bluuebunny/crossref_metadata_2025 huggingface dataset:
P181 Management Of recurrent vulvovaginal candidiasis and recurrent bacterial vaginosis in North East London Network For Sexual Health and HIV (NELNET)
Authors: Navsaria S , Lowe S M , Estcourt C S
Published: May 2012

Background

Recurrent Vulvovaginal Candidiasis (VVC) and Bacterial Vaginosis (BV) are common, associated with significant morbidity, often impact on psychological well-being and can be relatively costly to manage. BASHH guidelines acknowledge that the evidence base for recommendations is poor. We aimed to describe the management regimes of GUM Consultants who routinely manage these conditions within our large network prior to introducing sector-wide guidelines.

Method

We emailed appropriate GUM consultants from the six network centres requesting their standard management regimes for both conditions. We collated the responses and used BASHH Guidelines as a standard for comparison

Results

All 14 consultants responded. Treatment regimes for VVC were broadly similar but only three consultants prescribed according to BASHH Guidelines. 13 consultants prescribed induction regimes. All consultants used oral fluconazole, doses included 50, 100 and 150 mg. Duration of induction regimes ranged from 3 daily doses, alternate day doses, 72 h doses to daily dose for 14 days. Ten consultants prescribed maintenance therapy for 6 months, 4 stopped after 3 months. 11 consultants prescribed 150 mg weekly for at least 3 months. For recurrent BV there was considerable variation and no one followed BASHH guidelines. Regimes included oral metronidazole (2 g, 400 mg), metronidazole gel or clindamycin pessaries. Induction ranged from 5 to 14 days, maintenance from 3 to 6 months. All consultants prescribed menstrual regimes if appropriate. Three consultants also prescribed Balance Activ or equivalent.

Conclusion

Management of recurrent BV and VVC varied greatly across the network. Management of recurrent VVC was more closely associated with BASHH guidelines than management of recurrent BV. Management regimes are often based on clinicians' own experience. New network guidance has now been established providing a local standard for future case record audit.
P185 A pilot programme for the undergraduate teaching of sexual health using interactive demonstration for experiential learning
Authors: Flynn B , Fernando I , Cochrane R , Boyd K , Allan B
Published: May 2012

Background

In Edinburgh in May 2011, the GUM and FP/SRH departments integrated. A priority for the new service was reviewing and improving the undergraduate teaching offered in sexual health.

Aim

To increase and improve undergraduate teaching, using experiential learning to develop the skills and attitudes essential for managing patients with sexual health needs.

Methods

An OSCE format with interactive demonstration was chosen as the method to achieve these aims. Stations focused on effective communication and developing appropriate skills and attitudes. Three OSCE stations, based on common and important sexual health scenarios, were designed for interactive group work using simulated patients. The fourth station facilitated open discussion of sexuality and its implications for the well-being of patients. Four pilot sessions were run. Feedback questionnaires were given to students, facilitators and simulated patients. Strengths, weaknesses, and suggestions for improvement were requested. Participants were asked to score their level of enjoyment (from 1 to 10). Students also scored the course on how useful it was in meeting their educational needs (see abstract P185 table 1).

Abstract P185 Table 1

Participant evaluation of interactive demonstration for experiential learning

Simulated patientFacilitatorStudentNumber of returned forms122575“Enjoyment” mean score (1–10)888“Useful” mean score (Students only)8

Results

Feedback was extremely positive. Students felt the opportunity to practice their communication skills within sexual health consultations in a risk-free environment was the main strength. A request for “more scenarios” was the most commonly cited “weakness” and main suggestion for improvement.

Conclusion

Following this successful pilot, the programme will now be regularly provided to the undergraduate medical students of Edinburgh. A similar model of teaching could be achieved at other departments, and is a successful way of delivering experiential learning in teaching resource limited settings.
P192 What career choices do trainees make after attending the GU medicine taster?
Authors: Patel S , Lau R
Published: May 2012

Background

The GUM taster (running annually in London since 2009) is a 2-day educational programme for junior doctors before they apply for specialist training. It is popular and oversubscribed, receiving excellent feedback. We sought to investigate the career choices made by trainees who had attended previous GUM tasters.

Methods

All trainees who had attended one of three previous GUM tasters were contacted about their career progression. Four questions were asked, covering: (1) current specialty, (2) current year of training, (3) career choices/plan, (4) reasons for choice of specialty.

Results

Trainees were contacted by email and telephone, response rate 86% (90/105). Trainees currently in specialty or GP training (52%, 47/90) are listed below: The remaining trainees (43/90) were in: non-training clinical posts/working abroad (21), still in F2/CT1/CT2 (19), clinical fellowships (2) or had left medicine (1). Of these, 37% (16/43) planned to apply to GUM as their first choice specialty; with 26% (11/43) planning to apply for GP training. 71% (15/21) of trainees planning a career as a GP wanted to continue with GU as a specialist interest. Reasons given for choosing GU medicine included interest, work-life balance, opportunities for research/work abroad, lively colleagues, diverse patients and avoiding general medicine (see abstract P192 table 1).

Abstract P192 Table 1

Delegates choosing GUM as a speciality following taster day

SpecialtyNumber of trainees (% choosing specialty)GUM17 (36)GP10 (21)Microbiology/radiology3 each (6)ID/Public health/Surgery/O&G2 each (4)Dermatology/oncology/geriatrics/rheumatology/ACCS/psychiatry1 each (2)Total47

Discussion

37% (33/90) of those attending our GU Tasters were either already in GU training or considering applying for GU as their first choice specialty. In 2011, the Taster was successfully organised in London and in the Midlands (for the first time). The course has allowed trainees to be better informed about the specialty and has highlighted GU medicine as a popular alternative or additional career option for many.
P194 The use of capture re-capture to assess completeness of reporting of syphilis cases and to guide interventions for improvement
Authors: Waldram A , Gorton R
Published: May 2012

Background

Two North East Syphilis outbreaks underlined the need for complete reporting of cases. Completeness was assessed by comparing GUMCAD with regional Enhanced Syphilis Surveillance. Capture–recapture studies were undertaken at yearly intervals to estimate the true number of cases and put forward recommendations to improve reporting completeness.

Objectives

The objectives were to assess completeness of reporting of Syphilis cases in two surveillance systems, estimate the true number of cases, and provide recommendations for improving Syphilis reporting.

Methods

Completeness of reporting was assessed for the period January 2010–June 2010 using capture–recapture methodology to estimate the true number of cases. Intervention A (clinic visits discussing findings) was performed and the effect measured by repeating the process. Follow-up studies were undertaken covering January 2010 to Jun 2011 to measure the effect and a different intervention B (linelists sent to clinics) was performed.

Results

In the initial audit neither system included more than 73% of the estimated true burden of cases, although the aggregate figures suggested they were similar. After intervention A this increased to 94% in GUMCAD. The second audit showed a decreasing trend of reporting completeness after June 2010 to an average of 84% in January 2010–June 2011. After intervention B this improved to 96%. Causes of incompleteness in GUMCAD included incorrect coding and failure to record cases identified during screening leading to under-matching and overestimation of the total burden.

Discussion

Completeness of reporting before intervention was 84% in GUMCAD suggesting the true number of syphilis cases was 19% higher than reported by official statistics. Completeness increased after intervention A but subsequently declined and a further intervention was required to maintain data quality. Regular feedback of case lists to clinics to check for missing cases can enhance completeness of Syphilis surveillance.
P196 Service evaluation: sexual health promotion a “missed” opportunity for young people?
Authors: Lutterodt C , Wong-Taylor L , White B , Lewis G
Published: May 2012

Background

There is currently no widely accepted guidelines regarding sexual health promotion for paediatric staff. Consequently, valuable opportunities to provide much needed education are unfortunately being “missed”. Young people (YP) in hospital have an ideal opportunity to discuss sexual health in confidence with healthcare workers.

Objectives

The objective of this service evaluation was to assess the role of healthcare professionals and their views on providing sexual health education to adolescents on the wards. Understanding perceived views and identifying barriers and leavers is crucial in exploring some of the reasons behind why potentially ideal situations to provide sexual health information are currently being “missed”.

Methods

Questionnaires were completed by paediatric staff members. The responses were anonymised and data were collected from mid-October 2011 until the end January 2012.

Results

The overall response rate was 81%. The skills paediatric staff felt they possessed were: advising how to protect against pregnancy (91%), STDs (90%), prescribing contraception (61%), screening for psychosocial issues (26%), testing (34%) and treating STDs (40%). Almost 20% did not know about local sexual health centres. Furthermore, GPs were cited as the most appropriate healthcare professional to provide sexual health information.

Conclusion

There appears to be a role for sexual health education within secondary care. We suggest that opportunistic health promotion should be considered by paediatric staff when dealing with YPs. Clearer guidance would minimise the number of “missed” opportunities and additional information sources (eg, leaflets) for patients and staff would enhance the provision of health promotion.
P21 Post-exposure prophylaxis following sexual assault
Authors: Dhairyawan R , Muckart L , Forster G E
Published: May 2012

Background

HIV post-exposure prophylaxis (PEP) is recommended for survivors of sexual assault. Completion rates are often lower than for PEP prescribed in other settings, which may be related to psychological issues faced by survivors immediately after the assault and a lower threshold for prescribing.

Aims

To study outcomes of survivors of sexual assault prescribed PEP (Truvada and Kaletra) at an inner city sexual assault referral centre (SARC).

Methods

Forensic and follow-up notes were interrogated for data on clients prescribed PEP between 1 June 2010 and 31 May 2011.

Results

Data were available on 54 clients; 46 were female. Median age was 25 (range 14–40 years). Ethnicity: White European 35/54, 11/54 Black African/Caribbean and 8/54 Asian. 48/54 initiated PEP at the SARC, 4 in A&E and 2 in sexual health and all within 72 h. Exposure: 37 RVI, 14 RAI, eight unknown. 20/54 had an additional risk: 11 multiple assailants, eight defloration and seven ano-genital trauma. The assailant HIV status was unknown in all cases, but 11 were assessed to be high risk. 16/54 of the clients had never tested for HIV, 14 had tested negative previously and 24 were not documented. All had PEP prescribed within BASHH guidelines (2006). 36/54 continued care at the SARC. 20/36 (56%) completed 28 days of PEP. Nine were lost to follow-up, four discontinued due to side effects (Grade 1–2 nausea and vomiting), One due to abnormal blood results (Grade 1 rise in ALT and creatinine), one chose to stop and one was not documented. None had their PEP modified. 13/36 had an HIV test at 3 months post-PEP and all were negative.

Conclusions

This study shows that PEP was prescribed within national recommendations. Completion rates were comparable to a local tertiary sexual health/HIV clinic that followed-up patients prescribed PEP after occupational and sexual exposure (66%) but lower than the 2006 BASHH standards (75%). This suggests that survivors of sexual assault may require greater adherence support.
P22 A user centred approach to the design of p-of-care and self-test mobile phone diagnostics for sexually transmitted infections (STIs)
Authors: Gkatzidou V , Hone K
Published: May 2012

Background

Effective Sexually Transmitted Infection (STI) control is being challenged by inadequate access to prompt diagnosis and treatment for patients and relatively poor community STI surveillance. This work forms part of a larger eSTI2(Electronic Self-Testing Instrument for Sexually Transmitted Infections) consortium developing diagnostic devices for pathogen detection and integrating point-of-care tests with mobile technology.

Aim(s)/Objective(s)

Harnessing the widespread mobile phone use, this research develops innovative eSTI2technologies for reducing STIs transmission and providing greater personal control of sexual health. The aim of this study is to develop a wireless web-based management system that links chlamydia self-test diagnostics to further patient care pathways.

Methods

This research adopts a user centred approach to the development of a Human Technology Interface for self-managing STI diagnosis. The research methodology begins primarily with initial exploratory pilot studies to gather functional and user requirements regarding ethical and regulatory requirements of the Human Technology Interface. Iterative development of functional prototypes exploring design possibilities and technology features will be followed by the formative evaluation of interface design through qualitative and controlled usability studies with target users.

Results

In this paper we report on a user centred approach that allows for the successful capture and integration of social science methods to encapsulate user requirements with usability principles in order to develop an effective and user acceptable self-managing STI system.

Discussion and/or Conclusions

Working in a cross-discipline collaboration the overall aim is to investigate the impact of user-centred methods in the design of innovative mobile phone and web technology based rapid testing.
P26 The effectiveness of partner notification in diagnosing early HIV infection in Plymouth, UK
Authors: Warwick Z , Wimpenny T
Published: May 2012

Background

The aim of partner notification (PN) in HIV is to diagnose the undiagnosed and reduce the risk of onward transmission. Plymouth is thought to be a low HIV prevalence area and as such routine testing across medical settings is unlikely to be cost effective or practical. As part of our attempts to target testing, we have concentrated and improved our HIV contact tracing. We describe how the recent infection testing algorithm (RITA) has allowed us to focus PN and identifies individuals early in infection (infectious, high behavioural risk, untested) therefore reducing onward transmission.

Aim

To describe the number of recent infections diagnosed in Plymouth using PN.

Methods

RITA is performed in all newly diagnosed patients. This information is taken into account during PN. A retrospective review of all RITA results done in 2011 and how this has contributed to PN in Plymouth GUM is described.

Results

Of the 20 new HIV diagnoses made in Plymouth, 7 (35%) were incident infections and six were diagnosed as a direct result of PN. Of those with prevalent infection (n=12), 5 were diagnosed as a direct result of PN.

Conclusions

In low prevalence areas targeted testing will yield the greatest number of positive individuals per test. Along with other targeting strategies, PN in those newly diagnosed is a way of reaching an at risk group within this setting. It is important to prioritise HIV PN through a dedicated Health Advising team.
P34 Partner notification for HIV: a regional outcome audit
Authors: Bell G , Green S , Cox T , Naylor S , Bennett P , Dudley S , Martin J , Parsons S , Rothwell J , Allen D , Beckett W
Published: May 2012

Background

Partner notification (PN) for HIV facilitates early diagnosis among those at highest risk. Health advisers and HIV nurses from eight clinics (7 GUM, 1 ID) formed a regional HIV network public health group to optimise PN across the region by sharing intelligence of local HIV transmission and monitoring practice against national guidelines and standards. Since there is no national standard for HIV PN outcomes, we undertook a baseline local audit to inform discussion on the possibility of setting a regional standard.

Objective

To conduct a baseline audit for HIV PN outcomes across the regional HIV network.

Methods

HIV services across the network undertook a retrospective case note review of all patients newly diagnosed with HIV in 2011. Data were collected on the number of partners verified/reported as tested negative/positive before the index, or within 90, 180 or 360 days, following patient or provider referral.

Results

Results received from 7/8 clinics are presented below (see abstract P34 table 1).

Abstract P34 Table 1

HIV partner notification

Range per clinicOverallNumber partners verified tested per case <90 days0.17–1.31.05 (118/112)Number partners verified or reported tested per case <90 days0.66–1.331.15 (129/112)Number partners verified tested per case <1 year0.17–1.381.17 (131/112)Number partners verified or reported tested per case <1 year0.66–1.531.27 (142/112)

Conclusions

Overall PN outcomes are good across the region, although there was wide variation between clinics which makes it difficult to set a single regional standard that is both challenging and achievable for all. Outcomes were verified for most partners, but not possible if tested at an unknown clinic or abroad. The majority of tested partners attended within 3 months, but a small number took up to a year, suggesting PN efforts should continue until the partner is deemed untraceable.
P35 A collaborative approach to controlling an HIV outbreak among intravenous drug users
Authors: Bell G , Devey T , Cope A , Evans C , Hughes C , Naylor S , Greig J M , Tunbridge A J , Lagundoye O , McNaught R
Published: May 2012

Background

In 2008 an intravenous drug user (IVDU) admitted to the infectious diseases unit was diagnosed with late-stage HIV. He named five injecting partners, of whom three tested negative for HIV, one refused, and one was untraced. In early 2010 another IVDU was diagnosed, naming two injecting partners of the previous case who had either declined or tested negative in 2008.

Objective

To control an outbreak of HIV among IVDUs

Interventions

A multidisciplinary outbreak control team was convened in 2008 and 2010 with representation from the Health Protection Unit, the Drug and Alcohol Action Team, Genitourinary Medicine, Infectious Diseases, and Virology to develop a control strategy. Traditional partner notification was supplemented by cluster testing among associates in housing projects and drop in centres used by IVDUs. Opportunistic screening of IVDUs attending health services was promoted. Laboratory investigations included phylogenetic analysis and the recent infection testing algorithm.

Outcomes

A further 6 cases were identified in 2010: two through hospital screening and four through partner notification. Cluster testing did not yield any further cases among associates (0/29), but presented an opportunity to raise awareness of local HIV risk among IVDUs. Joint working between services was a feature of all interventions. All 8 cases 2008–2010 are the same strain, and 7/8 are linked to at least one other case. Despite extended surveillance at centres providing treatment for substance misuse, no further new cases have been identified since September 2010.

Conclusion

An HIV outbreak among a hard-to-reach population has been successfully controlled by a prompt and close collaboration between services to deliver a range of complementary control strategies. We remain vigilant to the possibility of further cases since the source of one case has not been identified.
P39 The acceptability and use of SMS text messaging for provider referral partner notification (PRPN)
Authors: Gilbart V , Town K , Lowndes C M
Published: May 2012

Background

Partner notification is important for STI control. With developments in technology notifying partners is now easier. The HPA was keen to understand the acceptability and use of SMS texting for PRPN for STIs.

Methods

A questionnaire distributed to GUM colleagues, cascaded by the Society of Sexual Health Advisers and posted on their website.

Results

65 sites responded. Most (61, 93%) use telephone for 1st attempt for PRPN with texting as preferred second choice (19, 29%). For 2nd attempt, telephone remained preferred method (51, 79%) but texting increased with 32 (49.2%) choosing this method; letter use also increased. Majority of sites used texting for PRPN (56, (86%); frequency varied—over half using it up to 50% of the time. 29 (45%) had texting guidelines and 31 (55%) used texting templates. Messages varied; 33 (59%) requesting partner make contact, 9 (16%) naming the infection. Six (11%) had contact with Information Governance Board about texting; no negative outcomes reported. Two partners complained, not about receiving a text but about being denied the identity of the index patient. 9 (14%) sites never used texting.

Conclusion

Telephone contact was the preferred option for 1st and 2nd attempt for PRPN. Texting was the 2nd most used method and was seen as acceptable within the clinic and also with Information Governance Board. Frequency varied considerably and message content differed but even if used infrequently, was seen as important if other methods failed. Reassuringly no complaints about texting were received from partners. A small number of sites never use texting.
P47 Systematic recall vs standard care, addressing the increased risk of re-infection in patients presenting with gonorrhoea
Authors: Fernando K , Flew S , Phattey J , Harding J , Fowler T , Caley M , Ross J
Published: May 2012

Background

Gonorrhoea is of increasing concern in UK, with the gonococcal resistance to antimicrobials surveillance programme reporting high levels of resistance to antibiotics. Prior history of gonorrhoea is a strong predictor of current infection, supporting the concept of a group of “core transmitters.” The US Center for Disease Control advises retesting of patients with gonorrhoea 3 months after treatment to identify repeat infections. Current UK guidelines only recommend a test of cure at 2–4 weeks.

Aim

To assess the feasibility, acceptability and effectiveness of routine retesting at a 3-month interval, in UK sexual health clinic attendees diagnosed with gonorrhoea.

Methods

Attendees between November 2010 and June 2011 diagnosed with gonorrhoea were offered retesting 3–6 months after treatment, with a subsequent reminder to attend (recall arm). Re-attendance rates and frequency of gonorrhoea diagnosis were compared to a historic group who attended between October 2006 and April 2007, controlling for age, sex, sexual orientation and history of STI (control arm).

Results

242 patients were assessed in the recall arm. 95 (39%) re-attended within 6 months of initial attendance and 15 (6%) were positive for gonorrhoea. Of 202 controls, 44 (22%) re-attended within 6 months and 12 (6%) tested positive for gonorrhoea. Being actively recalled increased re-attendance at the clinic (β=2.2, p=0.001) but did not detect additional cases of gonorrhoea (β=1.2, p=0.9).

Conclusion

These results strongly suggest that the CDC recommendation for re-testing for infection after 3 months is not an effective approach for unselected patients with gonorrhoea in the UK.
P49 Otosyphilis: missed opportunities for early treatment?
Authors: Bradshaw D , Pallawela S , Scott C , Asboe D , Nelson M , Day S
Published: May 2012

Background

Otosyphilis (OS) is one of the few reversible causes of hearing loss. Audiological symptoms and positive syphilis (SP) serology can be diagnostic of OS. Hearing outcome after treatment is poor and evidence for optimal management is lacking.

Aim

To identify how OS is managed in our unit.

Method

Case collection and notes review.

Results

Seven (6 male, 1 female) patients (pts) with OS were identified between 2007 and 2011, of median age 34 yrs. Of these 7 pts: 6 (86%) had secondary stage and 1 (14%) late stage SP; 6 (86%) were coinfected with HIV (2 testing HIV+ at SP diagnosis); all presented with deafness (bilaterally in 3 pts); all had other symptoms of SP (commonly rash (4, 57%) and ocular involvement (3, 43%)). Of 6/7 pts consenting to lumbar puncture, neurosyphilis was probable in 1 (17%), excluded in 2 (33%) and considered possible in 3 (50%) pts. Median time from audiological symptoms to treatment was 2 months (range 2 days to 6 m). Four (57%) had previously visited a health care professional who failed to diagnose OS. Six (86%) and 5 (71%) pts received a neurological regimen and steroid cover respectively. Overall, hearing improved in 3 (43%) and stabilised in 4 (57%) pts. An improved audiological outcome was seen in 2/3 (67%) pts receiving early treatment (within 1-month of hearing loss) vs 1/4 (25%) of those receiving late treatment and in 3/6 (50%) pts receiving a neurological regimen vs 0/1 pts receiving standard treatment. Median time to treatment was shorter in pts with established HIV infection (2 months) than those testing HIV+ at SP diagnosis or testing HIV neg (3.5 months).

Conclusion

This small study identifies a delay to treatment in many cases. Early treatment and treating with a neurological regimen may improve outcome. HIV+ pts may have more regular SP testing, reducing the delay to treatment. OS is uncommon, but with increasing rates of SP nationally, we must be alert to its manifestations and promptly initiate treatment.
P50 Chlamydia surveillance in the USA: the need for new strategies
Authors: Torrone E , Weinstock H S
Published: May 2012

Background

Preventing infertility through the prevention and control of chlamydia is a priority in the USA. Valid and timely surveillance data on chlamydial infections are needed to estimate disease burden, monitor trends, and inform and evaluate chlamydia prevention strategies.

Methods

We assessed the strengths and weaknesses of the US chlamydia surveillance system, including notifiable disease reports, opportunistic data from screening programs, and national surveys.

Results

Notifiable disease report data are heavily influenced by changes in screening coverage, empiric treatment, diagnostic test technology, and reporting practices. Although test positivity data from federally-funded screening programs can account for the number of tests conducted, data are affected by changes in clinics participating in the program, differences in screening criteria between clinics, and demographic shifts in clinic populations. National survey data are representative of the general population and estimate point prevalence. However, data are not timely and low national chlamydia prevalence (estimated prevalence in 2009–2010 was 1.7%, 95% CI 1.0% to 2.3%) combined with small survey sample sizes results in unstable estimates limiting the ability to monitor trends in demographic subpopulations.

Discussion

The current US chlamydia surveillance system does not provide valid and timely data to estimate disease burden and monitor trends in chlamydial infection. The use of multiple data sources is not sufficient to offset inherent biases in each surveillance method. Consequently, new approaches to monitoring chlamydia morbidity are needed. Sentinel surveillance may provide higher quality data and a more comprehensive understanding of chlamydia trends.
P53 PCR screening tests forChlamydia trachomatisorNeisseria gonorrhoeaedo not require a second test to confirm: an audit of patients issued with equivocal results
Authors: Hopkins M , Smith G , Hart I J , Alloba F
Published: May 2012

Background

UK testing algorithms for chlamydia or gonorrhoea should have a positive predicative value (PPV) >90%. Repeat of testing of screen positive samples might be required to achieve this. Patients issued with unconfirmed positive (equivocal) results are recalled to clinic to submit another sample.

Objectives

To assess the clinical utility of supplementary PCRs following a positive PCR screening test result.

Methods

Laboratory reports forChlamydia trachomatisorNeisseria gonorrhoeaeissued to GUM patients between April 2010 and April 2011 were reviewed retrospectively. Positive reports were routinely confirmed by supplementary PCRs andN gonorrhoeaeculture. Clinical records of patients with equivocal reports were retrieved to determine if infection was confirmed by a second sample on patient recall and the impact of this process on antibiotic management.

Results

Over 15 000 patients were tested during the study period. The prevalence of chlamydia and gonorrhoea was 972 (5.75%) and 76 (0.50%), respectively. A further 78 chlamydia and 2 gonorrhoea equivocal reports were issued. Only 56 (72%) patients with an equivocal chlamydia report returned to clinic, and of these, only 41 (73%) gave a second sample to retest. PPV of the PCR screening test was calculated at 98.0% and 97.5% for detection of chlamydia infection from urine and rectal swabs, respectively. Most patients accepted antibiotic treatment before infection status had been confirmed. Prevalence of gonorrhoea infection was low but PPV of the screening PCR remained high (98.75%).

Conclusions

Equivocal reports introduce delays to patient management while the risk of unnecessary antibiotic therapy appears acceptable to most patients. The cobas 4800 CT/NG PCR screening assay can achieve UK testing standards (PPV >90%) in extra-genital swabs and low prevalence gonorrhoea population without supplementary tests. A patient-led confirmation algorithm is proposed.
P54 Ocular syphilis: lessons from 4 decades of experience
Authors: Draeger E M , Durani Z K , Hitch G , Goh B T
Published: May 2012

Background

Ocular syphilis can affect most eye structures and can be the result of congenital and acquired infection. Many ocular signs are not specific to syphilis and it can be difficult to make the diagnosis.

Aim

This study aims to investigate the epidemiology of ocular syphilis presenting to an oculogenital clinic.

Method

Retrospective case notes review of ocular syphilis cases seen between 1965 and 2011. Of 307 cases with ocular signs and positive treponemal serology, 85 cases with a history of yaws were excluded, leaving 222.

Results

Of the 222 cases, 93 (42%) were late congenital (CS), and 129 (58%) were acquired (AS). Of the CS cases, the mean age was 47.5 (range 7–86), 37 (40%) were male, of whom 1 was MSM. 55 (59%) were from the UK, 19 (20%) from the Caribbean, 9 (10%) from Europe. Eye signs were as follows: interstitial keratitis 73, anterior uveitis 23, posterior uveitis 10, panuveitis 3, Argyll-Robertson pupils (ARP) 1 and optic neuritis (ON) 1. Of the AS cases, the mean age was 50.9 (range 17–85), 99 (77%) were male, of whom 15 were MSM. 31 (24%) were from the UK, 15 (12%) from Europe, 51 (40%) from the Caribbean and 16 (12%) from Africa. 17 (13%) were early syphilis (secondary/early latent) and 112 (87%) were late latent or tertiary syphilis. Eye signs were as follows: anterior uveitis 63, posterior uveitis 21, panuveitis 13, optic atrophy 9, ON 8 and ARP 5. 35 (38%) of CS cases and 8 (6%) of the AS cases had extra-ocular signs of syphilis. Treatment was with a neurosyphilis regimen. STI screen were offered to all patients. Concomitant STIs are shown in the abstract P54 table 1.

Abstract P54 Table 1

Number of patients presenting with concomitant STIs

CongenitalAcquired-earlyAcquired-lateGonorrhoea239Chlamydia227NSU103PID600Herpes214HIV011TV215Scabies301Warts041Any STI17725

Conclusions

(1) Ocular syphilis has varied presentations. (2) Screening for other STIs is important even in late CS and AS. (3) Ocular syphilis can be the only sign of syphilis: clinicians should consider syphilis as a cause of undiagnosed eye signs.
P57 To treat or not to treat
Authors: Thomas J , Mathew T , Carey P B
Published: May 2012

Background

The BASHH guidelines recommend offering full STI screening and epidemiological treatment to sexual contacts of those with confirmed Chlamydia infection. However, many patients attend sexual health clinics reporting to be contacts of Chamydia, but unable to give details of the index case. The management of these unverified Chlamydia contacts is unclear. Most clinics pragmatically treat contacts during their first visit; however some clinics may choose to wait for results before treating. This study was aimed at establishing current practice of management of Chlamydia contacts both verified and unverified, in a large inner city GUM clinic.

Method

Health care practitioners were requested to fill in a questionnaire when patients who reported to be contacts ofChlamydia trachomatisattended the clinic over a 6-month period.

Results

59 Questionnaires were returned. In 76% (45/59) of patients attending as contacts of Chlamydia, details of index case could not be verified. 62% of these patients were asymptomatic and 56% (25/45) treated on first visit. Subsequently 27% (12/45) had a positive Chlamydia test whereas 36% of Chlamydia tests were positive in the cases where details of index case could be verified. The difference the positive rates of verified and unverified Chlamydia contacts is not significant (p=0.51).

Conclusion

Despite acknowledging that our numbers are small, a high percentage of unverified Chlamydia contacts had positive Chlamydia tests. Given this we recommend that all patients attending STI clinics reporting to be contacts must be treated at first visit to avoid complications, losses to follow-up and decrease patient anxiety.
P61 IM ceftriaxone for all pelvic inflammatory disease: to give or not to give?
Authors: Lee P H , McQuillan O
Published: May 2012

Aim

To audit the care of Pelvic Inflammatory Disease (PID) in a city centre Genitourinary medicine clinic.

Objectives

(1) To assess the effectiveness of PID treatment offered by evaluating the auditable outcomes recommended within BASHH treatment guidelines. (2) To ascertain the level of detected infection withNeisseria gonorrhoeaein order to decide whether to implement IM ceftriaxone 500 mg stat as part of all PID treatment as per latest BASHH 2011 treatment guidelines.

Method

A retrospective review of patient case notes coded with B4/B5, C4A and C5 from June 2010 till December 2010. A proforma was formulated and results then analysed using SPSS.

Results

A total of 87 case notes were analysed. 100% of the patients were offered microbiological investigations (target—>95%) and 87.4% of the patients were treated with recommended regimens (target—>95%). 89.7% of the patients were referred for contact tracing (target—>95%) and the ratio of number of contacts screened/treated was 0.21 (target 0.4).

Discussion

Only one audit outcome (>95%—microbiological investigations) was achieved. Gonococcal PID was confirmed on microbiological testing in only 2/87 patients (2.3%).

Conclusion

We propose the introduction of a PID proforma to ensure greater uniformity of management and improve auditable outcomes. A local PID clinical guideline was adopted advising treating those at low risk of gonoccocal infection and mild to moderate PID with doxycycline plus metronidazole; and to add in IM ceftriaxone 500 mg stat to those with moderate to severe PID and/or those at high risk of gonoccocal disease. Re-audit will be conducted after the introduction of these measures.
P62 Managing the cardiovascular complications of late syphilis
Authors: Sacks R , Tipple C , Goldmeier D
Published: May 2012

Background

BASHH recommends full clinical examination and chest radiography (CXR) for patients with late syphilis. Steroid cover and cardiology referral are advised for cardiovascular involvement. Recent literature suggests variation in the clinical management of suspected cardiovascular syphilis.

Aim

To explore variations in the management of late syphilis in UK GUM clinics and to compare this with current BASHH guidelines.

Method

Lead clinicians of UK GUM clinics were invited to complete an electronic survey between November and December 2010 to establish management of late syphilis in their centre. Data collected using the online Survey Monkey system were analysed with Microsoft Excel and SPSS V.18.

Results

In total, 34% (53/156) of clinicians approached responded fully or partially to the survey (93% were consultants). An average of nine cases (n=45, SD 10.8) of late syphilis (KC60 codes A4, A5, A6) per clinic were seen between November 2009 and November 2010. Of these, 76% (n=42, range 0–100%) were estimated to have had a full clinical examination (and the use of CXR is described in abstract P62 table 1). *Other includes: older patients; HIV+ve patients; those with higher RPR; clinician dependent An ECG or ECHO was ordered routinely, or if the patient has symptoms or signs of cardiovascular syphilis, in 90% and 76% respectively. Cardiology referral was routinely made by 58% (18/31) and 35% (9/26) always used steroids, when managing cardiovascular syphilis.

Abstract P62 Table 1Q: Under which circumstances is a CXR requested?Routinely performedIf patient symptomaticIf patient has clinical signsIf routine, symptoms or signsOther*Mean % (no of respondents) n=4448% (21)41% (18)36% (16)89% (39)25% (11)*

Other includes: older patients; HIV+ve patients; those with higher RPR; clinician dependent.

Discussion

Management of late syphilis varies both between clinics and compared with BASHH guidelines. Not all patients are examined or offered a CXR, and in cases with suspected cardiovascular involvement, cardiology referral and use of steroids are variable. Conversely, many patients are over-investigated in the GUM clinic.
P65 Serological response between HIV-positive and negative cohorts treated for early syphilis
Authors: Dhairyawan R , Almeida A , Gunathilake M , Goh B
Published: May 2012

Introduction

Successful treatment response for early syphilis involves resolution of signs and a fourfold decrease in RPR/VDRL or sero-reversion between 3 and 6 months. However, in the HIV-positive population the serological response can be unusual.

Aims

To compare serological response after treatment of early syphilis between HIV-positive and negative cohorts.

Methods

Retrospective cohort study of 100 HIV positive (HP) and 92 negative (HN) patients with early syphilis at an inner city GUM clinic from 2002 to 2011. Data were collected on demographics, stage of syphilis, treatment and serological response.

Results

Both HP and HN cohorts were mainly MSM (72 HN, 96 HP) and Caucasian (HN 76, HP 78). Median age 33 (range 20–63 years) in the HN and 37 (range 19–59 years) in the HP. Stage of syphilis: HN group, 22/92 primary, 26 secondary and 44 early latent (EL). HP group: 26/100 primary, 34 secondary and 39 EL. The HN group were treated with the standard regimen for their stage of disease. 49/100 of the HP group received treatment for neurosyphilis. 25/92 HN and 14/100 HP were lost to follow-up following treatment. Excluding these patients, by 6 months, 18/20 (90%) of the HP group with primary syphilis sero-reverted or had a fourfold decrease in RPR/VDRL compared to 17/17 (100%) of the HN. By 6 months, 51/55 (93%) of the HP group with secondary/EL syphilis had sero-reverted or had a fourfold decrease in RPR/VDRL compared to 41/45 (91%) of the HN. Median CD4 count in the HP group was 380 cells/μl prior to treatment and 518 after treatment. There were 4 reinfections in the HN group and 10 in the HP.

Conclusions

There were high rates of serological treatment success for early syphilis in both groups. However, the HP group were less likely to have a successful response by 6 months in primary syphilis. This study also demonstrates the need for strategies to address the large number of patients lost to follow-up.
P67 Estimation of population coverage of chlamydia testing among young adults in England in 2010
Authors: Nardone A , Robinson C , Craig R , Woodhall S , Talebi A , Mercer C , Johnson A M
Published: May 2012

Background

The National Chlamydia Screening Programme (NCSP), established nationally in England in 2008, aims to prevent and control chlamydia infection in young adults under 25 years of age through opportunistic community based testing.

Aim

We wished to validate the NCSP estimates of chlamydia screening coverage in the target population of young adults by comparing to self-reported chlamydia testing among participants to the Health Survey for England (HSE).

Methods

Chlamydia screening coverage is calculated centrally by combining the number of tests reported from three sources of data: NCSP; sexual health clinics; and laboratories. All three sources provide data by age and sex. HSE is an annual general health survey of a nationally representative selection of households in England. In 2010, questions on previous history of testing for chlamydia were asked of all 4259 individuals aged 16–54 who were interviewed. Analyses presented here are limited to the 725 young adults aged 16–24 years old.

Results

In 2010, NCSP estimated that 2.2 million chlamydia tests were performed in England among young adults aged 15–24 years old, representing up to 33% of the target population (43% of females and 24% of males). In HSE 2010, 44% of females (177/402) and 27% of males (87/323) reported having ever had a chlamydia test. The proportion who reported having had chlamydia test in the last year was lower for both females (27%; 109/402) and males (17%; 55/323).

Conclusion

We have demonstrated the progress made by NCSP in achieving high national levels of coverage. Estimated coverage rates in 2010 reported by NCSP were slightly higher than those recorded by HSE which may be in part due to the inclusion of those who have had repeat chlamydia tests. The data collected by HSE has proved a valuable source of data with which to monitor the progress of NCSP in achieving national targets for testing coverage and improve the delivery of the programme.
P69 In those with high white cell counts per high powered field does extended azithromycin affect persistence/recurrence
Authors: de Burgh-Thomas A , Russell A Ross , Maple K , Karunaratne I
Published: May 2012

Aims

We will compare the effect of an extended azithromycin (2 g of over several days) vs 1 g stat for those where >50 WCs per hi power field were found.

Methods

We have reviewed all cases of NSU over a 3-month period following the introduction of extended treatment with azithromycin for those with hi levels of WCs per hpf. We will review the records of those patients diagnosed with NSU in previous years (over the same months) who were treated with regimes of either doxycycline 100 mg twice daily for 7 days or azithromycin 1 g stat.

Results

Following the change in policy half of all patients treated for NSU received an extended course. In the group who had hi levels of WC's 13% were subsequently found to be chlamydia positive by PCR and 87% were chlamydia negative. In the group with low levels of WC's 10% were chlamydia PCR positive and 90% were chlamydia negative. Of those with hi levels of WCs per HPF treated with a total of 2 g of azithromycin 18% returned to clinic complaining of continuing symptoms. This compares to 20% with low levels of WCs per hi powered treated with the standard 1 g of azithromycin who suffered persistence/recurrence following treatment We will present data on those patient treated in previous years with both doxycycline and azithromycin at a dose of 1 g.

Discussion

So far we have analysed only those cases following the change in policy. We will present data that will demonstrate any change in response to extended azithromycin. The results will demonstrate whether the extended course has any benefits and at what cost.
P7 A world record for HIV testing. Publicity stunt or effective outreach?
Authors: Jenkins J , McOwan A G , McCormack S , Chislett L J
Published: May 2012

Background

1 in 7 MSM in London are HIV positive, 1 of 5 of whom are unaware of this because they have never tested, or acquired HIV since their last test. Our service took the opportunity presented by World AIDS Day to promote the importance of regular HIV testing in MSM by staging a HIV testing world record attempt in a local gay bar.

Aims/Objectives

To promote the importance of HIV testing, and to see if the outreach was successful in targeting a less tested population of MSM.

Methods

The promotion was determined by the “opportunities to view” key messages. Individuals tested in the bar completed a form collecting age, gender, orientation, time since last HIV test, unprotected anal (UAI) or vaginal sex. Similar information was collected from 100 patients walking into the generic service for an HIV test on the same day. Age groups <25, 26–30, 31–39, >40 were chosen.

Results

There were 890 000 opportunities to view the key messages. 467 individuals tested in the gay bar, but only 441 forms were sufficiently complete for this analysis. MSM in the gay bar were younger than the clinic (54% and 44% respectively <30; p=0.027), and more likely to have never tested (18% and 6%; p=0.007). In the gay bar, only 9/89 (10%) of MSM aged 31–39 had never tested, only 2/9 (22%) reporting UAI. This contrasted to the 15%–24% of 54 MSM in the other age groups that had never tested, 60%–77% of whom reported UAI. Only five MSM attending clinic had never tested, 4 (80%) of whom were <25 (see abstract P7 table 1).

Abstract P7 Table 1

Demographic characteristics of individuals accepting HIV testing

Gay Bar (n=441)Clinic (n=100)Male379 (86%)91 (91%)MSM355 (80%)80 (80%)<25 years167 (38%)15 (15%)MSM <25131 (37%)12 (12%)No previous test101 (23%)15 (15%)Never tested, reporting UAI/UVI52 (51%)9 (60%)MSM never tested, reporting UAI39 (62%)2 (100%)

Discussion

As well as promoting the benefits of regular testing to the wider gay community, the event was successful in reaching a less tested, but nonetheless high risk population of MSM, in particular, those <25.