bluuebunny/crossref_metadata_2025_split huggingface dataset:
P180 Unusual causes of genital ulceration presenting to genitourinary medicine clinic – a case series
Authors: Kinghan Emma , Megarity Stephen , McCarty Emma 
Published: May 2024

IntroductionGenital ulceration presents frequently at GUM clinics, with herpes simplex (HSV) infection a common aetiology. A diagnosis of HSV is distressing with possible implications for relationships and future pregnancies. It is therefore important to consider other causes if atypical presentation or negative HSV PCR from area of active ulceration.MethodCase review of uncommon aetiologies of ulceration.ResultsCase 1: 25 year old. Prodromal sore throat and flu-like symptoms. Examination revealed deep ulcers on vulva and oral mucosa without eye or skin involvement. CRP 120, ESR 80, ASOT titre 400, negative autoimmune screen, monospot negative. Developed anterior uveitis and erythema nodosum 24 hours later. Diagnosed with Behcet’s disease requiring prednisolone and mycophenolate mofitil.Case 2: 28 year old. Prodromal sore throat and headache. Sexual history atypical for HSV. Known Graves’ disease, on propylthiouracil. On examination, patient looked unwell. Shallow vulval ulceration noted. Neutrophils 0.1, ESR 31. Diagnosed with apthous ulceration secondary to neutropenia and admitted for neutropenic-sepsis treatment. Required thyroidectomy with pathology revealing papillary carcinoma.Case 3: 13 year old referred by SARC. No history of sexual contact or features of child sexual exploitation. Prodromal flu-like illness. Of note, mother Influenza A positive.No response to empirical acyclovir. HSV PCR negative. Nasopharyngeal swab confirmed Influenza A. Case subsequently closed with SARC and Social Services.DiscussionThis case series highlights less common but important causes of genital ulceration. Full systemic history and clinical assessment remains essential in those where alternate diagnoses to HSV are being considered.
P191 Prevalence and impact of musculoskeletal pain among staff working in a large integrated sexual health service in uk
Authors: Malik Seema , Sundaram Sangeetha , Samraj Selvavelu , Turner Jill , Walker-Bone Karen 
Published: May 2024

IntroductionMusculoskeletal pain (MSKP) is common and contributes to sickness absence among people of working age. Little is known about the occurrence of MSKP in staff working in Sexual Health (SH).MethodsSH staff working in a large integrated service completed a questionnaire exploring MSKP at several different anatomical sites, its severity and impact on work and personal life.Results39/80 (49%) questionnaires were completed. One staff member reporting pre-existing MSK problems was excluded. 92% respondents were female. 61% of doctors and 85% of nurses reported MSKP. Low back (LB) pain was more common in nurses (76%) than doctors (27%). However, involvement of single or multiple sites and overall impact were comparable for both groups. Those with/without pain were not significantly different in terms of age, median time working in SH or types of routine procedures. The most common site of pain was LB (54%). Pain intensity was on average moderately severe during the day (29%) and more severe at night (46%). Moderate to fairly severe impact was reported for work/daily routine (34%), social activities/hobbies (29%), sleep (29%), fatigue/low energy (26%) and emotional wellbeing (23%).In terms of impact including seeking healthcare, using analgesia, missing work and interference with normal/recreational activities the most common sites implicated were LB, neck and hand pain in that order.DiscussionMSKP is very common among SH staff and causes significant impact professionally and personally. Reassuringly, symptoms were not markedly associated with any particular clinical procedure.
P192 Syndemics among gay, bisexual and other men who have sex with men in the united kingdom and the republic of ireland: empirical evidence of clustered health inequalities
Authors: McDaid Lisa , McAloney-Kocaman Kareena , Flowers Paul , Boydell Nicola , Coia Nicky , Kerr Yvonne , Frankis Jamie 
Published: May 2024

IntroductionGay men experience a multiple burden of ill health in relation to sexual health, mental health and substance use and there is growing recognition that these could cluster assyndemichealth inequalities. Few studies (outside the USA) have addressed the co-occurrence of such negative health outcomes. We examine empirical evidence of syndemic health outcomes in an online cross-sectional survey of MSM.MethodsSelf-report data on sexual, mental and physical health outcomes from the SMMASH2 survey of 3373 MSM in Scotland, England, Wales, Northern Ireland and the Republic of Ireland in 2016 were used to derive a measure of syndemic ill health.ResultsOverall, 68.2% reported at least one sexual health outcome, 60.4% reported at least one mental health outcome, and 61.0% reported at least one physical health outcome. There was significant co-occurrence of outcomes, with 67.0% reporting multiple health outcomes; 42.0% reporting two, and 27.0% reporting all three. There was statistically significant clustering of the behaviours at all levels. When examining all three outcomes concurrently, all were clustered with greater prevalence than expected if the outcomes where independent (O/E Ratio=1.07; 95% Confidence Interval 1.004 –1.14).DiscussionClustering of poor sexual, mental and physical health provides evidence of syndemic health inequalities in communities of gay, bisexual and other MSM surveyed online (at levels significantly higher than the nationally estimated prevalence of 8.4%). Current health improvement efforts are often characterised by disjointed services, which should be reconfigured to ensure a holistic approach to addressing the complex, multi-faceted, interrelated issues affecting these communities.
P194 Rolling out the uk’s first regional msm hpv vaccination programme: early evaluation and practical considerations
Authors: McIntyre Michelle , Quah Say , Wilson Yvonne , McCarty Emma , Dinsmore Wallace 
Published: May 2024

IntroductionThe four countries in the UK had different interpretations of the JCVI HPV vaccination recommendations. We aim to describe our experience to date of the full vaccination programme that commenced in our region in October 2016.MethodsWe conducted a retrospective review of our opportunistically-offered vaccination programme, using both electronic and paper records.ResultsFrom October 2016 until end January 2017, 827 vaccines were administered to 609 patients. The records of 274 vaccinees were analysed. 59% were HIV negative, 41% positive. 99% were MSM, aged 18 – 67, 12% were over 45, 43% were diagnosed with an STI or had PEP in the preceding 6 months, 74% had no documented history of genital warts. 11% attended solely for the HPV vaccine at their second visit. 91% of HIV positive patients re-attended for their second vaccine at their usual HIV clinic appointment. An estimated completion rate, calculated using those who re-attended as planned at one month and received a second vaccination, was 83%. For the HIV positive cohort, this was higher still at 95%.DiscussionWe found that opportunistically vaccinating this cohort resulted in only 11% of all second attendances being solely for a HPV vaccine, and only 6.5% in the HIV positive cohort. Our completion rate, calculated using data at one month, was high. We aim to present a full six months of data.
P200 Just google it! impact of media coverage of an outbreak of high-level azithromycin resistant gonorrhoea on attendances, and gonorrhoea testing and diagnoses at local sexual health clinics in england
Authors: Smolarchuk Christa , Furegato Martina , Mohammed Hamish , Town Katy , Fifer Helen , Wilson Janet , Nardone Anthony , Hughes Gwenda 
Published: May 2024

IntroductionWe investigated whether media coverage of an outbreak of high-level azithromycin resistant gonorrhoea in England, dubbed ‘super gonorrhoea’, affected online searches nationally, and attendances and gonorrhoea testing and diagnoses at sexual health clinics (SHCs) in affected areas.MethodsGoogle Trends was used to determine Relative Search Interest (RSI) for ‘gonorrh*’ and ‘super gonorrh*’ in England from 2015 – 2016. Using data from England’s national STI surveillance system, an interrupted time series analysis was performed to compare the sex-stratified, weekly rates of attendances, and gonorrhoea testing and diagnoses at 6 SHCs in Leeds and in five other affected areas. The analysis compared rates of events 6 weeks before and after initial media coverage of the outbreak in September 2015.ResultsThe RSI peaked during initial media coverage in September 2015 with smaller peaks coinciding with subsequent coverage. The number of SHC attendances by women in Leeds rose after initial coverage (p<0.01) by 36% (from 320 to 435/week), but there was only a 4% increase in attendances (from 326 to 340/week) by men (p=0.70). There was no change in rates of gonorrhoea tests or diagnoses in women (p=0.87 and 0.23) or men (p=0.51 and p=1.00). There were no significant increases in event rates in five other areas with a high RSI.DiscussionWe demonstrate that media coverage can impact health-seeking behaviours during high-profile outbreaks. Further research is needed to inform how best to target these messages to those most likely to benefit from attending and being tested in SHCs.
P202 Increase in diagnoses of early infectious syphilis: local outbreak or following the national trend?
Authors: Goode Deborah , Kennedy Sarah , Evans Amy , Talbot Angela , Page Emma , Cronin Mary , Hughes Gareth , Padfield Simon 
Published: May 2024

IntroductionThere has been a substantial increase in the incidence of early infectious syphilis (EIS) in our large city clinic, apparent since reconfiguration of services in July 2015.MethodsA retrospective case note review of electronic patient records was undertaken to investigate whether this was due to a local outbreak or in keeping with recent national trend. A database search for primary, secondary & early latent syphilis identified 78 and 116 cases in 2015 and 2016 respectively. These records were assessed using BASHH audit standards and reviewed for various lifestyle risk factors. We worked with Public Health England to address concerns regarding a possible local syphilis outbreak.ResultsOf 168 patients, 85% were MSM: 34% and 28% were HIV positive in 2015 and 2016 respectively. Of the patients with known HIV, 64% were diagnosed as part of their HIV care. Partner notification reached 0.56 contacts per index case. Of the 89 contacts, over 50% were positive for syphilis. Retrospective analysis of surveillance data identified a breakpoint in July 2014 associated with a monthly increase in cases since then with no observable change in patient demographics.DiscussionService reconfiguration focussed on MSM risk groups, coincided with increased EIS diagnoses within 1 year. However, epidemiological analyses indicate a continuum from 2014 following national trend. Routine syphilis screening in HIV care remains an essential tool for early case finding. As 80% were first syphilis infections we are evaluating syphilis point of care testing alongside capillary blood sampling to increase screening in outreach settings.
P205 The functionality of dating applications in sexual relationships and sexual health
Authors: Vojt Gabriele , Smith Matthew , Woode-Owusu Melvina , Mapp Fiona , Flowers Paul , Pothoulaki Maria , Estcourt Claudia , Palermo Amir , Valencia Mario , Ejedenawe Oluwatomilayo , Dankyi Stephanie , Attah Sally-Rae , Levy Noemie , Mercer Cath , Saunders John , Symonds Merle , Wayal Sonali 
Published: May 2024

IntroductionDating apps are an increasing way people meet each other for sex and relationships. Their functionality captures aspects of contemporary sexual culture and reflects the ways relationships are understood. This study systematically assed dating app functionality in relation to sexual relationships and sexual health.MethodsWe examined the top down-loaded 500 dating apps listed on a public platform of dating applications (App Annie). Following screening using inclusion and exclusion criteria, data were systematically extracted from included dating apps (n = 259). Data were collated regarding how the App functionality related to target population, and included links to sexual health interventions. We specifically coded how the Apps defined the kinds of relationship the app-user was in and the kind of relationship the app-user was looking for.ResultsForty percent of dating apps were designed for specific user populations defined by nationality, religion or sexual orientation and preference. Dating apps varied greatly in the ways their functionality reflected types of relationships (e.g, it’s complicated’, ‘something long term’, ‘friends with benefits’). Only a minority of dating apps (4.2%) provided a link to sexual health information, interventions or referral to clinical service options.DiscussionThis study can help clinicians to better understand the relationships people have, the words used to describe these relationships and the likely impact this has on sexual behaviours, onward transmission and potential partner notification interventions.
P207 Outbreak of hep a affecting msm: the london response
Authors: Mindlin Miranda , Crook Paul , King Michael , Chandra Nastassya , Maimo Mary , Gibson Kenny , Heffernan Catherine , Heathcock Simone Thorn 
Published: May 2024

Introduction:Outbreaks of hepatitis A virus (HAV) have previously been described in men who have sex with men (MSM). BASHH only recommends HAV vaccination for MSM during outbreaks. A UK cluster of HAV cases was identified and, by 27/2/2017, London had 45 probable and confirmed cases in MSM. London sexual health commissioning is in flux with new arrangements imminent.Methods:For individual notified cases, Health Protection Teams (HPT) routinely assess source, offer infection control advice to the case and organise vaccination of household and sexual contacts. A London outbreak control team (OCT) comprised epidemiologists, commissioners and providers of immunisation and sexual health services, health promotion partners and communications. The OCT scoped possible additional interventions to control the outbreak.Results:The OCT recommended: Awareness raising re risk behaviour:Distribute a nationally commissioned leaflet with safer sex advice to cases and to genitourinary medicine (GUM) clinics, plus relevant content on digital platforms.Liaison with providers, commissioners: Inform GPs. Survey current practice in GUM for HAV immunisation. Vaccinate MSM opportunistically in GUM clinics (if had a new or casual partner in last 3 months).Link with existing health promotion networks: Working with gay venues, to get understanding and cooperation.Set up vaccination clinics near the popular venuesDiscussion:It is challenging to set up an immunisation programme in a large city with complex commissioning relationships at short notice. Consideration should be given to vaccination between outbreaks to reduce the proportion susceptible, or ‘outbreak ready’ plans included in sexual health commissioning arrangements.
P214 The use of anabolic steroids in males attending a sexual health clinic
Authors: Horn Kate , Poore Sophie , Fernandes Arnold 
Published: May 2024

IntroductionA 2013 study by Public Health England stated ‘Men who inject anabolic steroids (AS) and tanning drugs are at higher risk of HIV and viral hepatitis’. Injectors of AS are now the biggest client group at many needle and syringe programmes in the UK. The British Crime Survey on AS use among 16–59 year olds in England and Wales found in 2009/2010 0.7% had ever used and 0.2% had used in the last year. There have been no studies looking specifically at prevalence in sexual health clinic attendees and we wondered whether this might represent a different population.MethodsAll male attendees to the sexual health clinic were invited to participate in the survey by self-completing an anonymous questionnaire about use of anabolic steroids, basic demographic details and details of known pre-existing blood borne virus infections.Results96 respondents. Age range: 3% <18, 55% 18–25, 42% >25. 82% self-identified as heterosexual. Only 1 patient admitted to having known HIV infection, none to hepatitis and 5 individuals opted not to answer this question. 4.1% admitted previous use of anabolic steroids. All were heterosexual, had injected and had used within the last year.DiscussionThe use of image and performance enhancing drugs has grown substantially, but the risk of exposure to blood borne viruses among those who inject drugs to change body appearance or improve performance has rarely been studied. Although small numbers, our survey identified higher than anticipated use of injected anabolic steroids in males attending our sexual health service.
P217 Syphilis on the rise – implementation of enhanced surveillance
Authors: West Daniel , Emmett Lynsey , Salimee Sultan , Reacher Mark 
Published: May 2024

IntroductionDiagnoses of infectious syphilis have risen dramatically in the UK since the late 1990s. This resurgence has been facilitated by a number of outbreaks across the UK, occurring mainly in men who have sex with men but also in heterosexual men and women.In response, a number of enhanced surveillance initiatives have been developed and implemented across England to collect timely demographic, clinical and risk factor information. These run alongside the routine surveillance system for sexually transmitted infections, the quarterly Genitourinary Medicine Clinic Activity Dataset (GUMCADv2). The system in the East of England is described here.MethodsUp to 2016 two paper based forms were utilised. A one page ‘surveillance’ form was completed for every case of infectious syphilis, and a more detailed ‘investigation’ form used if an unusual increase required investigation. During 2016 these two forms were merged and information is now entered into an online form. All forms are completed by the diagnosing clinic.Data collected is used to generate automatic reports, identify and investigate any unusual increases and for audits against GUMCADv2.ResultsEnhanced surveillance has allowed the identification of a number of unusual increases prompting timely and appropriate investigations to be launched; identified opportunities to improve reporting standards. The change to an online system has improved the timeliness and accuracy of reporting and made the system more secure.DiscussionOngoing enhanced surveillance complementing GUMCADv2 is important. This information provides timely intelligence on the epidemiology of infectious syphilis across the region.
O26 ‘It just gives you the heebie jeebies’: late middle-aged adults’ engagement with knowledge of sexually transmitted infections
Authors: Dalrymple Jenny , Booth Joanne , Flowers Paul , Hinchliff Sharron , Lorimer Karen 
Published: May 2024

IntroductionRates of sexually transmitted infections (STIs) among adults over 45 are rising in the UK and other Western countries. While STI rates are higher among men who have sex with men and young people, there is increased fluidity of sexual partnerships across the life course, exemplified by mid-life divorce and re-partnering, with sexual activity continuing beyond the age of 80. In order to develop a risk-reducing intervention for this age group, this qualitative study sought to understand the socio-cultural factors influencing late middle-aged adults’ knowledge of STIs.MethodsRecently sexually active heterosexual adults aged 45–65 (n=31) were recruited from a large city sexual health service and sport and leisure centres. In-depth individual interviews explored how STI-related knowledge was acquired across the life course. Interview data were transcribed and analysed thematically.ResultsMost participants (n=19) lived in areas of high deprivation and most were divorced, separated or bereaved from partners (n=24). Two key themes revealed that STI-related knowledge was acquired over the life course through personal social circumstances and wider cultural influences: 1) early stigmatisation of STIs influenced current understandings and 2) women in particular learned about STIs through parenting their adolescent children. Further themes showed that 3) knowledge of STIs was stated tentatively and 4) current STI knowledge did not necessarily facilitate health-seeking behaviour.DiscussionEngagement with STI-related knowledge among middle-aged adults is influenced by socio-cultural factors including the enduring stigmatisation of STIs. Interventions tackling stigma should aim to recognise and legitimate changing sexual partnerships across the life course.
P218 Safetxt: a randomised controlled trial of an intervention delivered by mobile phone messaging designed to reduce infection with chlamydia and gonorrhoea- recruitment methods
Authors: Free Caroline , Swinson Rebecca , Potter Kimberley , McCarthy Ona , Knight Rosemary , Baraitser Paula , Hickson Ford , French Rebecca , Michie Susan , Wellings Kaye , Palmer Melissa , Bailey Julia 
Published: May 2024

IntroductionTrial recruitment is one of the most important trial tasks as full recruitment provides trials with sufficient power to detect intervention effects. Yet, two thirds of randomised controlled trials fail to fully recruit. The NIHR safetxt trial is a single blind randomised controlled trial to evaluate the effect of a safer sex intervention delivered by text message on Chlamydia and Gonorrhoea infection at 12 months. 5000 people aged 16–24 are being recruited from UK GU and Sexual and Reproductive Health services. We describe the methods used to facilitate recruitment.MethodsMixed methods informed by evidence from behavioural science including: monitoring recruitment, feedback, rewards, identifying barriers to recruitment, shared learning between recruiting clinics and staff, development of materials to address barriers to recruitment and evaluation of materials developed.Results34 GU and Sexual and Reproductive Health Services across the UK are involved in the recruitment endeavour. A further 13 sites are due to start recruitment. Over 1100 participants have been recruited, ahead of current recruitment targets. Telephone and face-to-face meetings with staff in recruiting services generated ideas to increase recruitment, enabled services new to trial recruitment or research nurses new to Sexual Health to learn from experienced recruiters, facilitated mutual learning and resulted in the development of materials to support staff in recruitment.DiscussionThe safetxt trial is recruiting ahead of schedule. It will be a major achievement if the safetxt collaboration between GU and Sexual and Reproductive Health services and the trial management team recruit 5000 participants on time.