bluuebunny/crossref_metadata_2025 huggingface dataset:
P24 Regional experience of indications for switching patients to raltegravir and maraviroc and success after regimen change
Authors: Clarke E , Bhardwaj A , Sundaram S , Rowen D , Foley E , Samraj S
Published: May 2012

Background

In small centres there is wide variation in the accessibility of raltegravir (RAL) and maraviroc (MVC) as they are not on the formulary of several trusts. Individual PCT funding is sought on a named patient basis, a time consuming process leading to potential delays in treatment.

Objectives

To identify common clinical indications for treatment change to RAL or MVC. To formulate prescribing criteria on the basis of these in order to seek approval from the District Prescribing Committee and streamline treatment provision.

Methods

Retrospective case note review of patients started on RAL or MVC attending six HIV clinics within a regional network between 2008 and 2010 and collection of data on reasons for treatment change.

Results

40 patients were reviewed, 37 of whom started RAL and 3 MVC. Multiple factors contributed to therapy change. 22 patients (55%) had resistance to other antiretrovirals or treatment failure and 20 (50%) had significant side effects or intolerance to other drug classes. Other factors included cardiovascular risk (20%), co-infections (18%) and co-morbidities (18%). 14 patients were reviewed for immunological response following treatment. Two were excluded (one unrelated death). Of the remaining 13 patients, 46% had a suppressed viral load prior to starting RAL, and 92% were suppressed after 12 months of treatment.

Conclusions

This study demonstrates that identifying common indications for switching to RAL and MVC within a regional network supported the process of formulating criteria to prescribe these newer drugs. This unified approach within the region led to improved and timely access to these drugs thereby improving outcomes for patients at small centres. The agreed prescribing criteria were in instances where combination therapy was not possible due to intolerability, side effects, allergies, resistance, drug interactions, co-morbidities, or HIV-2 (for RAL).
P25 Epidemiological treatment for chlamydia co-infection in MSM With a presumptive diagnosis of urethral gonorrhoea in S. Australia
Authors: Khaw C , Li B , Waddell R
Published: May 2012

Background

Rates of up to 30%Neisseria gonorrhoeae(NG) andChlamydia trachomatis(CT) co-infection occur in men. Historically, Men who have Sex with Men (MSM) were considered to have a low incidence of CT. However, increasing prevalence of CT and NG in MSM, especially asymptomatic anorectal infection is a reality. Despite well-established guidelines providing presumptive co-treatment for CT to patients with treatment indications for NG, various centers in Australia differ in their approach to management in MSM. At our Clinic, epidemiological treatment for CT had only been given to heterosexual males with a presumptive diagnosis of urethral gonorrhoea.

Aim

This study was to determine if the local prevalence of CT co-infection in MSM justifies epidemiological treatment when a presumptive diagnosis of urethral gonorrhoea is made.

Methods

A retrospective review of case notes data, analysed for NG and CT co-infection in male patients was made over a 10-year period from 2001 to 2010. Data analysis was performed using STATA (V.10).

Results

The proportion of heterosexual males who were NG smear positive and also found to be CT positive was 33/274 (12%) CI 8.4% to 16.5%. The proportion of MSM who were NG smear positive and found to be CT positive as well was 22/207 (13.4%) CI 9% to 18.8%.

Conclusion

Based on this study, the guidelines at our Clinic were changed. All MSM with a presumptive diagnosis of NG infection are now given epidemiological treatment for CT infection as heterosexual men.
P27 An audit on the management of pelvic inflammatory disease (PID)
Authors: Chan S Y , Hegazi A , Beardall A , Hay P
Published: May 2012

Background

The 2005 (revised in 2011) UK national guidelines on the management of PID state two auditable outcomes: (1) Proportion of women receiving treatment with a recommended regimen—target 95%. (2) Proportion of named male contacts screened for infection and/or treated—target 0.4 (large urban centres) or 0.6 (other centres) per index case. The guidelines also recommend patients with moderate or severe PID are reviewed after 72 h and all patients are reviewed after 2–4 weeks.

Aims

To audit the management, follow-up and partner notification (PN) of PID in our clinic.

Methods

Retrospective notes review of PID cases presenting between December 2009 and July 2011. Data were collected on drug treatment, follow-up and PN. Cases with a sexually transmitted infection (STI) were compared to cases with no STI identified.

Results

Of 130 PID cases identified, 58 had an STI diagnosed of whom seven hadNeisseria gonorrhoeae(GC) and 57 hadChlamydia trachomatis(CT). Six cases had both GC and CT. One patient had no documentation of drugs prescribed and one received only Doxycycline (see abstract P27 table 1).

Abstract P27 Table 1

Management of patients diagnosed with PID

STI identified (n=58)No STI identified (n=72)Partner notification (PN) Partner notified21 (36.2%)19 (26.4%) Partner notified and treated20 (34.5%)5 (6.9%) PN recommended6 (10.3%)0 No documentation of PN31 (53.5%)53 (73.6%)Treatment prescribed Doxycycline and metronidazole46 (79.3%)59 (81.9%) Macrolide and metronidazole6 (10.4%)7 (9.7%) Ofloxacin and metronidazole (GC cover)5 (8.6%)5 (7.0%) Cephalosporin prescribed (GC cover)40 (69.0%)44 (61.1%)Follow-up Follow-up advised in 3 days00 Follow-up advised in 2–4 weeks47 (81%)69 (95.8%) Follow-up attended47 (81%)29 (40.3%)

Conclusion

BASHH guidelines recommend GC cover for all PID cases but the proportion receiving this was 72.9%. All cases diagnosed with GC received GC cover. PN rates did not reach national recommendations and this may be related to diagnostic uncertainty especially when no STI is apparent. PN was better in cases with a STI where health advisers were involved than in cases without an STI, seen by doctors. No patients were advised to return for follow-up within 3 days but the majority returned within 2–4 weeks. Those with an STI diagnosed were significantly more likely to attend follow-up p<0.0001.
P29 An audit of HIV partner notification practices in the North East
Authors: Dolan G , Foster K , Kain K
Published: May 2012

Background

Late diagnosis of HIV not only carries a risk of poorer outcomes for the individual, but of ongoing transmission of infection. Effective partner notification (PN) is key to identifying sexual contacts that may have been exposed, providing the opportunity to offer necessary advice, support and testing.

Aim

This audit explored current PN practices across the North East in order to identify opportunities for improvement and inform future guidance.

Methods

All genitourinary medicine and infectious diseases clinics across the North East were asked to complete questionnaires for up to ten newly diagnosed cases of HIV between January and December 2010, and provide additional background information on PN arrangements. Data were analysed used EpiData version 3.1.

Results

Seven out of nine (78%) clinics responded. PN was discussed with 82% (46/56) of newly diagnosed patients and documented in the records of 77% (43/56). The time taken to complete all PN outcomes ranged from 0–29 weeks (median 1.5 weeks) and a mixture of methods were used to calculate the PN period. A total of 70 regular partners were recorded, 32 of which were tested and 44% (14/32) found to be HIV positive. 95 casual partners were recorded, nine of which were tested and none found to the HIV positive. Additional outcomes such as safe sex discussions and condom use were generally less frequently documented.

Discussion and Conclusion

Although this sample is relatively small, there was engagement from the majority of regional services, suggesting that it is likely to be representative of local practice. It is clear that there is variation in current PN practices between clinics, and there are a number of challenges which may be particularly pertinent to HIV infection. These findings will be used to inform local policy and standards with the aim of improving the quality of local services and ensuring accountability for actions.
P3 Differences between attitudes to HIV testing and HIV testing practice among hospital doctors
Authors: Taylor R , Pammi M , Venkatesan P
Published: May 2012

Background

The BHIVA/BASHH/BIS UK Guidelines for HIV Testing (2008) state that all acute medical admissions in high prevalence areas, and all patients with specific clinical indicator conditions (CICs) should be offered an HIV test.

Aims

As our Acute Trust serves a Primary Care Trust with a high prevalence of HIV (2.35/1000), we aimed to explore the attitudes towards HIV testing among hospital practitioners, the actual practice of testing and whether this reflected physician's stated attitudes.

Methods

An electronic survey was circulated to all doctors within the Trust. The survey explored respondents' experience, awareness, knowledge, training requirements and willingness to expand HIV testing. A separate paper-based questionnaire was sent to Clinical Leads in selected specialties to explore local testing policy.

Results

214 responses were received from the online-survey. 76% had experience in testing, 73% felt they had necessary skills and 82% felt comfortable offering an HIV test. However, 45% had some concerns that their knowledge of HIV would be insufficient to answer patient questions. 99% favoured expanding HIV testing. The specialty survey revealed that only 20% of specialties had any departmental policy on testing. For one-third of AIDS-defining CICs only selective testing was offered. 7% of CICs would never prompt a test, 7% would always prompt a test and 86% would prompt testing only in selective circumstances.

Conclusions

Most doctors agreed with the importance of expanding HIV testing and felt they had the requisite skills. However, despite this, the practice of HIV testing varied and did not meet with UK Guidelines. If efforts to expand HIV testing in our Trust are to succeed, we need to continue to support and engage clinicians, to initially focus on facilitating strong departmental policies for AIDS-defining conditions prior to widening scope to include other testing strategies.
P32 Partner notification (PN) within non-specialist services
Authors: Cunningham C , McCormick K
Published: May 2012

Background

The local board has the highest rates of diagnosis of genital Chlamydia in Scotland. PN is critical to breaking the chain of infection but there is a clear lack of consistency in its provision outside the specialist services.

Aim

To meet the NHS Health Improvement Scotland Standard 4.2 for Sexual health services; “Individuals are offered partner notification in all settings delivering sexual healthcare, including in primary care, youth services and community pharmacies”.

Methods

A sexual health adviser was appointed to manage the positive Chlamydia diagnoses made out with the specialist services. This service commenced in March 2011 and coincided with the roll out of Chlamydia and Gonorrhoea PCR testing to these areas. Providers were informed to seek consent for referral at the time of testing and acquire the individual's mobile number. The PN service was advertised through email to all providers who undertake testing and in addition, educational sessions and updates were provided.

Results

The table shows progressive improvement in the uptake of PN over the course of the year (see abstract P32 table 1).

Abstract P32 Table 1

Partner notification of chlamydia positive patients in 2011

MarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberChlamydia positives38394967406863433639% of positives with consent for PN8101634403238475662

Discussion

Despite a marked increase in the referral rate for PN, uptake remains suboptimal. Specific GP practices that rarely test for Chlamydia or refer for PN are identified and contacted, reminding them of the importance of PN.
P33 Gonorrhoea in young heterosexuals: outbreak management and safe sex messages
Authors: Foster K , Waldram A , Sankar N , Jeffrey N , Stonebridge J , Bellamy S
Published: May 2012

Background

Increases in gonorrhoea infection in young heterosexuals have been reported in two distinct areas of the North East of England over the past 6 months. Multi-agency working between GUM, public health, health protection and communication teams has attempted to increase awareness and reduce transmission. From initial case and partner notification information, there appeared to be misunderstandings about the routes and risks of transmission, along with a perception that a negative chlamydia test could be regarded as an STI “all clear”.

Methods

Following the report of increase in area 1 in September 2011, a number of interventions were put in place, including enhanced surveillance, network mapping of contacts and cases, raising awareness among healthcare professionals, other organisations working with young people and with young people themselves. An increase in cases in area 2 was reported in November 2011. Similar interventions are being introduced and ongoing work to explore any links between the clusters.

Results

65 cases of gonorrhoea have been reported in area 1 since May 2011 (compared to a usual annual number of 15); in area 2 clustering of cases has occurred at higher rates than previously seen, although overall number of cases has not increased. Partner notification and network mapping has shown multiple casual partners although no large extended sexual networks. Dual-testing of chlamydia screening samples is now being considered to further outbreak control. We report the lessons learnt from managing these two clusters and how they can be applied to future STI clusters.
P36 Evaluation to assess patients' perceptions of receiving the recent infection testing algorithm [RITA] result
Authors: Gilbart V , Anderson E , Garrett N , Perera S , Rayment M , Williams H , Tosswill J H , Delpech V
Published: May 2012

Background

In the UK the primary objective of RITA has been to measure HIV incidence. The UK is the first country to routinely return results to patients and with over 7000 tests returned to clinicians so far, RITA is now seen as part of baseline HIV clinical care in participating centres.

Objectives

To evaluate patients' experience of receiving a RITA result, including effects on identifying likely timing of infection, partner notification and relationships.

Methods

Five HIV centres in England asked their patients to complete a questionnaire on their experience of receiving a “recently infected” RITA result soon after their HIV diagnosis.

Results

Forty patients with newly diagnosed HIV and a “recent” RITA result completed the questionnaire (93% MSM). The majority (30/40, 75%) said that receiving the recent RITA result was helpful; 10 were unsure how helpful it was, and no participants found it unhelpful. 24 patients (60%) reported RITA helped identify partners who may be at risk of HIV and 24 (62%) felt it helped them to better understand how they may have been infected. Most (35, 88%) either felt neutral or “not more upset” when they learnt that they were likely recently infected. Of those in a relationship 33/37 (89%) reported RITA testing had not caused any relationship problems.

Conclusion

The majority of patients receiving recent RITA results found this information helpful and no-one found it unhelpful. The result was felt to be useful in increasing an understanding of the likely timing of infection and for identifying “at risk” partners.
P37 Sex, drugs, risk taking and STIs
Authors: Keane F E , Thomas E , Picton A , Palmer J , Haddon L
Published: May 2012

Background

Hazardous alcohol consumption (HAC) and recreational drug (RD) use are associated with risky sexual behaviour but there is little hard evidence about actual sexually transmitted infection (STI) acquisition in these cohorts.

Aim

To investigate the association between HAC, RD use, risky sexual behaviour and STI acquisition.

Methods

Patients self-completed the Fast Alcohol Screening Test (FAST), a validated screening tool to identify HAC, and questions on RD use. Markers of sexual risk-taking and STI diagnoses were obtained from patient records. Three cohorts: those with/without HAC (ie FAST positive/ negative respectively), RD use ever/never and recent/no recent RD use were analysed. Statistical significance (p<0.05) was calculated using Pearson's χ2test.

Results

Convenience sampling identified 221 new/re-book patients, 21 were excluded due to administrative errors. Respondents included 70 (35%) men and 130 (65%) women (age range, 15–69 years; median 25. 105 (53.6%) and 91(46.4) identified as FAST positive and FAST negative, 85 (43.6%) and 110 (56.4%) reported RD use ever and never and 33 (16.8%) and 163 (83.2%) reported RD use and no RD use in the last 1/12 respectively. 67/102 FAST positives reported a new sexual partner in the previous 3/12 compared to 29/88 FAST negatives (p<0.001). Recent RD users were also more likely to report partner change (23/32 compared to those with no recent RD (75/159, p=0.011). There was an increase in STI diagnoses in FAST positive compared to FAST negative patients (34/105 and 17/91 p=0.029), no difference was observed in the other cohorts.

Discussion

HAC is very common among our patients and appears to be linked to increased STI acquisition. Recent RD use is not uncommon. Our findings support the recommendations of the recent Alcohol and Sexual Health Working Party that identification of hazardous drinkers and brief interventions may improve sexual health outcomes.
P4 Are routine chest x-rays necessary in asymptomatic patients newly diagnosed with HIV?
Authors: Cheshire M L , Babu C
Published: May 2012

Background

This audit looked at the use of chest-x-rays (CXRs) in newly diagnosed HIV patients at an inner-city GUM clinic. The Departmental guidelines recommended that all newly diagnosed HIV patients had a baseline CXR. The 2011 British HIV Association guidelines (which were under consultation at the time of the audit) proposed that CXRs should only be done in patients with current or previous chest disease, high-risk for TB or in intravenous drug users.

Aims

The aims of this audit were twofold, first to confirm whether all newly diagnosed patients had a CXR as per departmental guidelines, and second to review the results of the CXR in order to see whether, if any, factors predicted abnormal results.

Methods

The audit considered all newly diagnosed HIV patients from 1 April 2009–31 March 2011. Data including demographic details, past medical history, health on diagnosis and details of the CXR (if performed) were collected from electronic HIV summaries and radiology records. Statistical analysis was performed using SPSS.

Results

A total of 196 patients were identified, 69% of whom had had a CXR. In those who had a CXR and in whom results were available (n=132), 92% had a normal CXR and 8% abnormal. Significant predictors of abnormal CXRs included chest symptoms at diagnosis (p<0.001) and a CD4 count <200 (p=0.001). There was no significant link with the patients' country of origin but there was a pattern of association which was clinically relevant.

Conclusions

In this audit all CXRs in asymptomatic patients newly diagnosed with HIV were normal. No latent chest disease was identified as a result of routine asymptomatic screening with CXRs and the practice is not justified. Following this audit clinic guidelines have been appropriately amended in keeping with current British HIV Association guidelines with the additional criteria for performing CXRs in patients presenting with CD4 <200.
P40 Losing the battle? Time to focus the risk discussion with HIV-positive MSM
Authors: Perera S , McCormack S , Nwokolo N
Published: May 2012

Background

BHIVA 2008 Guidelines advocate development of prevention messages promoting sexual health of HIV-positive individuals to minimise onward transmission and acquisition of infections prevalent in such individuals, for example HCV and LGV.

Objectives

To assess the extent of unprotected anal intercourse (UAI) in an HIV-positive population attending a London sexual health clinic. To assess transmission and acquisition risks. To describe the nature of sexual health discussions with health care providers.

Methods

50 randomly selected notes of HIV-positive patients were reviewed. Data were collected on demographics, ART, viral load (VL), sexual partners and topics discussed.

Results

66% were from the UK and 74% were >30. 47 (94%) were MSM/Bisexual; 2 (4%) heterosexual females; for 1 (2%) male IVDU, orientation, partners and discussion were not documented. In 8/47 MSM it was unclear if AI had occurred; 1/47 reported AI but condom use was not documented. In 38 sufficiently complete records, all reported AI: 7 (18%) protected AI only, 12 (32%) UAI with positive partners only; 19 (50%) reported UAI with positive and negative partners, although 9/19 (47%) had VL <500. 7/10 MSM reporting UAI who had VL >500 used recreational drugs although only one reported doing so during sex. Discussion was not documented in 17 (34%) notes, and in 12 focus was only on transmission. 19 topics were discussed with no consistency but could be classified as transmission or acquisition related. Transmission risks were discussed in 15 (79%) of the 19 reporting UAI with negative partners; acquisition risks were discussed in 17 (55%) of 31 at risk.

Conclusions

Although UAI was reported by the majority of MSM, only 10 reported a clinically relevant risk of transmitting HIV, but the majority were at risk of acquiring HCV/LGV. The diversity in topics noted as discussed suggests that simpler, more focused messages of risk reduction would be helpful to sexual health service users and providers.
P41 Women's health study ofMycoplasma genitalium: a feasibility study
Authors: Dave S , Kerry S R , Oakeshott P , McGregor F , Cannon E , Stephenson J M
Published: May 2012

Background

The role ofMycoplasma genitalium(∼3% prevalence in women) in PID is unclear. An opportunity exists to study its natural history since there are no UK treatment guidelines. We conducted a feasibility study.

Objectives

In women attending GUM clinics to determine: (1) recruitment and follow-up rates after 3 and 6 months, (2) feasibility of obtaining NHS numbers, (3) facilitators and barriers to follow-up.

Methods

Women aged 16–24 years recruited from two GUM clinics completed a questionnaire and provided two self-taken vaginal samples. One sample was tested for chlamydia. We are testing forM genitaliumand conducting 3-month follow-up.

Results

Recruitment rate was 67% (199/296). Non-responders were similar in age to responders (20.6 SD 2.5 vs 20.7 SD 2.5 years) but more likely to come from ethnic minority groups: 56% (37/66) vs 36% (71/195), p<0.05. Among responders, mean sexual debut age was 16.3 years (range 12–23 n=198); 59% (116/195) reported ≥2 sexual partners and 17% (31/186) consistently used condoms in the preceding 12 months. 8.2% (16/197) had chlamydia and 0.5% (1/197) gonorrhoea on testing. At recruitment 196 participants consented to NHS numbers being obtained and used to access medical records; 197 participants agreed to 3-month follow-up. We have been able to contact ∼50% of participants for follow-up.

Discussion

Most women consented to NHS number and medical record access. This is important for investigating long-term sequelae of STIs. Fewer women took part in follow-up than agreed at recruitment. It is important to understand the reasons for this.
P44 An evaluation of gonococcal testing using a roche cobas PCR platform in a low prevalence area
Authors: Bhaduri S , Spice W
Published: May 2012

Background

The countywide sexual health service have recently adopted the roche cobas dual PCR for gonorrhoea testing. The locality has a low prevalence of gonorrhoea compared to national rates.

Aims

To assess the performance of the gonococcal (GC) nucleic acid amplification tests (NAAT) against culture and to advise all areas of sexual health.

Methods

Female endocervical, vulvovaginal and urine samples were taken for culture and NAAT. Male urethral swabs for culture were taken in parallel with urine samples for NAAT. Throat and rectal samples were also taken.

Results

309 cervical samples for culture, 289 cervical samples for NAAT. 97 vulvovaginal swabs and 93 female urine samples were taken. In males, 246 urethral culture samples and 251 urine samples were taken. 45 throat swabs and 29 rectal samples were taken. In females there was concordance in all results except for 1 throat swab (culture positive, NAAT negative) In males, there was concordance in all results except for two samples (urine NAAT positive, urethral culture negative). Two rectal samples were NAAT positive but culture negative—both were from men having sex with men (MSM) and were gonorrhoea contacts. Six throat samples were positive in NAAT but culture negative—(all MSM), 1 was a contact. 3 were sent for further testing using a different NAAT (aptima combo 2—all these assays were negative).

Conclusion

NAAT testing was recommended at all sites except for throat swabs given the lower specificity at this site (88%) in males. The study confirms the need to evaluate GC NAAT testing sampling in low prevalence areas but differs from other studies as regards testing from throat samples.
P45 The effect onNeisseria gonorrhoeaescreening rates in an integrated clinic following the introduction of dual nucleic acid amplification tests
Authors: Pease E , Kirkwood D , Dawson S , Desmond N , Mcintyre M , Ashby J
Published: May 2012

Background

Nucleic acid amplification tests (NAATs) to detectNeisseria gonorrhoeae(GC), allow less invasive sampling and are more sensitive than culture. Aptima combo 2 (AC2) has a high specificity but positive predictive value can be low in low prevalence populations. GC diagnoses may be lower in an integrated family planning (FP) and genitourinary (GU) clinic compared to those primarily providing GU care.

Aim

To investigate whether the introduction of GC NAATS into an integrated clinic has increased rates of GC screening and detection.

Methods

All patients having a GC screen 4 months prior to and following NAATS introduction were identified by laboratory databases. Notes were reviewed for those diagnosed with GC. Information regarding patient demographics, symptoms and risks were gathered (see abstract P45 table 1).

Abstract P45 Table 1

Patient demographics pre and post NAATs introduction

Pre-NAATS (n)Post-NAATS (n)No. of patients attending (re-attendees not included)92969917No. of GC screens carried out (% screened of those attending)2307 (25)3444 (35)No. of positive GC tests (%)20 (0.87)43 (1.25)Age (years) (%) <3012 (60)23 (53) 31–405 (25)9 (21) >413 (15)11 (26)Sex (%) Male11 (55)30 (70) Female9 (45)13 (30)RACE (%) White European11 (55)32 (74) Black (UK)1 (5)1 (2) Black African3 (15)1 (2) Black Carribean2 (10)4 (9)Asian other3 (15)5 (12) Men who have sex with men (MSM) (% of men)5 (45)11 (37) Symptoms signs of GC (%)13 (65)25 (58)

Results

Pre-NAATS: 2307 symptomatic and asymptomatic patients were screened with GC culture of which 20 (0.87%) were positive. Post-NAATS: 3444 symptomatic and asymptomatic patients were screened with AC2 of which 43 (1.25%) were confirmed positive for GC. 217 of the symptomatic patients were also cultured and 18 (8.3%) were positive. Of the 43 positive NAATS tests, 20 patients were also culture positive; 10 were culture negative, 1 grewNeisseria meningitidis(isolated in the throat) and 12 had no culture taken. All of the NAATs positive, culture negative individuals had symptoms, signs or high risks for GC. All patients with positive cultures were NAATS positive.

Conclusions

Following the introduction of NAATS, the proportion of patients attending clinic who were screened for GC significantly increased and the number of GC diagnoses doubled. This may be due to better acceptability and uptake of screening, including those attending for FP care. NAATs identified more cases of GC than culture alone. There was only one case of a possible false positive. This provides reassuring data to support use of NAATS in this setting.
P48 Yearly trends for the internet recruitment program, http://www.iwantthekit.org—what happened to the STI prevalence?
Authors: Gaydos C , Barnes M , Hsieh Y H , Jett-Goheen M , Quinn N , Whittle P , Hogan T
Published: May 2012

Background

The iwantthekit (IWTK) internet recruitment screening program began in 2004 and offered an opportunity to determine trends in prevalence for women and men were screened for STIs.

Objectives

To determine significance in trends for STIs for the population accessing screening over time.

Methods

Participants were recruited via the internet to request home collection kits and to collect either vaginal or penile swabs at home with subsequent mailing to a laboratory for screening for chlamydia (CT), gonorrhoea (GC), and trichomonas (TV) by NAATs. Prevalence for women and men were calculated by year and race for 2004–2011 for each organism. Linear regression analysis was performed to determine significance of temporal trends in gender-, STI-specific prevalence controlling for annual demographic composition of participants.

Results

3363 women were screened for CT and GC from 2004 to 2011; TV screening was added in 2006 (N=2692). From 2006 to 2011, 1370 men were screened for CT, GC, and TV. Prevalence varied: CT: 5.5%–10.6%; GC: 0.3%–2.7%; TV: 5.8%–13.3% for females and CT: 8.0%–15.4%; GC: 0.7%–1.9%; TV: 0.8%–12.4% for males. Most users were from Maryland (70.1%). The only statistically significant linear downtrend by year was CT prevalence in male participants <25 yr from 23.1% in 2007 to 12.5% in 2011, which was 2.4%/yr (p=0.012); while the prevalence in male ¡Ý25 years remained relatively stable from 6.2% in 2007 to 5.5% in 2011 (p=0.911). The remainder of STI prevalences in females and males did not show a downward linear trend by calendar year. GC prevalence in females was significantly correlated with the per cent of Black participants (p=0.030), while TV prevalence in females was positively associated with the number of participants <25 yr (p=0.032).

Conclusions

IWTK attracted participants with high-risk sexual behaviours to use home collection for STI testing. Prevalence by year and by organism, for the most part, did not show a significant downward trend.
P52 New treatment guideline ofNeisseria gonorrhoeaeand test of cure: how feasible is it?
Authors: Rodgers S , Murgartroyd M , Perez K , Kingston M , Lee V
Published: May 2012

Background

Treatment failure with oral cephalosporins in gonorrhoea caused by multidrug resistance has been reported. The national guidelines were updated in 2011 due to reduced sensitivity to antimicrobials. Test of cure (TOC) is recommended in all cases. However data regarding timing of TOC is limited.

Aims

To assess (1) the feasibility of implementing new treatment regimen and (2) the optimal time to perform TOC.

Method

Retrospective case note review of patients diagnosed with gonorrhoea in a GUM clinic between 1 June 2011 and 30 November 2011 was carried out. Data including demographics, HIV status, sites of infection, treatment and TOC were analysed.

Results

271 (242M, 29F) patients were included. 202 were men who have sex with men (MSM) of which 24% were HIV positive. In MSM group, 87 were urine TMA positive (95% had cultures performed), 115 positive pharyngeal TMA (97% with cultures done), 115 positive rectal TMA (96% had cultures done). 39 heterosexual males had positive urine TMA (94% with cultures done). 18 (62%) females had positive cervical TMA, all with culture performed. 12 (41%) pharyngeal, 5 (17%) vulvo-vaginal and 3 (10%) rectal were TMA positive; 58%, 60%, and 33% of these had cultures performed respectively. First-line treatment was given in 96% of cases. Second line treatments were given mostly due to penicillin allergy. TOC was attended by 55% of patients. 67% of TOC were done within 20 days of treatment. Three of these were positive, 2 within 20 days and one at 57 days post treatment which was a re-infection.

Conclusions

New treatment of gonorrhoea is generally accepted by patients. 4% received alternative treatments, which were valid and documented. The majority of patients (74%) had culture performed prior to treatment. TOC uptake was low (55%). However the majority were performed within 20 days of treatment. Follow-up strategies must remain a priority to increase rates of TOC. Further studies are required to determine optimum time for TOC.
P55 Evaluation of NAAT and POCT for detectingTrichomonas vaginalisinfection in women at a London sexual health clinic
Authors: Nathan B , Heron D , Appiah J , Saunders P , Brum R , Nichols T , Alexander S , Baraister P , Ison C
Published: May 2012

Background

TV is a common infection in our clinic, but the true prevalence is likely to be higher since microscopy-the current diagnostic test has a low sensitivity. Nucleic Acid Amplification (NAAT) and Point of Care Tests (POCT) are commercially available and are reported to have much higher sensitivities. To our knowledge this is the first study to evaluate four different tests for TV in a London Clinic.

Aim

To evaluate the clinical utility of NAAT and POCT compared to microscopy and culture.

Methods

All symptomatic women who presented to the clinic on Monday and Tuesday from September 2011 were invited to participate in the study. Swabs for a validated in-house NAAT, POCT (OSOM Genzyme Diagnostics) and culture usingTV In-pouchculture system were taken. Technicians processing the POCT, NAAT and cultures were blinded to all other results.

Results

A total of 247 symptomatic women were recruited over a 6-month period. 21 (8.5%) tested positive on culture, 22 (9%) on POCT and NAAT, 9 (3.6%) on microscopy. Using culture as the reference standard the sensitivities/specificities were: POCT 100% [95% CI 84 to 100]/99.6% [95% CI 97.5 to 99.9], NAAT 95.2% [95% CI 76 to 99.9]/99.1% [95% CI 96.8 to 99.9], microscopy 42.9% [95% CI 22 to 56]/100% [95% CI 98.4 to 100] and prevalence 8.5% [95% CI 5.4 to 12.8]. Using NAAT as the reference standard the sensitivities were: culture 90.9% [95% CI 71 to 98.9], POCT 95.5% [95% CI 77 to 99.9], microscopy 36.4% [95% CI 17 to 59] and prevalence 8.9% [95% CI 5.7 to 13.2].

Conclusions

The sensitivity of POCT and NAAT were as anticipated much greater than microscopy alone, resulting in a prevalence over double than previously estimated. Molecular methods for detecting TV infection in this population would diagnose a significantly greater number of women with TV. Clinics with high rates of TV may benefit from using POCT with the advantage of a rapid turn-around result over NAAT.
P58 Nuclei acid amplification tests (NAAT) forTrichomonas vaginalis: should they change who we screen for infection
Authors: Ng A , Ross J
Published: May 2012

Background

UK national guidelines recommend screening forTrichomonas vaginalis(TV) in symptomatic women and men with persistent urethritis using culture +/− wet mount microscopy. Screening of asymptomatic patients is not recommended due to the low prevalence of infection and low sensitivity of available tests. TV NAAT has been shown to have high sensitivity (96.7%) and specificity (97.5%) with the potential to increase the detection rate of TV infections.

Objectives

To determine an accurate prevalence of TV infection in a UK STI clinic using the TV NAAT and to characterise the risk factors associated with TV infection to inform an appropriate screening strategy.

Method

Over a 6-week period, unselected patients presenting to the UK STI clinic with a new clinical episode were offered a TV NAAT test (Gen Probe transcription-mediated amplification) as part of their sexual health screen. A vaginal swab was taken from women, and men provided either a urethral swab or urine sample. Information on demographics and clinical presentation was collected on a paper proforma. All data analysis was performed using SPSS V.19.

Results

3546 patients were seen in the study period of whom 98.8% provided a sample for TV NAAT testing. The prevalence of TV infection was 21/1483, 1.4% (95% CI 0.9% to 2.2%) in male patients and 72/2020, 3.6% (95% CI 2.8% to 4.5%) in female patients. The rate of TV positivity was higher in Black Caribbean patients compared to Caucasian patients in both men (5.4% vs 0.1%, p<0.001) and women (9.0% vs 1.2%, p<0.001). There was no significant difference in TV positivity across the age groups. In comparison to culture, TV NAAT detected an additional 24% of infections in symptomatic women.

Discussion

TV NAAT is a more sensitive test. The prevalence of TV in UK STI clinic population is still low compared to USA. Given the higher cost of NAAT, screening of all clinic patients is unlikely to be cost-effective but may be worth considering in high risk subgroups.
P59 Improving management of pelvic inflammatory disease by using a simple tick-box sticker
Authors: Connolly N B , Hamer S , Ward M , Mellor J , McQuillan O
Published: May 2012

Background

Pelvic Inflammatory Disease (PID) is a common condition with a reported 1:50 sexually active women in the UK developing it annually. An estimated 1:5 will consequently become infertile. Use of the 2011 BASHH guidelines provides an excellent tool in improving uniformity in treatment and advice provided.

Aim

To assess improvement in care from two cohorts of patient's with PID attending a District General Hospital clinic, at two points, 3 years apart by introduction of a PID tick-box sticker.

Method

Using a BASHH guideline based proforma, data were recorded and compared between 2 cohorts, the 1st from June to December 2008 (27pts), the 2nd from 2011 (25pts).

Results

In 2011: STI detection was increased at 48%, from 37% previously, reflecting national trends. 88% received 2 weeks of metronidazole and doxycycline (12% had erythromycin due to risk of pregnancy). None had ceftriaxone as per local guidelines based on this and an additional audit, which revealed very low prevalence of infection withNeisseria gonorrhoeaein the local PID population. Improvements with the introduction of the sticker included number of pregnancy tests performed—80% up from 26% and documentation of provision of written information which rose from 3.7% to 88%. 60% saw the HA at their clinic visit compared to 44% in 2008. Partner notification rates were unaffected with 51.6% of male contacts screened with a STI detected in 44% as opposed to 67% in 2008 with a STI in 37%.N gonorrhoeaewas not identified in any presenting woman, nor any screened contact in 2011 and in only one contact in 2008.

Conclusion

Introduction of a simple measure such as a PID sticker can aid documentation and adherence to correct management. Striving to improve better partner notification with subsequent screening and treatment, should remain a priority. Of note, there were no Gonococcal infections detected in any of our 2011 cohort and this reflects the local prevalence.
P6 Cultural differences in the acceptability of home sampling for HIV infection
Authors: Bowman C A , Bell G , Ellam H , Tunbridge A , Slack S , Atkin A , Evans C , Shutt A , Joseph E , Naylor S , Herman S , Green S , Kudesia G , Pryce A
Published: May 2012

Background

MSM community outreach using oral home sampling kits posted to virology for testing previously demonstrated success in attracting non-healthcare seeking individuals at risk of HIV. The outcome of targeting other specific at-risk groups to offer home sampling has not previously been described.

Objective

To determine the acceptability of home sampling kits for HIV using oral swabs in two at-risk groups Black Africans (BA) and partners of HIV positive patients (PPP).

Methods

Self-taken oral fluid home sampling kits were returned to virology for testing using two HIV assays: Roche COBAS and Genscreen Ultra (previously validated for oral fluid testing). Total IgG was also measured to assess sample adequacy. Participant recruitment was two-pronged: community based (BA) or via an HIV clinic (PPP). For BA recruitment, home sampling kits were actively promoted at relevant social events and venues by trained African volunteers from July to December 2010. 19 free condom distribution points were also utilised to provide information about HIV and the testing kits. From September to December 2011, PPPs of unknown current HIV status were contacted and offered the option of attending clinic or receiving an oral fluid home sampling kit by post.

Results

Despite intense promotional activity, only 12 kits from 11 individuals in the BA community project were returned: 5 male; 6 female. Two of these participants were not African. In the PPP clinic based study, of 46 partners offered a kit, 38 (83%) accepted, and 34 (89%) returned a sample. BA partners were less likely to accept a home sampling kit (9/13; 69%) than white partners (29/33; 88%) in the PPP group. Participant feedback was favourable in both studies.

Discussion

Further evaluation is needed to understand the difference in acceptability of this method of HIV testing in specific at-risk groups (MSM, BA and PPP) in community and clinic settings.
P63 Treatment of pelvic inflammatory disease using short-course azithromycin
Authors: Cunningham L , Murray A , Horner P J
Published: May 2012

Background

In our centre, a novel 5-day regimen of azithromycin (1 g stat then 500 mg daily for 4 days with or without metronidazole and/or ceftriaxone) is used and has been approved regionally. This is administered as an alternative regimen in selected cases of pelvic inflammatory disease (PID), usually those with milder symptoms and signs.

Aims and Objectives

We assessed the use and efficacy of short course azithromycin in PID. We also assessed follow-up rates and adherence for all cases of PID.

Methods

Retrospective case note review of 129 female patients coded as PID during the period 1 July to 31 December 2011. Data were collected and transferred to Excel for analysis.

Results

109/129 (84.5%) of women were diagnosed with PID based on symptoms and signs as described in the BASHH PID guideline. Chlamydia was subsequently diagnosed in 10/108 (9.3%) and gonorrhoea in 5/108 (4.6%). Chlamydia antibody titres of >1 in 256 were found in 20/65 (30.8%) of patients. Taking into account missing data, 39/51 (76.5%) patients completed the antibiotic course and 64/78 (82%) reported full or partial resolution of symptoms. 14/85 (16.5%) required further PID treatment, eight of whom had sexual intercourse with an untreated partner (see abstract P63 table 1).

Abstract P63 Table 1

Antibiotic regime for PID treatment and response

Principle antimicrobialTreated (%)Follow-up attended (%)Completed courseFull/partial clinical responseMissing dataMissing dataAzithromycin32 (29.4)215/81314/192Ofloxacin71 (65.1)5932/401946/554Doxycycline2 (1.8)20/2120Other4 (3.7)32121Total10985 (78)3934647

Discussion

In this study, 32/109 (29.4%) women were treated for PID with azithromycin either in combination or alone. Overall, the majority of women completed treatment and reported a full or partial improvement in symptoms. Follow-up rates were good but documentation was inadequate. Comparisons between regimens are limited due to missing data. Further work will look at novel follow-up methods such as routine telephone contact as well as standardisation of follow-up documentation.
P66 Testing forTrichomonas vaginalis(TV) by transcription mediated amplification (TMA). An evaluation in a large city clinic
Authors: Lawton M , Schembri G , Kingston M
Published: May 2012

Background

Trichomonas is worldwide, the commonest curable STI. While it's prevalence in the UK is less than other areas of the world, it remains a common cause of vaginal symptoms in women. Although not routinely tested in men it can be a cause of discharge and dysuria. It may be asymptomatic in both sexes. There is debate about the significance of TV infection, over and above it's symptomatology. The majority of centres use wet-film microscopy and/or culture for the detection of TV. The sensitivity of wet-film is recognised to be low. Culture has been considered the gold standard for TV detection, but is slow and costly.

Methods

Symptomatic female patients and men with recurrent/persistent NSU were tested for TV using the same sample as the Chlamydia/gonorrhoea specimen. They were analysed using the Gen-Probe APTIMA TV assay in addition to the usual Chlamydia/gonorrhoea AC2 assay. Patients symptomatic of discharge had wet-film microscopy done as per standard clinical practice. Demographic data and symptomatology were recorded. Comparison was made between results from TMA and wet-film.

Results

1457 patients were tested for TV using TMA. Almost all (97%) were women. The overall prevalence for Trichomonas, Chlamydia and gonorrhoea via TMA was 3%, 8%, 1% respectively. TMA identified significantly more cases of TV compared to wet-film (41 vs 20, p=0.009). The prevalence of TV was significantly higher than gonorrhoea (p=0.002). Subset analysis will be done prior to presentation.

Conclusion

Testing for TV via TMA identified significantly more infections compared with the current method of detection. It's overall prevalence was much higher than gonorrhoea which is routinely screened for in asymptomatic patients. Given the same sample is used for analysis, it does not add any additional clinic time or discomfort to the patient. Cost effectiveness of using TV TMA, particularly in asymptomatic patients has not yet been evaluated.
P71 Validation of an in house nucleic acid amplification (NAATs) PCR test forTrichomonas vaginalis
Authors: Appiah J , Saunders P , Yapa M , Tong C Y W , White J , Ison C , Alexander S
Published: May 2012

Background

Trichomonas vaginalis, a flagellated protozoan, is transmitted through sexual contact that commonly manifests itself as symptomatic in more women than men. However, the true prevalence of infection and the proportion that is asymptomatic is not known because of the lack of good diagnostic tests. Microscopy is the most common method of detection used but this is known to have a low sensitivity. Other methods include culture, which is considered the gold standard, a point of care test and molecular methods, which have increased sensitivity but are more time consuming or expensive.

Aim

To validate an in-house nucleic acid amplification test (NAAT) test for the detection ofT vaginalis.

Method

Two methods were established In-house. The first NAATs detectedT vaginalisby amplification of a 92 bp segment of theT vaginalis-specific repeat DNA fragment and the second amplified a segment of the â-tubulin gene, and was used to confirm the positive results. A further control ran alongside the first NAATs to identify inhibition by targeting the ribonuclease P gene. Sensitivity was initially validated with a positive controlT vaginalisstrain S1 and then validated against anonimised clinical samples previously tested using the APTIMAT vaginalis(ATV) transcription mediated amplification (TMA) kit and an in-house real-time TV PCR (see abstract P71 table 1).

Abstract P71 Table 1

TV diagnosed according to test

AssayAptima ATV TMAWT In-house PCRTV RT PCRTV confirmation PCRNumber of positives18 (18.75%)17 (17.9%)*17 (17.9%)17 (17.9%)*

One sample was a low level positive/negative, but this was also positive on Aptima.

Results

A total of 96 samples were tested. 17 (17.9%) of the specimens tested resulted in positiveT vaginalisNAATs using bothT vaginalisreal-time PCR and the TV confirmatory real-time PCR.

Conclusions

These in house NAATs gave good concordance with the commercial assay. It would be useful to further compare detection between this and other methods including the culture and POCT in asymptomatic patients. The methods established could also be used in comparisons in clinical studies.