bluuebunny/crossref_metadata_2025_split huggingface dataset:
O39 Improving the evidence-base to understand sti risk reduction capacity: the feasibility and acceptability of linking online behavioural survey data to genitourinary medicine clinic records
Authors: Blomquist Paula , Wayal Sonali , Mercer Catherine , Weatherburn Peter , Reid David , Hughes Gwenda 
Published: May 2024

IntroductionBehavioural surveys provide insight into the context associated with STI risk, but interpretation is hampered by using self-reported STI history. We aimed to determine the feasibility and acceptability of linking patients’ online survey data on STI risk factors with the national surveillance dataset on STI diagnoses (GUMCADv2).MethodsBetween May-September 2016, attendees at 16 GUM clinics across England were invited to complete an online survey on knowledge, attitudes, and behaviours around STI risk, using a clinic tablet or personal device. Clinic staff recorded respondents’ patient IDs, which we used to link surveys to GUMCADv2 (as well as age, gender, and clinic attendance date). We examined recruitment and linkage success and used Z-test for proportions to assess selection bias.Results6283 attendees agreed to participate, and 73.6% (4626) did so, with survey completion higher in those who completed the survey in clinic vs. those who did so at home (87.3% vs 16.8%). 95.9% (4437) of survey respondents were eligible, which was 59.2% of our recruitment target. 91.2% (4046/4437) of participants consented to data linkage, and of these 88.9% (3596) were linked to GUMCADv2. Consent did not differ by age or gender but was higher among MSM than heterosexual men (95.5% vs. 88.4%; p<0.01), and lower among black Caribbean than white participants (87.1% vs 93.8%; p<0.01).DiscussionOnline behavioural surveys distributed in GUM clinics with linkage to GUMCADv2 are both highly acceptable to attendees and technically feasible. Staff should encourage survey completion on clinic tablets to maximise recruitment and linkage success.
UG4 The predictive value of triage questionnaires in a sexual health clinic
Authors: Coles Rebecca , Hegazi Aseel , Prime Katia 
Published: May 2024

IntroductionTo assess the effectiveness of self-completed triage forms in eliciting symptomatic status and predicting subsequent diagnoses.MethodsConsecutive patients attending a GUM clinic 3/10/16–7/10/16. Data from self-completed patient triage forms were extracted and correlated with clinician findings documented in electronic patient records at the visit. Fisher’s Exact was used to calculate association.Results339 patients were included of whom 56.6% were female. Median age was 29 years (14–84) and 86.4% identified as heterosexual (n=293). 54.6% of patients (n=185) indicated symptoms on the triage forms c.f. 58.7% (n=199) documented as symptomatic by clinicians. Clinicians and patients agreed on symptomatic status in 85.3% (289/339) of cases. 57.7% (n=71) of symptomatic women reported lower abdominal pain (LAP), inter-menstrual/post-coital bleeding (IMB/PCB) or dyspareunia on triage forms which were subsequently documented by clinicians on 66.2% (41/71) of occasions. These symptoms were not significantly associated with a diagnosis of PID, or other infections, when documented by clinicians or patients (p<0.05). Patient and clinician documented ‘change in vaginal discharge’, ‘lumps on genitals’ and ‘genital blisters or sores’ were significantly associated with candidiasis and bacterial vaginosis (p<0.05), genital warts (p<0.05), and genital herpes (p<0.05) respectively. Patient and clinician reported dysuria was significantly associated with NSU in men and UTI in women (p<0.05).DiscussionThere was a high level of concordance between patients and clinicians regarding symptomatic status. Specific symptoms, when included in triage, are effective predictors of associated diagnoses with the exception of LAP, IMB/PCB and dyspareunia which appear to be non-specific.
UG6 A retrospective cohort study of treatment outcomes among HIV positive individuals with early syphilis at a single HIV clinic
Authors: Hobbs Emily , Lawrence David , Dean Gillian , Creswell Fiona 
Published: May 2024

IntroductionGuidelines for the treatment of early syphilis recommend benzathine penicillin G (BPG) for all patients regardless of HIV status. Concerns of HIV-positive patients developing asymptomatic neurosyphilis have prompted some to prescribe a neuropenetrative regimen of procaine penicillin (PP) with probenecid. There is heterogeneity in prescribing and the debate surrounding this issue is amplified by the global probenecid shortage. One centre in the UK has historically treated patients with PP regardless of syphilis stage. We compared serological response, adherence and tolerance among these patients compared with those receiving alternative regimens.MethodsA retrospective analysis of HIV positive individuals with early syphilis infection. Response to treatment was defined by ≥4-fold decline in VDRL titer within 13 months.Results197 patients were diagnosed with primary(24%), secondary(50%) or early- latent(26%) syphilis between 2012-2015. 102(52%) received PP, 26(13%) BPG, 38(19%) doxycycline for 28 days and 4(2%) amoxicillin plus probenecid. For 27(14%), treatment regimen was unknown. Of those who completed PP, 91% had serological response, BPG 65%, doxycycline 79%. Four patients on PP switched due to non-adherence. Of the PP patients median age 42, CD4 576 and 80% were on antiretroviral therapy. This did not differ greatly between those who achieved serological response and those who did not.Abstract UG6 Table 1Demographics and follow up of patients divided by treatment regimenPP (%)BPG (%)DOXY (%)AMOX+P (%)No. of patients started treatment102 (52)26 (13)38 (19)4 (2)No. of patients completed treatment94 (92)26 (100)34 (89)4 (100) Serological Response86 (91)17 (65)27 (79)3 (75) Serological Failure3 (3)1 (4)3 (8)1 (25) Lost to Follow up <13 months5 (5)8 (31)4 (11)0No. of patients did not complete treatment8 (8)04 (11)0 Serological Response7 (88)3 (75) Serological Failure1 (12)1 (25)Switched Treatment Regimen4 (4)01 (3)0 BPG1 (25)01 (100)0 Doxycycline3 (75)000 Serological Response4 (100)01 (100)0Age Median42443854 Range25–4629–6827–5840–63Syphilis Infection Primary24 (24)9 (35)7 (18)1 (25) Secondary47 (46)12 (46)25 (66)1 (25) Early Latent31 (30)5 (19)6 (6)2 (50)CD4 at Diagnosis Median576654534728 Range126–1223170–2384274–847404–1146On ART at Diagnosis Yes82 (80)21 (81)30 (80)4 (100) No20 (20)5 (19)8 (20)0PP=procaine penicillin plus oral probenecid; BPG= benzathine penicillin G; DOXY= doxycycline; AMOX+P= amoxicillin plus oral probenecid; HART=HIV antiretroviral therapyDiscussionWe demonstrate good adherence and tolerance of PP. There was a superior serological response to treatment in this group but a large loss to follow up among those treated with BPG. Further statistical analysis may identify factors associated with serological failure. Prospective studies exploring co-infection are required.
P008 A year of proctitis: aetiology and management in an urban gum clinic
Authors: Hanna Luke , Brusov Anton , Stockwell Sarah , Soni Suneeta , Richardson Daniel 
Published: May 2024

IntroductionChlamydia trachomatis (CT), including Lymphogranuloma venereum (LGV), Neisseria gonorrhoeae (NG), syphilis and herpes simplex (HSV) all cause proctitis in MSM. Local guidance recommends testing and treating for these organisms. We examined the aetiology and management of cases of proctitis at our sexual health clinics.MethodsClinical records were reviewed of all men coded for proctitis between January and December 2016. Clinical presentation, microbiology results, and treatments issued at initial clinic visit were recorded and data analysed.Results46 MSM were correctly coded as having proctitis. The median age was 38.5(19–75) years. 21/46(45.7%) were HIV-positive. Presenting symptoms included: rectal discomfort(69.6%), discharge(47.8%), bleeding(39.1%), altered bowel habit(23.9%), and tenesmus(17.4%). 7/46(15.2%) had anorectal ulceration.All patients were tested for CT and NG. NG was detected in 11/46(23.9%) and CT in 10/46(21.7%), including 4 with LGV. 27/46(58.7%) were tested for HSV, which was positive in 8/27(29.6%). 1 Mycoplasma genitalium and 4 Syphilis were diagnosed. Co-infections with >1 organism were identified in 8(17.4%). In 22/46(47.8%) no cause was identified. 41/46(89.1%) MSM received antibiotics for CT. In 30/46(65.2%) MSM this included anti-microbial cover for NG and 17/46(37.0%) had an extended course of doxycycline for LGV. Aciclovir was given to 12/46 MSM (26.1%).DiscussionNG was the commonest pathogen identified, however only 65% of MSM were treated. HSV testing rates were low despite one third of those tested being HSV positive. This indicates a need to better educate clinicians of the multi-pathogen, syndromic, approach to proctitis management to ensure that relevant pathogens are not missed.
P009 Risk of chlamydia/gonorrhoea naat contamination from clinic surfaces – need for patient and staff awareness in self-swabbing and pooling areas
Authors: Wallace Harriet , Daley Sharon , Loftus-Keeling Michelle , Wilson Janet 
Published: May 2024

IntroductionA self versus clinician Chlamydia/gonorrhoea (CT/NG) NAAT swab trial, with pooling of self-taken samples, recruited January 2015–September 2016. There was concern that nucleic acid contamination of clinic surfaces could be a source of false-positive samples during the pooling process.Aim(s)/objectivesTo ascertain levels of environmental nucleic acid contamination within clinic environments. To determine number of false positive pooled samples throughout study.MethodsEnvironmental samples of clinic rooms, sluices and toilets were performed and tested using Aptima Combo 2 throughout duration of study. In November 2015, the clinic relocated from old premises to a newly renovated site.Results were disseminated to staff throughout to raise awareness and to reduce risk of contamination during sampling/pooling. Posters in self-swab areas highlighted risk of contamination, importance of handwashing and no surface contact for swabs.ResultsOf 41 environmental sampling episodes over 12 months, 17 (41%) were CT/GC positive/indeterminate. These were distributed throughout the whole 12 months. Positive results were obtained from surfaces in all clinical examination rooms at the old site and toilets and sluices (where urines were pipetted) at both sites. 3/4 clinic rooms regularly used for examination at the new site remained contamination free. There were 7 false positive pooled samples (6 female, 1 male); all were in the first 6-months of the study.DiscussionNucleic acid contamination was repeatedly found throughout the clinic despite regular cleaning/decontamination. Raising staff and patient awareness did not reduce contamination but it did reduce false positive pooled samples, with none occurring after the first 6-months.
O06 Hepatitis c transmission in hiv negative men who have sex with men (msm) who do not inject drugs
Authors: Fitzpatrick Colin , Pinto-Sander Nicolas , Williams Deborah , Richardson Daniel 
Published: May 2024

IntroductionSince 2000 there has been an increase in reported acute hepatitis C in HIV infected men who have sex with men which is associated with injecting drug use (IDU), condomless anal sex, pre-exposure prophylaxis (PrEP) use and sexual practices including fisting. There have been very few reports of acute Hepatitis C in HIV negative MSM who do not inject drugs. Locally we have been screening all MSM and IDUs per year for Hepatitis C since 2005.MethodsWe looked at cases of hepatitis C diagnosed in our sexual health/HIV service per calendar year from 2012 – 2016 and looked at HIV status, injecting drug use and sexual behaviour.ResultsWe saw 37,012 attendances for sexually transmitted infection testing by MSM in the study period: There were 9 diagnoses of hepatitis C in HIV negative MSM in the study period. (2012:3, 2013:3, 2014:1, 2015:2, 2016:0). 5/9 HIV negative MSM diagnosed with hepatitis C gave a history of IDU. 4/9 HIV negative MSM diagnosed with (incident) Hepatitis C had no documented history of IDU, all had a recent history of condom-less anal sex at chem-sex parties; 2/4 had engaged in fisting and none were using PrEP at the time of diagnosis.DiscussionThere appears to be a very small amount of hepatitis C transmission in HIV negative MSM who do not inject drugs associated with condom-less anal sex at chem-sex parties and fisting. Screening for hepatitis C could be rationalised to these groups of MSM.
P017 Managing mycoplasma genitalium in clinic: don’t forget the partners
Authors: Cross Elizabeth , Ovens Katie , Reynolds-Wright John , Trotman Sarah , Soni Suneeta 
Published: May 2024

IntroductionThere is increasing UK interest in Mycoplasma genitalium(MG) testing of clinic attendees where indicated. Partner notification(PN) is a crucial part of STI management but as yet no national performance standards specific to MG have been defined.MethodsCase note review of all MG cases at our clinic from December 2015 to November 2016. Data collected on the four PN outcomes outlined in the 2012 BASHH statement on PN for STIs.Results114 cases were identified. Mean age 28.5, 82(71.9%) male of whom 36(43.9%) MSM. The proportion of cases with a PN discussion documented (83.3% [95% CI 75.2–89.6]) and the proportion of cases with an outcome of agreed contact action(s) documented (78.1% [95% CI 69.4–85.3]) were both lower than the national standard of 97.0% (p<0.0001).There were 0.22 (95% CI 0.17–0.28) contacts per index case whose attendance at a sexual health service for treatment was reported by the index case and 0.19 (95% CI 0.14–0.24) contacts per index case in which a healthcare worker verified treatment. Performance was lower than the national standard of 0.60(p<0.0001), and inferior to local chlamydial and gonorrhoeal PN data, 0.6 and 0.5 contacts per index case reported treated respectively. Performance across all PN outcomes was worse for men than for women.DiscussionPN for MG at our clinic falls below local and national standards for other STIs. Contributory factors may include poor documentation, absence of national guidance for MG PN performance standards and lack of patients’ appreciation of the importance of MG as an STI.
P018 Universal treatment – should we review?
Authors: Merali Shermin , Hourihan Martin , Higgins Sarah 
Published: May 2024

IntroductionGuidelines recommend epidemiological treatment of patients presenting as a contact of infection. This potentially reduces the prevalence of infection, reducing infectivity and reduces patient visits. Over prescription of antibiotics poses a threat of future resistance development and exposes the patient to unnecessary treatment. An audit was carried out to determine if any themes could be identified to indicate a likely positive result in contacts.MethodsWe audited asymptomatic contacts of chlamydia and gonorrhoea (PNC/PNG) attending GU services at BartsHealth (February 2016 for 3 months). Data on gender, sexual orientation, contacts (regular or casual), infection site, time since sex with contact, HIV status, STI in previous year were collected. Testing by Aptima NAATS for chlamydia/gonorrhoea and gonorrhoea culture.ResultsChlamydia75 asymptomatic contacts (55 male/20 female). All treated as contacts. 25 had a positive result (34%). No factors could be associated with predicting a positive result, except a suggestion that a regular partner v casual partner. Gonorrhoea: 85 asymptomatic contacts (76 male/9 female). All treated as contacts. 27 had a positive result (32%). Being male >24years old/MSM/>5 partners (in 3m) and contact being a regular partner were suggestive of predicting a positive result.DiscussionThe audit reinforces epidemiological treatment. Drawbacks of not treating include failure to return, onward STI transmission and inconvenience of re-attending. However, over 60% had potentially unnecessary treatment and with rapid turnaround of results (<2d), future universal treatment may need to be revised.
P026 Neisseria gonorrhoeae (GC): changing pattern of antibiotic sensitivity and persistence of DNA detection 2007 – 2016
Authors: Young Sarah , Bopitiya Shyamalie , Allan Sris 
Published: May 2024

IntroductionNucleic acid amplification testing (NAAT) is used in GUM clinics to diagnose GC infection; however its in-built sensitivity potentially detects DNA from non-viable organisms following successful treatment. BASHH guidelines stipulate that test of cure with NAAT (TOC) should take place 2 weeks post-treatment.This study aims to determine whether this is an adequate time interval to perform TOC. We also analysed the changing pattern of antibiotic sensitivity between 2007 – 2016.MethodsAll GC cases at our clinic between 01/01 and 30/06 in 2007–2016 were identified, assessed for antibiotic sensitivity and analysed for TOC data from 2013–2016.ResultsOf 131 cases in 2016, culture and sensitivities were available for 80, with TOC in 63.Abstract P026 Table 1Susceptibility to Antibiotic groups2007 (%)2009 (%)2011 (%)2012 (%)2013 (%)2014 (%)2015 (%)2016 (%)Fully sensitive to antibiotic testing panel4667594979594355Reduced susceptibility to 12715203810202323Reduced susceptibility to 215101686132115Reduced susceptibility to 3122532856Reduced susceptibility to 41TOC was performed between 6 and 77 days post-treatment with mean, median and mode of 18, 14 and 14 days respectively.DiscussionNo cultures were resistant to ceftriaxone. This is the first year a case has shown reduced susceptibility to 4 antibiotic groups. From 2015-2016 there has been an increase in GC fully sensitive to the antibiotic testing panel.Our data supports BASSH guidelines for TOC 2 weeks post-treatment.
P031 Epidemiological study on syphilis diagnoses at a local genitourinary clinic (guc)
Authors: Padovese Valeska , Gamoudi Donia , Farrugia Alexandra Gauci , Muscat Katya , Abela Maria , Carabot Philip , Scerri Lawrence 
Published: May 2024

IntroductionIn 2015 our country reported 11.5 confirmed syphilis cases per 100 000 population, which is one of the highest rates in Europe. The objective of our study was to analyse the epidemiological characteristics of patients diagnosed with syphilis.MethodsA retrospective analysis of medical records of patients attending the local GUC with a diagnosis of syphilis from 2002–2015 was carried out. Data concerning patient demographics (age, gender and sexual orientation), year of diagnosis, syphilis stage, treatment regime, HIV/STIs co-infections, partner notification and follow up were recorded.Data collected was inputted in an excel database.ResultsIn the study period a total of 291 patients were diagnosed with syphilis. 82.6% were males (n=238); 48.6%( n=143) were MSM and 5.2% (n=5) bisexual men. Syphilis was diagnosed in the primary stage in 11.3% of patients, secondary in 9.6%, early latent in 30.9% and late latent in 47.4%. All patients with syphilis were tested for HIV and 16.1% (n=147) resulted HIV positive, 74.5% of them (n=35) were MSM. Partner notification was not possible and/or not reported in 40.5% (n=118) of patients. In 21% (n=61) of cases, it was not possible to establish whether the treatment was successful because these were lost to follow up.DiscussionAs the syphilis rates continue to rise so rapidly, it is very important to have robust mechanisms in place to limit spread such as proactive recall for treatment and follow up and education and support regarding safer sexual practices.
P034 Association of mycoplasma genitalium and persistent abdominal pain- what srh doctors undertaking ultrasound need to know?
Authors: Aziz Najia 
Published: May 2024

IntroductionThe 2016 European guideline on Mycoplasma Genitalium (MG) states that significant association is found between MG and pelvic inflammatory disease (PID). MG is diagnosed through nucleic acid amplification testing. The aim of this study was to find out about the importance of testing for MG in patients with persistent abdominal pain.MethodsIt was a retrospective analysis of patients who were tested for MG in Sexual and Reproductive healthcare (SRH) consultant ultrasound clinic over a period of 17 months. The inclusion criterion for testing was persistent symptoms after PID treatment.Results9 patients were tested for MG in consultant led SRH ultrasound clinic. All were initially treated by other clinicians for PID with standard treatment but did not respond and were referred to SRH ultrasound clinic to exclude other pathology. Ultrasound for all of the patients was normal with no adnexal masses or free fluid. Pregnancy test was done in all cases and it was negative; all patients were also negative for chlamydia and Gonorrhoea. MG testing was done in all 9 cases and 2 came back positive (22%). Both were treated with Moxifloxacin 400mg OD for 10 days.DiscussionThis small study shows that there can be an association between persistent abdominal pain and MG. SRH doctors who are undertaking ultrasound on a routine basis should consider possibility of MG testing in patients with persistent abdominal pain. More research is needed in this area to establish a routine testing for MG in a patient with abdominal pain.
P035 Quick starting hormonal contraception after using oral emergency contraception: a systematic review
Authors: Murphy Lauren , Chen Zhong , Warner Valerie , Cameron Sharon 
Published: May 2024

IntroductionUnprotected intercourse after oral emergency contraception (EC) significantly increases pregnancy risk. This underlies the importance of promptly starting effective, ongoing contraception – known as ‘quick starting.’ However, theoretical concern exists that quick starting might interact with EC or hormonal contraception (HC) potentially causing adverse side effects.MethodsA systematic review was conducted, evaluating quick starting HC after oral EC (levonorgestrel 1.5mg [LNG] or ulipristal acetate 30mg [UPA]). PubMed, EMBASE, The Cochrane Library, ICTRP, ClinicalTrials.gov and relevant reference lists were searched in February 2016. A lack of comparable studies prevented meta-analysis.ResultsThree randomised controlled trials were identified. Two biomedical studies suggested HC action was unaffected by quick starting after UPA; one study examined ovarian quiescence (OR: 1.27; 95% CI 0.51 to 3.18) while taking combined oral contraception (COC). Another assessed cervical mucus impenetrability (OR: 0.76; 95% CI 0.27 to 2.13) while taking progestogen-only pills (POP). Quick starting POP reduced the ability of UPA to delay ovulation (OR: 0.04; 95% CI 0.01 to 0.37). Side effects (OR: 1.22; 95% CI 0.48 to 3.12) and unscheduled bleeding (OR: 0.53; 95% CI 0.16 to 1.81) were unaffected by quick starting COC after UPA. Another study reported higher self-reported contraceptive use at eight weeks among women quick starting POP after LNG, compared with women given LNG alone (OR: 6.73; 95% CI 2.14 to 21.20).DiscussionLimited evidence suggests quick starting HC after UPA does not reduce HC efficacy, however it reduces UPA efficacy. Consequently, women should delay starting HC after UPA.