for STI risk. Accordingly we encourage further research to determine the value of condom use training as a potential intervention to improve sexual health among MSM.
P127 An audit of the management of complainants of sexual assault compared with the British association for sexual health and HIV (BASHH) 2011 guidelines
Authors: McGranahan M , Gupta N , Goold P
Published: May 2012

Background

The revised BASHH guidelines for the management of sexual assault were published in 2011. Introduction of a new electronic patient record (EPR) at a sexual health clinic provided an opportunity to audit the management of sexual assault.

Aims

To review the clinical care of complainants of sexual assault against the auditable outcome measures identified in the guidelines.

Methods

The EPR of patients attending between 1 August 2010 and 31 July 2011 was searched using the term “assault.” Cases reporting a sexual assault for the first time were included and reviewed against the auditable outcome measures. Demographic data and sexually transmitted infection (STI) test results were recorded.

Results

236 records were identified but 99 cases fulfilled the inclusion criteria. Of the 14 auditable outcomes, only HIV risk assessment reached the 100% standard and seven achieved above 60% concordance (offer and provision of HIV post-exposure prophylaxis, emergency contraception, follow-up tests, forensic medical examination, hepatitis B vaccine and detailed history of assault). Child protection assessment was documented in 57% of under-19s. 28% had the recommended STI tests and 16% were offered STI prophylaxis. There were no self-harm risk assessments documented. STI prevalence was: Gonorrhoea 8%, Chlamydia 9%, HIV 2%, Hepatitis C Virus and Trichomonas 1%.

Conclusion

Low STI testing rates overall are explained by Hepatitis B and C testing not previously being a requirement unless there was a specific risk identified. The clinic conducts an automatic risk assessment for under-16s but not for under 19s. STI prevalence was high. A sexual assault pro-forma will be recommended and improved documentation is required.
P130 Antibiotic resistance profiles ofNeisseria gonorrhoeae(GC): a comparison of data 2007–2011
Authors: Sharp S R , Allan S
Published: May 2012

Objectives

This was a retrospective analysis of antibiotic use and resistance profiles of GC at a UK GU clinic.

Methods

All GC cases at our clinic between 1 January to 1 June in 2007, 2009, and 2011 were identified. The case notes were assessed for antibiotic resistance. The number of cases identified was 41, 78 and 75 for these respective years. Data on diagnostic method was also collected last two cohorts.

Results

63%, 56%, and 69% of patients diagnosed with GC were male in 2007, 2009, 2011 respectively. In 2011 the mean age of patients was 26, and the median 23. 19.5%, 8% and 12% were men who have sex with men (MSM) in 2007, 2009, 2011 respectively. First line antibiotics each year were as per BASHH guidelines (see abstract P130 table 1).

Abstract P130 Table1Antibiotic resistance profiles2007 (%)2009 (%)2011 (%)Percentage of GC fully sensitive to antibiotic testing panel466759Percentage of GC fully sensitive to antibiotic testing panel271520Reduced susceptibility to two antibiotic groups151016Reduced susceptibility to three or more antibiotic groups1225

Discussion

In 2011 the antibiotic sensitivity was unknown in 41%, it was 35% of cases in 2009. In 2011 27% of all cases were culture negative despite positive NAAT test. In 15% of all cases no culture was performed. Those without positive culture were diagnosed by NAAT, and in one case microscopy. Of those positive by NAAT alone 52% were female, compared to 75% in 2009. In 2011 54% with positive NAAT alone had co-currentChlamydia trachomatisinfection, compared with 40% of all GC patients. 100% of females with GC in 2011 were NAAT positive, compared with 69% in 2009. 83% of males with GC in 2011 were NAAT positive compared with 80% in 2009.

Conclusions

This data suggests that the levels of resistant gonorrhoea within our clinic reduced between 2007 and 2009, but has since risen in the last 2 years. This would indicate the need for the recent change in first line antibiotics. This could be a reflection of the changing percentages of MSM in the cohorts, which have altered in line with our antibiotic sensitivity. A large number of patients diagnosed with GC are culture negative. This may reflect the high sensitivity of NAAT or a high rate of false positive NAAT. It is interesting that a large proportion of those positive by NAAT alone are co-infected.
P131 Sexual health for the British Forces in Germany [BFG]—a Nurse-led service
Authors: Littler J E , Baker D P , Loader P , Singh S , Desai M , Bradbeer C S
Published: May 2012

Background

Before 2008 GUM provision in BFG comprised one central and two satellite GUM clinics. Run by a F/T consultant and 3 or 4 nurses, it covered an area the size of Scotland with little primary care input. Since 2008 Guy's and St. Thomas' [GSTT] and SSAFA Forces Help have held the contract to provide GUM services to the BFG population. The contract was for a nurse-led service with consultant cover provided remotely and through monthly visits from the UK.

Aim

To increase provision of screening and management of STIs across BFG by the new [reduced] staff.

Objectives

To modernise the GUM service; to develop the 15 primary care medical centres across the region to provide level 1 and 2 GUM service, and to offer out-reach screening to soldiers and school children.

Methods

The labs replaced routine cultures and chlamydia PCR with dual NAATs making it cost neutral. We modernised the GUM service and encouraged testing, especially for HIV. Training for primary care providers included STIF courses. Once trained, GPs supported their nurses to deliver screens. The GUM nurses visited medical centres to encourage and support provision. We also instituted young peoples' services for schools and targeted screening to soldiers at Health Fairs.

Results

60 multi-professionals have attended our STIF courses, mean evaluation score is 4.4/5. We used figures from the lab servicing the majority of BFG. Despite a steep decline in the community [soldiers, their dependants and contractors] from 46k in 2008 to 36k in 2011, there has been a marked improvement in all measures of SH provision. The GUM workload has also risen and HIV tests have doubled.

Conclusions

We describe a successful, innovative, cost effective model for a nurse-led GUM service which could be used elsewhere. There is now a vastly increased availability of STI screening for our scattered, high-risk population. We will present data for 2008–2011 by age and gender (see abstract P131 table 1).

Abstract P131 Table 1

Characteristics of GUM service of British Forces in Germany

Changes in GUM service outcomes from 2007 to 201120072011CommentTotal population of BFG48k36k25% declineNew/rebook attenders2427215411.2% declineFollow-up patients116237767.6% declineTotal chlamydia tests in GUM*2149191610.8% declineChlamydia positivity rate16.8%11.6%30.1% decline in incidenceGonorrhoea diagnoses332427.3% decline in incidenceTests at Health Fairs*02397.5% chlamydia positiveGP Chlamydia tests*787141579.8% increaseChlamydia positivity rate7.4%6.1%17.6% decline*

These tests were dual NAATs [chlamydia and gonorrhoea] from 2009.
P132 Management of symptomatic men in a level 2 sexual health service
Authors: Dearing N , Pammi M
Published: May 2012

Background

We established a young persons level 2 community sexual health service (YP clinic) to encourage access to care. BASHH STI Management Standards warrants in-house microscopy for managing men with dysuria and/or urethral discharge symptoms not currently available at this clinic.

Aims

To determine percentage of men presenting with dysuria and/or urethral discharge, rates of Chlamydia in men attending with and without these symptoms and number of untreated men after their clinic visit.

Methods

Case notes of all new male heterosexual patient attendances at the YP clinic from 5 January 2011 to 23 October 2011 were reviewed. The management of symptomatic men were compared retrospectively with the outcome to look for missed/untreated STIs (sexually transmitted infections).

Results

Total 91 attendances. 23 patients (25%) were asymptomatic of which 5 tested positive for Chlamydia. Commonest symptoms were dysuria (29%) rash/skin problem (25%) or lumps (20%). 10 patients presented with dysuria only, 1 tested positive for Chlamydia. 16 patients presented with discharge and dysuria, 5 tested positive for Chlamydia. In patients presenting with other symptoms (46%) the following STIs were diagnosed: warts n=15, ulcers n=1, scabies n=1. Two patients tested positive for Chlamydia.

Discussion

43% of patients who did not report symptoms required treatment for an STI. Overall 23% of the dysuria and/or discharge group and 11% of patients without these symptoms tested positive for Chlamydia. 86% of the positive Chlamydia test results in the dysuria and/or discharge group had been treated in clinic compared with only 57% of positive Chlamydia results in the remaining patients.

Conclusion

The absence of microscopy did not lead to more untreated Chlamydia infections in men with discharge and/or dysuria but denying symptomamtic young men the opportunity of being seen in the community may risk untreated infection, onward transmission and complication.
P133 Unwanted pregnancies after a GU consultation
Authors: De Burgh-Thomas A , Botly K , Morris G
Published: May 2012

Aims

To assess the contraception element of the consultation in patients seen in our GU service.

Objectives

To assess the proportion of patients attending for termination that had been seen in the GU service in the year prior. Establish how many of these patients were recorded as having inadequate contraception. The proportion of patients identified as needing enhanced contraception that received any. Establish the accuracy of the GU pregnancy risk assessment.

Methods

The 1st arm reviewed the GU notes of the patients that had attended GU within a year of their termination. The 2nd arm reviewed notes from 100 sequential females attending GUM.

Results

67 of 820 (8.2%) women undergoing a TOP had attended GU in the previous year. Seven stated at consultation that they wanted to be pregnant, Three patients attended twice which gives a sample of 63. Retrospective assessment showed that in 8 (13.3.%) pregnancy may have been avoided by intervention in GU. 41 women (41/63)(65.1%) that went on to become pregnant and underwent a termination were identified at their GU visit as either not using any contraception or were relying on condoms that are known to be an inadequate contraceptive choice. This compared to 29% in the general audit of women attending GU. Despite identifying inadequate contraception enhanced contraception was not initiated in any of the patients that went on to become pregnant (1st arm) and in only 7% of the general audit of GU attendees (2nd arm). Concordance between pregnancy assessment recorded in the notes and retrospectively assessed was 43% (1st arm) and 62% (2nd arm) (see abstract P133 table 1).

Abstract P133 Table 1

Contraceptive data collection of BASHH auditable standards

BASHH standard1st arm2nd armDate of last menstrual period100%89%90%Contraception type recorded100%93%100%Contraception compliance recorded100%31%41%Pregnancy risk assessed100%68%79%

Discussion

We demonstrate that 93% of those identified as having urgent contraceptive needs leave without their needs having been addressed. We also demonstrate that contraception compliance is documented poorly. We will discuss changes that we have introduced to meet this service need.
P134 Reaching youth with out-of-facility HIV and reproductive health services
Authors: Denno D , Chandra-Mouli V , Osman M
Published: May 2012

Background

Many young people, particularly those who are marginalised and most at risk for HIV and reproductive health-related problems, cannot or will not seek traditional facility-based health services. Policies and programs are being implemented to provide them with these health services in the community. We sought to systematically review the effectiveness of such community-based HIV and reproductive health service policies and programs delivered via outreach on increasing health service utilisation among adolescents and young adults (ie, among 10–24 year olds).

Methods

A systematic literature review of literature published prior to March 2010 was undertaken to identify policies promoting or programs delivering HIV or reproductive health services in the community. We reviewed studies that evaluated uptake of services or commodities. Data from studies meeting inclusion criteria were qualitatively analysed.

Results

20 studies met inclusion criteria, including 10 containing comparative data (eg, before and after study or control study design). The studies generally demonstrated positive impact, although results varied across settings and approaches. The most successful approaches included mail-based chlamydia screening in the Netherlands, condom distribution via street outreach in Louisiana, home-based HIV counselling and testing in Malawi, and promotion of over-the-counter access to emergency contraception in various countries.

Conclusions

Overall, the studies suggest that out-of-facility approaches can be important avenues to reach marginalised youth. Rigorous implementation research is needed to assess the true impact that such strategies can have. Determining ways to effectively reach adolescents and young adults with HIV and reproductive health services is crucial in reducing not only youth morbidity and mortality but also in mitigating adult disease burden.
P135 Factors that influence learning of sexual history taking for medical students
Authors: Davies J
Published: May 2012

Background

Training for medical students in the UK now incorporates formalised training in sexual health and HIV. While research has assessed knowledge and skills in medical graduates around sexual history taking, this has been largely approached from a quantitative paradigm rather than students own experience It was decided by the author to carry out a qualitative study to inform content and delivery of the current sexual and HIV module.

Aim

To explore the experiences of fourth year medical students in their learning of sexual history taking.

Methods

Semi-structured interviews were undertaken with six fourth year medical students. Framework analysis was used to identify emerging categories and themes from the data.

Results

Four distinct categories were acknowledged: prior experience, classroom based learning, clinic based learning, and future confidence. Themes identified included patient and student embarrassment, acquisition of key phrases, the use of proformas and patient consent. Factors influencing the learning of sexual history taking were often interwoven and stemmed from both the classroom and clinical setting. One common expectation was that another healthcare professional would take over while being observed with a patient. The issue regarding confidence appeared to be intrinsically built up from the start of their overall training. Students recommended that classroom based scenarios should include non-genito-urinary medicine settings. Student confidence was improved by the recognition that classroom teaching matched the clinical consultations, with no preference to designation of the health care professional teaching.

Conclusion

Acknowledgement of the influences experienced by medical students while undertaking classroom and clinic based learning of sexual history taking provides useful guidance for future curriculum development.
P137 The effect of a dedicated syphilis clinic on syphilis management outcomes
Authors: Fernando K , Hall K , Ross J D C
Published: May 2012

Background

Patients with syphilis are frequently managed within general sexual health clinics. Although the incidence of syphilis has recently increased, it remains a relatively uncommon STI and individual clinic staff may see only a small number of cases. It is not known to what extent the use of a dedicated “syphilis clinic,” where expertise is concentrated, can lead to an improvement in management. A dedicated specialist trainee/health advisor delivered syphilis clinic was introduced in April 2011 to optimise the care of patients with syphilis.

Aim

To assess, using outcomes from the UK syphilis management guidelines, the effect on patient care of introducing a dedicated “syphilis clinic.”

Methods

A case record review of patients with syphilis before (control arm) and after (intervention arm) the introduction of a dedicated syphilis clinic between October 2010 and September 2011.

Results

101 patients were analysed, 30 in the intervention, and 71 in the control arm. Repeat testing prior to treatment was undertaken in 19 (63.3%) of the intervention arm and 45 (63.4%) of controls [p=0.99]. Receipt of appropriate antibiotic treatment was observed in 28 (93.3%) of the intervention arm and 65 (91.5%) of controls [p=0.73]. The mean number of follow-up visits required was 1.23 (intervention arm) and 3.3 (controls) [p=0.334]. Of significance, however, was consultation length, being shorter in the intervention vs the control arm—mean duration of 49.7 min cf. 61.8 min (p=0.034).

Discussion

In addition to reduced consultation duration, continuity of physician involvement and optimisation of patient care are key potential benefits of a dedicated syphilis clinic.
P138 I don't know, let's try some canestan: an audit of non-specific balanitis treatment and outcomes
Authors: Powles E , Marsden R , Gupta N K , Green T
Published: May 2012

Background

Balanoposthitis commonly presents to Genitourinary Medicine and may be caused by a wide variety of unrelated conditions. The 2008 UK National Guideline on the Management of Balanoposthitis recommends biopsy to exclude malignant disease where clinical diagnosis is uncertain and balanitis persists for more than 6 weeks despite simple treatment.

Method

A retrospective audit of case notes with KC60 code C6c presenting between January and June 2011.

Results

90 patients were diagnosed with balanitis (age range 16–71 years, mean 30, mode 22, median 25). 68 cases were treated as presumed candidal balanitis with either Clotrimazole cream, Fluconazole or Daktacort. In the remaining cases no presumptive diagnosis was made but 10 patients were given empirical Trimovate cream, three had Metronidazole tablets, one had Dermovate cream and one had Betnovate cream. Seven patients did not receive any medication. In all but one case the balanitis had fully resolved within 6 weeks. In the persistent case, initial treatment was with Clotrimazole cream for presumed Candida; when the lesions persisted this was changed to Daktacort but a clear diagnosis was not made. However, he failed to attend for further follow-up so it is not known if the balanitis resolved with the change of treatment. No cases were referred for biopsy.

Conclusion

The rate of persistent balanitis was extremely low in this cohort and all except one case resolved with treatment. This patient did not return for further review and was not referred for biopsy. Penile biopsy is recommended where the balanitis persists and the diagnosis remains unclear as in this case. A robust system of recall management is needed to ensure that appropriate action is taken in such cases.
P139 Evaluation of a dedicated multi-disciplinary young person's integrated sexual health clinic
Authors: Davis T , Allstaff S L , Cunningham C
Published: May 2012

Background

Our local authority has the highest teenage pregnancy rate in Scotland. A needs assessment was undertaken and a dedicated young persons (YP) clinic was introduced for people aged 18 and under in partnership with the local youth health and information centre and the child protection team.

Aim

To evaluate the 6-month pilot of a dedicated YP multi-disciplinary integrated sexual health clinic.

Methods

All patients attending the YP clinic between January and June 2011 were included. Data collected included demographics, sexual orientation, STI diagnoses and the uptake of contraceptives. Data were also collected from an evaluation form offered to all patients.

Results

131 young people attended the YP clinic during the pilot period. 108 (81%) were female and 23 were male of which 4 (17%) were men who have sex with men. The mean age was 16 for both males and females (range 12–18). 61 (47%) were under the age of 16. Chlamydia infection rates were high (24.4%). Sub-dermal implants were fitted in 22.2% of eligible females. 75 young people completed evaluation forms (57.3%). The majority found the clinic times suitable (95%) and travelled to the clinic by public transport or on foot (76%). Young people most frequently heard about the clinic from the local youth centre or from friends. Service users frequently commented positively on the partnership working with other agencies.

Conclusions

The introduction of a YP clinic has been popular with service users. Due to the success of this service, a second clinic will be launched at the same site.
P140 Setting up a young person's contraception and sexual health (CaSH) service in a semi-rural GP practice—the first year
Authors: Hum O
Published: May 2012

Background

The National Strategy for Sexual Health and HIV talks about improving access to genito-urinary medicine (GUM) services by providing Level 2 services in other settings, including primary care. Rural teenagers often find it hard to access GUM services due to distance and time constraints. They may also dislike consulting their own General Practitioners (GPs) due to concerns about confidentiality.

Aims/Objectives

Poor access to sexual health and family planning services was noticed in our rural area. A small Level 2 service was set up within a GP practice in January 2011. It was designed in conjunction with, and widely promoted at, local schools and colleges. A walk in service, running once a week; it offers diagnosis and treatment of most STIs, registration for C card, and all forms of contraception including long acting reversible contraception (LARC). It also offers pregnancy testing, HIV testing, signposting and advice. Emergency contraception is offered at any time of the week. There are three members of staff, a GP, practice nurse and health care assistant.

Results

432 patients were seen, with a median age of 17, drawn from a large geographical area. 75% were female and 20% under 16. New to follow-up ratio was 3:1. 261 chlamydia tests were offered with an 11% positivity rate. 137 young people have been registered for the C card, with a short education session, and LARC was discussed with 216 patients. 102 prescriptions for oral contraceptives were given and 23 injections of Depo Provera. 17 contraceptive implants and two coils were inserted. A patient satisfaction survey with a sample size of 38 showed high satisfaction ratings. Offering a service within the non-threatening environment of a GP surgery was approved highly, and most felt that their right to confidentiality had been upheld.

Conclusions

In a semi-rural area, primary care can provide an effective, accessible and popular alternative to traditional CaSH services.
P142 Evaluating the vulval service within our genitourinary (GU) medicine department
Authors: Bradshaw C , Patel S , Dragovic B
Published: May 2012

Background

Vulval disorders with their psychosocial and psychosexual impact are frequently encountered within GU clinics. Dedicated specialist clinics should ideally be multidisciplinary with input from dermatology, GU and gynaecology; however this is not always feasible. A need for this service was recognised at our urban clinic—thus in 2005, a monthly vulval dermatoses clinic was set up and led by a GU physician with training in genital skin disease. In 2009 a monthly vulvodynia clinic was set up, staffed by a trained GU physician and psychosexual counsellor.

Aims

To review our service provision over a 1-year period.

Methods

Retrospective notes review of monthly vulval dermatoses and vulvodynia clinics were performed from November 2010–2011.

Results

There were 145 vulval clinic appts; patients were only counted once—94 notes were reviewed. Vulval dermatoses clinic (n=40; 20 new, 20 f/u): median age 36 (IQR 29–44); referred by GUM 85%, derm/gynae 10%, GP 5%. Referral symptoms: itching (23), burning (8), dyspareunia (6), vulval pain (5), other (12); median length of symptoms 2 yrs (IQR 1–3). Predominant conditions were: psoriasis 28% (11) and lichen sclerosis 28% (11). Vulvodynia clinic (n=54; 24 new, 30 f/u): median age 28 (IQR 25–32); referred by GUM 67%, GP 26%, gynae/derm 7%. Referral symptoms: superficial dyspareunia (42), vulval pain (11), itching (2); median length of symptoms 2 yrs (IQR 1–5). Diagnosis of vulvodynia made in 74% (40/54). 22/40 were seen for f/u, 73% (16/22) reported at least 50% improvement in their symptoms with treatment.

Conclusion

Our vulval service meets the needs of a significant number of symptomatic women allowing timely diagnosis, management and f/u. Recognising the multifactorial nature of vulval disorders means patients receive a thorough assessment in one clinic visit with a GU screen, dermatology review and psychosexual input, thus providing a service tailored to the patient.
P143 Patient satisfaction with their sexual health services in Yorkshire and Humber
Authors: Mammen-tobin A , Lee J , Andrews M
Published: May 2012

Background

Patient derived outcome measures such as patient satisfaction surveys are a vital tool in evaluating current services and can also be used to guide future health care provision.

Aims/Objectives

To undertake a re-audit of the initial survey in 2008 and incorporates specific questions about the process and experience of care that patients have received.

Methods

Service users were asked to complete the questionnaire anonymously and leave it in the sealed box provided. Seven clinics across Yorkshire and Humber participated in the survey with a total of 329 questionnaires returned.

Results

Compared with previous audit there were improved scores for ease of access as by then the 48-h target had been achieved in the region while the overall positive experiences of service remained high. The survey highlighted variations in the amount of time patients could expect to spend, with some reporting more than 60 min in clinic and this evidence will be helpful in influencing change. GPs and other medical services were still important sources of referral however increasingly service users used the internet to self-diagnose symptoms and obtain information about their local sexual health services. Preferences for clinic appointments were for evenings between 17:00–20:00, mornings 9:00–12:00 and afternoon's 13:00–17:00 in that order. Service user's experiences of services were overwhelmingly positive, and almost all would be happy to recommend the service to others.

Conclusions

This re-audit highlighted the need for some clinics to re-examine patient flows with the aim of reducing clinic waiting times. All clinics are advised to incorporate more evening appointments. The audit also highlighted the internet as a source of information about sexual health in general and local services in particular and it is important that individual clinics address this need.
P144 Chronic pelvic pain syndrome: should we be managing patients with this complex condition?
Authors: Crofts M , Mead K , Horner P
Published: May 2012

Background

Chronic pelvic pain syndrome (CPPS) affects 2%–6% of men who present to GUM departments. It is associated with a significant morbidity and there are no reliably effective treatments.

Aim

To evaluate the management of men with CPPS attending a dedicated clinic.

Methods

We performed a retrospective study on men with CPPS attending between September 2010 and November 2010. We extracted information regarding patient's clinical presentation, management and outcome. Outcome was quantified by the difference between the first and last scores generated by the National Institute of Health Chronic Prostatitis Symptoms Index (NIH-CPSI). A 4–6 point fall or a >25% reduction in score is considered significant. Scores can range between 0 and 43, with scores closer to 0 reflecting a more favourable status.

Results

Notes were available for 19 men, mean age 38 years (Range 23–59 years). The average number of clinic visits prior to referral to the specialist clinic was 9 (Median 3.00), with a mean of 98 days from onset of symptoms (Range 21–365). 21% had urethritis and the mean number of courses of antibiotics prior to attendance was 3 (Range 0–15). All patients had a discussion on the aetiology of CPPS and the importance of pelvic floor relaxation. 16 patients received antibiotic therapy, 12 received α-blockers, 8 tricyclic antidepressants and 10 were referred to urology. The mean number of consultations was 8 (Range 2–35). The mean NIH-CPSI score fell by 8.1 (36%) (p<0.01). 13 out of 19 patients (68%) found a >25% improvement in their symptoms score after attending the clinic (see abstract P144 table 1).

Abstract P144 Table 1

NIH-CPSI score before and after attending dedicated clinic for CPPS

DomainNIH-CPSI scorep ValueFirst attendanceLast attendancePain10.86.7<0.01Urinary symptoms3.72.90.11Quality of life8.54.8<0.01Total22.614.4<0.01

Conclusions

A significant fall in NIH-CPSI was observed in men with CPPS attending a dedicated clinic indicating that this condition can be successfully managed in GUM departments. Earlier identification and effective management may lead to better outcomes.
P147 Are video recordings of consultations in HIV and genitourinary medicine (GUM) acceptable to patients and staff?
Authors: Daniel B , Cohen C E , Day S , Mandalia S , Theobald N J
Published: May 2012

Background

Video recordings of consultations (VC) are used in general practice to improve junior doctors' training, having been shown to be acceptable to patients.

Aims

To determine the acceptability of VC in GUM/HIV, excluding physical examinations.

Methods

After identifying potential VC concerns from a pilot study, patient surveys were distributed within GUM/HIV clinics September 2010–May 2011. Staff (ST) surveys were distributed electronically and via post October 2011–January 2012. Both included questions on confidentiality, videotape storage, potential impact on the patient-clinician interaction and additional time incurred.

Results

Of 1171 patient questionnaires distributed, 1002 (86%) were returned; 57% (570) were GUM and 43% (432) HIV clinic attendees; 86% (860) aged 20–49 years. Two–thirds (659) were male, of whom 77% (507) were men who have sex with men. Nearly half (47%) considered VC acceptable. After adjustment for other factors, multivariate analysis showed non-acceptability was independently associated with concerns re confidentiality RR 10.7 (95% CI 6.5 to 17.5, p<0.001) and with not wanting the consultation to take two extra minutes RR 17.2 (95% CI 9.3 to 31.9, p<0.001). ST surveys were distributed to 140 members; 31% (44) returned. Of note, distribution coincided with introduction of a new coding system. In total, 34% (15) were nurses, 25% (11) consultants/associate specialists, 18% (8) ST/trust grades, 14% (6) trainee doctors, 9% (4) other. Two-thirds (29) were female. Of all ST, 73% (32) found VC acceptable. Univariate analysis did not show any possible cause for likelihood of non-acceptability.

Conclusion

Nearly half our patients thought VC acceptable, with concerns cited around confidentiality and time, compared to nearly three quarters of ST. ST survey uptake was low, perhaps due to the time constraints noted above. Once the specific patient concerns have been addressed, VC could be introduced in GUM/HIV as a valuable educational tool for all clinical ST.
P149 Evolution of the NCSP: Integrating chlamydia screening into community health services; policy and practice developments in England
Authors: Clarke J , Bone A
Published: May 2012

Background

The National Chlamydia Screening Programme is a major component of sexual health provision in England. Over 1.4 million tests were performed on asymptomatic under 25-year olds in 2010/2011, and over 87 000 diagnoses made. The expansion of chlamydia testing services in the NHS has occurred predominantly outside of GUM utilising both traditional health services and introducing alternative approaches for young people to access testing. Coverage of screening has been higher in deprived areas and among young people at increased risk of infection.

Discussion

The NCSP is evolving from a stand-alone programme to one that is integrated in primary care and sexual health services, with outreach screening being restricted to hard to reach groups. This integration is occurring both in terms of the way chlamydia screening is commissioned and provided, and in terms of data collection, removing the requirement for chlamydia-specific services. This process is expected to substantially improve value for money and maximise synergies between chlamydia prevention and other services. Clinical research and modelling, comparison with other programmes around the world and the major organisational changes in the NHS and public health system continue to shape the commissioning and delivery of screening. Clinical practice, from distribution of test kits to partner notification and treatment, is increasingly dependent upon electronic resources. Key discussion points include: How can we continue to develop flexible, responsive community sexual health services that include chlamydia screening as a core component? Will evaluation criteria for quality assurance and for clinical effectiveness currently applied to a stand-alone NCSP be valid in the integrated models?
P15 Are we following BHIVA guidelines in newly diagnosed HIV patients?
Authors: Thomas J , Fadzillah N H M , Carey P B , Bates C M
Published: May 2012

Background

BHIVA published guidelines in 2008 on the treatment of HIV infected adults. These guidelines were used as a basis for optimal patient care.

Aims

To audit the following against BHIVA guidelines: (1) Initial investigations, assessment and monitoring after diagnosis (2) Choice of first line ARV regimen (3) Attainment of target HIV viral load <50 by 6 months of treatment (4) G.P. involvement in patient care.

Methods

The medical records of 24 HIV positive patients, who were diagnosed and started on ARV medication during the preceding 12 months, were reviewed.

Results

Initial investigations and assessment were done in all patients (100%), with the exception of cardiovascular risk assessment which was documented in only 20% of patients. 18/24 patients (75%) were started on the first line regimen recommended [2NRTI and 1 NNRTI], out of which 14 patients (58.3%) were started on Atripla. 5 patients (20.8%) received [2NRTI and boosted PI] and one patient was on [2NRTI and integrase inhibitor]. 20 patients (83.3%) achieved the target VL<50 within 6 months of treatment. In 3/24 (12.5%) patients the viral load was still detectable at 6 months. One patient moved away from the region. The G.P. was informed about the HIV positive status in only 62.5% patients.

Conclusion

Several areas of clinical practice were identified for improvement and the following actions recommended: the use of a web-based virtual clinic resource which includes links to CVS risk calculators; proactive discussion with patients regarding the importance of disclosure of HIV status to their GP for safe and efficient care.
P153 Female genital mutilation (FGM)—providing a holistic approach and challenging taboos in a sexual health setting
Authors: Dominguez L , Dominguez L , Hopkins K , Mutalak O , Harish S , Nalabanda A , Osman S , Robinson L , Cohen C , Jones R
Published: May 2012

Background

In England and Wales nearly 66 000 women are living with FGM and a potential 22 000 girls are at risk each year. Due to increasing demand, a dedicated FGM service within the sexual health setting was initiated in partnership with a dynamic Somali facilitator and a voluntary community organisation.

Aims

To analyse the attendances of women with FGM to our dedicated clinic.

Methods

Retrospective analysis of all attendees to the FGM clinic between 1 December 2010 and 31 December 2011.

Results

Of 197 attendees, 96% were from Somalia (190); mean age was 38 (14–72 years) with 52% living locally. Of those in whom we had documented information, FGM was mainly undertaken for cultural reasons (83/105, 79%), the majority (50/68, 73%) being cut in groups at their home (66/113, 58%). Mothers were the main instigators (58/81, 71%). Nearly half (84/173, 49%) had female children and seven women reported having their daughters cut abroad. The majority were against the practice (112/114, 98%). Reasons for attendance included chronic pelvic pain (57%), dyspareunia (44%) and sub fertility (24%). There was a high uptake of sexual health screening, with almost all patients (191, 97%) having serology for HIV and syphilis. Interestingly, no HIV was detected but 7% (13/185) were hepatitis B surface antigen positive and 31% (58/185) had cleared hepatitis B. There were six diagnoses of late latent syphilis and two of chlamydia.

Conclusions

Our Somali facilitator has played a key role in challenging the taboo of sexual health issues within FGM-practising communities, providing a service that is culturally and linguistically appropriate. The rate of blood-borne viruses in this vulnerable group proves the importance of engaging them with sexual health services. Fast track referrals to on-site gynaecology and hepatitis clinic have facilitated re-engagement of some patients with medical care.
P156 Survivors of male sexual assault attending an inner city sexual assault referral centre (SARC)
Authors: Williams A , McManus T , Noonan M , Forster G E
Published: May 2012

Background

Male sexual assault (SA) is a widely unreported crime. Published data demonstrate that male victims are often lost to follow-up. We need to understand this group better in order that we target their specific needs.

Methods

Case notes of men attending an inner city SARC for a forensic medical examination (FME) between 1 January 2011 and 31 December 2011 were identified. A detailed notes review was performed and we report the findings.

Results

21 males received an FME in this time period, of whom 3 were <13. 18 men were aged 18–97 years (94%, 18–40). 50% were white, 28% black and 22% Asian. Of those who were sexually active, 56% were homosexual and 44% were heterosexual. 78% were referred by the police and attended within 72 h of the alleged assault. A third reported a suspected drug facilitated sexual assault. 78% reported factors increasing their vulnerability. 94% reported anal penetration. Receptive oral and digital penetration was also reported. No condom was used in 50% of incidents; in 39% condom use was unknown. 28% were assaulted in public, 44% in the assailants home and 22% in their home. 61% of assailants were strangers. One assailant was reported by 50% and two or more by 39%. The SA was accompanied by physical assault in 22%. Non-genital injuries were documented in 61%. PEP against HIV was commenced in 61%. 33% were followed-up at SARCs, 39% in sexual health clinics and three declined follow-up. Within the SARCs one client tested positive for Hepatitis C, one had latent syphilis and two were known to have pre-exisiting HIV.

Conclusion

When compared with published data regarding female SA, males are experiencing more assault from strangers, more extra genital injuries, higher numbers with multiple suspects and have higher rates of vulnerability. Small numbers of men are attending SARCs compared to females; this may in part be due to lack of awareness on the part of the victim. Increased help is needed from external agencies for aftercare and publicity campaigns.
P159 On the road: delivering sexual health services to vulnerable populations in hard-to-reach areas
Authors: McMillan S , Scott P , Ormerod D , Jones R
Published: May 2012

Background

Studies show a correlation between poor general and sexual ill health. These health inequalities are not evenly distributed within the population. Hammersmith & Fulham (H&F) houses some of the most deprived areas in England, many of which have high rates of ill health. Barriers to successful community healthcare engagement are manifold and encompass access, stigma and social issues.

Aims/Objectives

In order to tackle these barriers, increase engagement and subsequent uptake of screening we deliverwellpersonscreens, incorporating sexual health checks, in a purpose builthealthbustargeting the most economically challenged areas of H&F. The service was designed to normalise sexual health screening in the context of a routine“check-up.”

Method

In 2011, 15 clinics were provided. Data were collected pertaining to gender, ethnicity, screening/service provision, well-being parameters, referrals and follow-up.

Results

243 patients attended the health bus, 145 were male. Almost half (46.9%) accepted sexual health screening leading to the identification of HIV (one), Syphilis (one) and Chlamydia (five). Wellperson checks led to 59 referrals to allied services, pertaining to 52 individuals. One third (19) of those referrals were to level three sexual health services, just under two-thirds (37) were referred to their GP (25 for hypertension, one for glucosuria and 11 for other medical reasons) and three were referred to smoking cessation services.

Discussion/Conclusion

Linking sexual health with general well-being checks has shown to be an acceptable way to increase screening uptake in our local community. The clinic has also highlighted the extent of ill health in H&F, continued health promotion via innovative strategies such as the healthbus may help to tackle these health inequalities.
P163 Patient choice: is the local HIV service preferred?
Authors: Andrews S , Howard L
Published: May 2012

Aim

To investigate the distance travelled by patient to a specialist HIV clinic in the Home Counties.

Methods

Retrospective review of the electronic database of HIV patients attending the clinic from January 2011 to January 2012. Data on gender, ethnicity, sexual orientation, age and residential postcode was collected. The distance to our service was compared to that of the nearest available specialist clinic HIV clinic for each patient. Demographic data were also collected. χ2Tests were performed to compare categorical data.

Results

220 patients attended. The median age was 41 years, range 15–74. Our clinic was the closest HIV service for 89 (40%) patients. Of the 131 who selected our service in preference to their local service, 50% travelled up to 10 miles, 15% 11–20 miles, 14% 21–30 miles and 21% more than 30 miles. Interestingly the nearest service for 13 (10%) of these patients was an inner city teaching hospital. There was no significant difference in age, gender or sexual orientation between those who lived locally or travelled further, except for ethnicity. 66% of White British men and women were prepared to travel further for their HIV care compared to 51% for other ethnic groups (p=0.02) (see abstract P163 table 1).

Abstract P163 Table 1

Demographics of HIV cohort

Men (n=141)Women (n=79)Sexual orientation (%) Heterosexual64 (46)79 (100) Bisexual6 (4) Homosexual71 (50)Ethnicity (%) White British108 (77)16 (23) Black African24 (17)58 (73) Other9 (6)5 (4)

Conclusions

More than half our HIV patient cohort elected to travel further rather than utilise their local HIV services. The reason for this choice is unclear. However this study highlights the importance of considering patient choice when commissioning, planning and providing HIV services. Further research exploring the reasons for patient preference may aid our understanding of the aspects of HIV care that are particularly valued by our patients.