bluuebunny/crossref_metadata_2025 huggingface dataset:
P204 A junior doctor-led programme is effective in educating young people about sexually transmitted infections and their local sexual health clinic
Authors: Kearney Jessica , Subburaj Kartik , Shanmugathas Nimlan , Patel Harish
Published: May 2024

Introduction

It is well recognised that people aged 15–24 have the highest rates of sexually transmitted infections (STIs). In an area failing to meet national targets on chlamydia detection in this age group and overall HIV testing, junior doctors are delivering sessions to educate young people. The project aims to increase attendance at sexual health clinics and improve sexual health in this high-risk group.

Methods

Since 2012 junior doctors have been visiting secondary schools locally to deliver a 50-minute teaching session to 14–16 year olds covering condom application, symptoms of STIs and accessing their local sexual health clinics. The sessions have received positive feedback from teachers and students. This year a questionnaire has been introduced to quantify pre and post teaching knowledge.

Results

188 children completed the questionnaire. Pre-teaching scores included 25.9% on STI symptoms, 34.9% on where the local clinic is and 27% awareness of what happens there. The post-teaching scores showed an improvement of 49.8%. 89% students reported feeling more comfortable discussing STIs following the session.

Discussion

We have highlighted that there is a need to provide more information to 14–16 year-olds about the symptoms of STIs and their local sexual health clinic. We have also demonstrated that a junior doctor led programme is an efficacious method of delivering this. Education from a young age could contribute towards increasing screening and reducing STI rates.
P208 In an era of antibmicrobial stewardship is epidemiological treatment for syphilis still justified?
Authors: Wood Clare , Saxon Cara , Ahmad Sameena
Published: May 2024

Introduction

The BASHH guidelines for syphilis recommend the offer of epidemiological treatment or re-screening at 12 weeks (12w) after exposure for asymptomatic sexual contacts. We reviewed local practice and compliance with guidance in view of the increasing need for antimicrobial stewardship.

Methods

We conducted a retrospective case note review of patients coded as syphilis contact (PNS) between January 2015 and July 2016.

Results

We identified 44 patients (40 [91%] male; 35 [80%] men who have sex with men) reporting syphilis contact. There were 12 (27%) symptomatic, who were all given treatment; 7 (63.6%) with subsequently positive syphilis serology. Of 32 (73%) asymptomatic patients 25 (78%) received treatment. All 25 reported ongoing sexual contact with the index partner or others within the window period (WP) and serology was consistent with active infection in 5 (20%). Of the 7 (21.9%) that didn’t receive epidemiological treatment 5 were outside the WP and tested negative; 1 declined treatment and tested negative at 12w; 1 contact of late latent syphilis tested negative within the WP but failed to attend 12w follow up. There were 8 (18%) with other STIs at presentation.

Discussion

While penicillin-resistant syphilis is not an immediate concern, contacts may have other infections that could be partially treated with penicillin based or tetracycline antibiotics potentiating resistance. Over half our patients were at risk of re-infecting or transmitting to partners supporting the basis for epidemiological treatment but should we consider the option of treating symptomatics at presentation and abstinence advice pending results?
P211 Teens and sexting – a public health concern?
Authors: Handley Sally , Murray Rachael , Bains Manpreet
Published: May 2024

Introduction

Sexual messaging (sexting) has become a norm of peer-to-peer communication among young people. There are concerns about the negative impact sexting has on young people’s health and wellbeing. However, little is known about the nature of public health messages currently being provided on sexting. This study sought to understand the nature of information and advice on sexting available online for children, young people and adults.

Methods

A document analysis explored online resources from national agencies involved in promoting the welfare of children and young people. Thirty-eight documents were identified which included audio-visual files. The nature of information was analysed thematically.

Results

Definitions of sexting, the scope of the problem and the role of technology were key themes across the documents. Safeguarding prioritised the welfare of young people with advice and scenarios on legal issues. Immediate and longer-term consequences considered peer pressure, coercion, bullying and control, psycho-social distress, reputation damage and internet related crime. Advice focused on how to say ‘no’, minimising risk, dealing with the problem, relationship advice, safety and harm reduction including how to use social media.

Discussion

Sexting may play an important part in normative sexual development and sexual enquiry. Online digital relationships also create concern for some children and young people. This research found that there was a wealth of information and advice available and the nature of it is consistent across agencies. Harm reduction could be strengthened through a multi-agency commitment to promote inclusive, cross-curricular online safety and healthy peer relationship messages.
P213 The epidemiological features of herpes simplex virus cases in a cork sti clinic
Authors: Mitchell Jill , Cremin Suzanne
Published: May 2024

Introduction

Herpes simplex virus (HSV) is the leading cause of genital lesions worldwide. The transmission of sexually transmitted infections (STI’s) and human behaviour are intrinsically linked. A clear understanding of the characteristics that increase the risk of acquiring these infections is vital for STI control. European evidence lists large intracountry and intercountry differences in the epidemiology of genital herpes across Europe

Methods

Retrospective chart review, examining demographic, behavioural and diagnostic data of patients who attended a Cork STI clinic from 2011 to 2015 inclusive. Multivariate logistic regression models were used to study the epidemiological features of patients with a genital HSV infection (n=296) in comparison to a control group of patients with negative screen (n=307).

Results

Females (OR3.942, P<0.001) and those aged between 25 to 30 years (OR: 8.397, P<0.001) had increased odds of acquiring genital HSV. Subjects of non-Irish ethnicity (P=0.032) and females who engaged in sexual intercourse younger than 17 years of age were more likely to present with the infection (OR: 7.427, P<0.01). Alcohol and drug use were not significant predicting factors of HSV infection. High number of sexual partners was not associated with increased risk of the infection. Consistent condom use was very low in all subjects.

Discussion

Public health campaigns directed at young people, especially those engaging in sexual activity at a young age and non-Irish ethnic groups, may be beneficial. Increased distribution of condoms to at risk age groups should be considered. It is relevant to public policy design that classic risk taking behaviours were not associated with increased risk of genital HSV infection.
P226 ‘Agender for change’: representing gender and sexuality diversity in sexual health
Authors: Turner Kevin , Scofield Sara , Priestley Cecilia , Clarke Billy
Published: May 2024

Introduction

Trans* identities are under-represented in UK sexual health data. One possible reason is that the traditional representation of gender within the restricted binaries of male and female contributes to the low numbers seen in sexual health services. We aimed to obtain a clearer understanding of the hidden gender and sexuality identities accessing an LGBT-targeted sexual health service.

Methods

We offered full sexual health screening in a community LGBT clinic during National HIV Testing Week in 2016. A self-completed triage form was used to register patients. Additional gender identity options were added to the form. This included an ‘other’ box with an option to specify any gender or sexual identities that had not been represented on the form.

Results

78 patients completed the registration form. 52 identified as male and 18 female. 8 (10%) described different gender identities; 2 trans*-men, 2 demi-boys, 1 gender fluid, 1 bi-gender and 2 non-binary.

In terms of sexual orientation, 8 identified as heterosexual men, 50 as gay men, 2 as lesbian women, and 6 (2 male, 3 female and 1 non-binary) as bisexual. 11 identified themselves as pansexual and 1 (a demi-boy) as asexual.

Discussion

Increasing the options during registration captured a wide variation in reported gender identity and sexual orientation. To avoid a complex, multi-option question on the registration form, we would suggest that simplifying this to ‘please describe your gender’ and ‘please describe your sexuality’ would be advantageous for both the patient and health care professional.
P234 STI testing in HIV positive MSM patients: a missed opportunity?
Authors: Cain Charlotte , McCathie Radhika
Published: May 2024

Introduction

Approximately 1 in 20 men that have sex with men (MSM) are infected with HIV. The risk of acquiring a sexually transmitted infection (STI) is higher in this population compared with heterosexuals. Therefore, it is important for HIV positive MSMs to have regular sexual health screening to reduce the risk of transmission of STIs and HIV.

Consequently, the British HIV Association recommends that HIV positive MSMs should have annual STI screening. Furthermore, those that are classified as high-risk should be tested every 3 months.

Methods

This audit retrospectively gathered case notes of HIV positive MSMs that have been seen in the last 12 months, October 2015 to November 2016. The following criteria were assessed: annual or 3 monthly screening of STIs, hepatitis B and C immunity status, patient age, evidence of high-risk behaviours and year of HIV diagnosis. The criteria for high-risk behaviour included: multiple partners (>2 in the last 12 months) and drug use. The data will be used to assess what proportion of patients are screened in line with national guidelines and to identify ways the practice can increase the uptake of screening.

Results

The results show that 84% of cases were not screened annually for hepatitis C and 40% of patients were not receiving the minimum screening for STIs. However, 78% of patients were vaccinated against hepatitis B.

Discussion

In conclusion, this audit shows that there is a failure to meet the minimum level of screening for this high-risk group. We aim to improve this via a new pro-forma and education.
P236 Awareness and resources for individuals who are transgender with autistic spectrum disorder- a healthcare professional’s perspective
Authors: Murphy Lauren , Livesey Anne
Published: May 2024

Introduction

Autistic Spectrum Disorder (ASD) affected around 1% of the general population but has been reported in 7.8% of childhood gender identity clinic referrals. Gender identity is an increasing healthcare focus; the United Kingdom’s only childhood gender identity clinic witnessed a 930% increase in referrals in six years, with Sussex having the highest adult service referral rates. This study aims to assess healthcare professionals’ awareness of a co-occurrence between ASD and transgender, identify resources and determine how these could be improved, based on the needs and concerns of individuals.

Methods

A service evaluation of healthcare professionals who frequently see individuals about ASD and/or gender identity was conducted in Brighton. An anonymised online questionnaire, created using Survey Monkey, was accessible from January 2017 until March 2017. Participants were contacted via NHS emailing lists with explanatory information and a survey link. Quantitative data was collated as raw data and percentages. Qualitative data was organised into tables and key themes identified.

Results

Limited evidence suggests that healthcare professionals were unaware of an association between ASD and transgender and most were unsure if resources existed. Most felt that training would improve care, with a particular focus on local and online resources, referral pathways and current research evidence. Mental health issues, family concerns about gender identity interventions, not being accepted and vulnerability were major concerns.

Discussion

Co-occurring ASD and transgender is under-recognised by healthcare professionals. Future resources should focus on the specific needs and concerns of these individuals and aim to raise awareness.
P239 Returning sexually transmitted infection results to adolescents: a review of the literature
Authors: Jain Lakshmi , Francis Suzanna , Shahmanesh Maryam
Published: May 2024

Introduction

Sexually Transmitted Infections (STIs) are an important cause of poor reproductive and sexual health in adolescents. Prompt diagnosis and treatment are key to reducing long term sequelae. We reviewed the evidence on current methods of results delivery for STIs, with a focus on adolescent services.

Method

The literature was reviewed systematically between June and August 2016. Six databases were searched, reference lists reviewed and authors contacted for studies on methods of results delivery for STIs to adolescents (aged 15–25 years). Titles and abstracts were reviewed and full text obtained for quality assessment and data extraction.

Results

Of 549 studies identified, 19 fulfilled the inclusion criteria. Seven studies focused on adolescent populations, all in high-income settings. Three studies in low- and middle-income settings and nine included adolescents as a stratified group. Twelve studies were cross-sectional, two randomised control trials, the remaining employed mixed methods. Outcome measures varied widely, percentage preferences for method of results being the commonest measure. Findings show that mobile phone call and text were the commonest methods of returning results. Other modalities including text message, email and online notification demonstrated wide variations in acceptability. Preferences varied according to type of result, population type, location, client group and previous service use. Mobile phone calls and face-to-face consultations remain highly acceptable.

Discussion

The use of mHealth offers promising options for STI results delivery. Methods adopted must consider the target population accounting for gender, age, ethnicity and access to technologies. Customisation is recommended to meet user requirements for optimal health care delivery.
P241 Where there’s tea, there’s hope! – experience of green tea extract for treatment of genital warts
Authors: Megarity Stephen , McCarty Emma , O’Donnell Brian , Dinsmore Wallace
Published: May 2024

Introduction

Catephen® 10% ointment is novel extract from green tea which is licenced for genital wart treatment and included in BASHH guidelines (2015). Recommended application is 3 times daily for 16 weeks. We present real life data of Catephen® experience.

Methods

Review of patients treated with Catephen® and adjuvant cryotherapy between August 2016 – February 2017. Clinical outcomes and tolerability data were collected.

Results

33 patients identified, median age 26 years (32 male, 1 female). 2 HIV positive. Affected site; penis 23/33, perianal 7/33, both 2/33 and vulva 1/33. All cases were recurrences. 6 patients excluded as lost to follow-up. To date 17/28 have completed 16-week course Catephen® or achieved full clearance prior to this. Outcomes are still awaited for 2/27 patients and 8/27 discontinued treatment early. Of the 17 who have completed treatment, 11(65%) had total clearance and 6(35%) partial clearance. Mean time to clearance was 8 weeks with penile warts appearing to respond better than perianal. Catephen® was well tolerated with 43% stating they had fewer side effects than with previous treatments. Overall discontinuation rate was 8/27 (30%) with 1 report of vulval pain, 1 report of stained clothing and 6 reporting unsatisfactory response (mean duration of Catephen® use 6.5 weeks). An additional 3 patients reported skin discomfort but continued treatment.

Discussion

Catephen® ointment appears well tolerated with satisfactory clearance rates. It appears to be an acceptable alternative to other topical treatments for genital warts. To date there is no trial data on continued use after 16 weeks.
P243 Could the current outbreak of hepatitis a in men who have sex with men in london have been predicted or prevented?
Authors: Lewer Dan , Mindlin Miranda , Cordery Rebecca
Published: May 2024

Introduction

The current outbreak of Hepatitis A and the recent Shigella outbreak in men who have sex with men (MSM) highlight the importance of faeco-orally transmitted organisms in this population. This may suggest that outbreaks could be predicted or prevented.

Methods

We compared the age, sex and travel history of notifications of Hepatitis A with notifications of Shigella in South London between January 2010 and November 2016. We also reviewed documentation of previous outbreaks of Hepatitis A in MSM in London.

Results

Male and female cases of Hepatitis A had similar age profiles and a similar proportion reported recent travel. In contrast, Shigella cases peaked in males aged 30–39 with no travel history. Case notes for Hepatitis A notifications since January 2013 suggested fewer than five in MSM. Although this review suggested very few cases in recent years, outbreaks of Hepatitis A among MSM in London were documented in the late 1990s and in 2003. The second outbreak was associated with strains that caused concurrent outbreaks in MSM across Europe. Public health response to these outbreaks recommended health promotion and opportunistic immunisation.

Discussion

Hepatitis A outbreaks occur sporadically in a transnational population of MSM. Few cases may occur between outbreaks and preventative actions may be deprioritised. However, group immunity is likely to be highest after an outbreak and then wane in the absence of immunisation, increasing the risk of another outbreak. Health promotion and immunisation may be valuable outside of outbreak contexts.
O33 Significantly higher rates of chlamydia found in army personnel compared with non-military clinic attendees
Authors: Iveson Helen , Galbally Kate , Morris Georgina
Published: May 2024

Introduction

Our Sexual Health service covers a county-wide population, including large numbers of Army personnel. Despite military personnel being recognised as high risk for sexually-transmitted infections (STIs), accurate data on STI and HIV epidemiology within the military is lacking (1).The latter is compounded by difficulties differentiating military from civilian patients attending Sexual Health clinics. We introduced a local code (‘ARMY’) from April 2016. This has enabled us to monitor numbers of Army attendees and compare STI rates and risk factors with non-military patients.

Methods

Local ‘ARMY’ code added by clinicians at time of consultation, based on information including: patient self-reported occupation, garrison address, military uniform.

Electronic patient records for all male new or rebook attendees between 15/4/16 and 31/10/16 with an ‘ARMY’ code were reviewed (n = 234). These were compared with a non-military group of patients (n=234) attending during same time period and were matched for age group, gender, sexuality and presence/absence of symptoms.

Results

Army personnel were found to have significantly higher levels of chlamydia positivity (19.2%) compared with non-military attendees (11.1%) (p= 0.020, Fisher’s exact 2-tail). This higher rate of chlamydia was found despite comparable numbers of: sexual partners in prior three months, presentations as chlamydia contacts and high-risk alcohol users. Rates of gonorrhoea, warts, HSV, HIV and syphilis did not differ significantly. Army personnel were significantly more likely to be of non- white British ethnicity (11.1%) than non-military attendees (2.1%), reflecting local population (p =0.0001, Fisher’s exact 2-tail).

Discussion

Our findings support promotion of sexual health screening for military personnel and targeting of chlamydia testing. Military personnel often go home to other areas of UK and overseas during leave and could disseminate infections.
O34 Binge drinking, smoking and experience of intimate partner violence among women aged 16–44 years attending sexual health clinics
Authors: Edelman Natalie , Whetham Jennifer , Mercer Catherine , Cassell Jackie , Visser Richard de
Published: May 2024

Introduction

BASHH guidance includes assessment of smoking history, intimate partner violence and alcohol risk in Sexual Health (SH) clinics. As part of a study assessing psychosocial predictors of sexual risk among women of reproductive age, we investigated the prevalence of these issues and their associations with sexual risk.

Methods

A convenience sample of women aged 16–44 years attending a busy urban integrated Contraception and Sexual Health clinic was invited to complete a questionnaire about socio-demographic, sexual behaviour and psychosocial factors.

Results

Of n=532 eligible women 44.5% were aged 16–24 years. 42.1% of participants reported binge-drinking (6+ units on one occasion) on a weekly basis. 36.7% reported currently smoking cigarettes or roll-ups. Using an adapted HITS domestic violence (DV) measure, 16.1% were classified as currently or previously experiencing DV. None of these factors was associated with reported risk of unintended pregnancy in the last 6 months. Multiple partnerships in the last year was not associated with DV experience (p=0.187) but remained positively associated, after adjustment for age, with current weekly binge-drinking (adjusted odds ratio = 2.13) and with current smoking (AOR =1.87).

Discussion

Findings suggest that interventions for binge-drinking, cigarette smoking and DV may be warranted for a substantial minority of women attending SH clinics. In particular observed associations between binge-drinking, cigarette smoking and multiple partnerships may point towards broader lifestyle choices that could be addressed concomitantly in SH clinics to help reduce sexual risk behaviour.
O36 Management of acute epididymo-orchitis – supporting two services
Authors: Scrimgeour Gemma , Jackson Rachel , Drake Tamsin , Turner Kevin , Chapman Cordelia
Published: May 2024

Introduction

The mismanagement of acute epididymo-orchitis (EO) can have significant sequelae. Guidelines exist for the management of EO and we audited practice across two departments (Urology and Genito-Urinary Medicine [GUM]) within a District General Hospital.

Methods

Case notes of patients attending with acute EO between June 2015 – June 2016 were analysed retrospectively.

Results

152 men were seen; 85 by Urology, 67 by GUM. Mean age at presentation was 49 years (range 17–89). A full sexual history was documented in 15.3% of Urology patients, compared with 100% of those seen by GUM. Conversely, a full urological history was documented in 25.9% of Urology patients, compared with 2% of GUM patients. The differences in investigations requested are shown in Table 1.

Of the urine samples sent for culture by Urology, 36.4% were positive, and 50% had antibiotic resistance.

As well as failing to test for STIs, none of the patients seen by Urology were given advice regarding sexual abstinence and contact tracing. These recommendations were made by the GUM team in 93% and 88% cases, respectively.

In GUM 94% of patients were prescribed recommended first or second line antibiotic therapy, compared with 11% in Urology who had a wide variation of antibiotic use.

Abstract O36 Table 1

Urology v GUM

InvestigationUrology (%) of patients testedGUM (%) of patients testedUrine dipstick29.457.6Mid-stream urine51.828.4Chlamydia/gonorrhoea-NAAT0.097.0Test for urethritis0.036.0Inflammatory markers72.00.0Serology for Blood-borne viruses0.090.6

Discussion

All patients in this audit were treated by teams with expertise in the management of EO. Our data shows despite well published guidelines being available, investigation and management could be improved. A combined clinical pathway for patients with acute EO could facilitate inter-speciality working and improve patient outcomes.
O40 On becoming ‘normalised’: how are patients coping with the transformation of hiv into a ‘chronic disease like any other’?
Authors: Rai Tanvi , Bruton Jane , Day Sophie , Rowlands Jane , Higgs Chris , Ward Helen
Published: May 2024

Introduction

The widespread use of modern ARVs has increased self-management in HIV patients and reduced their contact with HIV services. We explored how patients adjusted to the changing model of care.

Methods

We conducted in-depth interviews with 52 adults from two HIV clinics. Participants were purposively sampled to achieve variation in: time since diagnosis and demographic characteristics. Data were examined using thematic analysis.

Results

Three-quarters of the sample were virally undetectable, financially stable and generally healthy, although some experienced psychological problems and/or other STIs including HCV. Having adjusted well to the medical regimen they tried to ‘normalise’ their life by a combination of: asserting control over their virus by staying informed about their immunological status and scientific developments; using ‘othering’ methods to assure themselves of the uniqueness of their situation; and keeping their seropositive status hidden from most others. Gay men felt keeping HIV secret was similar to keeping their gayness secret, and being virally undetectable gave some respondents medical legitimacy to not disclose even to sexual partners. By contrast, a quarter of the sample felt the need for frequent contact with the HIV clinic, either because of co-morbidities or other vulnerabilities. Half of this group reported relations with their clinicians suggesting emotional dependency.

Discussion

The chronic disease model of HIV management transforms HIV from a collective and political phenomenon into an individualised concern. While patients with complex needs continue to have frequent clinic contact, others isolate and conceal their HIV-positive identity to avoid experiencing stigma in their day-to-day lives.
UG3 Connect email – 8 years’ experience of an email clinic in an hiv outpatient setting
Authors: Beksinska Alicja , Nixon Eileen , Weir Gemma , Churchill Duncan , Whetham Jenny
Published: May 2024

Introduction

With advances in HIV therapy, many people are living longer healthier lives. Simultaneously our cohorts are ageing with 42% of individuals locally aged over 50. Our service looked for innovative ways of reducing visits for stable patients while increasing capacity to manage complex patients. In 2008 we introduced an email service whereby patients are seen once a year with interim results checked and emailed to them. We report on a review of the Connect email service.

Methods

Individuals who had ever registered with the email service and their current status were identified from our prospective clinical database. Reasons for ‘exiting’ or ‘pausing’ the service were identified by a case notes review. A service evaluation was carried out via staff and patient surveys.

Results

Since October 2008, 888 individuals have registered with our email service: 89.8% male (n=797); median age 48 (range 22–84). At the time of review (Oct 2016) 550 (550/2370 = 23% of total cohort) were under active email follow-up. In eight years, 171 (19.3%) have ‘exited’ the email service - reasons included: co-morbidities (46.2%); ARV switch/start (18.7%); patient choice (12.9%) and non-attendance/adherence (11.1%). A further 167(18.8%) has been ‘paused’, mainly due to co-morbidities (58.1%); ARV switch/start (20.4%) and research (16.2%). Non-attendance/adherence was more common in younger patients while co-morbidities predominated among older patients (aged >50). In the staff survey, barriers for enrolling patients on Connect included ‘difficulty letting go’ of regular appointments, email access and confidentiality concerns.

Discussion

As the email service is an integral part of HIV care in our unit, understanding why patients leave Connect and barriers to enrolment will enable continued effectiveness of the service.
P005 Quantifying the fitness benefits and cost of cefixime-resistance in neisseria gonorrhoeae
Authors: Whittles Lilith K , White Peter J , Didelot Xavier
Published: May 2024

Introduction

Gonorrhoea is among the most common bacterial sexually-transmitted infections in the UK, over 41,000 cases were recorded in 2015, with over half in men who have sex with men (MSM). As the bacterium has developed resistance to each first-line antibiotic in turn, we need improved quantification of fitness-benefits and costs of antibiotic resistance to inform control policy. Cefixime was recommended as a single-dose treatment for gonorrhoea from 2005–2010, during which time resistance increased, and then subsequently declined. We hypothesise that there is a net fitness-benefit to cefixime-resistance when cefixime is widely-prescribed and a net fitness-cost when cefixime-prescriptions decline.

Methods

We developed a stochastic compartmental model representing the natural history and transmission of cefixime-sensitive and -resistant strains of gonorrhoea in UK MSM, which was fitted to data on diagnoses and prescriptions over 2008-2015 using particle Markov Chain Monte Carlo (pMCMC) methods.

Results

The model replicated the observed data and indicated that the fitness-benefit of cefixime-resistance exceeds its cost when cefixime is prescribed for >31% (95% CI [26%, 36%]) of gonorrhoea diagnoses, and that the resistant strain is fitter than the cefixime-susceptible strain when cefixime is prescribed for >51% (95% CI [43%, 62%]) of diagnoses.

Discussion

The use of state-of-the-art pMCMC methods provided significant evidence in favour of our hypothesis and insights into the dynamics of cefixime-resistance in gonorrhoea. Our findings have important implications for antibiotic-stewardship and public health policies, such as targeted prescriptions and combination therapy; as well as emerging resistance through similar mechanisms to the current first-line treatment, ceftriaxone.
P006 Clinical evaluation of the resistanceplus™ mg kit, for detection of mycoplasma genitalium and screening for macrolide resistance
Authors: Erskine Simon , Tan Litty , Su Jenny , Murray Gerald , Bradshaw Catriona , Fairley Christopher , Garland Suzanne , Mokany Elisa , Tabrizi Sepehr
Published: May 2024

Introduction

European guidelines onMycoplasma genitalium(MG) infections and on the mangement of non-gonococcal urethritis strongly recommend NAAT testing for MG and screening for macrolide resistance. The ResistancePlus™ MG kit has been developed for the simultaneous detection of MG and five mutations in the 23S rRNA gene associated with azithromycin resistance.

Methods

The ResistancePlus™ MG kit (SpeeDx) was evaluated in a prospective-restrospective study on 182 urogenital samples from patients routinely tested for Chlamydia and gonorrhoea. The ResistancePlus™ MG (550) kit was performed using the 7500 Fast (Applied Biosystems), after sample extraction on the MagNA Pure 96 Instrument (Roche) using the DNA and Viral NA Small Volume Kit following the Universal Pathogen 200 protocol. Results were analysed using the FastFinder ResistancePlus™ MG (7500) analysis software. Results were compared with an in-house qPCR test for MG detection with positives subsequently sequenced to determine 23S rRNA mutation status.

Results

The ResistancePlus™ MG kit showed high clinical performance compared with the reference methods with sensitivity and specificity for MG detection of 98% and 100%, and 23S rRNA mutation detection of 92.5% and 100%, respectively. The ResistancePlus™ assay has an analytical sensitivity of 10-15 copies for all targets, and no cross-reactivity was seen in a wide range of non-target organisms.

Discussion

The ResistancePlus™ MG kit demonstrated excellent clinical performance for the simultaneous detection of MG and mutations associated with macrolide resistance. Detection of MG with resistance information is capable of guiding personalised treatment at the first health-care visit, reducing clinical-care costs and reducing the spread of antimicrobial resistance.
P010 Routine use of doxycycline for first-line chlamydia treatment: how hard can it be?
Authors: Joyce Megan , Worlock Lucy , White John
Published: May 2024

Introduction

BASHH guidelines advise either azithromycin 1g stat or doxycycline 100mg bd 7 days as first line treatment for uncomplicated Chlamydia infection. In practice, azithromycin 1g is favoured in many clinics due to perceptions of better adherence, tolerability and efficacy. Evidence has mounted of suboptimal efficacy of azithromycin, yet guidelines and practice remain unchanged. We routinely use doxycycline as first line treatment for Chlamydia infection. We sought to audit this practice, investigate rates of intolerance and adherence and explore treatment failure in those who had follow-up testing.

Methods

For all patients treated for Chlamydia during Jan–Mar 2016 we extracted clinical and treatment information from notes and follow-up phone calls. We collated results of patients who had a repeat Chlamydia test performed within 6 months after treatment.

Results

Data were available for 215 Chlamydia-positive patients: 82 heterosexual men, 66 MSM and 67 women; 96 were treated as symptomatic patients or Chlamydia contacts and 116 were recalled for treatment. Overall 92% were treated with doxycycline. From follow-up data only 3.0% reported failing to complete treatment, citing vomiting and forgetting to take tablets as reasons. 40% of patients had a repeat Chlamydia test within 6 months, with a 14% positivity rate. All such patients had either on-going sexual risk or evidence of failed PN.

Discussion

Discontinuation rates and evidence of persistent infection are low with routine use of doxycycline for Chlamydia. Clinics reluctant to make a switch to first-line doxycycline for Chlamydia and NGU might find these data useful.
P011 Treponema pallidum pcr (Tp-PCR) is a useful diagnostic test in addition to syphilis serological (STS) and dark ground microscopy in early diagnosis of primary syphilis
Authors: Scally Mark Daniel , Pinto-Sander Nicolas , Richardson Daniel
Published: May 2024

Introduction

There has been a significant increase in infectious syphilis in men who have sex with men (MSM) since 2000. We have been using a local Tp-PCR in conjunction with dark ground microscopy and serology in patients with genital ulcer disease to increase the sensitivity of primary syphilis diagnosis. The aim of this project was to evaluate the increased diagnostic yield that Tp-PCR offers our service.

Methods

We reviewed the microbiology (syphilis serology and Tp-PCR) of patients coded as primary syphilis between December 2015 and December 2016. We also collected demographic data on these cases.

Results

74 patients were accurately coded as having primary syphilis all of whom were MSM (24/74(32%)) HIV positive). STS was requested in 73 patients and 69/73(94.5%) tested positive. Tp-PCR was requested in 41 patients and 35/41(85.4%) tested positive. DGM was performed in 13 patients and 5/13(38.5%) tested positive. Both STS and Tp-PCR were requested in 40 patients: 30/40(75%) tested positive for both, 6/40(15%) tested positive only for STS and 4/40(10%) tested positive only for Tp-PCR (one had PCR which was negative). One patient had positive Tp-PCR but no STS result available.

Discussion

During a 12 month period 74 patients were diagnosed with primary syphilis. 40 had combined STS and Tp-PCR – within this cohort 10% (4/40) had confirmed primary syphilis due to Tp-PCR as STS was negative and DGM was either negative or not tested. The addition of Tp-PCR provided an opportunity for early confirmation of syphilis.
P013 The introduction of pharyngeal chlamydia and gonorrhoea sampling in a young persons’ clinic to assess for the possibility of pharyngeal only infection that would have otherwise been missed
Authors: Kelly Grainne , King Anne , Fitzroy Carla , Herraghty Fiona
Published: May 2024

Introduction

Prior to April 2016 the policy in the clinic was to ‘Consider taking a pharyngeal Chlamydia and Gonorrhoea swab in conjunction with exposure, history and symptoms’ in heterosexual males and females. However, in practice pharyngeal swabs were almost never taken from heterosexual patients and only routinely taken from men who have sex with men (MSM). Recent studies suggest that gonorrhoea and chlamydia infections are being missed by taking vulvovaginal and urethral samples only. Therefore, it was decided to take throat swabs for chlamydia and gonorrhoea from all patients aged 20 and under that attended the dedicated Young Persons’ Clinic for one year. The findings so far will be presented here.

Results

A total of 225 YPC attendees had a throat swab taken between April 2016 and February 2017. Twenty-five out of 225 patients (11%) were found to have pharyngeal chlamydia or gonorrhoea. Five patients had pharyngeal chlamydia and twenty had pharyngeal gonorrhoea. A significant number, fourteen of the twenty-five (56%), had pharyngeal chlamydia or gonorrhoeaonlywith no genital infection. Gonorrhoea was detected in twenty patients’ throats and chlamydia in five. Pharyngeal cultures were taken from eleven out of the twenty gonorrhoea patients, three of which were macrolide resistant and two macrolide intermediate.

Discussion

Prior to the study throat swabs were not routinely being taken from heterosexual patients. More than half of patients with pharyngeal infection had no genital infection and would not have received treatment under the current clinic guidelines. These are significant findings which may lead to a change in practice in the service.
P019 Are gps treating gonorrhoea appropriately?
Authors: Perera Sean , Gonah Tamuka , Dean Gillian
Published: May 2024

Introduction

Gonorrhoea continues to develop progressive antibiotic resistance. It is essential 1stline therapy is used wherever possible (intramuscular ceftriaxone with azithromycin 1g). GPs make an important contribution to gonorrhoea diagnosis and treatment (~5% of all diagnoses, of which ~40% are treated by GPs, 10% with recommended therapy).

Methods

To assess local practice, the department of microbiology provided a database of all the cases of gonorrhoea diagnosed across our city Jan 15–Dec16. We reviewed cases diagnosed in primary care.

Results

1.7% (34/1,956) of all gonorrhoea cases were diagnosed in primary care. Median age 32 (range 18-66); 18 male, 16 female. 88% (30/34) were registered with sexual health (SH); 19 (56%) had attended for the management of episode in question (two of these had prior treatment with azithromycin 1g, or azithromycin/cefixime). Of the remaining 15 cases:

Abstract P019 Table 1

Are GPs treating gonorrhoea appropriately?

1stline therapyTreated in primary care2Referred and treated in level 2 service2Non-1stline therapyOral cefixime 400 mg + azithromycin 1 g stat2Treated empirically at 1stvisit (azithromycin 1g); advised level 3 but DNA3Treated empirically at 1stvisit (doxycycline 1 week);advised level 3, DNA1Advised to attend level 2/3 services – no record/DNA32 no further information (1 surgery had closed)2

100% of patients not receiving 1stline therapy had ‘referral to SH advised’ documented in the notes.

Discussion

Knowledge of correct gonorrhoea management pathways was high. Oral cefixime/azithromycin is no longer recommended 1stline, however cure can be achieved at an individual level. It is likely some patients without record of attendance visited other services outside our area. The high number of female patients compared with our usual male to female ratio (10:1) raises doubts about false positive results in a low prevalence female population.
P022 Pharyngeal GC: maintaining standards in managing a silent infection
Authors: Decarli Jordan , Samuel Mannampallil , Brady Michael
Published: May 2024

Introduction

Our local area has the UK’s highest prevalence of gonorrhoea. Pharyngeal infection is commonly asymptomatic, thereby acting as a reservoir of undiagnosed infection. Development of antimicrobial resistance continues to be a challenge to preserving sensitivity to current first-line treatment. Aim: To assess the management of pharyngeal gonorrhoea at an inner city sexual health centre with reference to BASHH 2011 guidelines.

Methods

All cases of positive pharyngeal NAATs dating from 1stJuly 2014, to 1stAugust 2016, were identified from the clinical records portal and a case-note review completed.

Results

219 cases were included in the final data analysis - median age 33 (range 19–58). 131/219 (60%) lone pharyngeal gonorrhoea cases were identified. 194/219 (95%) were MSM. 89/131 (67%) pharyngeal cultures were obtained: (16%) positive forNeisseria gonorrhoea– 9/16 demonstrated some antimicrobial resistance. Only 8/131 (6%) had a sore throat documented at screening. 205/219 (94%) received treatments in clinic (14 patients lost to follow up). Of those treated 113/205 (55%) received a test of cure with 100% negative NAATs. All patients receiving 2ndline treatments were clinically justified. 1 patient was diagnosed HIV+ within 6 months of pharyngeal gonorrhoea treatment.

Discussion

The majority of infections were asymptomatic (94%) demonstrating validity of on-going triple site screening. The low sensitivity of positive pharyngealN.gonorrhoeacultures (16%) reinforces importance of pharyngeal NAATs for detection of infection and review of culture sampling techniques. A low rate of TOC reflected the difficulties in completing patient follow up seen in our clinic population
P040 Managing women requesting progestogen only implant in an integrated sexual health clinic
Authors: Dear William , Acharya Sashi , Arumainayagam Joseph , Ohizua Omi
Published: May 2024

Introduction

The progestogen only contraceptive implant is widely recognised as a reliable and cost-effective form of contraception. However, there is evidence to suggest that irregular or unpredictable bleeding is responsible for 60% of implant removals and another complication being that of deep implants. Continuous low-dose progestogen predisposes to breakthrough bleeding because uterine blood vessels proliferate and become disordered, with a ‘leaky’ basement membrane. The best approach is to provide oestrogen, usually in the form of the combined oral contraceptive pill (COC). We aimed to determine the proportion of women who have documented evidence of a palpable implant at the time of insertion and the proportion of eligible women with unscheduled bleeding offered the COC.

Methods

A retrospective case note review was performed on the electronic database for the period between 1 July 2016 and 31 January 2017. First 100 women who requested implant fitting and the first 100 women who requested implant removal due to unscheduled bleeding were recruited.

Results

Of the 100 women who had an implant fitted, 24% requested re-fitting. Palpable implants were documented in 76% of women. This was not documented in 24% of women, all of whom had another implant re-fitted. Of the eligible 100 women who requested removal for unscheduled bleeding and had no contra-indication for COC, only 49% had the offer of COC documented.

Discussion

This review has shown the need to improve documentation of implant palpation and to offer COC to eligible women which will reduce unnecessary early removals, thus ensuring cost-efficient provision of contraception. Other relevant demographic data will be presented.
P044 Contraception continuation rates in the under 18s
Authors: Lawton Katie , Malone Tessa
Published: May 2024

Introduction

England has one of the highest teenage pregnancy rates in Europe. Although there is a wide selection of available contraceptives, they must be used consistently and correctly to prevent pregnancy.

There is limited data on contraception continuation rates in teenagers in the UK.

This audit aims to establish baseline continuation rates of the contraceptive pill/injection in <18’s within a sexual health service.

Methods

A retrospective audit on all 305 <18’s started on the contraceptive pill/injection between Jan-March 2014. Continuation rates at 6 and 12 months were compared with the 2002 National Survey of Family Growth in the United States, standards cited by FSRH guidance.

Results

The continuation rates of the combined oral contraceptive pill (COC) at 6 and 12 months were 59% and 44.9% respectively, the progesterone only pill (POP) were 37.3% and 23.6% respectively and the injection were 60% and 22.9% respectively.

Discussion

The continuation rates were lower than the standard when compared with women of all ages. However, using age-adjusted rates, the COC continuation rate exceeded the standard by 3%, and the POP and injection rates were closer to the standard.

The COC had the highest continuation rate, suggesting the COC should be the method of choice in <18’s.

Continuation rates dropped off more sharply in the first 6 months, suggesting this is the crucial time to remind, educate and engage with teenagers.

Continuation rates were higher in the section of the service with a dedicated vulnerable young persons’ worker.
P046 3 cases of trichomonas vaginalis infection in pregnancy
Authors: Cheserem Emily , Conway Katie , Forrester Anne , Street Emma , Chaudhry Farah , Mammen-Tobin Amy
Published: May 2024

Introduction

Trichomonas vaginalis (TV) is not common in the UK, with under 7,000 cases in 2015. It is associated with poor pregnancy outcomes, and consensus on treatment pathways in persistent infection is needed. We present 3 cases of TV infection in pregnancy from 2 UK centres.

Methods

A retrospective review of electronic case records was performed.

Results

The median age was 21 years (range 20–31), with a median presentation at 13 weeks (range 7–22). Discharge was the main presenting symptom. Initial microscopy was performed in 2/3 and was positive; culture was positive in 3/3. All patients initially received oral Metronidazole 400mg twice daily for 5–7 days. At test of cure (TOC), one patient (Pt 1) remained positive, the second (Pt 2) did not attend, and the third (Pt 3) was negative. However, Pt 2 and Pt 3 re-presented after 5 weeks and 3 months, respectively: Pt 2 reported poor adherence; Pt 3 denied poor adherence or re-infection risk. All underwent further treatment. Pt 1 required 3 treatment courses before cure was achieved, with Metronidazole 800mg tds for 1 week. Pt 2 received 4 courses of oral or IV Metronidazole; she awaits TOC. Pt 3 received 5 different antibiotic courses, then opted to deliver and wean her baby before re-engaging with care. All denied re-infection risk after the second treatment.

Discussion

Factors that contribute to persistent TV infection in pregnancy include re-infection, poor adherence, resistance, poor engagement, and concerns about teratogenicity. Further research is needed to identify the optimal treatment strategy.