bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

IntroductionBASHH 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.MethodsA 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.ResultsOf 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).DiscussionFindings 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

IntroductionThe 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.MethodsCase notes of patients attending with acute EO between June 2015 – June 2016 were analysed retrospectively.Results152 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 1Urology v GUMInvestigationUrology (%) 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 viruses0.090.6DiscussionAll 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

IntroductionThe 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.MethodsWe 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.ResultsThree-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.DiscussionThe 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

IntroductionWith 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.MethodsIndividuals 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.ResultsSince 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.DiscussionAs 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

IntroductionGonorrhoea 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.MethodsWe 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.ResultsThe 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.DiscussionThe 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

IntroductionEuropean 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.MethodsThe 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.ResultsThe 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.DiscussionThe 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

IntroductionBASHH 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.MethodsFor 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.ResultsData 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.DiscussionDiscontinuation 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

IntroductionThere 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.MethodsWe 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.Results74 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.DiscussionDuring 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

IntroductionPrior 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.ResultsA 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.DiscussionPrior 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

IntroductionGonorrhoea 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).MethodsTo 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.Results1.7% (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 1Are 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)2100% of patients not receiving 1stline therapy had ‘referral to SH advised’ documented in the notes.DiscussionKnowledge 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

IntroductionOur 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.MethodsAll 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.Results219 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.DiscussionThe 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

IntroductionThe 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.MethodsA 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.ResultsOf 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.DiscussionThis 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.