bluuebunny/crossref_metadata_2025 huggingface dataset:
P198 Chemsex and antiretroviral therapy non-adherence in HIV-positive men who have sex with men: a systematic review
Authors: Perera Sean , Bourne Adam H , Thomas Sara
Published: May 2024

Introduction

Chemsex is associated with ART non-adherence and may therefore negatively influence HIV disease progression. However, there is no systematic examination of evidence for this association. Our objective was to summarise the extent of ART non-adherence among chemsex drug-using HIV-positive MSM worldwide and to quantify the effect that chemsex has on ART non-adherence by comparing chemsex drug-users to non-chemsex drug-users.

Methods

Pubmed and Embase were searched from inception to 25.06.15. Prevalence and analytical studies were included. Bias was assessed using a risk-of-bias assessment tool. Assessment of heterogeneity was conducted using I2 and Cochran-Q Chi2 statistics. Metaanalyses were conducted using fixed or random-effects methods. Metaregression assessed for formal statistical evidence of heterogeneity.

Results

3288 published and unpublished records were screened. Prevalence of ART non-adherence among chemsex drug-users (10 studies) ranged from 6% to 81%. 7 studies provided 10 effect measures for the association between chemsex drug-use and ART non-adherence. Chemsex drug-users had 23% higher odds of being ART non-adherent compared with non-chemsex drug-users (OR 1.23, 95%CI 1.10–1.38, I2 0%, p=0.372). Studies that used less specific definitions of chemsex drug-use found weak statistical evidence for an association (OR 1.96, 95%CI 0.52–7.31, I2 78.9%, p=0.009). Meta-regression failed to provide statistical evidence of why the effect varied between studies.

Discussion

In HIV-positive MSM, the prevalence of ART non-adherence among chemsex drug-users varied widely. There was evidence of an association between chemsex drug-use and ART non-adherence. Paucity of studies and substantial heterogeneity between studies limited interpretation of results. Further well-conducted studies in a variety of settings are needed.
P199 Are we testing in the right locations? use of public health mapping to investigate young people, chlamydia and socioeconomic status
Authors: Cousins Darren , Jefferies Grace , Gibbon Rhys , Fina Laia , Philips Amy , Thomas Daniel
Published: May 2024

Introduction

Chlamydia testing is universal and routine in all local sexual health clinics. Projected local population increases and expansion of the university sector necessitate the appraisal of current services and future planning to meet population need.

Objective

To investigate whether the current locations of Chlamydia testing services match areas of high need.

Method

We obtained data from the Sexual Health in Wales Surveillance Scheme (SWS) on Chlamydia diagnoses in integrated sexual health clinics by middle super output area (MSOA) of residence for patients living in our local area. Mapping software is used to overlay Chlamydia testing behaviour and positivity against locations of FE colleges, STI testing clinics, areas of high deprivation and areas with a high proportion of young residents.

Results

Between 2012 and 2016, 3,450 chlamydia diagnoses were recorded in Cardiff and Vale residents. The maps suggest that Chlamydia diagnoses were most common in areas usually habited by students. Furthermore, mapping fifths of deprivation suggested lower rates of Chlamydia in the more deprived areas, despite more testing venues.

Discussion

The maps suggest University students are frequent testers and have a high positivity for Chlamydia whereas those from more deprived areas have lower rates for Chlamydia. This descriptive analysis suggests that local chlamydia testing services may not be mapped to populations at greatest need. This association is difficult to measure without a robust statistical test and more analysis is needed to quantify the association. Alternative testing paradigms outside clinic settings could help manage demand on clinical services.
P203 The ‘lexicon of love’: understanding types of relationships as primary contexts of STI transmission
Authors: Pothoulaki Maria , Vojt Gabriele , Mapp Fiona , Woode-Owusu Melvina , Flowers Paul , Estcourt Claudia , Mercer Cath , Saunders John , Wayal Sonali , Cassell Jackie , Nandwani Rak , Symonds Merle
Published: May 2024

Introduction

Social contextual factors are often not taken into account when examining STI transmission. Understanding relationship types is central to targeting sexual health services, such as partner notification. This study examines the public’s understandings of the language used to describe different types of partners and sexual relationships.

Methods

A qualitative study, involving six focus groups was conducted in Scotland and England. Purposive sampling recruited 38 participants, including young heterosexuals (n=22) and gay men and other men who have sex with men (n=16). A semi-structured topic guide was used to facilitate the discussion, which included interactive tasks. An integrative thematic analytic approach was adopted by synthesising both textual data and the data derived from the interactive tasks.

Results

Findings highlighted the diverse ways that relationships are understood and the fluid nature of partner types. Themes illustrated the importance of a range of contextual factors such as the variable nature of sexual relationships and key differences in their affective elements, the importance of peer context, social identities and developmental trajectories and the role of online communication in developing and shaping sexual networks and partnership formation.

Discussion

Social identities and people’s historical and geographic context ‘shape’ the way people talk about relationships. Fluidity and contextualisation are two key elements to be taken into consideration in understanding the language and terms used to describe relationships. From a public health perspective, understanding relationship types can unveil pathways to understand transmission patterns of STIs and provide more effective sexual health services.
O25 ‘Side chicks’, and ‘side dicks’: understanding typologies and drivers of concurrent partnerships to prevent sti transmission among people of black caribbean ethnicity in england
Authors: Wayal Sonali , Mercer Catherine , L. Gilbart Victoria , Garnett Emma , J. Sutcliffe Lorna , Weatherburn Peter , Hughes Gwenda
Published: May 2024

Introduction

In Britain, STI diagnoses rates and concurrent partnerships are higher among black Caribbeans than other ethnic groups. Concurrency (having sexual partnerships overlapping in time), especially when condoms are not used, can enhance STI transmission probabilities. We sought to understand concurrency typologies and drivers among black Caribbeans in England.

Methods

52 black Caribbeans (n=20 men) aged 15–70 years were recruited from community settings and STI clinics. 4 audio-recorded focus group discussions (n=28 participants) and in-depth interviews (n=24) were conducted from June 2014–December 2015. Transcribed data were thematically analysed to identify concurrency typologies and reasons.

Results

Open, situational, and experimental concurrent partnerships were described. Open concurrent partnerships involved having a main partner and additionally men and women having sex with ‘side chicks’/‘thots’and‘side dicks’, respectively. Situational partnerships involved sex with an ex-partner, especially their child’s parent, while also having another partner. These partnerships were usually long-term, and condomless sex was common due to emotional attachment, to ‘entice’the ex-partner back, or because the relationship was founded on sexual pleasure. Experimental partnerships, common among single participants who were unsure about the type of partner to settle down with, were usually short-term and mostly involved condom use. Concurrency was perceived to be normalised in black Caribbean popular music, on social media, and fuelled by ease of ‘ordering sex via app’.

Discussion

Understanding of different types of concurrent partnerships experienced by black Caribbeans during clinic consultations can increase the likelihood of effective partner notification. Interventions addressing normative drivers of concurrency are also needed.
P209 What makes expedited partner therapy (EPT) and accelerated partner therapy (APT) work for partner notification for bacterial stis? a systematic review of interventions
Authors: Mapp Fiona , Pothoulaki Maria , Vojt Gabriele , Estcourt Claudia , Wayal Sonali , Cassell Jackie , Kanwar Tavishi , Patel Krish , Flowers Paul , Copas Andrew , Johnson Anne , Low Nicola , Mercer Cath , Roberts Tracy , Saunders John , Symonds Merle
Published: May 2024

Introduction

Expedited Partner Therapy (EPT) treats the sex partners of persons with STIs without prior clinical evaluation. These interventions have been shown to reduce rates of re-infection and treat a higher proportion of sex partners. EPT which includes remote medical assessment of sexual partners is known as Accelerated Partner Therapy (APT) and meets UK prescribing guidance. Understanding the sequential active behaviour change components of such partner notification (PN) interventions and their use of theory, enables their optimisation and translation to the UK health context.

Methods

We searched eight databases for studies detailing EPT and APT interventions for STIs implemented in high-income countries which included process and outcome data. Abstracts were screened and full-text articles analysed. Data were extracted relating to population, context, intervention components and associated behaviour change techniques (BCTs).

Results

We included 15 of 723 studies covering interventions implemented between 1996–2013 in the UK and USA. EPT interventions are composed of complex sequences of diverse components, representing heterogeneous ‘relay’ behaviour change interventions. They involve diverse behavioural targets and target populations (index patient, partners, healthcare professionals). However they employ a broadly consistent range of behaviour change techniques including: ‘how to perform a behaviour’ and ‘information about health consequences.’

Discussion

EPT interventions are atheoretical, developed in response to patient and provider needs. Systematically identifying the key behaviour components and processes involved in EPT/APT may help explain intervention effectiveness. Developing an explicit theoretical framework using identified BCTs will help in training healthcare professionals to deliver EPT/APT, improving generalisability of interventions and PN outcomes.
P220 Child sexual exploitation and the association with sexually transmitted infections in under 16 year olds attending genitourinary medicine clinics
Authors: Ward Chris , Hughes Gwenda , Mitchell Holly , Rogstad Karen
Published: May 2024

Introduction

Child sexual exploitation (CSE) can be difficult to identify, with few clinical symptoms or signs. There is limited evidence that markers such as sexually transmitted infections (STIs) are predictors of CSE. We present updated data and analysis from a study investigating the relationship between STI presentation at sexual health clinics (SHCs) and CSE.

Methods

SHCs with >18 STI diagnoses in 13–15 year-olds in 2012 were identified using the genitourinary medicine clinic activity dataset (GUMCAD). Cases with confirmed bacterial or protozoal STIs were matched by age, gender and clinic with non-STI controls. Lead clinicians were asked to complete an online questionnaire on CSE-related risk factors irrespective of STI presence. Associations between STI outcome and CSE-related risk factors were analysed using conditional logistic regression.

Results

Data was provided on 466 13-15 year-olds; 414 (88.8%) were female. 340 (80.0%) were aged 15, 108 (23.2%) 14 and 18 (3.9%) 13. In matched univariate analysis, an STI diagnosis was significantly associated with ‘highly-likely/confirmed’ CSE (OR 3.87, p=0.017) and safeguarding concerns (OR 1.94, p=0.022). A weak association between STI diagnosis and ‘highly-likely/confirmed’ CSE persisted after adjustment for partner numbers and prior clinic attendance (OR 3.85, p=0.053).

Discussion

Presentation with bacterial or protozoal STIs by 13–15 year-olds at SHCs may be considered a potential marker for CSE. It would be prudent to consider CSE, in depth assessment and potential referral for any under 16 year-old presenting with an STI.
P223 Impact of national chlamydia screening programme in children aged <16 years attending a sexual health clinic: 10 years later
Authors: Kawsar Mohanarathi , Kakowa Memory
Published: May 2024

Introduction

The objectives of this study were to compare the rates of sexually transmitted infections (STIs) and the uptake of chlamydia test in a Level 3 sexual health clinic during pre and post National chlamydia screening programme (NCSP) periods. The programme has also included children aged <16 years if they are found to be Fraser competent.

Methods

The study period1stSeptember 2002 – 31stAugust 2016. Data were collected retrospectively from the Lilie Sexual Health Management System.

Results

Total of 894 (N=894) children were studied; of whom 80% were girls. Age range was 13-15 years. Demographic details were similar in pre and post- NSCP periods.

Abstract P223 Table 1

STI and testing rates

Overall STI rateChlamydia rateTest UptakePre-NSCP2003&2004 (n=160)19%6%46%Introduction of NSCP locally in 2004Post- NSCP2005&2006 (n=155)23%13%59%2007&2008 (n=156)21%15%60%Level 2 young people sexual health service was introduced in 20082009&2010 (n=140), 5 years later14%7%64%2011&2012 (n=107)8%4%66%2013&2014(n=94)12%8%66%2015&2016 (n=82), 10 years later9%3%67%

Discussion

The rate of genital chlamydia infections had peaked during the immediate post- NSCP period. This is probably related to increased uptake of chlamydia test using the less invasive method. However, the overall trend has shown some reduction in both chlamydia and other STI rates in children aged 13-15 years attending our clinic for the past eight years. The reduction might have been contributed by NSCP in addition to changes in the sexual health services locally.
P225 Do commuters have time for safe sex? delivering an outreach quick check STI & contraception service to london commuters
Authors: Brown Mary , Mastin Jo Ann , Curnock Pauline , Apea Vanessa
Published: May 2024

Introduction

Sexual health services are under growing pressure to provide resource efficient STI screening and contraception services. At the same time busy people are seeking time efficient, convenient services to fit in with busy working lifestyles. By establishing an asymptomatic screening and contraception service in a well-known brand pharmacy at a busy mainline London railway station we hoped to meet both these needs.

Two weekly outreach sessions are provided by an Independent Nurse Prescriber covering both a lunchtime (12–4) and evening (4–8) session on different days. Appointments are booked online with minimal walk-in availability. Prescriptions are issued via FP10’s and collected from the pharmacy.

Methods

Of 1425 attendances in a one year period a retrospective case note review was done for a 3 month period July – Sept 2016 (329 attendances).

Results

Of these 329 patients 75% (248) women and 25% (81) men, of whom 3 MSM. Age range 18–51 (mean age 27yrs) 51% (169) new patients, 187 asymptomatic screens done (1% positivity CT). 147 contraception issued (72% COCP, 21% POP, 5.4%, VR, 1.3% Patch), New contraception 15% (22/147), Maintain 78% (114) Change method 6.8% (10). 26 patients required EHC.

Discussion

There is a high attendance and low DNA rate demonstrating this is a well-used, well positioned timely clinic to meet the needs of a busy commuter population. With more women expressing difficulty getting GP appointments for routine contraception more sessions like this would be appealing for the working population. The service is cost-efficient with low staffing and overheads.
P228 Sexual & reproductive healthcare outcomes among those at risk of child sexual exploitation: a retrospective review
Authors: Cassidy Seán , Solomons Neylya , Herbert Sophie , Forsyth Sophie , Ramsden Sophie , West Richard , Forbes Kimberley
Published: May 2024

Introduction

The purpose of Multi-Agency Sexual Exploitation (MASE) panels is to consider cases of high risk victims and offenders in relation to Child Sexual Exploitation (CSE) and the criminal justice response to offenders. A multiagency approach should ensure young people (YP) are supported by appropriate services including SRH.

Methods

A retrospective review of a selection of MASE cohorts from 2016 from three services across England was undertaken. The names of YP were cross-referenced with the SRH clinic system in the locality to determine if they had accessed the service. Information was collected on reason for attendance, sexual health screening, contraception and gravidity. Data was analysed using Excel.

Results

Of 92 young people discussed at MASE panel, 64 (69.6%) were known to SRH services. The age range was 12–19 years (median 16). Sixty (93.7%) were female. The most common reasons for attendance were request for contraception (35.9%), pregnancy testing (25%) and disclosure of sexual assault (10.9%).

19 (29.7%) individuals had tested positive for chlamydia on at least one occasion (25 episodes in total). Fourteen pregnancies were reported with 8 resulting in termination.

Discussion

Rates of chlamydial infection and pregnancy were high among the MASE cohorts reviewed. The multi-agency response should provide an opportunity to address health needs of this vulnerable group. Interventions should be targeted accordingly including prioritising referral into SRH services into the care plans of those identified to be at risk of CSE.
P242 Laser ablation treatment for complex HPV-related disease in a gum clinic setting
Authors: Gundrum Karl , Rayment Michael , Jones Rachael
Published: May 2024

Introduction

GUM specialist services to treat complex HPV-related diseases unresponsive to conventional therapies are limited. Laser vaporisation following local anaesthesia is an established treatment for refractory warts and intraepithelial neoplasia. Several service specifications have called for these treatments to be delivered and funded outside of Level 3 GUM clinics. A specialist Laser Clinic was established within our centre in 2015. A specially trained clinician reviews individuals. Where the diagnosis is unclear, biopsies are performed. CO2 laser vaporisation is instituted following application of local anaesthesia. Post-operative pain relief is provided and attendees are asked to follow a post-laser pain control algorithm. All attendees are asked to complete a feedback form.

Methods

The case notes and patient feedback of all attendees to the Laser Clinic were reviewed.

Results

155 unique patients have been seen since January 2015. 134 laser procedures have been performed with no evidence of recurrence or reinfection. Diagnosed cases of ano-genital intraepithelial neoplasia: PIN: 14, AIN: 24, VIN: 7 (45/134).

100% of attendees rated the service as excellent or good, with 95% stating that their pain was controlled throughout the procedure.

Discussion

30% of attendees were found to have intraepithelial neoplasia. Encouraging patient feedback, high rates of pathology and positive post-operative outcomes with no evidence of recurrence demonstrate that laser therapy is a valuable treatment option, avoiding the need for onward referral, general anaesthetic and more costly procedures outside of the GUM setting. This service illustrates the importance of maintaining complex service delivery within the GUM setting.
P244 An audit of hepatitis c testing in a sexual health service
Authors: Chou Matthew , Obeyesekera Sharmin , Theodore Cecelia , Dhairyawan Rageshri
Published: May 2024

Introduction

With new effective treatments for hepatitis C (HCV), identifying cases is increasingly important. The BASHH Viral Hepatitis Guidelines (2015) recommend HCV screening in sexual health services for people at high-risk. We carried out a retrospective audit in our clinic.

Methods

We reviewed our patient records and laboratory database for HCV antibody (AB) tests between 1stJanuary 2015 – 30thJune 2016. The management of those HCV RNA positive was compared with the BASHH auditable standards (2015).

Results

From 56483 attendances, 12008 HCV AB tests were taken. 18/12008 cases were HCV AB positive of which 11 were also HCV RNA positive giving a prevalence of 0.09%. 8/11 newly diagnosed; 6/11 male; 6/11 Eastern European, 3 White British, 2 Asian; 4 co-infected with HIV. Genotypes were available for 6/11 and of these 4 had G1a, 1 had G1b and 1 had G3a. 11/11 had LFTs/AFP (target 90%) and all had hepatitis B tests (target >95%). 11/11 were referred for ongoing care within 2 months (target 100%). All had a written follow up plan (target 97%) and all had a documented discussion regarding the natural history and transmission of HCV, but only 2 (18%) had documentation that written information was also given (target >95%). All had partner notification (target 97%).

Discussion

The prevalence of HCV infection in our screened population was lower than we expected (0.09%) for an area with a large migrant population. Our service met all auditable standards in management except for documenting that written information had been given.
P014 Does separation of HIV and sexual health services affect the management of stis in people living with HIV?
Authors: Colver Helen , Ball Rhiannon , Dhar Jyoti
Published: May 2024

Introduction

The presence of a bacterial STI increases the risk of HIV transmission. It is important that people living with HIV have easy access to STI treatment and that partner notification is robust. In our local area, HIV care is located and commissioned separately from the sexual health service. Does this affect STI treatment and partner notification?

Methods

All HIV positive patients with a diagnosis of gonorrhoea, Chlamydia or new/infectious syphilis during 2015 were identified from laboratory results and computer records. Demographic details for each patient were recorded and the management of their STI assessed according to BASHH standards.

Abstract P014 Table 1

Impact of separation of HIV and sexual health services

InfectionNumber of patientsMean interval between test and informing patient (days)Mean interval between informing patient and attendance for treatment (days)Mean number of partners attending within 4 weeks [BASHH standard]Gonorrhoea2414.64.50.375 [0.6]Chlamydia2313.34.80.348 [0.6]Syphilis1622.640.20.125 [0.4]

Results

DiscussionBarriers to timely treatment included difficulty contacting patients, need to travel to a different service to obtain medication and difficulty arranging appointments at acceptable times. Particular delays were noted in the management of syphilis. Clarification of each service’s responsibilities with regard to contact tracing could improve partner notification rates. Even when HIV and sexual health services are not jointly commissioned, it is essential that both departments work together to develop robust pathways for the management of STIs identified in people living with HIV.
P015 Receiving 1g azithromycin as part of mass drug administration (mda) for the control of trachoma is associated with reduced genital mycoplasma genitaliumprevalence
Authors: Harrison Mark , Harding-Esch Emma , Marks Michael , Pond Marcus , Butcher Robert , Solomon Anthony , Tan NgeeKeong , Nori Achyuta , Kako Henry , Mabey David , Sadiq STariq
Published: May 2024

Introduction

Mass Drug Administration (MDA) with 1g oral azithromycin for ocularChlamydia trachomatis(CT) infection, a key component of trachoma control, can concomitantly reduce genital CT prevalence. However, this dose is known to be sub-optimal for the treatment of genitalMycoplasma genitalium(MG) infection. Here we investigate factors associated with MG infection in pre- and post-MDA sample sets.

Methods

Pre-MDA (T1) and 6 months post-MDA (T2) CT-negative self-collected vulvo-vaginal swabs from women attending three outpatient antenatal clinics (Honiara, Solomon Islands), were tested for MG infection using nucleic acid amplification. Logistic regression was used to determine factors associated with infection. Variables tested included: patient age, clinic attended, ethnicity, time spent in education, living in an urban or rural environment, marital status, living with spouse, presence of symptoms associated with a sexually transmitted infection (STI), having an STI in the last 12 months, current CT, Gonorrhoea orTrichomonas vaginalisinfection, and at T2 only receipt of MDA dose.

Results

MG positivity was found in 11.9% (95%CI: 8.3–16.6; 28/236) of women at T1 and in 10.9% (95%CI: 7.7–15.4; 28/256) at T2 (p=0.7467). The only factor associated with having an MG infection was history of not having received MDA with azithromycin at T2 (odds ratio 0.19, 95%CI 0.07–0.53, p=0.001).

Discussion

Not having MG infection was associated with receiving 1g azithromycin as part of MDA for trachoma control six months previously. However there was no overall drop in population prevalence, indicating individual but not population benefits of MDA with regard to MG infection control.
P020 Comparison of the aptima mycoplasma genitalium tma assay and the fasttrack diagnostics (FTD) urethritis basic assay for detection of M. genitalium in gum specimens
Authors: Cliff Penny , Vidican Cristina , Hassan-Ibrahim Mohammed , Ovens Katie , Wilson Andrea , White John , O’Shea Siobhan , Soni Suneeta
Published: May 2024

Introduction

Testing forM. genitaliumin the UK is limited and detection has relied on realtime PCR assays. The Hologic AptimaMycoplasma genitaliumTMA assay for use on the Panther® system is now available. This study compared a commercial realtime PCR and the Aptima assay using stored clinical specimens.

Methods

Clinical specimens (76 urines, 33 vaginal swabs, 2 rectal swabs, 1 pooled sample and 2 unknowns) from men with urethritis and women with pelvic inflammatory disease were tested forM. genitaliumDNA using the FastTrack Diagnostics (FTD) Urethritis Basic assay. Residual specimen was then transferred to an Aptima urine tube and tested for the presence ofM. genitaliumribosomal RNA using the Aptima TMA assay.

Results

Of the 113 specimens tested, 24 (21%) were positive and 87 (77%) negative on both assays. There were two discrepant results (1.7%) in urine specimens that were positive on the Aptima TMA assay and negative on the FTD Urethritis assay. One was confirmed as positive by the Reference Laboratory using their in-house MgPa PCR, indicating a false negative result on the FTD Urethritis assay. The other discrepant result was low level positive on the Aptima TMA assay and negative at the Reference Laboratory.

Discussion

98% of samples gave concordant results, indicating that both assays are appropriate for use in clinical service. However, the additional positive detected by the Aptima assay, explained by detection of target in multiple copies in each bacterial cell, suggests that this assay is more sensitive.
P021 Mycoplasma genitalium- testing and treating in a level 2 primary care service
Authors: Gonah Tamuka , Scrivener Jodie , Gando Isata , Richardson Daniel
Published: May 2024

Introduction

Mycoplasma genitalium (MG) is an emerging sexually transmitted infection causing up to 20% cases of urethritis in men and is a cause of PID. Most UK centres do not have access to MG testing. Locally we use an algorithm for testing and management of MG in collaboration with our level 3 service screening men with urethritis and women with PID.

Methods

We reviewed the electronic Patient records of patients tested for MG from January 2016 to February 2017.

Results

66 patients were screened, all with genital symptoms. 35(53%) were male. 10/66(15.2%) patients tested positive for MG, 6(9.1%) males and 4(6.1%) females: median age was 34. The clinical symptoms were: 4/66(6.1%) -penile discharge, 4/66(6.1%)-long history of increased vaginal discharge, 1/66(1.5%)-haematospermia, 1/66(1.5%) penile sores. 8/10(80%) were treated with 1st-line treatment (extended course of Azithromycin) in our primary care service while 2/10(20%) were referred to Level 3 service for assessment and treatment. Partner notification was done and documented in 50% of the positive cases but interestingly none of the 10 patients attended for test-of-care as advised.

Discussion

We have shown that MG testing and treatment is feasible in a level 2 primary care setting in collaboration with level 3 services and that MG prevalence is high in symptomatic patients using this service.
P024 Reducing repeated chlamydia and gonorrhoea infections
Authors: Raffe Sonia , Patrick Helen , Murdock Rebecca , Power Jozette , Dean Gillian
Published: May 2024

Introduction

The role of Sexual Health Services (SHS) is not only to treat sexually transmitted infections (STIs) but also to reduce repeat infection through appropriate antimicrobials, health education and partner notification (PN). We reviewed the management of patients with repeat infections.

Methods

A retrospective case-note review of patients attending the SHS with more than one episode of chlamydia and/or gonorrhoea, July 2015 – June 2016.

Results

156 patients were identified of which a random sample of 30 (20%) were reviewed. All were male; median age 29.5 (range 21-58). 70% (21) were MSM, 23% (7) heterosexual, 7% (2) bisexual. 30% (9) were HIV positive. Risk-factors for unsafe sex (e.g. substance misuse/sex-work/mental-health diagnosis) were noted in 77% (23). 77% (23) had 2 infective episodes; 23% (7) had 3 episodes. Of the 67 infective episodes all were treated appropriately; 40% (27) were treated the same day, 9% (6) within 1-week, 24% (16) within 2-weeks, and 22% (15) within 2–4 weeks. Patients reported 1–100 partners in the 6-months prior to review. 73% (48) saw a health advisor (HA); in the remaining 28% the most common reason for not seeing a HA was being managed in non-sexual health clinics e.g. PEP/HIV-research/general HIV. PN was undertaken in 82% (55) of episodes although only completed in 52% (35) largely due to untraceable partners.

Discussion

Focusing on addressing risk factors for unsafe sex may facilitate a reduction in repeat STIs. While most patients were able to access HA support, referral pathways from non-SHS clinics need improving. PN remains challenging in the context of multiple casual partners and novel strategies such as electronic PN should be urgently explored.
P028 Characterising neisseria gonorrhoeae (NG) infections and treatment in a large, urban cohort
Authors: Rashid Taslima , Jayaratne Nirmitha , Taher Marjan , Barber Tristan , Nwokolo Nneka , Rayment Michael
Published: May 2024

Introduction

Better detection and more frequent testing may explain increases in NG. We wished to characterise patients attending our clinics with NG, and audit management against BASHH standards.

Methods

300 sequential NG patients attending in 2016 were reviewed. Data collected: demographics, NAAT/culture positivity (per site), antimicrobial treatment and resistance, and test of cure (TOC).

Results

Mean age was 34 (17–65); 92% male; 75% white; 86% MSM. 415 site specific infections captured. Site distribution by NAAT, culture concordance/sensitivities, and TOC are presented below:

Abstract P028 Table 1

Gonorhoea infections

SexualityCulture resultsTest of CureNAAT+ by SITEMSMHetero – MaleHetero – FemaleCultures takenCulture negativeCiprofloxacin resistanceTOC DoneTOC FailureVVSNANA7%
(21/300)76%
(16/21)19%
(3/16)7.6%
(1/13)76%
(16/21)0%
(0/16)Urethra42%
(126/300)7%
(21/300)NA90%
(132/147)3.7%
(5/132)33%
(43/127)53%
(78/147)2.6%
(2/78)Pharynx37%
(111/300)0.7%
(2/300)1%
(3/300)68%
(79/116)51%
(37/72)43%
(18/42)66%
(77/116)5.2%
(4/77)Rectum43%
(128/300)0.3%
(1/300)0.7%
(2/300)63%
(83/131)12%
(10/83)48%
(35/73)65%
(85/131)3.5%
(3/85)

75% NAAT+ patients (310/415) had cultures performed. There was one case of ciprofloxacin and azithromycin resistance (MSM). 96% (287/300) received ceftriaxone plus azithromycin. Reasons for alternatives related to penicillin allergy. Median time to treatment 0 days (0-45d). 63% (189/300) attended for TOC (median time: 21d (7-188d)) and 94% (177/189) patients tested negative. Failed TOC was due to reinfection in 92%.

Discussion

Our clinics maintain reasonable adherence to BASHH standards. Cephalosporin resistance was not observed. TOC times can be lengthy.
P033 Improving clinical standards in GU medicine: a retrospective audit of neisseria gonorrhoeae
Authors: Young Sarah , Bopitiya Shyamalie , Allan Sris
Published: May 2024

Introduction

We present a retrospective analysis of clinic performance in the 5 domains of management and treatment of Neisseria gonorrhoeae (GC) according to current British Association of Sexual Health and HIV (BASHH) guidelines.

Methods

All cases of GC diagnosed at our clinic between 1stJanuary and 30thJune 2016 were identified. The case notes were reviewed and assessed against current BASHH criteria. This was compared with data from the same clinic for the same six months (1stJanuary to 30thJune) in 2007-2015.

Results

87% of patients treated for GC were recommended to have a test of cure (TOC) (61% had a TOC.). 100% of with GC were screened for Chlamydia trachomatis or received presumptive treatment for this. 88% of patients with GC had partner notification carried out. 56% of patient’s received written information about GC. 97% of patients with GC received 1stline treatment, or the reason for not doing so was documented.

Discussion

We have demonstrated consistent improvement in 2 of the 5 domains compared with previous years’ data. Recommending a test of cure, partner notification and offering patient information leaflets have decreased over the last year. To address this, teaching sessions were carried out and a quality improvement project to ensure patient information leaflets are offered is underway.

Further staff training and awareness of management of N.gonorrhoeae will be addressed on a regular basis and a re-audit is recommended next year.
P039 User experience of online booking tool for larc appointments
Authors: Siddiqui Farzana , Horn Kate
Published: May 2024

Introduction

Timely access to contraceptive counselling and increased use of LARCs is recognised as the key to avoid unintended pregnancy. In line with national SRH strategy, we aimed to improve access to LARC by supporting women to make informed choices and reducing barriers. The Sexual Health hub includes access to sexual health, well-being and contraception information, with positive promotion of LARCs, in one accessible site. Delivering pre-LARC counselling through online videos enables women to attend for a single focussed LARC fitting appointment.

Methods

We recorded a number of metrics to assess uptake and impact on service provision and surveyed users to assess acceptability.

Results

In the first 5 months we saw:

151% increase in visits to LARC self-help content and use of pre-consultation videos

11% of available bookable appointments made online, the majority out of hours

10% reduction in call volumes to services

Improved patient experience and choice as evidenced through user survey

Very easy or easy to book an appointment online: 84%.

Very easy or easy to find information and advice online: 92%

Very likely or likely to recommend to a friend: 96%

Very likely or likely to use the website again: 95%

Positive free text comments

Discussion

Our experience to date shows this approach is well received by patients who appreciate the flexibility it offers in their busy lives. It has also delivered efficiencies in administrative time, releasing staff for other tasks. We are monitoring the impact on uptake of LARC and anticipate data will further support this approach.
P045 Vaginal infections and contraception – results of a patient questionnaire
Authors: Wallace Harriet , Ekong Nadia , Loftus-Keeling Michelle , Ross Jonathan , Armitage Catherine , Wilson Janet
Published: May 2024

Introduction

Bacterial vaginosis (BV) and candida are common problems among females using contraception. Associations between BV/candida and different contraception are described but not proven.

Aim(s)/objectives

Establish knowledge of BV/candida among contraceptive users. Assess whether future research on BV/candida and contraception would interest patients.

Methods

Surveys were distributed to females at two sexual health clinics and a student General Practice by staff not seeing patients. Responses were anonymous. Questions included knowledge of BV/candida, existing contraception, future contraceptive choices related to BV/candida and importance of research findings.

Results

298 completed a survey; 157/298 attending for contraception (90% using/starting a method), 141/298 attending for other sexual health reasons/GP consultation. Of 157 contraception patients, 22% were <20yrs, 96% were <35yrs. Overall, 40% had heard of BV and 39% of candida but in <20yrs, 26% had heard of BV, 17% candida. 47% were interested in outcomes of further research between BV/candida and contraception (30% neutral, 17% not interested), rising to 56% in those who had heard of BV and/or candida. Similar results were seen in surveys from 141 females not attending for contraception (58% interested if heard of BV and/or candida). 81% stated they would definitely/probably change from a contraceptive if it was proven to increase the development of BV/candida, and they acquired the infection.

Discussion

There is patient interest in further research assessing associations between contraception and BV/candida, which would influence contraception choices. Patients preferred more knowledge on any links between contraceptive types and BV/candida rather than number of recurrences or persistence of symptoms.
P049 Evaluating the use of long-acting reversible contraceptives; what can be done to improve uptake?
Authors: Gorman Caitlin , Tensel Wesley
Published: May 2024

Introduction

Despite an improvement in the rate of unplanned pregnancies in England, the problem persists, particularly in the teenage population, with a large proportion of these conceptions being attributed to contraceptive failure. The OCP and male condoms remain the most widely used contraceptives, which considering their dependence on user-compliance is worrying. Long-acting reversible contraceptives are an alternative with much lower failure rates, partially attributable to the removal of this concern.

Methods

An audit was carried out at Wellfield Medical Centre in Manchester, one of the areas with persistent high teenage pregnancy rates.

Results

A review of records highlighted that the OCP remained the most commonly prescribed contraceptive in women over the preceding year. LARC accounted for only 29% of the new prescriptions given to 15–24 year olds and 41% of under-35s, with LARC being favoured only in the older population.

Discussion

This was in keeping with the literature, which suggested that social norms and negative experiences of friends and family are accountable, along with a lack of education of LARC compared with other methods. These findings indicate that an improvement in the awareness of safety and efficacy of LARC is necessary, particularly in this young population. This should be initiated in a practice context, but the wider reach of social media may be required to ensure an adequate impact. The skill and ability of providers to counsel women on LARC needs to be addressed, as does an increase in time available for counselling and detailed recording of these discussions.
Impacts of conservation agriculture on soil C and N stocks and organic matter fractions: comparing commercial producer fields with a long-term small-plot experiment in Brown Chernozems of Saskatchewan
Authors: St. Luce Mervin , McConkey Brian , Schoenau Jeff , Brandt Kelsey , Hangs Ryan , Zhang Hongjie
Published: May 2024

Conservation agriculture (CA) is increasingly promoted to build soil organic matter (SOM) based on findings from predominantly small-plot long-term agroecosystem experiments (LTAEs), with minimal on-farm data. Using commercial producer fields ( n = 20) in the Brown Chernozemic soil zones of Saskatchewan, Canada, which were sampled before (1996) and after (2018) adopting direct-seeding and continuous cropping (1997), we examined changes in soil organic carbon (SOC) and soil total nitrogen (STN) stocks, along with C and N stocks in particulate (POM) and mineral-associated organic matter (MAOM), and compared them to an LTAE in the same soil zone. After 21 years, SOC and STN stocks (0–30 cm depth) increased by 13% and 21%, respectively, in commercial producer fields, and were more pronounced in finer- than coarser-textured soils. Conversely, there were no significant changes (0–30 cm depth) after 18 years (1998–2016) with CA (continuous wheat and pulse-wheat under no-tillage (PW-NT)) in the LTAE, except that STN stock for PW-NT decreased by 7.7%. The estimated rate of change to 30 cm depth was similar between the commercial fields and LTAE for SOC (0.28 and 0.16 Mg C ha−1 year−1, respectively), but not STN (0.04 and −0.03 Mg N ha−1 year−1, respectively). Changes were more evident in the MAOM than POM fraction in both cases. Although the impact of CA may be similar, as observed for SOC, actual on-farm changes will depend on site-specific factors, and specific CA practice. Therefore, on-farm monitoring studies are needed for more accurate assessments of SOM changes and C sequestration potentials.
Droplet motion driven by humidity gradients during evaporation and condensation
Authors: Barrio-Zhang Hernán , Ruiz-Gutiérrez Élfego , Orejon Daniel , Wells Gary G. , Ledesma-Aguilar Rodrigo
Published: May 2024

The motion of droplets on solid surfaces in response to an external gradient is a fundamental problem with a broad range of applications, including water harvesting, heat exchange, mixing and printing. Here we study the motion of droplets driven by a humidity gradient, i.e. a variation in concentration of their own vapour in the surrounding gas phase. Using lattice-Boltzmann simulations of a diffuse-interface hydrodynamic model to account for the liquid and gas phases, we demonstrate that the droplet migrates towards the region of higher vapour concentration. This effect holds in situations where the ambient gradient drives either the evaporation or the condensation of the droplet, or both simultaneously. We identify two main mechanisms responsible for the observed motion: a difference in surface wettability, which we measure in terms of the Young stress, and a variation in surface tension, which drives a Marangoni flow. Our results are relevant in advancing our knowledge of the interplay between gas and liquid phases out of thermodynamic equilibrium, as well as for applications involving the control of droplet motion.

Graphic abstract
Assessing the Impact of Static, Contextual and Character Embeddings for Arabic Machine Translation
Authors: Nouhaila Bensalah , Habib Ayad , Abdellah Adib , Abdelhamid Ibn El Farouk
Published: May 2024

Word embeddings/representations are an important component of Natural Language Processing (NLP) tasks. Most Neural Machine Translation (NMT) systems that use such representations disregard word morphology by assigning a unique vector to each unique word in the used vocabulary and thus cannot handle Out-Of-Vocabulary (OOV) words. In some languages, such as Arabic, the meaning of words is associated with the meaning of the individual characters that constitute them, as these characters embody internal information. In this study, a combination of character- and word- level models is used to determine the most effective approaches to semantically and morphologically representing affective Arabic words. Furthermore, this work examines the strategy of combining static, character and contextual word embeddings to obtain richer representations for the Arabic Machine Translation (MT) task. To the best of our knowledge, we are the first to investigate the combination of static word embeddings, contextual ones and character-level representation in Arabic MT. Furthermore, a Deep Learning (DL) architecture is employed on data preprocessed by various prominent preprocessing techniques. Various experiments were conducted and the findings indicate that the integration of various models for word embedding and character-level representation is feasible and more effective than the state-of-the-art Arabic MT systems.
Do Word-of-Mouth and Quality Have the Same Influence in Choosing a Doctor Online? A Study from Elaboration Likelihood Model Perspective
Authors: Wu Juhua , Chen Wanqi , Tao Lei , Liu Qian
Published: May 2024

From the theoretical perspective of the elaboration likelihood model and service quality, this study attempts to provide an empirical study of patients’ medical choice behaviour and the moderating effect of disease risk under different paths with a real data set from an online healthcare community. The results demonstrate that factors from the central and peripheral routes affect patients’ behavioural intention regarding online medical choices. Disease risk plays an important moderating role. Low-risk patients are mainly influenced by factors from the peripheral route including doctors’ service reputation and disclosure of service qualifications, while high-risk patients are mainly influenced by factors from the central route including service quality of treatment and reviews quality.
CoreKube: An Efficient, Autoscaling and Resilient Mobile Core System
Authors: Ferguson Andrew E. , Larrea Jon , Marina Mahesh K.
Published: May 2024

Almost everyone on the planet has a mobile phone with data connectivity to the Internet. Mobile (cellular) networks enable ubiquitous and on the move connectivity to such end user devices as well as to a myriad Internet of Things (IoT) devices. At the heart of any mobile network is the mobile core. This essential component not only handles all control functionality (authenticating devices, managing user sessions, mobility, roaming, billing, etc.) but also provides a bridge between connected devices and external networks such as the Internet. Compared to a base station whose operation affects only a small geographical area in its coverage, the mobile core serves a much wider area, so its responsive and reliable operation is key to ensuring good user experience.
Aging in females has minimal effect on changes in celiac artery blood flow during dynamic light-intensity exercise
Authors: Shiozawa Kana , Saito Mitsuru , Lee Jordan B. , Seo Natsuki , Kondo Haruna , Kashima Hideaki , Endo Masako Yamaoka , Ishida Koji , Millar Philip J. , Katayama Keisho
Published: May 2024

During exercise, the splanchnic arteries vasoconstrict, contributing to blood flow redistribution and the blood pressure response. Blood pressure responses to exercise are exaggerated with aging in females; however, the physiological mechanism responsible has not been clarified. We show that celiac artery blood flow changes during light-intensity dynamic exercise do not differ with age in females. This indicates the exaggerated blood pressure to exercise with aging is likely not due to a difference in splanchnic vasoconstriction.
Metabolomic pattern associated with physical sequelae in patients presenting with respiratory symptoms validates the aestivation concept in dehydrated patients
Authors: Barrueta Tenhunen Annelie , Butler-Laporte Guillaume , Yoshiji Satoshi , Morrison Dave R. , Nakanishi Tomoko , Chen Yiheng , Forgetta Vincenzo , Farjoun Yossi , Marton Adriana , Titze Jens Marc , Nihlén Sandra , Frithiof Robert , Lipcsey Miklos , Richards J. Brent , Hultström Michael
Published: May 2024

We have previously shown that humans exhibit an aestivation-like response where dehydration leads to a metabolic shift to urea synthesis, which is associated with long-term weakness indicating muscle wasting. In the present study, we validate this response in a new cohort and present a deeper metabolomic analysis and pathway analysis. Finally, we present a sex-stratified analysis suggesting weaker aestivation in women. However, women show less dehydration, so the association warrants further study.