bluuebunny/crossref_metadata_2025 huggingface dataset:
P72 Microscopy and culture forTrichomonas vaginalis(TV): are both tests required and should test of cures (TOC) be performed routinely?
Authors: Gilmour C , Jones L , Jones R , Cohen C E
Published: May 2012

Background

Testing for TV has changed locally in recent years dependant upon whether the woman has symptoms. Microscopy and culture are now only performed in symptomatic women or in contacts of TV. All patients diagnosed with TV must be seen by the Health Advisers to discuss partner notification and to arrange a TOC within 2 weeks.

Aim

To ascertain if both microscopy and culture remain warranted for symptomatic women and those attending for TOC or whether microscopy alone is sufficient for diagnosis. To compare audit findings with previous audits using BASHH auditable standards.

Method

Case notes of patients diagnosed with a KC60 code of C6A between 1 October 2009 and 31 October 2010 were reviewed.

Results

A total of 58 patients were included in the audit pertaining to 65 episodes. Largest ethnic group was Black/Black British Caribbean (34%). The majority (93%) were symptomatic. Nine (14%) patients had positive microscopy and negative culture, 10 (15%) had negative microscopy and positive culture and 46 (71%) had positive microscopy and culture results. The majority (97%) received Metronidazole therapy. 43 (74%) saw a Health Adviser after initial diagnosis. Almost all (88%) had documented partner notification and 27 contacts attended for treatment. 46 (79%) attended for TOC and of these 36 (78%) attended within 2 weeks. Of the 46 attending for TOC, 42 (91%) were symptomatic but only five (12%) were TV positive on TOC. Auditable standards comparison (see abstract P72 table 1).

Abstract P72 Table 1

Comparison of auditable standards and rate

Auditable standardsBASHHLocalAudit 2011 n=58Audit 2006 n=94Patients diagnosed with TV should receive treatment with Metronidazole—either 400 mg twice daily 5/7 or 2 g stat100%–97%96%Symptomatic female patients at presentation should have a TV wet mount and culture–100%100%98%Those diagnosed with TV infection should have contact tracing performed100%–88%71%One or more traceable contacts should treated within 1 month60%–47%33%Women with TV on cervical cytology should be offered confirmation of diagnosis with a vaginal swab before treatment and offered100%–100%–Patients should return for a TOC within 2 weeks of treatment–50%78%71%

Discussion

Overall the results from this audit have demonstrated an improvement in respect to previous audits in line with BASHH auditable standards. Findings related to microscopy and culture results do not appear to demonstrate a significant risk in missed diagnoses and those who were microscopy negative (subsequently culture positive) had Hay and Ison Grade 2/3 and treatment with Metronidazole. In skilled hands, microscopy alone may be sufficient to diagnose TV in those attending with symptoms.
P75 Do cash incentives increase the uptake of chlamydia testing in pharmacies?
Authors: Martin S J , Currie M J , Deeks L S , Cooper G M , Parker R M , Del Rosario R , Hocking J S , Bowden F J
Published: May 2012

Background

Chlamydia screening uptake rates in Australian and overseas pharmacies vary widely (11% to 58%).

Aim

To determine the effect on the uptake of chlamydia screening in community pharmacies when a cash reward is offered to young people and participating pharmacies.

Methods

The study was advertised in print and electronic media. People aged 16–30 years requested, or were offered, chlamydia testing kits by pharmacy staff (assistants and pharmacists). Participants who provided a urine sample and completed a questionnaire received AUD$10; pharmacies received AUD$10 per person recruited. Urine specimens were tested in pools using PCR, with reflex testing of individual samples when the pool tested positive. Positive cases were notified by sexual health nurses and offered treatment.

Results

Six urban community pharmacies took part in the study, each for 15 days. 979 testing kits were given out and 970 sample pots returned (99.1%); 66 (7%) did not contain urine. 74% (670/904) of the urine samples were determined to be from unique individuals, 65% of whom were male. 19 people (13 females and 6 males) tested positive; positivity rates were 5.2% (95% CI 2.8 to 8.8) for females and 1.4% for males. 11 (61%) of those testing positive were contacted and eight attended a local sexual health centre for treatment, three were treated elsewhere. Of the eight people treated at the sexual health centre, two females aged 15 and 20 years were diagnosed with pelvic inflammatory disease. Contact with the remaining eight positive individuals was not possible due to disconnected, incorrect or non-existent telephone numbers.

Conclusion

The 68% specimen return rate found in this study significantly exceeds those reported elsewhere. Strategies to prevent repeat testing, non-urine specimens and incorrect contact numbers are needed to ensure good clinical care and optimum use of resources.
P78 The acceptability of digital self-examination in men who have sex with men (MSM) at risk of anal intraepithelial neoplasia (AIN)
Authors: Bayley J , Perry N , Shaw S , Campbell L , Richardson D
Published: May 2012

Background

AIN is a pre-cancerous change in the anal mucosa caused by human papilloma virus (HPV) which untreated, may progress to anal squamous cell carcinoma with 500 new cases per year in the UK. There is currently no evidence about the efficacy of self-examination, but this may be a quick, cheap and effective screening tool to aid early diagnosis and prevent cancer.

Methods

Patients attending a GU/HIV clinic were given a questionnaire exploring knowledge and risk factors of AIN and attitudes to self-examination. They were then given an educational leaflet on what to do and feel for. Inclusion criteria were males >18 years old who identified as MSM. Results on an SPSS database were analysed using standard statistical methods.

Results

103 questionnaires were returned, 60 (58%) were HIV positive. 10/103 (9.9%) were aware of AIN. 68/93 (73.1%) who were unaware of AIN wanted more information about the condition. 95/103 (92.2%) thought digital self-examination was acceptable. 55/103 (53.4%) self-examined regularly. Of people who self-examined 26/55 (47.3%) had a history of warts, compared to 12/48 (25%) with no history of warts (p=0.02). 38/48 (79.2%) who did not self-examine wanted more information compared to just 34/55 (61.8%) who regularly self-examined (p=0.06).

Discussion

This study highlights a lack of awareness about AIN and the acceptability of self-examination for this condition. Over half were regularly self-examining but only a small proportion had heard of AIN, suggesting that although they are happy to self-examine, they are unsure what to look for. Most MSM wanted more information. Digital self-examination may therefore provide a rapid, cheap, effective and acceptable screening tool. This may help to diagnose AIN earlier and allow education about self-examination and information regarding AIN to be regularly incorporated into clinic visits for MSM. Further research into the efficacy of this technique for detecting AIN is required.
P79 Colposcopic management of cervical warts
Authors: Nori A , Kola-Bankole S , Goh B T
Published: May 2012

Background

There is a paucity of evidence and guidance for genitourinary medicine (GUM) clinicians on the management of cervical warts (CW). These patients are either treated in a routine clinic without colposcopy examination (CE) or referred to gynaecology.

Aim

To describe the management of patients in a GUM diagnostic colposcopy service where a CE (×7 magnification) performed before and after application of 5% acetic acid to the cervix to identify flat acetowhite epithelium (AWE) in addition to the CW.

Methods

Notes of patients who attended the service with a diagnosis code of C11 between June 2006 and December 2011 were reviewed and 48 patients with CW were identified. Details of demographics, presenting features, associated STI, cervical cytology, biopsy results, treatment and follow-up were analysed.

Results

Median age of 48 patients was 24 years (range 16–63); 23 (47.9%) were Caucasians, 16 (33.3%) Afro-Caribbeans. 25 patients had no prior cervical cytology as they were under 25 years of age. Of the 23 patients who had a previous cervical cytology, six had a history of abnormal smears. 17 (35.4%) had CW alone, 31 (64.6%) also had vulvo-vaginal/perianal warts. Seven (14.3%) had other concomitant STIs.15 (30.6%) had AWE that on biopsy showed histopathological evidence of HPV and, 10/15 (66.7%) also had evidence of CIN1/2. Of the 33 patients with no AWE, histopathology was available on 23 CW which showed CIN1/2 in 16/23 (69.5%). 10/48 (20.8%) patients were treated with electrocautery, 11 (22.9%) with excision biopsy and 26 (54.2%), with both. 31 patients responded after the first treatment; nine had a further 1–3 treatments. One recurred after 6 months. 26 patients with associated CIN were referred to gynaecology.

Discussion

We report a high prevalence of CIN in CW and in associated subclinical lesions in this predominantly young cohort of women, suggesting the need for colposcopy to assess cervical warts or more careful follow-up with cervical cytology.
P8 Tests of recent HIV infection in clinical practice: the patient perspective
Authors: Anderson E R , Taegtmeyer M , Delpech V , Chawla A , Gilbart V
Published: May 2012

Background

A test for recent infection (avidity test) is offered for all patients newly diagnosed with HIV in England and Wales as part of an HIV incidence surveillance programme. The UK is currently the only country to return these results to individual patients.

Objectives

To determine the acceptability and patient experience of receiving a RITA test result soon after HIV diagnosis.

Methods

This was a qualitative study using semi-structured interviews. 14 people recently diagnosed with HIV who had a RITA result consented to participate. Analyses were based on the framework method using N-Vivo software. Interviews were transcribed, coded and emergent themes identified.

Results

All participants agreed that the more information available to them about the possible duration of infection the better. Unsurprisingly the HIV diagnosis and the emotions and practical issues associated with it had far more impact than the RITA result. None of the participants experienced any problems with former partners as a consequence of their RITA result although some could see the theoretical potential for such problems. “Recently infected” RITA results were felt to be potentially useful for identifying “at risk” partners. However partner notification was not altered in the study group because the individuals concerned had other reasons to suspect recent infection. Other major themes identified were the perceived stigma; the difficulty of sharing the diagnosis of HIV with family and friends; and the many conflicting emotions that people had to deal with at diagnosis including anger, grief, self-blame, fear and depression.

Conclusion

RITA testing is a potentially useful epidemiological tool. These interviews demonstrated that receiving a RITA result, while useful to some people, is a minor issue compared with dealing with the HIV result itself. Reassuringly none of the participants reported negative outcomes from receiving the RITA result.
P81 Point (young person's) clinic audit
Authors: Chan S Y , Zhou J , Rashbrook S , Dragovic B
Published: May 2012

Background

Young people attending sexual health clinics should receive an adequate standard of care, according to BASHH clinical effectiveness group guidance.

Aims/Objectives

To carry out an audit of clients attending the Point clinic—a sexual health clinic for clients aged ≤18. To describe client characteristics and compare practice against BASHH guidelines.

Methods

We carried out a retrospective case notes review of all clients attending the Point clinic from 1 November 2009 to 30 April 2010. Patients were only counted once (new/rebook). Only patients having sexually transmitted infection (STI) screens were included. Information was collected on demographics, risk assessment, STI screening, HIV testing and contraception.

Results

123 clients attended. 51 did not have a screen. Reasons were: not sexually active, requesting contraception/condoms only, attending for results. Included in the audit were 72 patients who had STI screens. 53 out of 72 (73.6%) were female with a mean age of 16.9. 10 out of 72 (13.9%) were <16. Fraser competence was assessed in all <16 years old. Risk assessment (age of partner/alcohol/drugs use/housing/mental health issues) was documented in 63/72 (87.5%) and in all <16 year olds. Contraception was reviewed in 64/72 (88.9%). Additional contraception advice was given to 36/72 (50%). Of the 34 not given additional contraceptive advice, six were not using any contraception. HIV test was offered to 71/72 and 35 accepted. 11/72 (15.3%) had an STI, most common beingChlamydia trachomatis(6/11).

Conclusion

We are managing patients in accordance with BASHH guidelines. All <16 year olds (and those 16–18 where indicated) had a risk assessment completed. Offer of HIV tests was very good. It was identified that improvements were required with regards to provision of additional contraceptive advice.
P83 Review of the first attendances in under-16 year olds in a community based integrated sexual health service
Authors: Pal N , Ashby J
Published: May 2012

Aim

To analyse sexual and risk behaviour in under 16 year olds newly attending our services.

Methods

Computer databases were used to identify the last 100 under 16 year olds who newly attended the sexual health services up until December 2011. Patient records were retrospectively reviewed and clinical, social, sexual and reproductive data were collated using excel.

Results

Age of the attendees ranged from 13 to 15 years; 95% were girls. 98% reported heterosexual orientation. Ethnicity and primary reason for attendance as shown in abstract P83 table 1. Fraser competence was documented as present in 100% of attendees. Vulnerability factors were assessed in all attendees. Age at coitarche ranged from 9 years of age upwards. 94% were sexually active and 91% reported unprotected sexual intercourse. Other than condoms, no other forms of contraception were in use. Contraception was discussed with 100% of attendees and 47% commenced contraception at first visit. 6% had at least one previous unplanned pregnancy. 9% reported symptoms of a sexually transmitted infection and 10% of attendees were diagnosed with at least one sexually transmitted infection at the first visit. 6% reported non-consensual sex of which 2/6 were reported to the Police. 45% reported partners over age 16. 15% had social services or other agencies input.

Abstract P83 Table 1

Ethnicity and primary reason for attendance

% of attendeesEthnicity White UK81 White other7 Black African/Caribbean6 Asian5 Mixed1Primary reason for attendance Contraception planning41 Emergency contraception28 Sexual health screen19 Sexual health advice6 Termination of pregnancy4 Sexual assault2

Conclusions

High rates of underage sexual activity and unsafe sex were observed in this group of young people attending clinic for the first time, with significant amounts of sexually transmitted infections identified and unplanned pregnancies seen. This highlights a need for earlier interventions, as often sexual risk had already occurred prior to the young people attending clinic.
P85 Congenital syphilis in the UK: results from enhanced surveillance, 2010/11
Authors: Simms I , Tookey P , Goh B , Lyall H G , Evans B , Ison C
Published: May 2012

Background

Since 2001, rates of congenitally transmissible syphilis have increased amongst reproductive age women. Concerns have been raised about the effectiveness of intervention which has been restricted by an absence of national surveillance data. In 2010, a 3-year study was established to provide an evidence-base for control strategies.

Aim

To explore the epidemiology of congenital syphilis.

Methods

The surveillance dataset consisted of returns to the British Paediatric Surveillance Unit, diagnoses made in genitourinary medicine clinics (GUMCAD) and laboratory reports. Infants diagnosed with congenital syphilis under the age of 24 months were included (detailed methodology at:http://www.rcpch.ac.uk/).

Results

Between 1 February 2010 and 1 November /2011, 11 cases (male=9, female=2) of congenital syphilis were confirmed, all reported from England. Most infants (6/10) were born at over 37 weeks: median birth weight was 2910 g (range: 1340 g to 3690 g). Clinical presentation varied from asymptomatic (1) to acute, including severe anaemia, hepatosplenomegaly, rhinitis, oedema, thrombocytopaenia and skeletal damage. Median maternal age at delivery was 19 (range: 17–28). Many of the infants' mothers were White and came from the UK and Eastern Europe. Where maternal stage of infection was recorded, 4/7 presented with primary and 3/7 with secondary syphilis. One infection diagnosed late in pregnancy was the result of re-infection acquired after effective screening and management in the first trimester. All diagnoses were managed according to BASHH Guidelines.

Conclusions

Congenital syphilis presents a complex social, clinical and public health problem. Antenatal screening is largely effective in controlling congenital syphilis but delivering effective health care to women who are marginalised in society and at-risk of acquiring congenitally transmissible syphilis represents an emerging challenge.
P87 Development of regional good practice arrangements for the management of pregnant women with syphilis and their babies in the north east of England
Authors: Hew Y , Hussey J , Mitchell L , Vallappil M , Clarke J , Clarke J , Foster K
Published: May 2012

Background

The re-emergence of congenital syphilis in the North East and outcomes of a regional audit prompted the development of regional good practice arrangements in managing pregnant women with syphilis and their babies.

Aims

Guidance documents for the various clinical specialties were present for the management of pregnant women with syphilis in our region, but not a clear description of the whole patient (mother and baby) pathway. The overall aim of the good practice arrangement was to clarify precise roles of clinicians looking after these pregnant women, prompt re-testing of syphilis based on subsequent risks and concerns, create referral pathways and encourage multidisciplinary communication in management of pregnant women with syphilis.

Method

Current national guidance was reviewed and discussed between Northern BASHH group, Health Protection Agency (HPU and virology), regional Paediatric Infectious Diseases and Antenatal screening coordinators. Audit outcomes highlighted areas needing improvement and these were addressed including use of named rather than numbered GUM serology specimens.

Results

The good practice arrangement outlines clearly the patient journey from diagnosis to delivery and follow-up of her baby. It is divided into different stages, with each outlining clearly who is responsible for care, locally recommended practice and referring to national guidance where indicated for the management of that stage. These stages are antenatal screening and referral process to GUM, management of positive results in mother, investigations of baby at birth, follow-up of babies born to mothers with positive syphilis results and treatment of baby with suspected congenital syphilis. Good practice is included on the management of mothers who do not attend GUM follow-up, communication to those involved in care and a named lead paediatrician in every hospital trust in the North East region has been created.
P92 Routine enquiry for domestic violence, alcohol and drug use in a sexual health clinic
Authors: Loke W C , Maclellan J , Maurice J
Published: May 2012

Background

Addressing domestic violence (DV) against women is highlighted in the 2011/12 NHS Operating Framework. Genitourinary medicine is cited as one of the services where victims of abuse may present. Alcohol and drug use are recognised as factors affecting sexual risk taking behaviour. Routine enquiry for DV (women only) and drug and alcohol use was implemented in this service in June 2011.

Aims

To audit if routine enquiry for DV, alcohol and drug use was done and identify interventions when DV was disclosed or if risk taking was found to be affected by drug or alcohol use.

Methods

A casenote review was done on all new and rebook (attending again after 3 months or more for a new episode of care) patients who attended during the first week of September 2011. The history proforma included questions on DV, alcohol consumption, recreational drug use and if they felt this affected their risk taking. Asymptomatic patients for screening were excluded as no detailed history was taken.

Results

The history proforma was filled out for 55 women and 22 men. All were heterosexuals. The median age was 25. 26 attended for contraception, 44 for sexual health screen and 7 for both. 21 were rebook patients. 38/55 (69%) women were asked about DV. Five gave a history of DV, four were historic, one unspecified. 63 (82%) and 62 (81%) were asked their alcohol and drug use respectively. One man disclosed drinking >21 units/week and that it affected his risk taking. 10 used drugs: six cannabis, one cocaine and three unspecified. None were referred to other agencies. Of those not asked about DV, alcohol or drug use, no reason was documented.

Discussion

The relatively low rate of enquiry for DV may increase with training and awareness raising. Only one patient considered his risk taking affected by alcohol. This may be due to the lack of sensitivity of direct questioning. Closer working with supporting agencies for DV, alcohol and drug use may increase referrals.
P93 The acceptability of routine enquiry of gender-based violence at sexual health clinics
Authors: Innes K , Fraser P , Baguley S D K
Published: May 2012

Background

In 2008/09, 53 861 incidents of GBV were reported to the police in Scotland; 84% were male perpetrator against female victim and 14% female vs male. National guidance recommends routine enquiry of abuse (REA) amongst female attendees at sexual health clinics. Section SH 4.3 of the Sexual Health and Blood Borne Virus Framework says that levels of GBV should be recorded. Research in an antenatal setting found that 99% of respondents thought REA was acceptable. However, a literature review found no assessment of the acceptability of REA in sexual health clinics. It is also unclear what value there may be of REA in male attendees.

Aim

In order to elucidate these areas, attendees at the sexual health service in the city were asked for their opinion of REA and their experience of GBV.

Method

As part of our 2010 patient satisfaction survey, attendees were asked: We are considering asking people whether they have been a victim of domestic violence (eg, being hit by a girlfriend, boyfriend, husband or wife). Q1. Do you think we should routinely ask patients this? Q2. Have you ever been the victim of domestic violence? (Support is available here).

Results

Of the 110 respondents, 100 answered Q1 and 104 Q2. Of the 100, 81% (95% CI 72% to 88%) said REA would be acceptable. No significant difference between men and women or abused and non-abused (9/10 of abused, 90% (CI 56% to 100%)). One man (1/42 2% (CI 0.1% to 12.6%) and 10 women (10/42, 16% (CI 8% to 28%) reported GBV (p=0.025 for gender difference). One man and three women declined to answer. Comments from women who reported GBV included “Other departments should deal with this ” – 38 yr old seen at CSRH and “Gives them someone who will listen” – 64 yr old seen at GUM.

Discussion

REA was acceptable to the majority. GBV history was not insignificant in men. This survey used a narrow definition of GBV and reports may have been higher had a more inclusive definition been used. Implications are that REA should be done in clinics and should be considered in men, perhaps using a self-completed questionnaire.
P98 Is pooling of self-taken specimens an effective and acceptable method of testing for sexually transmitted infections in MSMs?
Authors: Sultan B J , Fish R , Carrick G , Gilson R , Robinson A , Mercey D , White J , Benn P
Published: May 2012

Background

APTIMA Combo 2 (AC2) performs well for the detection ofChlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG) from extra-genital sites in high prevalence groups such as men who have sex with men (MSM), but testing three samples (pharynx, urethra and rectum) is a significant cost pressure for services.

Aims

To determine the; (1) Performance of AC2 to detect CT and NG from a pooled specimen: self-taken pharyngeal and rectal samples added to first-void urine (PS) compared with standard of care testing from individual sites (SOC). (2) Acceptability of pooling among MSM.

Methods

MSM (symptomatic or contacts of CT/NG) attending two London sexual health services were recruited. Information about demographics, sexual behaviour, symptoms, signs and acceptability of pooling was collected. PS and SOC sampling order was randomised and results compared.

Results

Of the planned 1400 MSM, 99 (53 HIV+) have been recruited. Two equivocal results were excluded from analysis. Some of the questionnaire data were missing. 80%(73/91) were symptomatic and 60% (57/96) reported unprotected anal sex in the last month. The prevalence of CT and/or NG infection was 35% (95% CI 26% to 45%), CT alone 14% (95% CI 8% to 23%) and NG alone 21% (95% CI 13% to 30%). The sensitivity and specificity of PS vs SOC to detect CT/NG is 88% (95% CI 72% to 96%) and 100% (95% CI 93% to 100%), respectively (abstract P98 table 1). PS failed to detect four NG cases (3 pharynx, 1 rectum). MSM reported confidence (n=74, 86%) and willingness (n=75, 88%) to take their own samples (see abstract P98 table 1).

Abstract P98 Table 1

Sensitivity and specificity of pooled samples according to test

Number positive (%) SOC testing [95% CI]Number positive (%) PS testingSensitivity % [95% CI]Specificity % [95% CI]CT &/ or NG* (*CT&NG, n=4)34 (35) [26 to 45]30 (88)88 [72 to 96]100 [93 to 100]CT14 (14) [8 to 23]14 (100)100 [73 to 100]100 [95 to 100]NG20 (21) [13 to 30]16 (80)80 [56 to 93]100 [94 to 100]

Discussion

Pooling specimens in MSM offers the potential for significant savings and improved access to testing. Missed infections may be due to sampling error or low organism load. The evaluation of this strategy continues.
P99 Socio-demographic and behavioural characteristics of men who have sex with men (MSM) and heterosexuals infected with gonorrhoea
Authors: Obi C , Chisholm S , Webster E , Town K , Anderson J , Nichols T , Ison C , Lowndes C
Published: May 2012

Background

As well as monitoring antimicrobial resistance, the enhanced Gonococcal Resistance to Antimicrobial Surveillance Programme dataset can be used to understand the epidemiology of gonococcal infection.

Objective

To explore socio demographic and behavioural characteristics of MSM (HIV positive and negative) and heterosexuals (male and female) infected with gonorrhoea.

Methods

Demographic and behavioural data from Gonococcal Resistance to Antimicrobial Surveillance Programme, collected annually between July and September 2005–2010 from 26 sentinel GUM clinics were analysed.

Results

Of 9239 gonorrhoea cases, 3089 (36%) were in MSM, of whom 861 (28%) were HIV positive; 5588 in heterosexuals, of whom 3012 (54%) were men. Predominantly of white ethnic background, HIV positive MSM (mean age 36 y) were older than HIV negative MSM (mean age 30 y). A higher proportion of HIV positive than negative MSM were co-infected with another STI (OR=1.6, 95% CI 1.3 to 1.9), mainly chlamydia (18% vs 15%) or syphilis (5% vs 2%). HIV positive MSM were also more likely (OR=1.5, CI 1.3 to 1.8) to report rectal gonococcal infection. Over a quarter of HIV positive MSM reported ≥6 sexual partners in the past 3 months compared to 18% of HIV negative MSM. Within the heterosexual population, higher proportion of women than men were of white ethnic background (74% vs 43%) and <25 y (72% vs 47%). Compared to heterosexual men, women were more likely to be co-infected with another STI (OR=1.5, CI 1.4 to 1.7) primarily chlamydia (41% vs 35%). Nearly two-third of heterosexual men reported ≥2 sexual partners in past 3 months while most women (64%) reported one or no sexual partners.

Conclusion

Gonorrhoea is concentrated amongst specific population sub-groups. Our analysis indicates that these groups are at high risk of contracting and transmitting other STIs as well as HIV, and underlines the need for targeted interventions.
B1 Is super accelerated hepatitis B vaccination best way forward?
Authors: Thomas J , Busby S , Chauhan M
Published: May 2012

Background

Hepatitis B vaccination offers protection against hepatitis B in high-risk individuals like IVDU, homosexuals and in sex workers. Super accelerated vaccination schedule of 0, 7, 21 days has been found to increase the compliance to the vaccination and has been found to be effective against hepatitis B transmission. We followed this schedule in our GUM clinic.

Objectives

1. To assess the uptake of Hepatitis B vaccination in homosexual and bisexual men. 2. To assess whether full STI screening including testing for HIV, hepatitis B and C is being done along with checking HBs antibody levels in those already immunised.

Methods

We looked at 30 patient notes, which included homosexual and bisexual men.

Results

All (100%) patients got full STI screen including HIV, hepatitis B and C testing. 30% of patients were vaccinated before and so immune to hepatitis B as shown by HBs antibody levels. Out of the remaining 70% of patients, 40% received three doses of Hepatitis B vaccination on the super accelerated vaccination schedule. 13% got two doses, 10% got only one dose and the remaining 7% declined.

Conclusion

All high risk individuals attending the sexual health clinic should receive a full STI screen including HIV, Hepatitis B, C testing and HBs antibody levels checked who has previously received vaccination. The accelerated vaccination schedule encourages patients to receive the full course of immunisation. Education of highrisk individuals is necessary to improve the vaccination uptake. A written card with vaccination appointment dates given to patients at the beginning will further improve the patient attendance to finish the full course of the vaccination.
B2 Space occupying lesion in an HIV positive male- are common things always common?
Authors: Haidari G , Singh S , Freudenthal B , Peters B , Kulasegaram R , Desai M , Bodi I
Published: May 2012

A 62-year-old man with well controlled HIV infection presented to clinic in December 2011, with a 6 week history of increasing forgetfulness, unsteady gait and visual disturbance. He was well established on highly active antiretroviral therapy, with a CD4 count of 524 and an undetectable viral load. On examination his GCS was 15/15, and he was noted to have a homonymous hemianopia. MRI confirmed a large mass in the deep thalamus extending into the brainstem which did not typically enhance. He went on to have a brain biopsy confirming a high grade glioblastoma multiforme. Post biopsy he developed a dense right sided hemiplegia thought to be due to disease progression. There have been 21 case reports of glioblastoma multiforme in HIV, raising the possibility we are now seeing an increasing number in HIV positive patients. In all documented cases, HIV was not found in glial tumours, although it is thought the role of the immune system in glial cell transformation could be compromised in HIV.

Discussion

HIV patients with glioblastoma multiforme are presenting at younger ages and have poorer outcomes than non-HIV patients. Glioblastoma multiforme should be considered in the differential for HIV patients presenting with neurological symptoms, especially in patients stable on highly active antiretroviral therapy with a good CD4 count, in an effort to reduce diagnostic delay.
B3 Social and welfare in clinic support service
Authors: Hale J
Published: May 2012

Background

Patients social and welfare care needs can be poorly served. Two factors contributed to this, lack of a specialised staff member for social and welfare needs and the few external organisation that are known, frequently changed their criteria or closed down.

Aim

Provide stable background for patient's thus decreasing non-adherence, enabling more free appointment time for increasing number of new diagnosis.

Method

Employ an experienced worker, to complete the multidisciplinary holistic care for people living with HIV, ensuring joined-up care between medical and social well-being with an excellent two way communication. We have one set of notes for all these needs and one focal point for external services to feedback to. Patients receive full assessment in addition to their presenting issue.

During an assessment, advice and referrals are offered on:

Social/Peer Support Groups

Benefits/Housing: assess patient's entitlement, avoiding unnecessary supporting medical letters. Alleviates patients approaching different legal orgs with same request. This system ensures who do require the help receive it.

Immigration

Employment skills and voluntary work

Travelling abroad with HIV

Insurance

HIV at work

Complimentary therapies

Recreational drug misuse

Domestic violence

Sex workers

Charity goods

Results and Conclusions

350 patients seen, 1 h each per year. Service currently just 2 days per week Full time role is envisaged. Database used to produce outcomes including needs, referrals made and gaps in services. Clinic staff freed to spend time on medical issues.
B4 In PID
Authors: de Burgh-Thomas A , Hills A , Medland V
Published: May 2012

Objectives

To review the management of PID in hospital inpatients and compare it to standards of care.

Methods

We reviewed the management of all those women admitted to hospital in Gloucestershire over a calendar year who were coded as having PID. We compared their management against BASHH and the RCOG standards (see abstract B4 table 1).

Abstract B4 Table 1

Compliance of management of patients with PID with standards

TargetAchievedAdequate sexual history95%25%Chlamydia testing100%55%Gonorrhoea testing100%70%Appopriate antibiotics100%75%GUM follow-up arranged95%5%Contact tracing 6/12 pre60%0%

Results

20 Patients were identified.

Conclusions

There is insufficient liaison between Gynaecology and GUM. We will discuss simple measures that have been introduced and planned changes to improve the management of PID.
Coefficients of active earth pressure with seepage effect
Authors: Barros Pérsio L.A. , Santos Petrucio J.
Published: May 2012

A calculation method for the active earth pressure on the possibly inclined face of a retaining wall provided with a drainage system along the soil–structure interface is presented. The soil is cohesionless and fully saturated to the ground surface. This situation may arise during heavy rainstorms. To solve the problem, the water seepage through the soil is first analyzed using a numerical procedure based on the boundary element method. Then, the obtained pore-water pressure is used in a Coulomb-type formulation, which supposes a plane failure surface inside the backfill when the wall movement is enough to put the soil mass in the active state. The formulation provides coefficients of active pressure with seepage effect which can be used to evaluate the active earth thrust on walls of any height. A series of charts with values of the coefficients of active earth pressure with seepage calculated for selected values of the soil internal friction angle, the wall–soil friction angle, and the wall face inclination is presented.
Origin of vein-graphite derived from metamorphic fluids in Moine (Glenfinnan Group) rocks, NW Scotland
Authors: Wright A. J. , Blamey N. J. F. , Conliffe J. , Costanzo A. , Parnell J.
Published: May 2012

Synopsis

Proterozoic metasediments at Glen Strathfarrar, Inverness-shire, host a deposit of vein-graphite that is unique within the Moinian stratigraphic sequence. Carbon isotopic analysis, Raman microspectroscopy, fluid inclusion studies and volatile gas analysis were used to constrain the origin of the vein-graphite. Carbon isotopic analysis shows that the carbon is heavier than that expected for sedimentary material (δ
13
C value of −14.35‰), suggesting that fractionation has taken place since sedimentation. Graphitization of sedimentary carbon in the Glenfinnan Group pelitic gneiss occurred in response to changes in both temperature and pressure arising from a series of regional metamorphic events. Scavenging of carbon by metamorphic fluids generated during amphibolite-grade metamorphism associated with the youngest, possibly Caledonian, event is the most probable source of the vein-graphite at Glen Strathfarrar. Similarities in gas composition with quartz veins occurring in Dalradian rocks show that carbonaceous sedimentary sequences consistently generate fluids rich in CO
2
and N
2
, making volatile gas analysis a valuable tool in determining the history of metamorphic fluids. The occurrence of crystalline graphite in the pelitic gneiss at Glen Strathfarrar makes it highly likely that the carbon-rich fluids have been generated from within the Glenfinnan Group sediments rather than from Lewisian rocks at depth. Despite the assertion that graphite is uncommon in Moine rocks, the high ammonium content of biotite in these metasediments and the consistently high N
2
values of fluid inclusions within the siliceous schist and quartz veins suggest that, prior to metamorphism, the sediments contained more organic matter than their present composition suggests.

Supplementary material:

The results of incremental crush analysis of vein samples from localities within the Moine, Dalradian and Old Red Sandstone are available at
http://www.geolsoc.org.uk/SUP18499
.
Differential effects of oxyntomodulin and GLP-1 on glucose metabolism
Authors: Du Xiaobing , Kosinski Jennifer R. , Lao Julie , Shen Xiaolan , Petrov Aleksandr , Chicchi Gary G. , Eiermann George J. , Pocai Alessandro
Published: May 2012

Glucagon-like peptide-1 (GLP-1) and oxyntomodulin (OXM) are peptide hormones secreted postprandially from the gut that stimulate insulin secretion in a glucose-dependent manner. OXM activates both the GLP-1 receptor (GLP1R) and the glucagon receptor (GCGR). It has been suggested that OXM acutely modulates glucose metabolism solely through GLP1R agonism. Because OXM activates the GLP1R with lower affinity than GLP-1, we generated a peptide analog (Q→E, OXMQ3E) that does not exhibit glucagon receptor agonist activity but retains the same affinity as OXM for GLP1R. We compared the effects of OXM and OXMQ3E in a glucose tolerance test and, to better characterize the effect on glucose metabolism, we performed controlled infusions of OXM or OXMQ3E during a hyperglycemic clamp performed in wild-type, Glp1r −/−, and Gcgr −/− mice. Our findings show that OXM, but not OXMQ3E, activates the GCGR in vivo. Second, OXM and OXMQ3E improve glucose tolerance following an acute glucose challenge and during a hyperglycemic clamp in mice. Finally, OXM infusion during a glucose clamp reduces the glucose infusion rate (GIR) despite a simultaneous increase in insulin levels in Glp1r −/− mice, whereas OXM and OXMQ3E increase GIR to a similar extent in Gcgr −/− mice. In conclusion, activation of the GCGR seems to partially attenuate the acute beneficial effects on glucose and contributes to the insulinotropic action of oxyntomodulin.
Acute hypoxia induces hypertriglyceridemia by decreasing plasma triglyceride clearance in mice
Authors: Jun Jonathan C. , Shin Mi-Kyung , Yao Qiaoling , Bevans-Fonti Shannon , Poole James , Drager Luciano F. , Polotsky Vsevolod Y.
Published: May 2012

Obstructive sleep apnea (OSA) induces intermittent hypoxia (IH) during sleep and is associated with elevated triglycerides (TG). We previously demonstrated that mice exposed to chronic IH develop elevated TG. We now hypothesize that a single exposure to acute hypoxia also increases TG due to the stimulation of free fatty acid (FFA) mobilization from white adipose tissue (WAT), resulting in increased hepatic TG synthesis and secretion. Male C57BL6/J mice were exposed to FiO2= 0.21, 0.17, 0.14, 0.10, or 0.07 for 6 h followed by assessment of plasma and liver TG, glucose, FFA, ketones, glycerol, and catecholamines. Hypoxia dose-dependently increased plasma TG, with levels peaking at FiO2= 0.07. Hepatic TG levels also increased with hypoxia, peaking at FiO2= 0.10. Plasma catecholamines also increased inversely with FiO2. Plasma ketones, glycerol, and FFA levels were more variable, with different degrees of hypoxia inducing WAT lipolysis and ketosis. FiO2= 0.10 exposure stimulated WAT lipolysis but decreased the rate of hepatic TG secretion. This degree of hypoxia rapidly and reversibly delayed TG clearance while decreasing [3H]triolein-labeled Intralipid uptake in brown adipose tissue and WAT. Hypoxia decreased adipose tissue lipoprotein lipase (LPL) activity in brown adipose tissue and WAT. In addition, hypoxia decreased the transcription of LPL, peroxisome proliferator-activated receptor-γ, and fatty acid transporter CD36. We conclude that acute hypoxia increases plasma TG due to decreased tissue uptake, not increased hepatic TG secretion.
Roles of three branchial Na+-K+-ATPase α-subunit isoforms in freshwater adaptation, seawater acclimation, and active ammonia excretion inAnabas testudineus
Authors: Ip Yuen K. , Loong Ai M. , Kuah Jie S. , Sim Eugene W. L. , Chen Xiu L. , Wong Wai P. , Lam Siew H. , Delgado Inês L. S. , Wilson Jonathan M. , Chew Shit F.
Published: May 2012

Three Na+-K+-ATPase ( nka) α-subunit isoforms, nka α1a, nka α1b, and nka α1c, were identified from gills of the freshwater climbing perch Anabas testudineus. The cDNA sequences of nka α1a and nka α1b consisted of 3,069 bp, coding for 1,023 amino acids, whereas nka α1c was shorter by 22 nucleotides at the 5′ end. In freshwater, the quantity of nka α1c mRNA transcripts present in the gills was the highest followed by nka α1a and nka α1b that was almost undetectable. The mRNA expression of nka α1a was downregulated in the gills of fish acclimated to seawater, indicating that it could be involved in branchial Na+absorption in a hypoosmotic environment. By contrast, seawater acclimation led to an upregulation of the mRNA expression of nka α1b and to a lesser extent nka α1c, indicating that they could be essential for ion secretion in a hyperosmotic environment. More importantly, ammonia exposure led to a significant upregulation of the mRNA expression of nka α1c, which might be involved in active ammonia excretion. Both seawater acclimation and ammonia exposure led to significant increases in the protein abundance and changes in the kinetic properties of branchial Na+-K+-ATPase (Nka), but they involved two different types of Nka-immunoreactive cells. Since there was a decrease in the effectiveness of NH4+to substitute for K+to activate branchial Nka from fish exposed to ammonia, Nka probably functioned to remove excess Na+and to transport K+instead of NH4+into the cell to maintain intracellular Na+and K+homeostasis during active ammonia excretion.
Defective renal water handling in transgenic mice over-expressing human CD39/NTPDase1
Authors: Zhang Yue , Morris Kaiya L. , Sparrow Shannon K. , Dwyer Karen M. , Enjyoji Keiichi , Robson Simon C. , Kishore Bellamkonda K.
Published: May 2012

Ectonucleoside triphosphate diphosphohydrolase-1 hydrolyzes extracellular ATP and ADP to AMP. Previously, we showed that CD39 is expressed at several sites within the kidney and thus may impact the availability of type 2 purinergic receptor (P2-R) ligands. Because P2-Rs appear to regulate urinary concentrating ability, we have evaluated renal water handling in transgenic mice (TG) globally overexpressing hCD39. Under basal conditions, TG mice exhibited significantly impaired urinary concentration and decreased protein abundance of AQP2 in the kidney compared with wild-type (WT) mice. Urinary excretion of total nitrates/nitrites was significantly higher in TG mice, but the excretion of AVP or PGE2 was equivalent to control WT mice. There were no significant differences in electrolyte-free water clearance or fractional excretion of sodium. Under stable hydrated conditions (gelled diet feeding), the differences between the WT and TG mice were negated, but the decrease in urine osmolality persisted. When water deprived, TG mice failed to adequately concentrate urine and exhibited impaired AVP responses. However, the increases in urinary osmolalities in response to subacute dDAVP or chronic AVP treatment were similar in TG and WT mice. These observations suggest that TG mice have impaired urinary concentrating ability despite normal AVP levels. We also note impaired AVP release in response to water deprivation but that TG kidneys are responsive to exogenous dDAVP or AVP. We infer that heightened nucleotide scavenging by increased levels of CD39 altered the release of endogenous AVP in response to dehydration. We propose that ectonucleotidases and modulated purinergic signaling impact urinary concentration and indicate potential utility of targeted therapy for the treatment of water balance disorders.
Reduced kidney lipoprotein lipase and renal tubule triglyceride accumulation in cisplatin-mediated acute kidney injury
Authors: Li Shenyang , Nagothu Kiran , Ranganathan Gouri , Ali Syed M. , Shank Brian , Gokden Neriman , Ayyadevara Srinivas , Megyesi Judit , Olivecrona Gunilla , Chugh Sumant S. , Kersten Sander , Portilla Didier
Published: May 2012

Peroxisome proliferator-activated receptor-α (PPARα) activation attenuates cisplatin (CP)-mediated acute kidney injury by increasing fatty acid oxidation, but mechanisms leading to reduced renal triglyceride (TG) accumulation could also contribute. Here, we investigated the effects of PPARα and CP on expression and enzyme activity of kidney lipoprotein lipase (LPL) as well as on expression of angiopoietin protein-like 4 (Angptl4), glycosylphosphatidylinositol-anchored-HDL-binding protein (GPIHBP1), and lipase maturation factor 1 (Lmf1), which are recognized as important proteins that modulate LPL activity. CP caused a 40% reduction in epididymal white adipose tissue (WAT) mass, with a reduction of LPL expression and activity. CP also reduced kidney LPL expression and activity. Angptl4 mRNA levels were increased by ninefold in liver and kidney tissue and by twofold in adipose tissue of CP-treated mice. Western blots of two-dimensional gel electrophoresis identified increased expression of a neutral pI Angptl4 protein in kidney tissue of CP-treated mice. Immunolocalization studies showed reduced staining of LPL and increased staining of Angptl4 primarily in proximal tubules of CP-treated mice. CP also increased TG accumulation in kidney tissue, which was ameliorated by PPARα ligand. In summary, a PPARα ligand ameliorates CP-mediated nephrotoxicity by increasing LPL activity via increased expression of GPHBP1 and Lmf1 and by reducing expression of Angptl4 protein in the proximal tubule.