bluuebunny/crossref_metadata_2025 huggingface dataset:
P157 Re-audit reflections: management of sexual assault attendances to GUM
Authors: Ackah F , Barrett A , Woodroffe T , Soni S
Published: May 2012

Introduction

In 2008 we showed that our management and documentation of sexual assault (SA) improved significantly with the introduction of a specific proforma and health advisor led care.

Aim

To describe SA attendances to our clinic, audit notes against new BASHH guidelines and compare with audit 2008 results.

Methods

Retrospective case note review of all SA attendances in 2010. BASHH standards (2011) were used. Exclusion criteria: prior attendance at another GUM clinic post-SA, SA >1-year prior to attendance. Results were compared with previous audit and p values obtained using χ2and Fisher's exact tests.

Results

Of 84 attendances, 87% were female, 92% white, 88% heterosexual, median age was 23 years. 57% were self referrals. 42% had partial or no recollection of the SA. Abstract P157 Table 1 showing comparison of standards between audit 2008 ad 2010 Documentation of standards new since BASHH 2011 guidelines was poor: self harm risk assessment 3.4%, physical injuries 17% and bleeding 0%.

Abstract P157 Table 1Audit 2008Audit 2010p Valuen=127 (%)n=84 (%)Proforma use79 (62)69 (82)0.002Assailant details asked123 (97)84 (100)0.159Anal/oral penetration asked86 (68)77 (92)0.001Condom use documented112 (88)84 (100)0.001Documented victim alcohol/drug use89 (70)65 (77)0.242Prophylactic antibiotics offered62 (49)44 (52)0.612Emergency contraception offered127 (100)82 (98)0.157

Discussion

Proforma use has continued to improve since 2008 and consequently documentation overall is better. Despite this we achieved less than the recommended 100% in some standards. Although adherence to newer BASHH standards was poor, revision of our current proforma to include these should lead to measurable improvement. SA victims were young and worryingly almost half had little or no recollection of the event. Several reported alcohol/drug use prior to assault but also expressed concern around drink spiking. GUM clinics should work closely with other organisations to raise awareness of alcohol misuse and vulnerability to assault.
P160 Complex GUM: an audit of a consultant led service
Authors: Mabonga E , Williams D , Collins E
Published: May 2012

Background

A minority of patients present to GU services with complex, recurrent or chronic issues requiring senior review which is challenging in a busy walk-in service. A specialist clinic was set up to facilitate appropriate diagnosis and management.

Objectives

To describe referral patterns, diagnoses and outcomes.

Methodology

Retrospective case note review of booked patients between 2 September 2010 and 9 December 2010. Demographics, referrer, reason for referral, management and outcomes collected.

Results

102 appointments were made for 84 patients 65 attended, 82 reviewed. 55% were female. Average age 36. 94% referred from within the service, all staff groups represented including SpRs, nurses and clinical assistants. 20 patients had biopsies with 17/20, 85% providing a diagnosis. Of the 102 appointments 13% DNA; 11% cancelled by patient. Patients with vulval pain will be studied in more detail, data to follow (see abstract P160 table 1).

Abstract P160 Table 1

Diagnoses of patients with complex GU problems

PresentationDiagnosisWomen (n=36)Vulval pain-12Vulvodynia-5, dermatitis-2, lichen sclerosis-1, atrophic vulvitis-1, BV-1, psychological-1, endometriosis-1Recurrent thrush-11Recurrent thrush-9, C.glabrata-1, lichen planus-1Recurrent HSV-5Recurrent HSV-4, apthous ulceration-Vulval itching-4Lichen simplex-1, eczema-1, NAD-2Lichen planus-1Lichen sclerosis-1Genital ulceration-1Recurrent HSV-1Recurrent BV-1Recurrent BV-1Vaginal discharge-1Referred for TVUSS-1Men (n=29)Genital dermatoses-19Zoons balanitis-8, lichenoid reaction-2, infective balanitis-2, eczema-2, seborrheic dermatitis-1, lichen planus-1, lichen sclerosisPersistent HPV-3Persistent HPV-3Recurrent NSU-2Chronic prostatitis-1; recurrent NSU-1AIN-1Sebaceous cyst-1Folliculitis-1Recurrent HSV-1Recurrent HSV-1Recurrent HSV-1Haematoma-1Resolved-1

Conclusion

The clinic was utilised by all staff groups, saw patients with a variety of conditions, predominantly dermatological and in the majority a definitive diagnosis was made. As well as improving patient management the clinic provided an excellent training opportunity and has resulted in improved links particularly with Dermatology and Histopathology.
P162 STD prevention online: a resource for the STD/STI professional community
Authors: Rietmeijer C
Published: May 2012

Background

STDPreventionOnline.org (STDPO) is an online professional networking site for the sexually transmitted diseases/infections (STD/STI) work force, including researchers, clinicians, epidemiologists, disease intervention specialists, and programme managers. The site was developed by the internet and STD Center of Excellence, originally funded by a grant from the US Centers for Disease Control and Prevention (CDC) and currently sponsored by the American Sexually Transmitted Disease Association (ASTDA). The site was conceived as two-way clearing house of current STD/STI information and resources, where members could both download and upload information in a variety of formats including text, audio, and video files as well as blog and forum postings. Membership is free.

Objective

To describe current users and usage of STPDPO.

Methods

Descriptive statistics were obtained from embedded website metrics and Google Analytics©.

Results

Since its inception in 2007, the site has registered 3500 members and the site's monthly newsletter has over 4000 subscribers. The predominance of site members (92%) live/work in the US, however a substantial number (n=258 as of January 2012) are non-US users with 47 countries represented. Most members (58%) work in STD/HIV programmes in state/local health departments, 13% in community or private clinics, 11% in a university setting, 8% in federal government, and 8% in community organisations. During 2011, the site logged 14 778 individual site visits and 61 205 page views; respectively 284 and 1177 per week. To date, over 1150 resources have been uploaded to the site which, have been downloaded over 40 000 times, an average of 35 downloads per resource. Topics related to internet use and online interventions are particularly popular, followed by clinical slide sets, and podcasts.

Conclusion

During the 4 years of its existence, STDPO has demonstrated to meet a need in the STD/STI professional community for an interactive, two-way, clearing house of STD/STI-related information.
P173 Case report: rare cause of adult onset seizures identified in an HIV positive adult
Authors: Pease E , Dawson S , Quaghebeur G , Ashby J
Published: May 2012

Case Report

A 63-year-old male with a long history of poor social interactions presented acutely confused. There was no alcohol or recreational drug use. Baseline bloods and routine microbiology were normal. CT and MRI of the brain found no causative pathology. Lumbar puncture (LP) only revealed a raised protein (1.47). An HIV test was positive; CD4 170 cells/μl, viral load (VL) 238 281 copies/ml. The patient refused antiretroviral (ARV) treatment, depressive episode was diagnosed and mirtazapine commenced. Three days later he went into status epilepticus. A repeat MRI brain was unchanged and LP showed: protein 0.84; glucose 4; WBC 5/cmm; India ink, CRAG, virology, acid fast bacilli and cytology were negative. Seizures were unremitting and nevirapine and truvada were commenced and mirtazapine withdrawn: seizure activity ceased. Gradually he improved and his CD4 rose to 280 cells/μl, HIV VL <50. Despite treatment, the patient re-presented with seizures on several occasions. No trigger was identified, and reported ARV adherence good. Repeat investigations revealed no new abnormality. In the absence of an adequate explanation for seizures, neuro-imaging was reviewed by a specialist neuroradiologist. Nodules within the frontal horns of the lateral ventricles were identified, indicating a diagnosis of subependymal nodular heterotopia (SNH).

Discussion

This is the first report of SNH in an HIV positive adult. SNH are congenital, occurring during foetal neuronal proliferation and have no known association with HIV. Patients usually present in their 2nd decade with seizures and exhibit cognitive difficulties. SNH presenting in the 7th decade of life with status epilepticus is rare and we postulate that the cerebral atrophy associated with untreated HIV infection may have precipitated seizures in a predisposed individual. This case described demonstrates the importance including non-HIV related causes, when considering the aetiology of seizures in patients with HIV.
P18 Post exposure prophylaxis following possible exposure to HIV infection: an evaluation of 391 attendances at three central London sexual health clinics
Authors: Janmohamed K , Bull L , Payne D , Cooper F , Lake C , Nwokolo N , Natha M
Published: May 2012

Background

Providing post exposure prophylaxis (PEP) following possible HIV exposure is a common GU presentation. However, few studies have evaluated this practice.

Aim(s)/Objective(s)

To answer the following on PEP presentations: age, sex, nature of exposure to HIV, time to presentation for PEP, side effects, completion rates, presence of sexually transmitted infections (STIs), appropriateness of PEP dispensing and comparisons of findings with other published studies.

Methods

GUM clinic attendances were evaluated from April 2009 to March 2010.

Results

There were 391 PEP attendances: 373 males (96% MSM), 18 females. Age range 19–57 (mean 35.4) years. Presentation followed anal sex in 89%, vaginal sex in 5%. The remainder attended following oral sex, splash incidents, injecting drug use, or other exposure. Forty six percent attended within 24 h, in one instance PEP was dispensed beyond 72 h. The majority completed PEP (82%). GI side effects were experienced by 60%. Baseline screening for hepatitis B showed active infection in 1% and immunity in 74%. A baseline HIV test was conducted in all but one patient. An STI screen was conducted at or around day 14 in 69% of patients, with 12% testing positive for an STI in line with previously published data. Follow-up rate at 3–6 months was 52%: Of 203 patients tested for HIV at follow-up, 2 (1%) tested positive.

Conclusions

PEP was dispensed appropriately in the majority of cases. The fact that 82% of individuals completed treatment despite side effects is likely to be due to the use of more tolerable regimens than were used historically. The presence of an STI in 12% of people tested highlights the importance of screening in individuals presenting for PEP. The fact that only 52% of patients attended for a follow-up HIV test at 3–6 months is of concern and warrants further exploration.
P180 Vulval pathology in HIV positive women attending a tertiary vulval dermatology clinic over a 5-year period
Authors: Dosekun O , Farrugia P , Lewis F , Sethi G
Published: May 2012

Background

Studies have suggested that HIV infected women are at increased risk of developing invasive vulval carcinoma and recurrent herpes simplex type 2 (HSV-2) reactivation.

Objective

To describe the spectrum of HIV associated vulval disease in women attending a tertiary dermatology referral centre in a busy urban setting.

Methods

A retrospective case note review of all HIV positive women seen in the vulval dermatology clinic from January 2007 to January 2012.

Results

11 women were identified (see abstract P180 table 1). 9 (81%) were black Africans. The mean age at vulval disease diagnosis was 37 years. Most (81%) were already known to be HIV infected and on combined antiretroviral therapy (cART). There were six cases of undifferentiated vulval intra-epithelial neoplasia (uVIN) (43%) with two cases being diagnosed prior to an HIV diagnosis. The three cases of HSV-2 occurred in women with near-complete immune restoration on cART. Six women remain under regular dermatology follow-up, a median of 20 months since diagnosis.

Abstract P180 Table 1

HIV positive women seen in vulval dermatology clinic 2007 to 2012

CaseVulval diagnosisOn cART*CD4 (cells/μl)*VL (copies/ml)*1Multifocal uVINNANANA2Multifocal uVINYes7612353Multifocal uVINYes47997HSV-2Yes351204Lichen simplex chronicusYes502366CondylomaYes975205uVINNANANAVulval lichen simplexNANANA6SCC in situ outer aspect labium majusYes268407uVINYes318718Chronic hypertrophic HSV-2Yes590409Multifocal uVIN of Bowenoid typeYes8268810Recurrent HSV-2Yes7846311EczemaYes6230 441*

At time of vulval diagnosis.

Conclusion

There were no cases of invasive vulval carcinoma. HSV-2 may cause atypical disease even in the context of near-complete immune reconstitution on cART. Most women with vulval disease were already under HIV care, on cART and had a CD4 cell count above 200 cells/μl.
P188 Do genitourinary medicine physicians need to know about tropical diseases?
Authors: Loftus H , Powles E
Published: May 2012

Background

Many individuals presenting to genitourinary medicine (GUM) clinics have travelled or may have been born outside the UK. A number of tropical infections can present with genitourinary symptoms.

Aims

To investigate how many cases of schistosomiasis were diagnosed in a GUM clinic over a 3-year period, whether they were treated according to the European Association of Urology guidelines for the management of urogenital schistosomiasis and whether treatment led to symptomatic improvement.

Methods

All the schistosoma serology requests from our clinic in 2009–2011 were obtained and identified as positive, negative or equivocal results. The results were separated into those from our HIV clinic and those from GUM. The notes for all the positive and equivocal results were reviewed.

Results

182 tests were performed on 168 different individuals. 151 tests (83.0%) were carried out in HIV clinic, 31 tests (17.0%) in GUM. 4 (2.6%) of the tests carried out in HIV clinic were positive. 4 (12.9%) of tests carried out in GUM were positive. All positive results were non-British born males ranging in age from 28 to 42. All individuals with positive results had symptoms or signs that could have been attributed to urogenital schistosomiasis. Five of the 8 individuals had urine and stool sent to look for schistosome eggs, two had just urine analysed and 1 had neither. 6 individuals were referred to Infectious Diseases, two were managed in GUM. Seven of the 8 individuals were treated with praziquantel according to the guidelines. One individual declined treatment. Of those individuals treated, two had full resolution of signs and symptoms, three had partial resolution, one was followed-up in another department and one had no resolution of symptoms.

Discussion

Genitourinary medicine physicians should consider a diagnosis of schistosomiasis in at-risk individuals when standard tests have not provided a diagnosis and resolution of symptoms.
P189 A national mentoring scheme within genitourinary medicine (GUM): is it working?
Authors: Cohen C E , Fox E , Fernando I , Dhar J , Singh G , Mullan H , Street E , Rooney G
Published: May 2012

Background

Collaboration between BASHH and the Royal College of Physicians saw the development of a National mentoring scheme for newly qualified consultants in GUM. Mentors were recruited from senior GUM clinicians, and invited on a tailored mentoring course. On appointment, new consultants are offered and allocated a mentor for 18 months.

Objectives

To determine the effectiveness of the mentoring scheme thus far.

Methods

Voluntary interim questionnaires were distributed via Survey Monkey to mentor/mentee pairs who had joined the scheme for >3 months in January 2011. Responses were anonymous and quantitative data are presented.

Results

18 mentees and 17 mentors responded. The mean time from mentor allocation was 9.1 months (ranging 3–17). 80% of mentees found it easy to arrange their first meeting with their mentor, 72% had met their mentor between 1 and 4 times in person. Almost three-fourth (71%) felt they had received ample contact with their mentor, and in those who hadn't, time constraints and multiple competing service demands were repeatedly cited as barriers. Encouragingly, 69% of mentees felt the programme had helped them, with a further 25% responding, “not yet” as it was “too early in their mentorship”. 93% of mentors responded they felt confident to support their mentee, and 79% perceived the relationship with their mentee was going well. Mentee feedback particularly favoured greater structure, including alerts to encourage meeting prioritisation and further guidance on what could be covered within mentorship.

Discussion

The mentoring scheme, which now hosts 67 BASHH mentors and 41 mentees, is providing significant support to new GUM consultants. By developing a mentoring module with clear guidance for final year registrars, and opening the scheme to them prior to commencement of their substantive posts, we anticipate that these changes will bring further benefits to those in the mentoring programme.
P19 What's up? Erectile dysfunction (ED) in HIV positive men
Authors: Williams A , Dharmaratne S , Goh B T
Published: May 2012

Background

Antiretroviral therapy in HIV positive patients has resulted in improvements in survival, quality of life and fulfilling sexual relationships. Treatment using phosphodiesterase type 5 inhibitors (PDE5i) for ED has simplified management. However nitrates, including “poppers”, and protease inhibitors (PIs) can interact with PDE5i leading to hypotension and high levels of PDE5i. Ethical issues are a consideration as treatments can lead to HIV transmission if safer sex is not practised. We reviewed our HIV positive men with ED and their outcomes after treatment.

Methods

94 HIV positive patients attending our ED clinics from 2006 to 2012 were identified. Data were collected by review of notes and databases. Patients on PIs were started on half of the lowest dose tablet of PDE5i and titrated upwards if no response. Safer sex was advised.

Results

Of 94 patients, 58 were Caucasian, 34 black; 58 were men who have sex with men, 35 heterosexual; 65 had a stable partner, 41 (47.8%) had >30 lifetime partners, 25 (26.5%) were >50 years; 36 (38.2%) used recreational drugs. Two were on therapeutic nitrates. Mean CD4 on presentation was 481 (range 35–1558); 60 (63.8%) had an undetectable VL at baseline. 30 (32%) had ED symptoms for >5 years. Risk factors: smokers 35 (37.2%); peripheral neuropathy 8; diabetic 2; abnormal cholesterol 44 (47%); abnormal hormone profiles 4. Sildenafil was the first agent in 55 (59%) patients and tadalafil in 28 (30%). 18 were on “poppers” and were told to stop before starting PDE5i. Improvement was noted in 51 (54%) after the first agent and 68 (72%) after the final agent. 36 (38%) had PDE5i side effects. 39 (41%) was on PI based Antiretroviral therapy. None reported priapism.

Conclusion

It is safe to treat patients on PI with PDE5i by starting with half of the lowest dose tablet. Treatment of ED improves the quality of life in HIV positive patients but care must be taken to avoid serious drug interaction and safer sex practices should be emphasised.
P190 Barebacking: opinions of HIV negative men who have sex with men
Authors: Grundy-Bowers M , Black A
Published: May 2012

Background

Men who have sex with men (MSM) remain disproportionately affected by HIV and sexual infections. 2010 saw the highest number of new UK HIV diagnoses, acquired predominately through condomless anal sex (CAS) with an estimated 67% acquired in relationships. To reduce risk taking behaviour, a deeper understanding of what influences MSM not to use condoms is required.

Aim

To explore the opinions and rationales for CAS in HIV negative MSM.

Methods

MSM were targeted, via gay press and leafleting, to complete an online questionnaire exploring issues around CAS. Data were collected from November 2010 to October 2011 following ethical approval. Responses from HIV negative MSM were reviewed and themed to quantify opinions and motivations for CAS in this cohort.

Results

Data are drawn from a larger study. A total of 158 males met the criteria; 73.4% (n=116) did not identify themselves as a barebacker, the remainder did. There was a mean age of 35.4 (range 18–72), with the majority being White British (48.7%, n=77). All participants had engaged in unprotected anal sex. Barebacking was identified as contextual (eg, only in relationship) by 36 or behavioural (eg, I bareback) by 28 respondents. Relationships (79, 50%), trust (44, 27.8%) and infection screening (42, 26.6%) featured most frequently as personal reasons for engaging in CAS. Alcohol (63, 39.9%), physical sensation (58, 36.7%) and the thrill of the risk (53, 33.5%) were the most common opinions on why others had unprotected sex.

Conclusions

CAS remains a complex issue and the definition of “barebacker” varies. Perceptions why others engaged in CAS have more negative connotations, however individual rationales for engaging in CAS predominantly focussed around love and relationships. Given the significant number of MSM that acquire HIV in relationships there is a clear need to maintain safer sex messages that are contextualised for those in relationships to observe the principles of negotiated safety.
P191 Demonstrating performance of a low-cost ultra-rapid PCR assay forTrichomonas vaginaliswith point-of-care applications
Authors: Pearce D M , Styles D N
Published: May 2012

Objectives

We have developed a novel Point-of-Care (PoC) system, Velox, comprising an assay-specific cartridge and instrument with a turnaround time of 25 min. The system has been developed forChlamydia trachomatisandChlamydia/Gonorrhoea. We have now developed aTrichomonas vaginalis(TV) test suitable for integration onto the cartridge. The assay utilises a novel electrochemical detection method to demonstrate low copy number amplification and detection of TV in <25 min.

Methods

The method employs prototype PCR cartridges in conjunction with an ultra-rapid thermocycler. All reagents necessary to perform the extraction, amplification and detection are deposited into the cards and air dried at the point of manufacture. A sample is added to the card and DNA extracted from the sample. The resulting eluate reconstitutes dried PCR reagents and PCR is performed using rapid thermocycling. Amplified target is detected using electrochemically-labelled TV target-specific probes and a double-stranded DNA-specific exonuclease to release the electrochemical label. Released label is read by applying a voltage to a screen printed carbon electrode and at a known oxidation potential the label is oxidised producing a measurable current.

Results

Analytical sensitivity of the TV assay was evaluated by testing dilutions of the organism in the presence of Internal Control (IC) DNA. The results show a TV limit of detection of 50 copies when co-extracted, amplified in duplex and detected electrochemically with the IC DNA. Tests on the reagents dried into the device showed stability for 18 months when stored at ambient temperature (20–25°C).

Conclusions

The results show that in conjunction with the instrument, the TV assay could be used to perform ultra-rapid PCR with no user intervention after sample addition. This allows minimally-trained staff to carry out the assay in <25 min, meeting the needs of a PoC device.
P23 ‘This is a policy not a pilot’: how to implement routine opt-out HIV testing for acute medical admissions in an NHS trust in a high prevalence area
Authors: Barbour A , Elgalib A , Draper S , Phillips D R
Published: May 2012

Background and Aims

Feasibility and acceptability of HIV testing in acute medical settings has been demonstrated in pilot studies. Whereas we report our success of embedding HIV testing in routine clinical care, delivered and sustained by medical staff in an NHS trust.

Methods

From July 2011 all patients aged 16–79 years, attending the Acute Medical Unit (AMU), have had a standard HIV test unless they decline. Laboratory costs are funded by the local NHS. Literature was produced for staff and patients. Verbal consent and test ordering is carried out by general medical doctors and AMU nurses, all had training by the local HIV team. AMU proformas were updated with sections for HIV test offer and reason for refusal. The HIV team made regular AMU visits to motivate, troubleshoot and feedback progress. From the outset, nurses were more proactive than doctors in applying the policy. Building on their enthusiasm, nurses were empowered so that by October 2011 AMU visits were weaned as nurses took the lead to enforce the policy.

Results

3709 attendees in the first 6 months, median age 57 years, 50% female, 54.7% Caucasian, 6% Black African. 1390 (37.5%) had samples for HIV testing; their demographic profile is comparable to that for all attendees. HIV test rate went from 33.2% July–September to 41.3% October–December (p<0.005 χ2). For a random sample (n=396), HIV test uptake was 84%. Detailed analysis on offer rate and factors associated with uptake will be presented at the conference. Seven new HIV diagnoses were made, all but one had CD4 >200.

Conclusion

A routine opt-out HIV testing policy can be delivered by frontline medical staff in an acute setting with no extra resource requirement beyond laboratory costs. Such a policy identifies new HIV patients who would not otherwise have tested and reduces late diagnosis. We believe that policy ownership by nurse champions, with the HIV team as background advisors, is key to achieving and sustaining high test rates.
P28 A Re-audit of partner notification in HIV positive individuals in Plymouth
Authors: Wimpenny T , Warwick Z
Published: May 2012

Aims

Following an audit in 2010 we wanted to establish whether changes in our approach to PN in newly diagnosed HIV patients or patients seen for the first time had improved our HIV PN outcomes and documentation.

Methods

A retrospective case note review was carried out in patients attending the clinic for the first time in 2011. We looked at whether patients had a partner history completed for the look back period, how many partners were contactable and whether the outcome of the PN was recorded. These results were compared with a similar audit carried out in 2010.

Results

31 patients were included in the re-audit, 12 transfers into Plymouth GUM and 19 newly diagnosed HIV positive patients. 77% were male and 23% were MSM. 100% of patients had a contact tracing proforma in their notes and 97% (30/31) had been completed. 36 (40%) partners were untraceable. Of those which were contactable13 were current partners and HIV+; 16 ex-partners who were HIV+; 15 ex-partners verified as HIV−; 7 current partners tested HIV−; two partners remain untested. There were 13 patients who transferred into the department in 2010, three of whom had PN performed since joining our clinic. There were 13 new diagnoses, 10 of whom had documented CT.

Conclusion

PN can be significantly improved using audit in this way. A dedicated Health Advising team is essential where targeted testing for HIV is likely to be the most efficient way of detecting undiagnosed HIV.
P30 An analysis of patient characteristics associated with gonococcal resistance to past therapeutic agents in England and Wales
Authors: Town K , Lowndes C M , Chisholm S , Kall M , Webster E , Nichols T , Anderson J , Obi C , Willey B , Ison C
Published: May 2012

Background

Antimicrobial resistance inNeisseria gonorrhoeaerestricts effective treatment options. Recent UK treatment guidelines recommend ceftriaxone as first line treatment. If ceftriaxone becomes unsuitable for treating gonorrhoea there are no suitable available alternatives. The potential for using past therapeutic agents for gonorrhoea treatment should be assessed.

Aim(s)/Objective(s)

Identify risk factors associated with antimicrobial resistance to penicillin, tetracycline and ciprofloxacin.

Methods

Data from the Gonococcal Resistance to Antimicrobials Surveillance Programme were analysed for trends in antimicrobial resistance across sub-groups of the Gonococcal Resistance to Antimicrobials Surveillance Programme population. Using 2010 data patient variables associated with penicillin, tetracycline and ciprofloxacin resistance were identified using univariate and multivariable analyses of ORS.

Results

Rates of penicillin, tetracycline and ciprofloxacin resistance have increased across all regions in England and Wales in recent years, with very high levels found in white MSM. Lower rates of resistance, with <15% prevalence, indicating a susceptible population, are found in women (penicillin 6.4%, ciprofloxacin 12.8%), black ethnicity (penicillin 6.1%, ciprofloxacin 13.4%), and in some cases heterosexual men (penicillin 13.2%) and those aged under 24 (penicillin 12.6%). Univariate and multivariable analysis identified patient variables, including sexual orientation, ethnicity and age as strongly associated with penicillin, tetracycline and ciprofloxacin resistance.

Conclusions

By using sub-group population prevalence data on resistance, as well as information about patient variables strongly associated with resistance, it may be possible in some cases to adapt treatment regimens to make use of previously recommended antimicrobials and preserve the use of ceftriaxone for high-risk groups.
P31 How important is it to know where index patients meet their sexual partners in order to control the transmission of sexually transmitted infections?
Authors: Ford R , Clarke M , Lloyd I , Speare N , Maleham K , Robertshaw R , Morgan C
Published: May 2012

Background

Learning where people have met their sexual partners has previously been acknowledged as a way of identifying key locations that are functional to sexually transmitted infection transmission.

Aims

To gather local data on where patients diagnosed with chlamydia, gonorrhoea, syphilis, HIV, trichomonas and hepatitis B have met their partners. This is the first stage of an on-going project which aims to develop a more targeted health promotion intervention(s) for key locations in Bristol identified as being important for STI transmission. The ultimate aim is that this intervention(s) will contribute to a reduction in STI transmission rates and therefore STI prevalence(s) in Bristol.

Method

Patients were asked where they met their sexual partners during all health adviser partner notification interviews conducted in 2011. 2052 interviews were conducted and data were collected from 1257 patients.

Results

Across all patients, the most regularly cited meeting place was in a bar or club (29%) This was followed by “through friends/ old friends” (28%). 12% met their sexual contacts via the internet. The most common mode of meeting contacts in heterosexual patients was via friends (31%) while for gay men it was via the internet (36%).

Discussion

The data provides the names of key locations in Bristol and a number of internet sites that are important for transmission. These locations can now be targeted by health promotion and outreach work in order to contribute to a reduction in STI transmission and prevalence. Over a quarter of all sexual contacts were met via friends or they were a friend of the patient. It is likely that the perception of STI risk diminishes if a contact is known or if they share the same social network. As well as targeting locations and internet sites, further research is now needed to explore patient's perception of STI risk, alongside health promotion work that highlights potential misperceptions.
P38 Quantifying the public health value of provider-led partner notification using an evidence-based algorithm with routinely-collected data
Authors: Mercer C , Bell G , Low N , Estcourt C S , Brook G , Cassell J A
Published: May 2012

Objectives

To assess (i) the public health benefit of provider-led partner notification (PN) and (ii) the importance of taking into account the number and types of partners when assessing the cost-benefit of provider-led PN.

Method

We used data on 346 partners reported by 220 chlamydia index patients (n=127 men) seen by a PN professional at one GUM clinic, April–June 2011. We used a published, evidence-based algorithm to quantify PN impact, including the measure the “Number Needed to Treat to Interrupt Transmission” (NNTIT), defined as the number of partners who need to be treated to interrupt 1 onward (secondary) transmission. A lower NNTIT indicates less PN effort is required to prevent onward transmission.

Results

Men reported 216/346 partners and women 130/346. Men more often described partners as casual (56% vs 28%), while women more often reported regular (40% vs 30%) and ex-partners (23% vs 12%). For traceable partners (73% of men's; 88% of women's), 9/157 men's partners and 16/114 women's partners required provider-led PN. Almost all were casual or ex-partners (8/9 men's; 13/16 women's). NNTITs were lowest for ex-partners: 0.6 and 0.45 for men and women, respectively, followed by casual partners: 0.8 and 0.6, then regular partners: 1.80 and 0.9.

Discussion

Provider-led PN is required more often with casual and ex-partners than with regular partners. This may have greater cost implications for services, but, as casual and ex-partners are likely to have greater numbers of partners themselves, the potential for preventing onward transmission is greater, yielding greater public health benefit. Services should collect data from their index patients on the number and type(s) of partners, as well as the PN method(s) required (patient vs provider referral). Together with cost data, these data were key for demonstrating the cost-benefit of provider-led PN.
P42 An audit ofNeisseria gonorrhoeaedetection methods in a district general hospital genitourinary medicine service
Authors: Phillips M D , Davies A , Hewart R , Acladious N , Morgan E
Published: May 2012

Background

This service is located in a large district general hospital bordering a large UK city. It was noticed over a short period that there were several discrepant results returned for detection ofNeisseria gonorrhoeae(GC) using PCR technologies and traditional culture.

Aim

We performed a 3-month look back at all samples sent for GC detection, in order to define local incidence of GC and discrepant results.

Methods

All samples sent over the preceding 3 months from this service, either as local testing or as part of the national programme, were identified using computer records and then recorded into an excel spreadsheet for comparisons (see abstract P42 table 1).

Abstract P42 Table 1

Comparison of programme and methodology for GC collection

ProgrammeSite of collectionCollection kitMachine for analysisLocalUrethra or endocervixBD ProbetecBD ViperNational (R U Clear)Urethra (urine)Aptima comboGenprobe Tigris

Results

1245 cases were identified during the 3-month period. The total number of cases with at least one positive GC result from culture and PCR was 41 (3.29% of tested). 902 patients (72.5% of those tested) had samples sent for culture. Culture was on vancomycin-colistin-nystatin-trimethoprim enriched agar. 24 (2.7%) were reported positive for GC. There was a total of 1225 PCR based tests collected between the local and national programmes (98.4% of all cases). Abstract P42 Table 1 shows the specific methods of these two programmes. Of the 1225, 39 tests were positive (3%). All cases with a positive result were then further analysed. 27 had concordant results, that is, either the culture and PCR matched, or only one of the two tests was performed. This gave 14 patients with discordant results (1.1% of all tested, 34% of all positive results). 13 cases had a positive PCR but negative culture (93%), and one patient had a positive culture but negative PCR.

Discussion

The overall numbers are too low for accurate statistical analysis, but our incidence of GC is around 3%. PCR detected many more cases than culture would alone, although there was a single case of culture positive and PCR negative. We plan to perform a 1-year analysis to obtain sufficient cases for statistical analysis.
P43 RPR titres following syphilis treatment: does HIV status affect the magnitude or rate of response?
Authors: Drayton R , Johnston C E
Published: May 2012

Aims

Co-infection with HIV has been shown to alter the serological response to, and the course of, infection withTreponema pallidum. We aimed to determine whether the rate or magnitude of response to treatment, as measured by falling Rapid Plasma Reagin (RPR) titres, was different in HIV positive compared to HIV negative patients in the modern era.

Methods

A retrospective case note review was undertaken of patients who were diagnosed with syphilis between 1 January and 31 December 2008. The change in RPR titre at 1, 3, 6 and 12 months post-treatment was determined. Statistical analysis was performed using Microsoft excel; p values were calculated using χ2or Student t test.

Results

During the study period, 57 HIV negative and 23 HIV positive patients were diagnosed with syphilis. Of the patients with a RPR titre greater than neat at diagnosis, 30/40 (75%) HIV negative patients and 12/15 (80%) HIV positive patients showed a two dilution or greater fall in RPR titre 3 months following treatment (p=0.72), with 36/39 (92%) and 16/16 (100%) achieving a two dilution drop by 6 months, respectively (p=0.24). There was no significant difference in the median RPR titre at diagnosis between HIV positive and negative patients at all stages of syphilis infection. 3/16 (19%) HIV positive patients and 3/38 (8%) HIV negative patients, who were not thought to have been reinfected, continued to have a RPR titre of 1:16 or greater at 6 months post treatment (p=0.26). Where data were available, all these patients achieved a RPR titre of less than 1:16 by 12 months post treatment. Two patients, both HIV positive, were re-infected during the study period, one patient being re-infected twice.

Conclusions

Overall, treatment appeared to be effective and the majority of patients showed a two dilution or greater fall in RPR by 6 months post-treatment. There was no significant difference in the rate or magnitude of response in HIV positive compared to HIV negative patients.
P46 Pelvic inflammatory disease diagnosis, treatment and contact tracing in a fully integrated sexual health centre
Authors: Goodall L , Oroz C
Published: May 2012

Background

BASHH guidelines on pelvic inflammatory disease (PID) were updated in 2011. A recent national audit of PID management in UK GUM clinics suggested that adherence to BASHH guidelines in terms of treatment regimen and partner notification was below national standards. Our GUM service has recently integrated with family planning to form a fully integrated sexual health centre. We were interested to see how our PID management compared to national findings.

Aims

To determine whether our management of PID was in line with current UK guidance.

Methods

A prospective audit of all cases of PID seen at our sexual health centre over a 6-month period was performed by asking all clinicians to report suspected cases of PID and by review of our clinic database to identify any further patients treated for PID. The audit determined criteria for PID diagnosis, treatment regimen, follow-up plans and partner notification.

Results

There was some variation in criteria used to make a clinical diagnosis of PID. However, all patients treated for PID complained of lower abdominal pain and most had adnexal tenderness or cervical excitation on examination. Most women were treated with ofloxacin and metronidazole although there was variation in the duration of metronidazole therapy prescribed. All women were offered a follow-up appointment, most of which were 1–2 weeks from initial diagnosis. Partner notification was poor and fell below current UK targets.

Discussion

Unfortunately, despite the benefits of skill sharing of family planning and GUM professionals within a fully integrated sexual health centre our management of PID in terms of drug regimen, follow-up and partner notification did not meet recommended national standards. Workshops on PID have been built into our protected teaching time to explore reasons for non-adherence to current national guidelines and to try and improve our standards of care.
P5 Changing trends in HIV diagnosis in an inner city London teaching hospital between 2007 and 2011
Authors: Wilkin-Crowe H , Lau R , Pakianathan M
Published: May 2012

Background

In 2008, guidelines were published by the British Association for Sexual Health and HIV, British HIV Association and British Infection Society recommending normalisation of HIV testing to reduce stigma and to increase the number of early diagnoses. The guidelines aimed at reducing morbidity, mortality and reducing the risk of onward transmission of HIV. Local initiatives were carried out in South West London to achieve this by extensive general practice education programmes to raise HIV testing awareness in non-sexual health (SH) settings.

Aims

To establish the effect of a number of local initiatives to promote HIV testing in non-SH settings at a large South West London hospital.

Methods

Data on all new diagnoses referred to the HIV outpatient were collected and analysed from electronic patient records, including ethnodemographic data, place of diagnosis and clinical data including baseline CD4 count. Previously diagnosed patients having received HIV care elsewhere transferring into the service were excluded. Fisher's exact t-test was used for statistical analysis.

Results and discussion

There were 394 patients with a new diagnosis of HIV between 2007 and 2011. Diagnosis by primary care and other non-SH settings increased by 184%. There was an increase of 37% in the median CD4 count at diagnosis, taking the median count to 372 cells/mm3in 2011, showing the majority of patients to have been diagnosed at an early stage. The proportion of very late presenters decreased by 24%.

Conclusions

The evidence suggests that local initiatives are successfully implementing National guidelines. More work is needed to increase HIV testing and reduce the number of late diagnoses.
P51 Patient-reported effects of vaginal lactose as a prebiotic for bacterial vaginosis
Authors: Emery S J , Tomlinson M J , Hansen I D
Published: May 2012

Background

Bacterial vaginosis (BV) is a common, frequently recurrent condition typically treated with oral metronidazole. Using lactose as a vaginal prebiotic to support Lactobacilli growth and lactic acid production is a new approach to treating and preventing overgrowth of vaginal pathogens. A vaginal tablet containing lactose 1.2 mg (LadyBalance ApS, Denmark) has been available in Denmark since 2004. For the treatment of BV, it is administered once daily for 1-week; it can subsequently be used on alternate days to prevent recurrence and to maintain the vaginal environment.

Aims

To evaluate the perceived effect of a lactose vaginal tablet (LVT) on vaginal health.

Methods

Women who had used the LVT between 2005 and 2009 were invited to complete a web-based questionnaire.

Results

In the 728 responders who had used the LVT, the most commonly reported reasons for use were vaginal discharge with/without malodour (73%/18%), vaginal itching or irritation (37%), and vaginal dryness (16%). 90% of women with self-reported vaginal discharge with offensive odour reported improvement within 1 week. Improvement of symptoms within 1 week was also reported by 81% of women with vaginal discharge without odour, 83% with vaginal itching and irritation, and 76% with vaginal dryness. These effects were generally maintained in women who continued to use the product over longer periods (up to 1 year). Reported side effects were minor and included clear or powdery discharge.

Discussion

An LVT offers the potential of a natural treatment for BV, vaginal itching, irritation and dryness and for protection against recurrent BV or vaginal candidiasis. Its lack of serious side effects and drug interactions could make it an attractive alternative to standard therapies. The clinical effectiveness and tolerability of the LVT require further investigation.

Conclusions

The LVT was perceived as highly effective in treating a range of vaginal symptoms.
P56 Does ceftriaxone plus azithromycin reduce gonorrhoea retreatment compared to ceftriaxone plus doxycycline? a retrospective comparison
Authors: Schumacher C , Ghanem K
Published: May 2012

Background

Currently, the combination of Ceftriaxone (CTX) and Azithromycin (AZM) is favoured over CTX and Doxycycline (DOXY) for treatment of uncomplicatedNeisseria gonorrhoeaeinfections (GC) in both the UK and the USA.

Aims/Objectives

To retrospectively compare retreatment rates between patients receiving CTX + AZM and those receiving CTX + DOXY.

Methods

We analysed clinic records for all patients treated for GC at either of Baltimore's public STD clinics between January 2004 and June 2011 and measured time to retreatment from the date when the CTX regimen was administered. Patients were censored 2 years after treatment was received or on 30 September 2011, whichever came first. Kaplan–Meier curves and Cox Proportional Hazards models were used to compare retreatment rates.

Results

Overall, 4134 patients were treated for GC with CTX + AZM (n=1185, 31.5%) or CTX + DOXY (2830, 68.5%), 406 (9.8%) of whom were retreated. Treatment regimen was not related to time to retreatment, even when controlling for risk factors associated with re-infection (adjusted HR 0.88, 95% CI 0.70 to 1.14); a sub analysis of patients who were retested for GC within 90 days of CTX treatment also found no difference in retreatment rates across treatment regimens. Other factors that independently increased the risk of retreatment included: being a man who has sex with men, aged <25 years, having a history of GC or chlamydia, and reporting >2 sex partners within the past 6 months at time of CTX treatment. Patients treated after Expedited Partner Therapy (EPT) became available were 30% less likely to be retreated regardless of whether the patient themselves received EPT.

Discussion/Conclusions

Compared to CTX + DOXY, CTX + AZM did not provide enhanced efficacy in this population. EPT is associated with a reduction in retreatment rates in the population even among those who did not receive EPT themselves.
P60 Low sperm counts in asymptomatic and symptomatic non-specific urethritis and other sexual health clinic attendees
Authors: Carne C , Chilcott S , Palmer C R , Green O , Bridge S , Walsh R , Gramy-Mason A , O'Donovan M
Published: May 2012

Background

Little is known about semen parameters among men attending Sexual Health clinics. The significance of asymptomatic non-specific urethritis is controversial.

Aims

(1) To investigate whether there is a higher incidence of abnormalities in the semen of men with urethritis compared to controls. (2) To investigate whether asymptomatic urethritis has similar effects (if any) on semen to symptomatic urethritis.

Objective

To conduct a case-control study of abnormalities in the semen of Sexual Health clinic attendees compared to General Practice controls.

Methods

Rates of semen abnormalities were compared between the different groups (19 with symptomatic and 27 with asymptomatic NSU, seven with symptomatic non-NSU and 64 clinic controls) and between clinic attendees and 417 patients attending general practice for the first investigation of possible infertility.

Results

117 clinic volunteers were included in the study. They were shown to have statistically significantly worse total sperm counts (p=0.002), volume of semen (p<0.001) and percentage of abnormal forms (p<0.04) compared to 417 GP controls. Compared to the rest of the clinic volunteers, asymptomatic NSU patients had statistically significantly lower total sperm counts (p<0.02). Asymptomatic NSU patients had statistically significantly lower total sperm counts compared to symptomatic NSU patients (p<0.02). Compared to GP controls, clinic controls had statistically significantly inferior total sperm counts (p=0.009) and semen volume (p<0.001).

Conclusions

Sexual Health clinic attendees are more likely to have abnormalities of semen than patients attending general practice for a first check for possible infertility. A high rate of abnormal semen findings are found in patients with and without NSU but the highest rate occurred in those with asymptomatic NSU. Is asymptomatic NSU therefore pathogenic and does it require treatment like symptomatic NSU?