bluuebunny/crossref_metadata_2025 huggingface dataset:
P123 Is there a relationship between the tendering history of a genitourinary medicine clinic and its accessibility?
Authors: Yekini Stephen , Khatun Azra , Agathangelou Gabriela , Rose Thomas , Foley Elizabeth , Patel Rajul
Published: May 2024

Introduction

Since 2004, DH guidance has recommended that GUM clinics in England should endeavour to see patients within 48 hours of initial contact. Recent changes in service commissioning and the wider adoption of competitive tendering since 2013 has led to concerns about maintaining 48-hour access.

Aim

To establish whether there is a relationship between the tendering history of a GUM clinic and its accessibility.

Methods

Postal questionnaires regarding tendering history were sent to lead clinicians of all 262 GUM clinics in the UK. Only questionnaires which were returned within a two-month window were analysed. Each clinic with a returned questionnaire was telephoned eight times by male and female researchers posing as patients with symptomatic and asymptomatic presentations. The researchers asked to be seen as soon as possible and recorded whether this fell within 48 hours.

Results

67 clinics (25.6%) returned their questionnaires on time. A chi-square test found no statistically significant difference between clinics tendered within the last five years (n=49) and the rest (n=18), regarding 48-hour access (86.5% and 86.2% respectively, p=0.916). Interestingly, 88% of contacts with clinics still undergoing a tender resulted in a 48-hour appointment compared with 100% of contacts with clinics which completed the process 3–5 years ago. However, this was not statistically significant.

Discussion

The negative effect of tendering on accessibility seems to be overstated. Moreover, if this effect does exist, it seems more pronounced during the actual tender, followed by an apparent boost in access. A larger study may be required to confirm this.
P125 Use of digital sexual health services by under-16s and an evaluation of safeguarding procedures
Authors: Bakhai Minal , Perera Sean
Published: May 2024

Introduction

Digital health is an increasingly popular way for young people to access health services. There is paucity of research exploring the use of e-health services by under-16s. As an online doctor service offering sexual health services to adults, we reviewed under-16s trying to access services and evaluated safeguarding procedures.

Methods

A retrospective audit of under-16s trying to access e-sexual health services between January-December 2015.

Results

66 patients were identified, 71.2% female, mostly distributed in urban areas (13-fold increase from 2008-2013).

The most frequently accessed services were emergency contraception (27.3%) and routine contraception (43.9%). 22.7% (n15) entered an incorrect date-of-birth. Along with answering a questionnaire online, of the remaining patients, 52.9% (n27) completed a safeguarding assessment with a doctor via telephone, 5.9% (n3) via online messaging, both guided by ‘Spotting- the-Signs’, 41.2% (n21) did not respond to requests for further information and could not be contacted. Safeguarding concerns were identified in 37.3% (n19) and referred to social services. All were directed to appropriate face-to-face services and advised GP follow-up.

Discussion

Our data shows increasing access by under-16s to esexual health services. A significant proportion were identified as being at-risk of sexual exploitation. A telephone safeguarding assessment together with our online evaluation was effective for identifying safeguarding concerns. Alongside IT systems to prevent those trying to bypass checks online, many of our services (including contraception and emergency contraception) require attendance to pharmacy. This provides an additional opportunity to verify identity and screen for safeguarding concerns supporting the ongoing safety of young people.
P129 Designing sexual health services to meet the needs of young people in the uk: results from a qualitative study to inform discrete choice experiment (DCE) development
Authors: Jackson Louise , Ross Jonathan , Al-Janabi Hareth , Roberts Tracy
Published: May 2024

Introduction

Young people experience the greatest burden of sexually transmitted infections (STIs) in the UK. STI screening is now being provided in a wider range of settings such as GP surgeries, pharmacies, and via online services. It is important that screening provision reflects the preferences of young people from different cultural backgrounds. The specific aims of the study were: to explore the factors that are important to young people when thinking about and participating in STI screening in different settings; to examine the characteristics of screening services that influence choices about screening.

Methods

Qualitative methods were used to inform the development of a discrete choice experiment (DCE) to provide quantitative measurement and analysis of the choices made by young people in relation to STIs. A series of eight focus groups and 2 interviews were undertaken with 43 young people in specialist and community settings, with the inclusion of participants from different cultural groups. Discussions were transcribed and analysed using constant comparison methods.

Results

The focus groups revealed a range of aspects of screening that were important to young people. The main themes identified related to stigma, understanding of STIs and risk, setting, interactions with staff, convenience and the nature of the screening test. Attributes for the DCE were developed around waiting times, setting, type of screening test, and staff attitude.

Discussion

The complexities and challenges involved in designing and delivering services for young people are highlighted, particularly in relation to reflecting the preferences of young people from varied cultural backgrounds.
P143 Establishing a regional management pathway for peri-anal and anal cancers and pre-cancers in a moderate prevalence hiv setting
Authors: Ogbonmwan Daisy , Hussey Jane
Published: May 2024

Introduction

There is a rising incidence of anal cancer and pre-cancer among people living with HIV (PLWH), largely thought to be driven by sexual transmission of the Human Papilloma virus. However, a wide difference in screening methods exists. BHIVA guidelines state centres should incorporate a pathway of managing suspected peri-anal and anal cancers and pre-cancers.

Methods

Our aim was to collate data on current screening and referral methods for peri-anal and anal lesions within our region to guide establishing a regional management pathway.

An online survey was sent to specialists involved in managing PLWH. This included trainees and Consultants in Infectious Disease and Genito-urinary medicine. They were asked the methods used, if any, in routine clinics for identifying PLWH with anal and peri-anal cancers and pre-cancers, and whether there was a local established management pathway.

Results

33% of respondents stated that they regularly screened PLWH for peri-anal and anal lesions; the majority by enquiring about symptoms or carrying out proctoscopy examination, largely in men who have sex with men and PLWH with known anogenital warts. Only one Infectious Diseases specialist felt comfortable in using a proctoscope, and 67% of clinicians did not feel that they could be involved in the annual surveillance of peri-anal and anal intra-epithelial neoplasia.

Discussion

The results have supported the need for the implementation of a peri-anal and anal cancer and pre-cancer management pathway within our HIV regional network, alongside further education and streamlining of screening within the region.
P153 Using information technology to improve linkage into sexual health care in patients receiving hiv post exposure prophylaxis for sexual exposure (PEPSE) in emergency departments
Authors: Metcalfe Rebecca , Gaughan Claire , Kilmurray Kim , Carroll Louise , Pollock Kay , Murchie Martin , Smith Hannah
Published: May 2024

Introduction

HIV PEPSE should be commenced within 72 hours (ideally 24) after possible exposure to HIV. Patient education on PEPSE includes advice on attendance at Emergency Department (ED) if outside opening hours of local sexual health services (SHS). Our healthboard serves a population of 1.2 million with four EDs. An initial four month audit revealed 12 patients who received a 5-day starter pack of PEPSE at ED and no communication between departments; patients were told to self-refer to SHS. We recognised there was no robust mechanism to ensure these high risk patients were not lost to follow up (LTFU). HIV testing at baseline was also poor in this setting, highlighting importance of linkage into SHS.

Methods

HIV PEPSE 5 day pack leaflets were altered to ask the dispensing clinican to refer patient via secure email or telephone message to the sexual health advisers.

Results

Prospective four month re-audit revealed 19 patients attended ED for PEPSE and all subsequently attended SHS for follow up(100%). 12/19(63%) were referred by email, 6/19(32%) via answering machine, 1/19(5%) self referred. 11/19(60%) reported unprotected receptive anal intercourse with someone from a high risk group.

Discussion

Following implementation of the email/telephone referral intervention, we found an increased number of patients received HIV PEPSE from EDs in the health board area and all were successfully linked into sexual health services. We cannot be sure that this increase is due to the prevention of patients being LTFU; other reasons include an increased awareness of PEPSE and where to obtain.
O20 Online prescribing for sexually transmitted infections – what’s on offer!
Authors: Okecha Elizabeth , Patel Saleha , Boardman Emily , Morgan Emile
Published: May 2024

Introduction

In 2016, The British Association of Sexual Health and HIV (BASHH) expressed concern over the use of medications purchased online to treat Sexually Transmitted Infections (STIs) ‘without full examination and specialist input’. Few studies have investigated the extent of this practice; our service wanted to establish availability of treatment and determine if patients are managed according to BASHH guidelines.

Methods

A prospective internet search was performed using the keywords ‘STI treatment online’. UK based internet pharmacies offering treatment for Gonorrhoea, Chlamydia, Herpes and Trichomonas were included in the study.

Results

30 websites were identified; 5 were excluded. 25(100%) required assessment by a Doctor/Pharmacist Prescriber. 5(20%) offered Gonorrhoea treatment; of these, only one offered Ceftriaxone 500mg/Azithromycin 1 gram and no websites made customers aware that Gonorrhoea cultures were required prior to treatment.

23(92%) websites offered Chlamydia treatment as Azithromycin 1 gram stat and/or Doxycycline 100mg twice daily for seven days however, none of the websites asked whether treatment was required for patients at risk of rectal Chlamydia or Lymphogranuloma Venereum. Patients seeking Chlamydia treatment were advised to abstain from sex on 16(64%) websites and partner notification was advised on 18(72%) websites.

22 (88%) websites offered treatment for Herpes. 6(27%) required no photographic/laboratory diagnosis of Herpes before purchase. 15(68%) did not discuss partner disclosure of a Herpes diagnosis.

Discussion

Online pharmacies have established a niche market for patients who are reluctant to access clinic based healthcare. Our results show variable adherence to BASHH guidelines which may compromise health outcomes for patients seeking internet based therapy.
P159 Audits of both management of chlamydia and also emergency contraception provision as a marker of quality in an integrated service
Authors: Bhaduri Sumit , Mann Melanie
Published: May 2024

Introduction

The county wide sexual health service has been integrated long-term as regards health care worker (HCW) training and governance. Service delivery still remains in some units geared to towards either contraception (C+RHC) or sexually transmitted infections (STIs) management although all patient needs are addressed holistically. Is there equitable service delivery in all units?

Methods

Audits of both chlamydia management and emergency contraception provision was carried out across all subunits regardless of subspecialisation.

Results

In the chlamydia audit, standards were achieved for offering anti-chlamydial treatment (100% achieved) and partner notification verified by HCW (0.47 in STI units, 0.58 C+RHC units). Standards were suboptimal for a) the offer of written information (45% for STI units 18% for C+RHC units and b) offer of retesting for under 25s (61% for STI units, 68% for C+RHC units.) Emergency contraception audit standards were achieved in offering quick start contraception (96%) but suboptimal a) for IUCD offer (73% for STI based units, 57% for C+RHC units), b) documentation of hours since last unprotected sex (58% for STI units 89% for contraception based units), c) documentation of day of cycle (69% for STI units, 89% for contraception units and d) offer of STI screens (82% in STI based units, 76% in contraception units)

Discussion

Although variation between units exists it is noteworthy that partner notification was best delivered in C+RHC unit setting and IUCD offer in STI unit setting. Emphasis on documentation was made to staff with reaudit planned.
P162 NHS GGC staff HIV anti-stigma campaign
Authors: Zinger Jo , Carroll Louise
Published: May 2024

Introduction

People living with HIV, and maintained on ARVs, can live long and healthy lives.

Consequently, there is a growing cohort of people living and ageing with HIV, who are attending NHSGGC for non-HIV related conditions. However, many patients report experiencing stigma and discrimination within these services. NHSGGC responded to this by creating a HIV anti-stigma campaign.

Methods

A baseline staff survey was conducted to ascertain knowledge, attitudes and training needs. These results and input from the HIV Patient Forum shaped the campaign, which consisted of: A range of materials, merchandise and activity including posters, road shows, factsheets; training, digital updates and direct messaging to service managers; A patient toolkit which empowers them to challenge stigma and discrimination; Short dramatic videos illustrating patient experience; A repeat staff survey was carried out in 2016

Results

4000 responses to the baseline survey; 9,325 unique website hits; 300+ staff engaged at road shows; 15 delegates attending training; 1,521 responses to the repeat survey; excellent partnership working between NHSGGC staff and members of the patient forum.

Discussion

The campaign was successful in raising HIV with non-specialist staff. However, uptake of training was low despite an expressed need. Lack of time to train in non-mandatory areas was an issue. Those that did attend training evaluated it well. Results from the repeat survey will shape future interventions for staff.
P166 Partner notification: are australian approaches feasible for the chilean context?
Authors: Iturrieta-Guaita Nicole , Temple-Smith Meredith , Tomnay Jane
Published: May 2024

Introduction

Partner Notification (PN) in Australia has been studied and improved in recent decades. International researchers have highlighted the use of new technology as an alternative approach for PN. Using the Australian experience as an example, we aim to explore clinicians’ perspectives about the use of specialised websites, such as ‘Let them know’ and professional counselling support, to facilitate PN in the Chilean context.

Methods

58 semi-structured interviews were conducted with health care providers (HCP) and key informants. A third of the interviews were transcribed verbatim and translated from Spanish to English for thematic analysis, which followed an inductive approach based on grounded theory. Following the identification of themes, remaining interviews were coded utilising a method of constant comparison to highlight concordance and dissonance of participant views.

Results

The majority of participants were unaware of the use of new technologies for PN, and demonstrated a high interest. Many agreed this could be a feasible strategy considering the high use of mobile technologies and the Internet in Chile. Participants’ primary concerns around this approach were confidentiality, privacy and efficacy, given the local cultural context. The creation of a counsellor position for professional support and guidance was identified as essential to strengthen PN in Chile.

Discussion

The use of new technologies for contacting sexual partners with professional counselling support could be an alternative PN strategy for Chile. However, the involvement of local staff will be essential in tailoring interventions.
P171 Drug-drug interactions in hiv patients taking pharmacokinetic enhancers
Authors: MacCann Rachel , Hollywood Paul , McConkey Samuel , Lorigan David
Published: May 2024

Introduction

Antiretroviral medications have the potential to produce serious drug interactions by interfering with the hepatic cytochrome P450 cascade. Ritonavir, a protease inhibitor, is a known CYP450 inhibitor that is commonly used in the treatment of HIV1. Iatrogenic Cushing’s syndrome is caused by exposure to glucocorticoids and may be promoted by interaction with additional drugs that result in hypothalamic-pituitary adrenal axis suppression2. It is well documented in HIV patients receiving inhaled steroids in combination with a ritonavir-containing antiretroviral regimen3. Following one such severe drug-drug interaction in a patient, a clinical audit was conducted to identify potential drug-drug interactions in a HIV clinic at Beaumont Hospital, Dublin.

Methods

200 patients receiving Ritonavir were interviewed and screened for harmful prescribed and non-prescribed co-medications. Patients receiving regular steroid doses and Ritonavir were identified and all drugs were cross-referenced to the Liverpool Drug Interactions website to highlight any dangerous drug interactions.

Results

86% of patients had concomitant prescribed medications, three-quarters of which were undocumented. Furthermore, 45% of patients used regular over the counter-medication and 2.7% used recreational drugs. 8% of patients were flagged for potentially dangerous drug-drug interactions and of these, 15% contained steroids.

Discussion

The interaction between corticosteroids and PIs is significant and deserves close attention and evaluation. Timely communication among all prescribing physicians for a given patient is indicated in order to proactively detect significant interactions before they manifest themselves clinically.
P183 Retrospective analysis of the utilisation of scrotal ultrasound scan in sexual health clinic
Authors: Ramogi Malaki
Published: May 2024

Introduction

Most scrotal/testicular symptoms and signs are benign. US Scan is investigation of choice in these patients. However, several studies have shown ultrasound scan findings rarely changes management of these patients. Our aim was to understand how ultrasound scan influenced the diagnosis and management of men with scrotal or testicular symptoms seen in our sexual health clinic.

Methods

Retrospective data collected from clinical records of all men seen in sexual health clinic and referred for US scan between 2010 and 2016. Data collected include age, presenting symptoms, STI screen, clinical and ultrasound finding.

166 men had ultrasound scan. 23 men excluded due to incomplete data. Data collected and analysed for 143 men.

Results

Median age was 33 years (range 15 – 72 years). Common scrotal/testicular symptoms were: lump 72 (50%), aches/pain 45 (31.5%), others 15 (10.5%). Ultrasound scan diagnoses were: Benign epidydimal or tunica albuginea cyst 40 (28%), Varicocele 25 (17.5%), Hydrocele 15 (10.5%), Normal 34 (24%), other 26 (18%), Cancers (testicular 2 and sarcoma 1) (2%). 7 men were referred to urologist for cancer treatment and embolization of varicocele.

Discussion

Most men had benign scrotal conditions or normal findings confirmed on scan. This did not change their management plan. Two cases of testicular cancers were initially suspected on clinical examination.
P188 An audit of management of patients presenting with urinary tract infection (UTI) in a sexual health clinic
Authors: Vijayappa Shashirekha , Narayana Srinivasulu , Browne Rita
Published: May 2024

Introduction

Patients with symptoms suggestive of UTI is a common presentation in sexual health clinics.

Methods

Laboratory data retrospectively identified all patients who had a MSU sent from May 2015 to October 2015. Data was retrieved from Electronic patient records and analysed using Excel.

Results

There were 150 patients, 107 females and 43 males. Median age 32 years and range 16 – 74 years. Ethnicity: 36% were White British and 22% black Afro-Caribbean. 5 were female sex workers, 3 MSM and the rest heterosexual. 98% were symptomatic (104 had dysuria and 43 increased urinary frequency). 92% had 1 partner in the preceding 3 months.

Urinalysis was positive for leucocytes in 71, Nitrites in 55 and blood in 38 patients.

The audit standards our service achieved were: 84% of all patients who had symptoms suggestive of UTI had Urinalysis, 88% received appropriate first line antibiotics, 63% of women with pelvic pain had a pregnancy test and 100% of all male patients with a UTI were referred to Urology. 40% of MSU were positive and bacteria isolated were 73% E coli, 15% Coliform and 6% Proteus.

The table below shows sensitivities to antibiotics:

Abstract P188 Table 1

UTI antimicrobial sensitivity

Trimethoprim sensitivityNitrofurantoin sensitiveSensitive80%91%Resistant17%9%Intermittent3%0%

Discussion

We are currently discussing with our local microbiologists about stopping routine MSU in line with NICE guidance and a change to nitrofurantoin as first line treatment. Staff training has been done to remind staff about the need to do a pregnancy test in women with pelvic pain.
P193 Making online contact count: addressing health needs in under 18s attending srh
Authors: Forbes Kimberley , West Richard , Cassidy Seán , Daniels David
Published: May 2024

Introduction

The Five Year Forward Review calls for an upgrade in prevention and public health and Making Every Contact Count suggests utilisation of provider encounters to enable positive behavioural change. The London Sexual Health Transformation Programme will be implemented in April 2017 and it is proposed that asymptomatic patients will access services online rather than attending a clinic.

Methods

In the financial year 2015 – 16 there were 1975 attendances of 998 individuals <18 at a sexual & reproductive health service. A risk assessment proforma was used in 98.82% (n=505/511) of those 16 or under and 72.9% (n=355/487) of those aged 17. These were analysed using an electronic report.

Results

Current mental health problems, smoking, drug and alcohol use was recorded in 837 (97%), 694 (81%) and 818 (95%) records respectively.

Abstract P193 Table 1

Under 18s attending SRH

Under 16 n=205Age 16 n=300Age 17 n=355Mental health difficulties47 (23%)63 (21%)93 (26%)Smoking70 (34%)85 (28%)122 (34%)Alcohol use alone67 (32.7%)124 (41.3%)128 (36%)Drug use alone5 (2.4%)12 (4%)10 (2.8%)Drug + alcohol use14 (6.8%)18 (6%)31 (8.7%)

Discussion

Mental health difficulties, smoking, drug and alcohol use are common across all ages. Assessment enables health promotion through brief interventions and is important to identify young people at risk; commissioners should ensure that opportunities are not lost with online access. We suggest commissioning of a one stop shop model for under 18s or robust online screening protocols to ensure opportunities for intervention are not lost.
O24 Which sexually transmitted infections do gay and bisexual men find most scary and why? a qualitative focus group study in four cities in england
Authors: Reid David , Datta Jessica , Wayal Sonali , Mercer Cath , Hughes Gwenda , Weatherburn Peter
Published: May 2024

Introduction

Men who have sex with men (MSM) are a priority for STI prevention interventions including the promotion of regular testing and condom use. Effective intervention design requires understanding of MSM’s knowledge and fear of STIs, which may affect attitudes and behaviour related to risk, testing and treatment.

Methods

We recruited a diverse sample of MSM in four English cities, through social networking sites and community organisations. 61 men attended eight focus group discussions. Topics included knowledge and attitudes towards 11 STIs. Discussions were audio recorded, transcribed and analysed thematically.

Results

Participants demonstrated variable knowledge and awareness of STIs. No focus groups were unanimous in their ranking of fear of STIs, although HIV and HCV were considered the most ‘scary’ in all groups. Fear of syphilis and herpes was also considerable. Gonorrhoea was considered a ‘rite of passage’ and was not widely feared. Other infections showed no clear patterning within or between groups. Participants suggested a complex range of explanations for fear of particular STIs. Participants weighed up the scary and less scary attributes depending on the extent of their knowledge and experience, their prevalence among MSM, associated stigma, transmission mechanisms, contagiousness, symptoms, severity, and the availability, effectiveness and ease of use of vaccines, treatment and/or cure.

Discussion

Participants expressed a range of nuanced fears and concerns related to individual STIs and STI testing and treatment. Understanding these fears, and how they might be mitigated, will help improve the impact of interventions promoting STI testing and treatment.
P206 Prevalence and risk factors associated with chlamydia trachomatis (CT), mycoplasma genitalium (MG) and neisseria gonorrhoeae(NG): cross-sectional study in three sexual health clinics
Authors: Broad Claire , Harding-Esch Emma , Harrison Mark , Pond Marcus , Tan NgeeKeong , Soares Clare , Fuller Sebastian , Okala Sandra , Sadiq Syed Tariq
Published: May 2024

Introduction

Chlamydia trachomatis(CT),Mycoplasma genitalium(MG), andNeisseria gonorrhoeae(NG) infections contribute to major reproductive health sequelae. CT and NG are routinely tested for in sexual health clinics (SHCs), whereas MG is not. Population prevalence estimates for males and females for CT and MG are >1% and <0.1% for NG infection. Risk factor data, which help target control interventions, are limited in men-who-have-sex-with-men (MSM). We assessed prevalence and risk factor data in symptomatic patients accessing SHCs.

Methods

Patients aged ≥16 years with symptoms of an STI provided: vulvovaginal swabs (females), first void urine (men-who-have-sex-with-women (MSW) and MSM) and pharyngeal and rectal swabs (MSM). Routine clinic results were obtained and FTD Urethritis Plus kit used to detect MG. Risk factors (RFs) were analysed using univariate (UV) and multivariate (MV) logistic regression.

Results

Abstract P206 Table 1

Prevelance and risk factors associated with STIs

Females n=305MSW n=174MSMUrine n=79Rectal n=80Pharynx n=87CT% (95%CI)8.20(5.61–11.82)20.96(15.43–27.47)6.33(2.73–13.97)7.50(3.48–15.40)1.18(0.21–26.80)MG% (95%CI)7.54(5.08–11.06)17.82(12.84-24.18)1.27(0.22–6.83)8.75(4.30–16.98)0.00(0.00–4.23)NG% (95%CI)1.31(0.51–3.32)6.32(3.57-10.96)13.92 (7.96–23.24)27.50(18.92–38.14)17.44(10.86–26.80)

The only RFs associated with any organism in MV analyses was in females. Being aged 16–19, a contact of someone with an STI, and not bleeding were associated with CT and being a contact was the only RF for NG.

Discussion

CT and MG positivity were highest in MSW compared with other patient groups, whereas NG positivity was highest in MSM, especially rectal samples. In the absence of routine MG testing, NG-positive MSM would be treated with 1 g azithromycin, (combined with 500 mg ceftriaxone) which could result in MG antimicrobial resistance development. From our study population, with no RFs for CT, NG or MG, a targeted test and treat approach would not be beneficial in MSW or MSM.
P210 A cluster of infectious syphilis cases
Authors: Goodall Lisa , Rehman Yasmin , Coetzee Nic
Published: May 2024

Introduction

In 2016 the Field Epidemiology Service (FES) noted an increase in cases of infectious syphilis reported to the Enhanced Syphilis Surveillance Scheme (ESSS) from our clinic. From 01 January 2016 to 31 December 2016, 55 cases were reported to ESSS; compared with 12 cases from January to December 2015.

Methods

Data was extracted from GUMCAD and the ESSS. FES collated and analysed the data using appropriate measures of disease frequency, central tendency and spread in order to describe the epidemiological characteristics of the cluster.

Results

All cases were maleThe median age was 37 years (range 16 to 74). 75% were men who have sex with men (MSM), 18% heterosexual and 7% bisexual. 89% were of white British ethnicity. 64% were HIV negative. 18% reported chem-sex.

38% were diagnosed as primary syphilis, 36% secondary syphilis and 27% early latent syphilis.

Venue and/or web application information was recorded for 71% of cases. GRINDR was the most commonly mentioned application (48% of cases mentioning use).

Discussion

In order to reduce syphilis transmission it is vital that new cases are identified and treated and strategies put in place to target populations at higher risk. Incident Management Team meetings were held in 2016 including representatives from Public Health England, GUM, sexual health promotion team and commissioners. Education and awareness programmes have been implemented focussing on specific websites, apps and venues such as bars and clubs popular among MSM. We continue to monitor cases of infectious syphilis on a monthly basis.
O27 Beyond sexual health: identifying healthcare needs of trans and gender variant people in a specialist clinic service
Authors: Nambiar Kate , Davies Julia , Woodroffe Tamara , Sander Nicolas Pinto , Richardson Daniel
Published: May 2024

Introduction

Sexual health services targeted towards specific populations have been an effective way of responding to complex needs. As demand for gender identity services increases, a trend in hormone self-medicating has become more apparent with patients obtaining treatment from internet pharmacies, friends or illicit sources. This study highlights the healthcare needs of patients attending a clinic service for transgender patients.

Methods

Clinical audit of a sexual health service for transgender people in 2015 and 2016.

Results

81 attendances were recorded (56 unique patients). Median age was 32 (IQR 24–41). Reported gender identity: Trans male (Assigned Female At Birth [AFAB]) 29 (51.8%), Trans female (Assigned Male at Birth [AMAB]) 15 (26.8%), Non-Binary (AFAB) 9 (16.1%), Non-Binary (AMAB) 3 (5.4%). AMAB patients were older than AFAB – Median age 39 vs. 29 years (p=0.03). Most attendances were for STI screening or genital health issues – 47 (58%). 6 (7.4%) attended for psychosexual assessment. 31 (38.3%) attended for endocrine advice and monitoring of hormone therapy. 13 (38.3%) patients were self-medicating (10 Trans male/Non-Binary AFAB, 3 Trans female/Non-Binary AMAB). 7 of the trans male and 1 of the trans female patients were using intramuscular hormones. Only 2 of the patients self-medicating had informed another healthcare professional.

Discussion

The number of patients self-medicating without medical supervision raises concerns about adverse effects and unsafe injecting practice. Identifying such patients and meeting their needs raises novel issues for sexual health services. The study highlights the need for additional education for clinicians working with transgender patients.
O29 Patient experiences of sex education in schools – bridging the gap
Authors: Scrivener Jodie , Gonah Tamuka , Richardson Daniel
Published: May 2024

Introduction

Rates of STIs are increasing in the UK among young people: here is little data on the quality, coverage and outcome of sex education in schools.

Methods

A Self-completed service-evaluation survey of patient experiences of sex education and subsequent sexual health was offered to all patients aged under 25 attending our GP level 2 sexual health service in November 2016.

Results

110 completed surveys were returned; Median age was 20. 64% F, 35% M, 1% Trans*. 23% identified as LGBT. 27/110(24.5%) reported previous diagnosis with an STI. 92/110(83%) were educated in the UK; 10/110(9%) reported no sex education at all. 55% of respondents felt that the majority of their sex education came via school. The most covered topics in school sex education were: Puberty (81%), Contraception (80%) and STI’s (80%). LGBT relationships (8%) and Anal sex (9%) were rarely included. Safe internet use was discussed with 18% of respondents, and consent with 39%. 63% felt they had enough information to protect themselves. 38% Females and 33% MSM reported having sex without consent, conversely only 8% Heterosexual men reported non-consensual sex. 51% respondents would use a sexual health clinic to gain more information about sex, 55% would use a website for information.

Discussion

Sexual health services may be ideally placed to work alongside schools in providing sex education. It must not be assumed when seeing patients that they are fully aware of how to protect themselves from sexual harm, and steps must be taken to address any gaps in knowledge attendees may have.
O03 Impact of prep on sexual behaviour? significantly lower rate of rectal ct in non-prep users in the deferred phase of proud disappeared when everyone had access to prep
Authors: Sullivan Ann , Lacey Charles , White Ellen , Mackie Nicky , Clarke Amanda , Gilson Richard , Portman Mags , Dewsnap Claire , Taylor Steve , Dunn David , McCormack Sheena
Published: May 2024

Introduction

PROUD is uniquely placed to compare rates of STIs between PrEP users and non-PrEP users, and to provide longitudinal data in PrEP users between Nov12–Nov16. We describe reported STIs in the year prior to enrolment, and rates during the deferred and post-deferred phases of PROUD when all participants had access to PrEP.

Methods

Data were extracted from baseline self-completed questionnaires. Staff were asked to capture STI screens and diagnoses from quarterly study and interim routine clinic visits. We compared incidence rates of selected STIs for those with immediate (IMM) access to deferred (DEF) access during the deferred and post-deferred phase.

Results

517 participants completed the STI baseline questions, reporting a median (IQR) of 3 (2–4) screens in the 12m prior to enrolment; 172 (89 IMM, 83 DEF) reported a rectal infection. Rectal STI rates were similar by phase and arm with the exception of lower rates of rectal CT in the DEF arm during the deferred phase (p-value=0.024):

Abstract O03 Table 1

Rectal infections in PrEP

Deferred PhasePost-deferred PhaseRate (N/pyrs)IMMDEFIMMDEFRectal GC35.3 (81/229)33.7 (67/203)31.4 (129/411)32.7 (116/355)Rectal CT33.6 (77/229)21.2 (43/203)33.1 (136/411)29.9 (106/355)

Discussion

The ongoing high rates of rectal infections show that participants remaining in follow-up continued to need PrEP. The significantly reduced incidence of rectal CT in those allocated to deferred PrEP was not observed in the post-deferred phase when everyone had access to PrEP. This may be chance or may reflect an influence of PrEP on sexual practices.
O35 Spatial and temporal associations between sexually transmitted and recent congenital syphilis cases in england
Authors: Furegato Martina , Fifer Helen , Vanta Paul , Mohammed Hamish , Simms Ian , Logan Louise , Gill Noel , Charlett Andre’ , Hughes Gwenda
Published: May 2024

Introduction

Four infants with congenital syphilis (CS) born to UK-born mothers who screened syphilis negative at first trimester antenatal screen were identified in England between March2016–January2017. Simulation modelling using historic data suggested the probability of observing these events was about 1%. We assessed whether these recent CS cases were associated with underlying epidemiology of infectious syphilis (IS).

Methods

Data from 01/2011–09/2016 were obtained from GUMCADv2, the national STI surveillance system in England. We defined three syphilis epidemiological areas (SEAs): wider incident areas (WIAs; the affected and immediate surrounding counties); endemic areas (established epidemics in men who have sex with men-MSM); non-incident/non-endemic areas (NINEAs). IS rates/100,000 population were derived and associations between IS characteristics and SEAs were assessed using bivariate analyses. Mothers of CS cases were excluded from analyses.

Results

From 2011–2016, IS rates/100,000 in WIAs rose in heterosexual women (1.5–2.5, 67% increase) and MSM (9.0–13.7, 52% increase) but fell in heterosexual men (4.3–2.7, 37% decrease). In NINEAs, rates rose in heterosexual women (1.6–1.9, 19% increase), MSM (5.0–11.9, 138% increase) and heterosexual men (2.7–3.2, 18% increase). In 2016, the proportion of UK-born heterosexual women with IS was greater in WIAs (82%) than in NINEAs (81%) and endemic areas (35%;p<0.001). The proportion of MSM identifying as bisexual was greater in WIAs (14%) compared with NINEAs (9%) and endemic areas (5%;p<0.001).

Discussion

Increased syphilis transmission among MSM in WIAs may have created opportunities for IS acquisition in women. Health promotion to raise awareness of potential risks of acquiring syphilis during pregnancy is needed.
UG2 The association between birth order and sexual health outcomes:how is birth order associated with learning about sex, early sexual experience, and sexual risk behaviour?
Authors: Elton Lotte , Macdowall Wendy , Palmer Melissa
Published: May 2024

Introduction

While the effect of birth order on psychosocial outcomes has been widely discussed in the literature, little research examining birth order effects on sexual health has been undertaken. This analysis identifies the associations between birth order and learning about sex, first sexual experiences and sexual risk behaviours.

Methods

This analysis uses data from Natsal-3, a stratified probability sample survey of 15,162 men and women aged 16–74 in the UK. Bivariate logistic regression was conducted to identify crude odds ratios for the association between birth order and sexual health outcomes. Multivariate logistic regression was performed adjusting for socio-demographic factors and sibling number.

Results

Middle-born and last-born men were less likely to have found it easy to speak to their parents about sex around age 14 (OR 0.59, p=0.003; OR 0.69, p=0.009) and to have learned about sex from their mothers (OR 0.64, p=0.014; OR 0.76, p=0.045). Last-born women were less likely to report a parental main source of sex education (OR 0.64, p=0.003). Being a last-born male was associated with decreased odds of having had 5+ lifetime heterosexual partners (OR 0.75) and reporting ever had heterosexual anal sex (OR 0.77).

Discussion

These results provide the basis for further research on the association between birth order and learning about sex, and highlight later-born males in particular as being less likely to report parental involvement in sex education. Qualitative research is recommended in order to gain a broader understanding of the ways in which birth order effects manifest in learning about sex.
P007 Effective clinical designs of multiplex point-of-care-tests for genital discharge syndrome management in women: which pathogen combinations and testing protocols deliver the best outcomes?
Authors: Kolodziejczyk Anna , Broad Claire , Harrison Mark , Fuller Sebastian , Okala Sandra , Harding-Esch Emma , Sadiq STariq
Published: May 2024

Introduction

Syndromic management of sexually transmitted infections (STIs) is common practice in sexual health clinics (SHC). Implementation of multi-pathogen point-of-care-tests (POCTs) can improve patient management by providing same day diagnoses and treatment. We assessed the potential impact of five POCT protocols consisting of tests for different combinations ofChlamydia trachomatis(CT),Neisseria gonorrhoeae(NG),Mycoplasma genitalium(MG) andTrichomonas vaginalis(TV) infections, on a standard care pathway (SCP), for 81 symptomatic female patients.

Methods

5 virtual POCT protocols (assuming 100% sensitivity and specificity) were analysed against diagnoses and laboratory results. Reflex tests (i.e. tests used dependent on the result of another test) were incorporated into protocols to investigate utility of testing for certain pathogens separately. McNemar’s test was used to compare proportions of correct diagnoses from each protocol against each other and establish which is most effective. P values were adjusted using Holm-Bonferroni correction.

Results

Protocol P1 was statistically the most effective at providing the correct diagnosis (p=0.000). P5 was also statistically more effective than the SCP (p=0.001). No significant differences were found between other protocols. Although P4 and P5 diagnosed equal proportions of patients, P5 had better performance (p=0.001) compared with P4 (p=0.0012).

Abstract P007 Table 1

Point of care test results

Testing protocolsCorrect diagnoses (%)95% Confidence Interval (%)SCP75.3164.92 to 83.41P1: CT/NG/MG/TV100.0096.96 to 98.30P2: CT/NG + MG reflex92.5986.89 to 98.30P3: NG/MG88.8982.04 to 95.73P4: CT/MG + NG reflex95.0690.34 to 99.78P5: NG/MG + CT/TV reflex95.0690.34 to 99.78

Discussion

P1 was more effective than the SCP and all other protocols, however, may not be technically feasible. P5 was not statistically different from P1 and may be a valid alternative. Due to high rates of MG and CT infection in this cohort, a protocol including tests for both pathogens would be desirable for this population.
P012 Highlighting clinical need in diagnosing mycoplasma genitalium infection: use of a modified delphi approach to obtain a uk perspective
Authors: Ross Jonathan , Fifer Helen , Muir Peter , Gwynn Simon , Horner Patrick , Ison Catherine , Nicholls Jane , Radcliffe Keith , Taylor-Robinson David , White John
Published: May 2024

Introduction

DespiteMycoplasma genitalium(MG) being increasingly recognised as a genital pathogen in men and women, commercial testing has only recently become available. The opinion of sexual health clinicians and allied professionals was sought on how MG testing should be used.

Methods

32 consensus statements were developed by an expert group and circulated to clinicians and laboratory staff who were asked to evaluate their level of agreement with each statement; 75% agreement was set as the threshold for defining consensus for each statement. A modified Delphi approach was used and high levels of agreement obviated the need to test the original statement set further.

Results

60 respondents returned questionnaires, most (48) being sexual health consultants. More than 10% of UK GUM consultants therefore responded. 27 (84.4%) of the statements exceeded the 75% threshold for consensus. Respondents strongly supported MG testing of patients with urethritis or PID, or unexplained persistent vaginal discharge, or post-coital bleeding. Fewer favoured testing patients with proctitis and support was divided for routinely testing chlamydia-positive patients. Testing sexual contacts of MG-positive patients was supported, as was a test of cure for MG-positive patients by most respondents, although agreement fell below the 75% threshold. Respondents agreed that all level 3 services should have access to testing for MG (98.3%).

Discussion

There was strong agreement for having MG-testing available for specific patient groups, which may reflect concern over antibiotic resistance and the desire to comply with clinical guidelines that recommend MG testing in sexual health clinic settings.
O07 National response to an outbreak of hepatitis a associated with men who have sex with men in england, 2016/2017
Authors: Edelstein Michael , Beebeejaun Kazim , Ngui Siew Lin , Woodhall Sarah , Simms Ian , Crook Paul , Hughes Gwenda , Mandal Sema , Balogun Koye
Published: May 2024

Introduction

Hepatitis A virus (HAV) is a vaccine-preventable infection, mainly travel-associated in the UK. Since July 2016 Public Health England has detected an increase in hepatitis A laboratory notifications in men who have sex with men (MSM). We described the outbreak characteristics to inform implementation of nation-wide control measures.

Methods

A confirmed case was defined as a HAV infection with one of three outbreak strains and symptom onset after 31//6/16. Demographics, travel history and sexual behaviours were collected using a questionnaire.

Results

By February 2017, 73 confirmed cases were detected across England. Of these 58 identified as MSM (median age 36 years) and 28 reported travel within the incubation period, primarily to Spain. 25% reported >1 casual partner in the previous 8 weeks. In addition to supporting the local public health response, PHE collaborated with national STI, HIV and liver associations to refine immunisation recommendations for at-risk MSM and alert front-line clinicians, and worked with the NHS and sexual health charities to raise awareness and promote personal hygiene and immunisation among MSM via social media, posters and leaflets.

Discussion

The outbreak is likely associated with other MSM outbreaks with the same strains in other UK and European countries. The investigation suggests initial multiple importations from abroad followed by secondary sexual transmission within the MSM population in England. This outbreak highlights the need for MSM and healthcare professionals to consider the potential of HAV as a sexually transmitted infection, and the need to consider immunisation of MSMs where recommended.
P025 Accurate cultures for gonorrhoea. how do community services and secondary care compare?
Authors: Board Thomas , Mitchell Sue , Russell Judy
Published: May 2024

Introduction

BASHH guidelines emphasise the importance of accurate cultures in the diagnosis and management of gonorrhoea. This audit’s aim was to establish if there was a measurable difference in the positive culture yield between community and secondary care services in the months following a change in contract which has moved a proportion of walk in patients from secondary care to the community setting.

Methods

Relevant databases were searched for gonorrhoea patients after 1stOctober 2017 when the service was changed. A retrospective audit of the notes was then carried out to establish the rates of positive NAATS tests and positive culture yield and compared the two services.

Results

In secondary care 25 patients (20 men & 5 women) were treated for gonorrhoea over two months. In these patients 22 had a positive NAATs test, of these 17 had a positive culture giving a positive culture yield of 77.2%.

In comparison the community service identified 10 patients in the first month of the new contract with a positive NAATs test, of these 9 had a culture. 1 culture was positive giving a NAATs/culture concordance rate of 11.1%; this is to be re-audited by the community service.

Discussion

Accurate cultures are vital for the treatment of gonorrhoea, particularly in areas where antibiotic resistance is high. Appropriate storage and prompt processing is important to ensure the viability of these tests. This audit raises a question about viability ofNeisseria gonorrhoeaeduring transfer from community settings to the central hospital laboratory.