bluuebunny/crossref_metadata_2025 huggingface dataset:
P114 Sensitivity and cost-effectiveness of trichomonas vaginalis naat (nucleic acid amplification) assay in symptomatic female patients attending a genitourinary medicine clinic
Authors: Swaris Beruwalage , Partridge David , Dewsnap Claire , Taylor Cheryl , Sahib Sura
Published: May 2024

Introduction

Trichomonas vaginalis is the commonest curable sexually transmitted infection worldwide. Diagnosis is by detecting Trichomonas organisms or its DNA. Sensitivity of microscopy in females is 45–60%. Culture has a higher sensitivity than microscopy but molecular detection offers the highest sensitivity and is considered gold standard. We currently use only microscopy and this may lead to false negatives. This study assesses sensitivity and cost-effectiveness of TV NAAT assay compared with microscopy and acridine orange (AO) staining in symptomatic female patients.

Methods

Prospective study looking at symptomatic female patients attending sexual health clinic during the period from 05/10/2015 to 17/05/2016.Female patients with one or more of the following symptoms; vulval soreness, itchiness, ulceration or abnormal discharge were included. Wet microscopy was performed and dried slide was sent to the lab for AO staining. TV NAAT was added to the Chlamydia/Gonorrhoea dual testing swab.

Results

452 patients were included. Age ranged from 14–65 years. 31,18 and 8 patients had positive NAAT, microscopy and AO respectively. Considering NAAT as the gold standard; sensitivity, specificity, PPV and NPV of microscopy and AO was 48%, 100%, 100%, 95% and 28%, 100%, 100%, 94% respectively. 51.6% of the cases would have been missed if only the microscopy was used to diagnose TV.

Discussion

Overall prevalence of TV positivity in our study population was 7.52%.Microscopy provided the advantage of rapid result but failed to identify half the positives.TV NAAT testing in carefully selected symptomatic women will be of value to provide better patient care.
P115 Six years of outreach testing- does it work?
Authors: Emerson Carol , Wilson Yvonne
Published: May 2024

Introduction

We have been running an outreach program since January 2009 in order to target high-risk MSM using sex on premise venues.

Methods

Monthly outreach sessions to high-risk venues, inc annual pride events, run in conjunction with a LGBT organisation. Patients offered serological testing for HIV, syphilis, hepatitis B and C, triple site testing for Chlamydia/Gonorrhoea PCR and vaccination for hepatitis A and B.

Results

Over 6years, 79 outreach sessions held, with 1305 assessments. 226 patients have attended more than once. 424 (68%) patients had never previously attended GUM and 391 (62%) had never had HIV testing. Testing found 13 HIV, 61 untreated syphilis (46 early), 4 chronic active hepatitis B, 63 Chlamydia (21 UR, 36 rec, 6 Th), 48 gonorrhoea (3 UR,18 rec, 27 Th). All patients attended for follow up at GUM clinic. HIV never testers decreased from 34% 2009 to 14% 2014. Vaccines given 160 in 2009, 40 in 2014.

Discussion

The outreach program is a very important initiative, reaching high risk men who very often would not have been tested (34% in 2009). There was a high rate of infection diagnosed. Over time less vaccines required, percentage of HIV ‘never testers’ dropped 34–14% and 6mthly testing increased 13–45%. The outreach has increased access and raised the profile of the health services offered by GUM.
P116 Our new statutory obligations under the amended female genital mutilation act 2003 (sections 70–75 of the serious crime act 2015); one year on
Authors: Howe Alice
Published: May 2024

Introduction

The UN estimates 200 million women and girls worldwide are living with the effects of female genital mutilation (FGM), with 137,000 victims in England and Wales. Following the introduction of the amended FGM Act 2003 in October 2015, I reported that 1385 new cases were identified in England in the quarter before the new law and 1316 in the quarter following. In keeping with my aim, I have reviewed the data from the year following the new legislation, to determine its effect.

Methods

Using hscic and NHS digital data, combined with reports from UN and WHO, I analysed the 12 months following the legislation change. I also searched Ministry of Justice reports to study how many FGM protection orders (FGMPOs) and convictions have been made.

Results

Data revealed similar numbers of new cases of FGM reported in each 3-month period since October 2015 (1242, 1293 and 1204 respectively). However, there are large gaps in the data. Since July 2015, there have been 97 applications for FGMPOs and 79 orders. There have still been no FGM related convictions in the UK, despite 32 cases being reported to have happened in the UK between January and September 2016.

Discussion

The results are disappointing and we are yet to see substantial change. £4million has been spent and 22,000 FGM training sessions have been delivered but we are still failing to report properly and prosecute offenders. To achieve 2015’s Sustainable Development Goals, the UK must play its part to help end FGM.
P117 A review of sexual health provision at coastline homeless day centre
Authors: Sidebotham Charlotte , Haddon Lisa , Gates Pam
Published: May 2024

Introduction

Homelessness goes beyond rooflessnessIt is isolating and destructive. The government recognises the homeless are more vulnerable to sexual health risks and need targeted interventions. Cornwall’s sexual health outreach is limited.

Methods

A fortnightly afternoon drop-in sexual health clinic, run by a senior nurse and healthcare assistant, was established in a Health-for-the-Homeless (HFH) General Practice service in a socially deprived area of Cornwall. Shared-care with the HFH service whereby patients gave permission for results to be copied to the GP service.

Results

Between September 2013 and January 2017, there were 498 clinic attendances, with 109 (22%) females, and 389 (78%) male clients. Of all attendances, 181 (36%) accepted sexual health screening. Of these, 17 (9.4%) were diagnosed with a sexual infection and/or hepatitis C, including 7 (3.9%) of chlamydia; 4 (2.2%) of new hepatitis C infection; 3 (1.6%) of genital warts; and 1 (0.6%) of: gonorrhoea, herpes and molluscum contagiosum. All infections were treated. 5 (5%) females had cervical cytological assessment. A 140-strong sample of notes were scrutinised to ascertain examination uptake. Of 82 indicated examinations, 26 (32%) accepted, 56 (68%) clients declined. Poor uptake may account for the low rate of skin conditions diagnosed. 20 (4%) attendances culminated in vaccination. The clinic managed 3 (0.6%) recent sexual assault cases.

Discussion

Client feedback suggests that medical help would not have been sought elsewhere. Meeting in a safe environment, we believe we have broken down barriers. An increasing number of returning clients we hope reflects trust in the service. Service costing will be discussed to develop contraception provision.
P118 Patients’ satisfaction with medication information provided by nurses using independent nurse prescribing (INP) or patient group directions (PGDS) in uk sexual health services
Authors: Black Adam , Courtenay Molly , Gage Heather , Norton Christine , Franklin Bryony Dean
Published: May 2024

Introduction

Nurses’ ability to independently deliver medication was introduced to improve patients’ access to medication and experience of healthcare services. INP and PGDs are used frequently in sexual health services; however, there is limited evidence of patients’ satisfaction with medication information provided.

Methods

Nurses (INP or using PGD) from five UK sexual health services distributed a questionnaire to patients with whom they had consulted and delivered medication, Sept 2015 – Aug 2016. The questionnaire was informed by Birmingham’s sexual health service satisfaction questionnaire and the Satisfaction with Information about Medicines Scale (SIMS).

Results

Of the 393 patients who received a questionnaire, 92% (n=360) responded. Patients who had received medicines via a PGD and INP reported nurses to be friendly and approachable (n=359/360, 99%); that they installed confidence and trust (n=357/360, 99%); explained the reasons for medications clearly (n=349/360, 97%); and suitably answered questions (n=335/360, 93%). Of the 89% (n=348/360) of respondents who completed the SIMS, an overall score of 13.3/16 was achieved: the higher the score, the greater the satisfaction. The largest points of dissatisfaction related to not receiving information on whether they could drink alcohol (n=58/348, 17%), potential for drowsiness (n=54/348, 16%) or side effects (n=37/348, 11%).

Discussion

Patients predominantly provided positive feedback regarding their medication consultations with nurses. High SIMS scores identified overall satisfaction with medication information. Further consideration may be needed on the potential problems medications can cause to further improve patient satisfaction (e.g. advice on alcohol consumption, side effects and drowsiness potential).
P135 A review of local test of cure (TOC) practice following treatment for rectal chlamydia and lymphogranuloma venereum
Authors: Fauzi Mohd , Ahmad Sameena , Saxon Cara
Published: May 2024

Introduction

Previous reports of up to 22% treatment failure in rectal Chlamydia informed our local clinic policy of routine test of cure (TOC) following rectal chlamydia or lymphogranuloma venereum (LGV) treatment. We set out to review our local TOC practice and treatment failure rates for both chlamydia and LGV.

Methods

Case notes of patients diagnosed with rectal chlamydia and LGV between 01/07/15 and 01/07/16 were reviewed. Data was collected on symptoms, antibiotic choice, compliance and TOC.

Results

There were 89 patients identified with rectal chlamydia; 7 (8%) were confirmed LGV. Median age was 30 years; 69 (78%) men who have sex with men (MSM) and 20 (22%) female. Treatment was primarily with 1 week of doxycycline (81/89; 91%).

Of 89 patients, 53 (60%) attended for a TOC with the remainder (36; 40%) lost to follow-up. There were 3/48 (6%) positive TOC results in those with non-LGV rectal chlamydia with one reporting sexual contact during treatment giving a failure rate of 4% (2/48). Of those with LGV 5/7 (71%) attended for a TOC and all were negative. Of those with a negative TOC 3/45 (6%) patients reported sexual contact during treatment.

Discussion

Over a 12-month period our local treatment failure rate was low at 4% for rectal chlamydia and 0% for LGV. A significant proportion of patients failed to return for TOC. These results suggest that removal of routine TOC would be locally acceptable, reduce health advisor workload and be in line with current BASHH guidance.
O18 Internet testing for chlamydia reported through national surveillance in england
Authors: Hollis Emma , Harb Ana , Talebi Alireza , Shah Ammi , Connor Nicky
Published: May 2024

Introduction

To support and monitor growth of online testing, the National Chlamydia Screening Programme published guidance on commissioning online testing services. Coding was amended in national surveillance systems to differentiate tests requested online from testing in other venues.

Methods

National surveillance data from January 2015–September 2016 were linked to the IMD 2015 and ONS urban rural classification indices to analyse the trends in online testing and test positivity by gender for 15–24 year olds. Patterns of repeat testing were explored.

Results

163,062 tests and 13,422 diagnoses were reported from online services covering 89% of local authorities in England. Test positivity was higher in men (10% vs. 7.6% women; RR 0.80,p<0.0005), residents of urban areas (8.4% vs. 7.4% rural; RR 1.08,p=0.002) and those living in the most deprived areas of England (9.6% vs 7.0% least deprived; RR 0.79,p<0.0005). Test positivity online was higher than in general practice (8.2% vs GP 6.1% p<0.0005) and lower than in specialised sexual health services (8.2% vs 9.9% GUM and 9.5% SRH p<0.0005). In 2015, 18% of online testers had a subsequent online test within 6 months. Test positivity was higher at first than subsequent test (8.5% vs 7.3%).

Discussion

Patterns in online test positivity were comparable with those found in other services suggesting that they are used by the population at risk not just the ‘worried well’. Around 1-in-5 of those testing online had subsequent online tests. These findings support the provision of online testing services as well as face-to-face venues.
P137 Burden of chronic liver disease in an hiv cohort
Authors: Bell Laura , Megarity Stephen , McIntyre Michelle , Wilson Yvonne , Cash Johnny , McDougall Neil , Hunter Michael
Published: May 2024

Introduction

HIV monitoring guidelines recommend 3-to-12 monthly monitoring of LFTs in HIV-infected patients. Liver-related deaths account for 10–15% of mortality in patients with HIV-infection. Draft NICE guidance, covering the identification of chronic liver disease, is under consultation.

Methods

200 HIV-infected patients were randomly selected from a cohort of 1000 patients. Those patients who were not engaged in care (i.e. less than 2 out-patient appointments in the past 12 months) or not on ARVs were excluded. Demographics, lifestyle factors and laboratory parameters were recorded. Patients at greatest risk of liver cirrhosis were screened using transient elastography.

Results

Of the 161 HIV-infected patients on ARVs, 49 (30%) had a raised AST or ALT within the preceding year. Only 105 (65%) had a documented alcohol history. Of patients with elevated transaminases, the cause was already established in 21/49 (43%). Factors included alcohol, IM testosterone, viral hepatitis, cryptosporidium infection and hepatotoxic medication. 12 patients were found to have an AST-to-platelet ratio index (APRI) of greater than 0.7. Of these the causes identified included: 4 hepatitis C co-infected, 1 hepatitis B co-infected, 2 alcohol related, 1 Budd Chiari awaiting liver transplant, 2 medication related and 2 not established. Patients with raised transaminases were offered metabolic risk factors screening and transient elastography.

Discussion

There is a small but significant burden of liver disease in patients on ARVs. Lifestyle counselling, to reduce harmful alcohol consumption and viral hepatitis infection could be improved. Implementation of NICE guidelines may improve the diagnosis of cirrhosis.
P139 Sexual risk profiles, and sti testing behaviour among users of a postal home sampling sti testing service (PHSSTS)
Authors: Chirwa Mimie , Ume Uchenna , Hardie Jamie , Nulty Kate , Jensen Sigrid , Doku Eric , Hall Angela , Pickard Graham , Merritt Jeremy , Day Sara
Published: May 2024

Introduction

The London Sexual Health Transformation Programme promises an online Postal Home sampling STI testing services (PHSSTS) for asymptomatic patients. Our aims were to pilot a PHSSTS, determine the STI prevalence, sexual risk profiles and STI testing behaviours.

Methods

November 2015 – October 2016, adult patients visiting our clinic website had the opportunity to complete an online sexual health questionnaire and order a home sampling kit (HSK). Tests; Gonorrhoea, Chlamydia, Syphilis and HIV. Results were sent via SMS plus recommendations about their sexual health.

Results

946 HSK were ordered by 871 users. 650 (69%) samples were returned. Mean age 30 years; 58% female; 62% white British; 73% heterosexual: 20% MSM. 8% reused PHSSTS. 34% and 23% of users had never tested for STIs and HIV respectively. Median of 2 partners (<3 months).

43% reported condomless sex (<2 weeks) and 62% of MSM reported high risk behaviour. 29% women were not using contraception at all or correctly.

25%, 3% and 8% of all patients were eligible for Hepatitis B/C testing and Hepatitis vaccination respectively. 38% of eligible patients required Hepatitis B vaccination.

STI prevalence was 3%;1 HIV, 5 syphilis, 14 chlamydia and 1 gonorrhoea.All were recalled for treatment. Median return time for samples was 6 days.

Discussion

PHSSTS proved acceptable, enhanced access and was a preferred method of testing. Additional sexual health needs could not be directly met by an online service. PHSSTS therefore must work collaboratively with GUM clinics to meet the full needs of PHSSTS users.
O19 Who uses online services where? a comparison of online sti testing service use across england
Authors: Parry Glyn , Clune Mark , Sa Joia de , Baraitser Paula , Holdsworth Gillian
Published: May 2024

Introduction

Online sexual health testing services may enable access to testing by different sectors of the population. An innovative online sexual health service designed to improve access to and availability of sexual health services in partnership with terrestrial services is commissioned in seven areas across England. This study compares use across commissioned areas.

Methods

We used routinely collected testing data to analyse use of the service in different areas. We included cumulative data on use of the service since roll-out.

Results

In areas outside London, fewer users had been to a clinic before (66.5%–73.1% vs 81.1%). Positivity rate was also generally higher outside London (6.8 – 11.0% vs 6.8%). The majority of users were asymptomatic, which is appropriate for the service. Within the London boroughs, the majority of users (51.8%) were in the 25–34 age bracket while in all other areas there was a higher proportion of younger users. In all areas, females used the service more than males. Use by ethnicity was related to local area demographics.

Abstract O19 Table 1

Use of service as of end November 2016

Area 1Area 2Area 3 (London)Area 4Area 5Area 6Orders to date976046215,9247131,0481,726Return rate68.8%58.9%71.1%76.9%76.7%78.9%Positivity rate7.6%11.0%6.8%6.8%9.0%10.4%% asymptomatic90.1%89.2%90.8%85.6%86.6%85.5%Clinic visited before66.5%67.1%81.1%73.1%66.7%67.1%

Discussion

The online service increased access to STI testing in all commissioned areas and shows important differences in online service use in different geographical regions. This may reflect differences in unmet need and access to terrestrial services. Further work is needed to understand these differences.
P147 An audit into the optimum time for neisseria gonorrhoeae test of cure following treatment in sexual health centres
Authors: Slack Daniel , Gilson Rebecca
Published: May 2024

Introduction

Neisseria gonorrhoeaeis the second most common bacterial sexually transmitted infection worldwide and has evolved resistance to several antibiotic classes. BASHH Guidelines 2011 currently recommend ceftriaxone 500mg IM plus azithromycin 1g stat as first line treatment and also recommend a test of cure (TOC) at 14 days. In our centre the time period between treatment and TOC was reduced to 14 days in July 2016. Anecdotal evidence suggests that this may be producing a higher false positive rate.

Methods

Clinical notes for all positive gonorrhoea tests (pharyngeal, rectal, urethral, cervical) in a 3-month period were reviewed. Positive TOC were identified and reasons for these assessed (reinfection, treatment failure, false positive). Cycle threshold (CT) values were used to help identify false positives.

Results

7.5% of TOC results performed at 14 days were likely false positive (no risk of reinfection or treatment failure, high CT values), compared with 2.7% of TOC performed after 14 days. 8.3% of pharyngeal samples and 12.5% of urinary samples were false positive. There were no false positives found for rectal and vulvovaginal samples.

Discussion

There is a significantly higher rate of false positives when a TOC is performed at 14 days and they are more prevalent in pharyngeal and urinary samples. This has a negative impact on both patient and health care provider time and can lead to unnecessary retreatment. Potential interventions could be to extend the TOC time period, include CT values for all TOC results or move to a less sensitive NAAT for TOC.
P151 Developing an asymptomatic screening pathway for men who have sex with men
Authors: Cook Sinead , Lomax Nicola , Drayton Rachel
Published: May 2024

Introduction

Many sexually transmitted infections (STIs) are known to disproportionately affect men who have sex with men (MSM) in the UK; therefore regular easily accessible asymptomatic screening is vital among this group. Asymptomatic screening pathways that allow healthcare support workers (HSCWs) to see patients can reduce long clinic waits, which may encourage more people to attend for screening and increase capacity for screening.

Methods

We developed and trialled an asymptomatic pathway for MSM within our service. This extended our existing pathway, which allowed asymptomatic service users to complete a questionnaire and see a HCSW, to include MSM, as it previously had not. The service was piloted, then implemented and audited.

Results

A 5 month audit of 45 notes showed that the pathway is generally being used appropriately. 93% (27/29) service users were offered referral to a health advisor when indicated by the pathway and two were offered referral without any clear indication. This resulted in 29(64%) men seeing a health advisor for health promotion after completing their STI screen as 2 men declined. All patients received appropriate Chlamydia, Gonorrhoea, HIV, Syphilis and Hepatitis B testing, but 7(16%) were not tested for Hepatitis C when indicated by the pathway. 4(9%) men had an STI (Chlamydia or Gonnorhoea).

Discussion

We believe this model can reduce clinic visit duration. This should increase accessibility and acceptability and also allow trained staff to manage more complex patients, while allowing for risk identification and health promotion among asymptomatic MSM who may also be at higher risk.
P156 What is telephone access really like for gum clinic patients in the U.K.?
Authors: Agathangelou Gabriela , Khatun Azra , Yekini Stephen , Rose Tom , Foley Elizabeth , Patel Raj
Published: May 2024

Introduction

How patients fare when accessing care by telephone at GUM clinics in the UK can be assessed by ‘mystery shopping’ methods. This study aimed to establish current access levels when contacting clinics by telephone and investigate the potential barriers.

Methods

During October – November 2016 all 262 GUM Clinics in the UK were called during clinic opening times on eight occasions, each by male and female researchers posing as patients requesting to be seen as soon possible.

Results

Overall 1589/1905 (83.4%) calls were offered an appointment. Of these, 63.7% of ‘patients’ were invited to attend a walk-in service. Most clinics were consistently contactable, with 72.9% of calls being answered on the first attempt, however 22.9% of clinics were un-contactable at on at least one occasion. Contacting a clinic over four calls can establish the probability of clinic access, with 68.8% of clinics accommodating a minimum of 6/8 callers.

The time to speak to a human ranged from 1 second – 39 minutes. The mean length of conversation was 93 seconds, with longer speaking time increasing chance of success. Although male and symptomatic ‘patients’ spent longer on the phone, females were 14.6% more likely to offered an appointment (p=0.037). Symptomatic scenarios did not have improved access over asymptomatic contacts (p=0.074).

Discussion

Access appears to be falling further below the BASHH standard. Various difficulties in establishing contact were identified, including long hold times and the need for multiple call attempts, that may be barriers to patient access.
P157 Utility of chlamydia care pathway for standardisation of quality measures for management of chlamydia trachomatis
Authors: Chung Emily , Saunders John , Robinson Angela
Published: May 2024

Introduction

The Chlamydia Care Pathway (CCP) describes individual steps of comprehensive case management for Chlamydia trachomatis (CT) providing standardised methodology to compare outcomes. We audited CCP in a central London service to identify aspects requiring service improvement.

Methods

All patients diagnosed with CT in 6 months in 2016 were identified from the electronic patient record system. A random sample of 60 notes was assessed against each step of the CCP.

Results

There were 35,995 new patient appointments and 1700 patients had positive CT results. Of the sample, 32 were male, 28 female. Median age for men was 34, range 20–71 years, women 24, range 17–28 years. 14/32 of males were MSM, 18/32 heterosexual. All females were heterosexual. 14/60 of patients were contacts of CT and 11 of the male patients were diagnosed with non-specific urethritis and were treated on the same day. Test turnover time was median 6, range 2–10 days. 50/60 patients were informed on the day the results were available. Of the 35/60 patients requiring treatment, time taken for them to attend was median 1, range 0–50 days. 56/60 had documented contacts informed, 18/60 had documented contacts treated. 19/60 attended for repeat tests 3 months later of whom 2 had new infections.

Discussion

This review identified areas for improvement, such as partner notification documentation and test turnover time. Review of other sites within the sustainability and transformation footprint is planned. This tool may be useful to commissioners for standardising quality measures and comparing performance of testing sites in a locality.
P165 HIV inpatient experience
Authors: Malik Seema , Chapman Cordelia
Published: May 2024

Introduction

‘Standards of care for people living with HIV 2013’ provides recommendations for the clinical care of HIV positive patients, including inpatients. We conducted an audit to describe patterns of service use with particular reference to time to diagnosis of HIV, presenting illness, medication, length of stay and follow up.

Methods

Data was collected retrospectively from notes of 36 inpatients from 1stJanuary to 31stDecember 2014.

Results

4 patients were newly diagnosed with HIV, of which, 3(75%) presented with an AIDS defining illness. HIV test was performed in MAU on 2 patients (50%). In the remaining 32 patients, 8 presented with AIDS defining illness. 11% had evidence of drug-drug interactions. 37% had no evidence of HIV Team inpatient review. 25 patients were discharged within 7 days, however, 4 stayed for more than 28 days. Only 41% were seen in HIV Outpatients within 4 weeks after discharge. After admission with AIDS defining diagnosis, all patients were alive at 30 days and 72% alive at 6 months.

Discussion

Complex care accounted for a sizeable proportion of our inpatient work. Current BHIVA recommendation of immediate commencement of HAART will significantly reduce disease progression and inpatient admission. This audit highlights the need for continued effort to raise awareness of HIV testing among non-HIV specialists and GP’s.
O21 HIV testing in abortion services: missed opportunities for earlier diagnosis
Authors: Logan Louise , Folkard Kate , Connor Nicky , Ncube Fortune , Nardone Anthony
Published: May 2024

Introduction

The 2016 National Institute of Clinical Excellence (NICE) HIV testing guidelines reiterated the need to include HIV testing in abortion services. This survey aimed to determine whether HIV testing was commissioned in abortion services and how much testing was performed.

Methods

143 CCGs were invited to provide service specifications and monitoring data for the number of women seen for care, tested for HIV and diagnosed as HIV positive.

Results

Of 103 CCGs that responded, 45 (42%) stipulated that HIV testing should be offered to all women, 10 (9%) requested that providers work towards this, 27 (26%) requested sign-posting and 21 (20%) had no mention of HIV. All 10 CCGs in extremely high HIV prevalence areas (where diagnosed HIV is >5/1000) commissioned HIV testing. 54% (14/26) of CCGs in high prevalence areas (diagnosed HIV is 2–5/1000) and 45% (30/367) of CCGs in low prevalence areas (diagnosed HIV is <2/1000) did so. 40 of 103 CCGs reported testing data. Of 35,023 women reported as seen for care, 35% (12,179) were tested for HIV and 0.14% (17) tested positive. Uptake ranged from 0% to 97% and positivity ranged from 0% to 0.53%.

Discussion

Overall positivity rates exceed those required to make HIV testing cost effective. Less than half the CCGs reported commissioning HIV testing in abortion services, including 54% in high prevalence areas. These gaps in service provision mean opportunities to diagnose women earlier; thereby improving their prognosis and reducing undiagnosed infection were missed. Further advocacy for testing HIV testing in abortion services is required.
P169 Gonorrhoea culture audit in a community setting
Authors: Rejaei Yasmin , Ladipo Zana
Published: May 2024

Introduction

Gonorrhoea (GC) accounted for 10% of all STI diagnoses in 2015. Diagnoses increased by 11% from 2014 to 2015, continuing an established trend beginning in 2012. BASHH guidelines recommend that cultures are routinely taken as it is cheap and offers antimicrobial susceptibility testing which is of increasing importance given the emergence of resistant GC strains. The primary aim of this audit was to assess the rate of GC culture and the outcome of the culture results in a community service.

Methods

20 cases, coded positive for GC, were recruited over a 19 month period. The standard for GC culture rate was set at 100%, with positive GC culture set at 85–95%. Standards were established from BASHH GC management and testing guidelines.

Results

Of the 20 patients 55% had a sample for GC culture taken. The sex distribution of culture sampling was 10:1, male to female. Of these 11 patients 45% had a positive culture, despite all patients having a positive NAAT. These rates are almost half of the expected standards.

Discussion

Cultures for GC are not routinely taken at this service. It is plausible that the incorrect storage of samples and delay in plating are contributing factors to the increased false negative rate. This may be a nationwide effect as services move into the community and transport times to laboratories increase. The audit results have been presented to staff at the service and discussion is ongoing with the laboratory regarding expediting transport of samples.
P170 Improving staff integration through means of a combined clinic rota
Authors: Connolly Noel B , Stott Cheryl , Babu Chitra
Published: May 2024

Introduction

With the national move to integrated sexual health services confusion regarding staff leadership and roles can increase already high levels of stress and anxiety. Costs for professional rota management services can vary so we aimed to achieve an in-house system.

Methods

Though co-located in the same building SRH and GU/HIV clinics were traditionally staffed separately. The local tender was awarded to the University Hospital clinic as hub with spokes providing an equitable city-wide service. Previously there were four separate rotas to staff SRH, GUM, and HIV services. Bringing together a group of health professionals with varying degrees of dual training can be difficult so we took this opportunity to ensure an adequate skill mix was available for each clinic, help staff identify who was available for advice, improve cross-specialty training and thereby enhance the overall patient experience. A clinic co-ordinator doctor role was established to provide focus for leadership and advice (GU/HIV) with corresponding clinic co-ordinator nurse staffed by senior contraception clinicians.

Discussion

Rotas were combined onto a single colour-coded template. Editing rights were restricted to named individuals aware of staff mix and availability. Numbers were calculated at the start of each day and communicated to reception to ensure spread of appointments. The CCD role was utilised to help teach SRH colleagues in GU with the CCN providing a reciprocal service for contraception. Combining the rota encouraged staff to integrate and get to know each other so that perceived fears were dealt with in a safe reassuring environment.
P173 Artistic representations of HIV in northern ireland: how the arts can contribute to HIV awareness, prevention and stigma-reduction in a conservative environment
Authors: Campbell Alyson
Published: May 2024

Introduction

The International AIDS conference in Melbourne in 2014 gave rise to a diverse set of cultural responses around HIV and AIDS, including my own practice-as-research performance installation,GL RY, in a public square throughout the conference. Using the concept of a hole as metaphor for transmission and transformation, it asked what histories, secrets, stigma, information, art, affects might slip through a small hole?

Methods

In 2016 the work had a new iteration in Belfast for the Outburst Queer Arts Festival. We worked closely with people living with HIV in Northern Ireland to find ways to convey their experiences safely in a public arena. It took up the challenge from 2014 where, working alongside long-time HIV activist and artist Kim Davis, it became clear that women are particularly marginalised in the public discourses and representations of HIV and AIDS. This resulted in a performance installation in a shopfront in Belfast city centre, focusing on the experience of women and asking for solidarity with women living with HIV through participation.

Results

Three new works on HIV and AIDS made in Belfast in November 2016 with collection of data including audience and participant feedback.

Discussion

The paper argues that art can intercede in powerful ways in public discourses, in modes that other forms of information and education cannot. In creating a sound archive based on interviews with people living with HIV, I suggest that this work could productively be used in therapeutic use in clinics and in HIV agencies and medical training.
P175 Vacuum therapy in ed: outcomes from a specialist vacuum clinic
Authors: Megarity Stephen , Dinsmore Wallace , Bell Laura , McCarty Emma
Published: May 2024

Introduction

Vacuum devices are a safe and inexpensive treatment for erectile dysfunction (ED) particularly when other treatments are not tolerated or contraindicated.

Methods

Chart review of patients attending specialist vacuum clinic over 2 year period was conducted. Data collected included outcomes with previous treatments and vacuum device.

Results

55 patients (median age of 65 years) were prescribed a vacuum device. The median time from initial assessment at ED clinic to prescription of the device was 18 months. The majority had significant underlying co-morbidities: 25/55 diabetes, 23/55 CVD, 3/55 prostate surgery, 2/55 stroke, 1/55 spinal injury and 1/55 MS. All patients received prior ED treatment with PDE5i inhibitor and/or intracavernosal alprostadil. With regards to PDE5i, 43/55 reported poor/no response, 1/55 failed to tolerate, and in 11 patients a PDE5i was contraindicated. All 55 patients were subsequently offered intracavernosal alprostadil injections however 17 declined. Of the 38 patients who accepted, 27 reported poor/no response, 7 discontinued due to pain and 4 enquired about alternative treatments. On initial assessment at specialist vacuum clinic 32 patients consented to physical demonstration and all achieved an erection suitable for penetration. 36/55 were discharged after their initial vacuum assessment with no re-referrals. Of the19 reviewed only 1 patient discontinued use of the device and 6 patients continued on additional ED treatments.

Discussion

Vacuum devices are a well-tolerated treatment option in those who fail or are deemed unsuitable for other treatments. To date, reported outcomes have been excellent with only 1 patient discontinuing use.
P179 Erectile dysfunction clinic: exploring drivers and barriers to seeking help
Authors: Megarity Stephen , Dinsmore Wallace , Bell Laura , McCarty Emma
Published: May 2024

Introduction

Erectile dysfunction (ED) may affect up to half of men in their lifetime. Barriers can prevent discussion of symptoms with their GP and on occasions they will present at GUM clinics. Understanding these barriers can be useful in assessing their experiences and expectations of treatment.

Methods

Anonymous self-administered questionnaire issued to new patients attending ED clinic. The Sexual Health Inventory for Men (SHIM) score used to classify ED severity.

Results

75 patients with median age of 52 years (range 19–78 years) participated. 93% had significant co-morbidities or vascular risk factors. In regard to SHIM, 47% classified as severe ED, 16% moderate, 26% mild-moderate and 11% mild. Duration of ED prior to attendance was greater than 5 years in 53% of patients. 50% reported significant impact on quality of life and notably 40% had underlying depression and/or anxiety. Seeking treatment was important/very important in 96%. Relationship difficulties prompted 65% patients to seek help. Barriers to seeking treatment included embarrassment in 47% and lack of treatment awareness in 29%. Initial discussion about ED was prompted by the patient in 85%. Regarding support, 73% discussed the issue with their partner and 16% with a friend/relative. 7% self-sourced treatment prior to attendance. The majority of patients (88%) reported limited knowledge of ED with 77% suggesting patient information leaflets would be useful prior to clinic attendance.

Discussion

Patients presenting with ED often delay seeking advice. Medical comorbidities, relationship difficulties and embarrassment are significant issues affecting patients which should be taken into consideration during consultations.
P181 Is promotion of blood donation in the GU clinic all in vein?
Authors: Wood Clare , Saxon Cara , Ahmad Sameena
Published: May 2024

Introduction

In the UK less than 3% of the population donate blood. The blood donation service faces a constant challenge of recruiting new donors and stocks remain at critically low levels.

The histories we take in genitourinary (GU) clinics match closely with screening questions asked by the donation service and we wanted to explore whether there would be any value in utilising this similarity in promoting blood donation to our often young and otherwise healthy patient population.

Methods

We conducted a prospective review of 100 consecutive patients seen during clinic, adding one extra question (regarding recent travel) to our usual history proforma to match the screening questions.

Results

Of the 100 patients 25 (25%) would never be able to donate blood (18 sexually active men who have sex with men (including 4 with HIV), 6 with precluding health conditions, 1 ex-intravenous drug user). There were 13 (13%) not eligible to donate blood for up to 12 months (9 ‘high risk’ sexual contact in last 12 months, 2 travel related, 1 pregnant, 1 on PEP post needlestick). Of these and the remaining eligible patients (62%), only 18 (24%) have donated (or attempted donation) previously.

Discussion

We may not think of a GU clinic as a location to identify blood donors, however we found that 75% of the patients seen were potentially eligible. No additional time was needed to identify potential donors and only a brief intervention or posters in the clinic could be used to promote or signpost blood donation.
P185 Sex & relationships education (SRE): focusing on the positives
Authors: Pak Sea Ming
Published: May 2024

Introduction

With the focus of SRE mainly unwanted pregnancies and STIs, due to the growing statistics, is that enough to educate and empower young people (YP) to help reduce them, or should we focus on the positives, like sexual pleasure and what sex actually is, to really engage young people and motivate behaviour change? In 2014, while working for a sexual health charity in West London, a College student approached the mobile sexual health clinic that I partnered with to encourage young people to STI test. He concluded that SRE was too ‘negative’ and just about STIs and unwanted pregnancies and so I invited him to help me develop a resource that makes SRE more ‘positive’. Preceding that incident, ‘Talking to Young People about sexual pleasure’ training facilitated by Sussex University Researcher, Ester McGeeney (EM), was attended.

Methods

In partnership with the student and EM, we put together a questionnaire to gather qualitative research to find out what YP want from SRE and what they understood about good and bed sex. From July 2014 – Dec 2015, 297 young people (148 females, 148 males, 2 unknown) were interviewed anonymously at 14 locations (6 × YP Hostels; 4 × Youth Centres; 2 × YP Charities; 3 × Colleges) with the majority of those YP residing in West London (60%; 25% from South; 2% from North; 5% from East London and 8% unknown). The majority of the participants were BME (56% Black; 5% Asian; 23% Other) with 12% from a White background and 4% unknown.

Results

The top 4 topics that the YP wanted to know about, are already on the curriculum – Relationships (13%); Safe sex, condom use & negotiation (12%); STIs (12%); Being ready for sex/Consent (10%). However, the topics of Pleasure (7%) and the act of sex (8%) weren’t far behind. The top 6 answers on what the YP understood what good sex was included Pleasure/Satisfaction (23%); Having a connexion (13%); Feeling/Being in Love (11%), Safe sex (10%); Mutual Feelings (9%); Passionate (8%). The top 5 answers on what YP understood what bad sex was, included Rape (18%), Mechanical/No feelings/Just for pleasure (15%); Unsatisfying/Incompatible/Disappointing (14%); Too quick/Premature Ejaculation (11%); Unprotected sex.

Discussion

This shows that if YP know that good sex is about pleasure and having a connexion with someone, and bad sex involves no consent, no pleasure and no feelings, then surely we need to be adding more about sexual pleasure and how this relates to healthy relationships and consenting to sex, to SRE?
P189 Reflections on school sex education from young adults: a survey via social media
Authors: Powell Bethan , Barber Tristan
Published: May 2024

Introduction

With inconsistency of sexual education in schools, we used social media to ascertain opinions from a group aged 18-25 in the UK.

Methods

A short survey of four questions was distributed via Facebook to immediate contacts to the primary author. 91 anonymous responses received (demographics not available).

Questions were

• Which topics were covered in your sex education during your time in school?

• When do you think it is appropriate to begin sex education?

• Which areas of sexual education would you like to see improved?

• Is there anything that you wish you had been told during your sexual education?

The first two were multiple choice; second two were free text.

For analysis, ‘sex education’ was used as an umbrella term for education relating to sex (anatomy and practice), relationships, gender and sexuality. Responses for questions 3 and 4 were combined as they generated similar results.

Results

Question 1:

Abstract P189 Table 1TopicsResponsesTopicsResponsesAnatomy of sex81(89%)Consent and rape26(29%)STDs79(87%)Sexuality14(15%)Safe sex77(85%)Sexual harassment11(12%)Female contraception58(64%)Gender identity3(3%)Drugs and alcohol58(64%)Non-heterosexual intercourse2(2%)

63/91 (69%) believed sexual education should begin during primary school. 31/91 (34%) wished that consent had been covered better, often combined with the implication that this lack of education had affected their personal life.

Discussion

While not without limitations, our short survey gave some interesting results worthy of further exploration, suggesting that UK sexual education needs reform before it meets the needs of modern young people.
P197 An interpretative phenomenological analysis to explore the experiences of patients after speaking with a health adviser about partner notification
Authors: Tickle Laura , Symonds Merle , Sutcliffe Lorna
Published: May 2024

Introduction

Partner notification (PN) is pivotal in controlling spread of sexually transmitted infections (STI) by reducing onward transmission and preventing reinfection. We explored the experiences of patients undergoing PN after being diagnosed with a STI.

Methods

259 patients diagnosed with a STI over a 3 week period were invited to complete a PN survey comprising quantitative and qualitative questions. Qualitative data was analysed using Interpretative Phenomenological Analysis (IPA).

Results

76 patients, 20 female and 24 male responded (not all questions were answered). Mean age was 31 (range 16-58). 21 identified as single and 16 partnered. 29% said this was their first clinic attendance, 65% said this was their first ever STI diagnosis and 36% said they attended as a STI contact. Eight main themes were identified: (1) infection source; (2) how to contact partners; (3) difficult information to discuss ‘specific sexual acts performed with every one of them’; (4) uncertainty of partner testing and treatment; (5) concern of providing partner details; (6) future expectations; (7) use of social media; and (8) Health Adviser (HA) qualities. Patients understand PN, but face barriers due to partnership dynamics and lack the skills required for PN. Further partners were contacted following consultation with a HA. Evidence of alternative PN being offered (i.e. provider referral) was limited.

Discussion

In line with BASHH guidelines, the importance of specialist staff in delivering PN was evident. Novel ways to facilitate sexual history taking and methods to contact partners (i.e. social media) are preferred and should be explored further.
P201 How can sexual history taking for sexually transmitted infection partner notification be improved?
Authors: Vojt Gabriele , Pothoulaki Maria , Estcourt Claudia , Flowers Paul , Mapp Fiona , Woode-Owusu Melvina , Mercer Cath , Saunders John , Cassell Jackie , Nandwani Rak , Symonds Merle
Published: May 2024

Introduction

National guidelines, standards and policies help health care professionals to elicit information during sexual history taking as part of partner notification (PN) for sexually transmitted infections (STI). Accurate information about sexual partners and sexual behaviours is vital to prevent onward transmission. This study focuses on patients’ experiences on how sexual history questions for the purpose of PN could be improved.

Methods

We conducted 12 focus groups with members of the public and patients at sexual health clinics in Glasgow and London. All patient participants had been diagnosed with a (non-HIV) STI in the past six months. Data were analysed using thematic analysis.

Results

Analysis revealed a number of interrelated themes arising from participants’ experiences and perceptions. Shared beliefs about sensitivity and reflexivity of questions regarding the frequency, riskiness and contactability of sexual partners influenced the way in which patients experienced and responded in sexual health consultations. Congruence in language and clinician-led consideration of the context of individual sexual behaviour contributed to the extent to which information was shared.

Discussion

Sexual history taking for PN is embedded within a complex interaction between clinicians and patients. The need to accurately identify all partners is balanced against acknowledging that questions asked must be sensitive yet unambiguous. This study suggests that establishing congruence in language and investing time to examine contextual factors within the patient’s sexual behaviours can lead to active collaboration within a time-efficient window, and enhancing the accuracy of information shared thereby enabling health professionals to offer appropriate options for PN.