bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4 Are routine chest x-rays necessary in asymptomatic patients newly diagnosed with HIV?
Authors: Cheshire M L , Babu C 
Published: May 2012

BackgroundThis audit looked at the use of chest-x-rays (CXRs) in newly diagnosed HIV patients at an inner-city GUM clinic. The Departmental guidelines recommended that all newly diagnosed HIV patients had a baseline CXR. The 2011 British HIV Association guidelines (which were under consultation at the time of the audit) proposed that CXRs should only be done in patients with current or previous chest disease, high-risk for TB or in intravenous drug users.AimsThe aims of this audit were twofold, first to confirm whether all newly diagnosed patients had a CXR as per departmental guidelines, and second to review the results of the CXR in order to see whether, if any, factors predicted abnormal results.MethodsThe audit considered all newly diagnosed HIV patients from 1 April 2009–31 March 2011. Data including demographic details, past medical history, health on diagnosis and details of the CXR (if performed) were collected from electronic HIV summaries and radiology records. Statistical analysis was performed using SPSS.ResultsA total of 196 patients were identified, 69% of whom had had a CXR. In those who had a CXR and in whom results were available (n=132), 92% had a normal CXR and 8% abnormal. Significant predictors of abnormal CXRs included chest symptoms at diagnosis (p<0.001) and a CD4 count <200 (p=0.001). There was no significant link with the patients' country of origin but there was a pattern of association which was clinically relevant.ConclusionsIn this audit all CXRs in asymptomatic patients newly diagnosed with HIV were normal. No latent chest disease was identified as a result of routine asymptomatic screening with CXRs and the practice is not justified. Following this audit clinic guidelines have been appropriately amended in keeping with current British HIV Association guidelines with the additional criteria for performing CXRs in patients presenting with CD4 <200.
P40 Losing the battle? Time to focus the risk discussion with HIV-positive MSM
Authors: Perera S , McCormack S , Nwokolo N 
Published: May 2012

BackgroundBHIVA 2008 Guidelines advocate development of prevention messages promoting sexual health of HIV-positive individuals to minimise onward transmission and acquisition of infections prevalent in such individuals, for example HCV and LGV.ObjectivesTo assess the extent of unprotected anal intercourse (UAI) in an HIV-positive population attending a London sexual health clinic. To assess transmission and acquisition risks. To describe the nature of sexual health discussions with health care providers.Methods50 randomly selected notes of HIV-positive patients were reviewed. Data were collected on demographics, ART, viral load (VL), sexual partners and topics discussed.Results66% were from the UK and 74% were >30. 47 (94%) were MSM/Bisexual; 2 (4%) heterosexual females; for 1 (2%) male IVDU, orientation, partners and discussion were not documented. In 8/47 MSM it was unclear if AI had occurred; 1/47 reported AI but condom use was not documented. In 38 sufficiently complete records, all reported AI: 7 (18%) protected AI only, 12 (32%) UAI with positive partners only; 19 (50%) reported UAI with positive and negative partners, although 9/19 (47%) had VL <500. 7/10 MSM reporting UAI who had VL >500 used recreational drugs although only one reported doing so during sex. Discussion was not documented in 17 (34%) notes, and in 12 focus was only on transmission. 19 topics were discussed with no consistency but could be classified as transmission or acquisition related. Transmission risks were discussed in 15 (79%) of the 19 reporting UAI with negative partners; acquisition risks were discussed in 17 (55%) of 31 at risk.ConclusionsAlthough UAI was reported by the majority of MSM, only 10 reported a clinically relevant risk of transmitting HIV, but the majority were at risk of acquiring HCV/LGV. The diversity in topics noted as discussed suggests that simpler, more focused messages of risk reduction would be helpful to sexual health service users and providers.
P41 Women's health study ofMycoplasma genitalium: a feasibility study
Authors: Dave S , Kerry S R , Oakeshott P , McGregor F , Cannon E , Stephenson J M 
Published: May 2012

BackgroundThe role ofMycoplasma genitalium(∼3% prevalence in women) in PID is unclear. An opportunity exists to study its natural history since there are no UK treatment guidelines. We conducted a feasibility study.ObjectivesIn women attending GUM clinics to determine: (1) recruitment and follow-up rates after 3 and 6 months, (2) feasibility of obtaining NHS numbers, (3) facilitators and barriers to follow-up.MethodsWomen aged 16–24 years recruited from two GUM clinics completed a questionnaire and provided two self-taken vaginal samples. One sample was tested for chlamydia. We are testing forM genitaliumand conducting 3-month follow-up.ResultsRecruitment rate was 67% (199/296). Non-responders were similar in age to responders (20.6 SD 2.5 vs 20.7 SD 2.5 years) but more likely to come from ethnic minority groups: 56% (37/66) vs 36% (71/195), p<0.05. Among responders, mean sexual debut age was 16.3 years (range 12–23 n=198); 59% (116/195) reported ≥2 sexual partners and 17% (31/186) consistently used condoms in the preceding 12 months. 8.2% (16/197) had chlamydia and 0.5% (1/197) gonorrhoea on testing. At recruitment 196 participants consented to NHS numbers being obtained and used to access medical records; 197 participants agreed to 3-month follow-up. We have been able to contact ∼50% of participants for follow-up.DiscussionMost women consented to NHS number and medical record access. This is important for investigating long-term sequelae of STIs. Fewer women took part in follow-up than agreed at recruitment. It is important to understand the reasons for this.
P44 An evaluation of gonococcal testing using a roche cobas PCR platform in a low prevalence area
Authors: Bhaduri S , Spice W 
Published: May 2012

BackgroundThe countywide sexual health service have recently adopted the roche cobas dual PCR for gonorrhoea testing. The locality has a low prevalence of gonorrhoea compared to national rates.AimsTo assess the performance of the gonococcal (GC) nucleic acid amplification tests (NAAT) against culture and to advise all areas of sexual health.MethodsFemale endocervical, vulvovaginal and urine samples were taken for culture and NAAT. Male urethral swabs for culture were taken in parallel with urine samples for NAAT. Throat and rectal samples were also taken.Results309 cervical samples for culture, 289 cervical samples for NAAT. 97 vulvovaginal swabs and 93 female urine samples were taken. In males, 246 urethral culture samples and 251 urine samples were taken. 45 throat swabs and 29 rectal samples were taken. In females there was concordance in all results except for 1 throat swab (culture positive, NAAT negative) In males, there was concordance in all results except for two samples (urine NAAT positive, urethral culture negative). Two rectal samples were NAAT positive but culture negative—both were from men having sex with men (MSM) and were gonorrhoea contacts. Six throat samples were positive in NAAT but culture negative—(all MSM), 1 was a contact. 3 were sent for further testing using a different NAAT (aptima combo 2—all these assays were negative).ConclusionNAAT testing was recommended at all sites except for throat swabs given the lower specificity at this site (88%) in males. The study confirms the need to evaluate GC NAAT testing sampling in low prevalence areas but differs from other studies as regards testing from throat samples.
P45 The effect onNeisseria gonorrhoeaescreening rates in an integrated clinic following the introduction of dual nucleic acid amplification tests
Authors: Pease E , Kirkwood D , Dawson S , Desmond N , Mcintyre M , Ashby J 
Published: May 2012

BackgroundNucleic acid amplification tests (NAATs) to detectNeisseria gonorrhoeae(GC), allow less invasive sampling and are more sensitive than culture. Aptima combo 2 (AC2) has a high specificity but positive predictive value can be low in low prevalence populations. GC diagnoses may be lower in an integrated family planning (FP) and genitourinary (GU) clinic compared to those primarily providing GU care.AimTo investigate whether the introduction of GC NAATS into an integrated clinic has increased rates of GC screening and detection.MethodsAll patients having a GC screen 4 months prior to and following NAATS introduction were identified by laboratory databases. Notes were reviewed for those diagnosed with GC. Information regarding patient demographics, symptoms and risks were gathered (see abstract P45 table 1).Abstract P45 Table 1Patient demographics pre and post NAATs introductionPre-NAATS (n)Post-NAATS (n)No. of patients attending (re-attendees not included)92969917No. of GC screens carried out (% screened of those attending)2307 (25)3444 (35)No. of positive GC tests (%)20 (0.87)43 (1.25)Age (years) (%) <3012 (60)23 (53) 31–405 (25)9 (21) >413 (15)11 (26)Sex (%) Male11 (55)30 (70) Female9 (45)13 (30)RACE (%) White European11 (55)32 (74) Black (UK)1 (5)1 (2) Black African3 (15)1 (2) Black Carribean2 (10)4 (9)Asian other3 (15)5 (12) Men who have sex with men (MSM) (% of men)5 (45)11 (37) Symptoms signs of GC (%)13 (65)25 (58)ResultsPre-NAATS: 2307 symptomatic and asymptomatic patients were screened with GC culture of which 20 (0.87%) were positive. Post-NAATS: 3444 symptomatic and asymptomatic patients were screened with AC2 of which 43 (1.25%) were confirmed positive for GC. 217 of the symptomatic patients were also cultured and 18 (8.3%) were positive. Of the 43 positive NAATS tests, 20 patients were also culture positive; 10 were culture negative, 1 grewNeisseria meningitidis(isolated in the throat) and 12 had no culture taken. All of the NAATs positive, culture negative individuals had symptoms, signs or high risks for GC. All patients with positive cultures were NAATS positive.ConclusionsFollowing the introduction of NAATS, the proportion of patients attending clinic who were screened for GC significantly increased and the number of GC diagnoses doubled. This may be due to better acceptability and uptake of screening, including those attending for FP care. NAATs identified more cases of GC than culture alone. There was only one case of a possible false positive. This provides reassuring data to support use of NAATS in this setting.
P48 Yearly trends for the internet recruitment program, http://www.iwantthekit.org—what happened to the STI prevalence?
Authors: Gaydos C , Barnes M , Hsieh Y H , Jett-Goheen M , Quinn N , Whittle P , Hogan T 
Published: May 2012

BackgroundThe iwantthekit (IWTK) internet recruitment screening program began in 2004 and offered an opportunity to determine trends in prevalence for women and men were screened for STIs.ObjectivesTo determine significance in trends for STIs for the population accessing screening over time.MethodsParticipants were recruited via the internet to request home collection kits and to collect either vaginal or penile swabs at home with subsequent mailing to a laboratory for screening for chlamydia (CT), gonorrhoea (GC), and trichomonas (TV) by NAATs. Prevalence for women and men were calculated by year and race for 2004–2011 for each organism. Linear regression analysis was performed to determine significance of temporal trends in gender-, STI-specific prevalence controlling for annual demographic composition of participants.Results3363 women were screened for CT and GC from 2004 to 2011; TV screening was added in 2006 (N=2692). From 2006 to 2011, 1370 men were screened for CT, GC, and TV. Prevalence varied: CT: 5.5%–10.6%; GC: 0.3%–2.7%; TV: 5.8%–13.3% for females and CT: 8.0%–15.4%; GC: 0.7%–1.9%; TV: 0.8%–12.4% for males. Most users were from Maryland (70.1%). The only statistically significant linear downtrend by year was CT prevalence in male participants <25 yr from 23.1% in 2007 to 12.5% in 2011, which was 2.4%/yr (p=0.012); while the prevalence in male ¡Ý25 years remained relatively stable from 6.2% in 2007 to 5.5% in 2011 (p=0.911). The remainder of STI prevalences in females and males did not show a downward linear trend by calendar year. GC prevalence in females was significantly correlated with the per cent of Black participants (p=0.030), while TV prevalence in females was positively associated with the number of participants <25 yr (p=0.032).ConclusionsIWTK attracted participants with high-risk sexual behaviours to use home collection for STI testing. Prevalence by year and by organism, for the most part, did not show a significant downward trend.
P52 New treatment guideline ofNeisseria gonorrhoeaeand test of cure: how feasible is it?
Authors: Rodgers S , Murgartroyd M , Perez K , Kingston M , Lee V 
Published: May 2012

BackgroundTreatment failure with oral cephalosporins in gonorrhoea caused by multidrug resistance has been reported. The national guidelines were updated in 2011 due to reduced sensitivity to antimicrobials. Test of cure (TOC) is recommended in all cases. However data regarding timing of TOC is limited.AimsTo assess (1) the feasibility of implementing new treatment regimen and (2) the optimal time to perform TOC.MethodRetrospective case note review of patients diagnosed with gonorrhoea in a GUM clinic between 1 June 2011 and 30 November 2011 was carried out. Data including demographics, HIV status, sites of infection, treatment and TOC were analysed.Results271 (242M, 29F) patients were included. 202 were men who have sex with men (MSM) of which 24% were HIV positive. In MSM group, 87 were urine TMA positive (95% had cultures performed), 115 positive pharyngeal TMA (97% with cultures done), 115 positive rectal TMA (96% had cultures done). 39 heterosexual males had positive urine TMA (94% with cultures done). 18 (62%) females had positive cervical TMA, all with culture performed. 12 (41%) pharyngeal, 5 (17%) vulvo-vaginal and 3 (10%) rectal were TMA positive; 58%, 60%, and 33% of these had cultures performed respectively. First-line treatment was given in 96% of cases. Second line treatments were given mostly due to penicillin allergy. TOC was attended by 55% of patients. 67% of TOC were done within 20 days of treatment. Three of these were positive, 2 within 20 days and one at 57 days post treatment which was a re-infection.ConclusionsNew treatment of gonorrhoea is generally accepted by patients. 4% received alternative treatments, which were valid and documented. The majority of patients (74%) had culture performed prior to treatment. TOC uptake was low (55%). However the majority were performed within 20 days of treatment. Follow-up strategies must remain a priority to increase rates of TOC. Further studies are required to determine optimum time for TOC.
P55 Evaluation of NAAT and POCT for detectingTrichomonas vaginalisinfection in women at a London sexual health clinic
Authors: Nathan B , Heron D , Appiah J , Saunders P , Brum R , Nichols T , Alexander S , Baraister P , Ison C 
Published: May 2012

BackgroundTV is a common infection in our clinic, but the true prevalence is likely to be higher since microscopy-the current diagnostic test has a low sensitivity. Nucleic Acid Amplification (NAAT) and Point of Care Tests (POCT) are commercially available and are reported to have much higher sensitivities. To our knowledge this is the first study to evaluate four different tests for TV in a London Clinic.AimTo evaluate the clinical utility of NAAT and POCT compared to microscopy and culture.MethodsAll symptomatic women who presented to the clinic on Monday and Tuesday from September 2011 were invited to participate in the study. Swabs for a validated in-house NAAT, POCT (OSOM Genzyme Diagnostics) and culture usingTV In-pouchculture system were taken. Technicians processing the POCT, NAAT and cultures were blinded to all other results.ResultsA total of 247 symptomatic women were recruited over a 6-month period. 21 (8.5%) tested positive on culture, 22 (9%) on POCT and NAAT, 9 (3.6%) on microscopy. Using culture as the reference standard the sensitivities/specificities were: POCT 100% [95% CI 84 to 100]/99.6% [95% CI 97.5 to 99.9], NAAT 95.2% [95% CI 76 to 99.9]/99.1% [95% CI 96.8 to 99.9], microscopy 42.9% [95% CI 22 to 56]/100% [95% CI 98.4 to 100] and prevalence 8.5% [95% CI 5.4 to 12.8]. Using NAAT as the reference standard the sensitivities were: culture 90.9% [95% CI 71 to 98.9], POCT 95.5% [95% CI 77 to 99.9], microscopy 36.4% [95% CI 17 to 59] and prevalence 8.9% [95% CI 5.7 to 13.2].ConclusionsThe sensitivity of POCT and NAAT were as anticipated much greater than microscopy alone, resulting in a prevalence over double than previously estimated. Molecular methods for detecting TV infection in this population would diagnose a significantly greater number of women with TV. Clinics with high rates of TV may benefit from using POCT with the advantage of a rapid turn-around result over NAAT.
P58 Nuclei acid amplification tests (NAAT) forTrichomonas vaginalis: should they change who we screen for infection
Authors: Ng A , Ross J 
Published: May 2012

BackgroundUK national guidelines recommend screening forTrichomonas vaginalis(TV) in symptomatic women and men with persistent urethritis using culture +/− wet mount microscopy. Screening of asymptomatic patients is not recommended due to the low prevalence of infection and low sensitivity of available tests. TV NAAT has been shown to have high sensitivity (96.7%) and specificity (97.5%) with the potential to increase the detection rate of TV infections.ObjectivesTo determine an accurate prevalence of TV infection in a UK STI clinic using the TV NAAT and to characterise the risk factors associated with TV infection to inform an appropriate screening strategy.MethodOver a 6-week period, unselected patients presenting to the UK STI clinic with a new clinical episode were offered a TV NAAT test (Gen Probe transcription-mediated amplification) as part of their sexual health screen. A vaginal swab was taken from women, and men provided either a urethral swab or urine sample. Information on demographics and clinical presentation was collected on a paper proforma. All data analysis was performed using SPSS V.19.Results3546 patients were seen in the study period of whom 98.8% provided a sample for TV NAAT testing. The prevalence of TV infection was 21/1483, 1.4% (95% CI 0.9% to 2.2%) in male patients and 72/2020, 3.6% (95% CI 2.8% to 4.5%) in female patients. The rate of TV positivity was higher in Black Caribbean patients compared to Caucasian patients in both men (5.4% vs 0.1%, p<0.001) and women (9.0% vs 1.2%, p<0.001). There was no significant difference in TV positivity across the age groups. In comparison to culture, TV NAAT detected an additional 24% of infections in symptomatic women.DiscussionTV NAAT is a more sensitive test. The prevalence of TV in UK STI clinic population is still low compared to USA. Given the higher cost of NAAT, screening of all clinic patients is unlikely to be cost-effective but may be worth considering in high risk subgroups.
P59 Improving management of pelvic inflammatory disease by using a simple tick-box sticker
Authors: Connolly N B , Hamer S , Ward M , Mellor J , McQuillan O 
Published: May 2012

BackgroundPelvic Inflammatory Disease (PID) is a common condition with a reported 1:50 sexually active women in the UK developing it annually. An estimated 1:5 will consequently become infertile. Use of the 2011 BASHH guidelines provides an excellent tool in improving uniformity in treatment and advice provided.AimTo assess improvement in care from two cohorts of patient's with PID attending a District General Hospital clinic, at two points, 3 years apart by introduction of a PID tick-box sticker.MethodUsing a BASHH guideline based proforma, data were recorded and compared between 2 cohorts, the 1st from June to December 2008 (27pts), the 2nd from 2011 (25pts).ResultsIn 2011: STI detection was increased at 48%, from 37% previously, reflecting national trends. 88% received 2 weeks of metronidazole and doxycycline (12% had erythromycin due to risk of pregnancy). None had ceftriaxone as per local guidelines based on this and an additional audit, which revealed very low prevalence of infection withNeisseria gonorrhoeaein the local PID population. Improvements with the introduction of the sticker included number of pregnancy tests performed—80% up from 26% and documentation of provision of written information which rose from 3.7% to 88%. 60% saw the HA at their clinic visit compared to 44% in 2008. Partner notification rates were unaffected with 51.6% of male contacts screened with a STI detected in 44% as opposed to 67% in 2008 with a STI in 37%.N gonorrhoeaewas not identified in any presenting woman, nor any screened contact in 2011 and in only one contact in 2008.ConclusionIntroduction of a simple measure such as a PID sticker can aid documentation and adherence to correct management. Striving to improve better partner notification with subsequent screening and treatment, should remain a priority. Of note, there were no Gonococcal infections detected in any of our 2011 cohort and this reflects the local prevalence.
P6 Cultural differences in the acceptability of home sampling for HIV infection
Authors: Bowman C A , Bell G , Ellam H , Tunbridge A , Slack S , Atkin A , Evans C , Shutt A , Joseph E , Naylor S , Herman S , Green S , Kudesia G , Pryce A 
Published: May 2012

BackgroundMSM community outreach using oral home sampling kits posted to virology for testing previously demonstrated success in attracting non-healthcare seeking individuals at risk of HIV. The outcome of targeting other specific at-risk groups to offer home sampling has not previously been described.ObjectiveTo determine the acceptability of home sampling kits for HIV using oral swabs in two at-risk groups Black Africans (BA) and partners of HIV positive patients (PPP).MethodsSelf-taken oral fluid home sampling kits were returned to virology for testing using two HIV assays: Roche COBAS and Genscreen Ultra (previously validated for oral fluid testing). Total IgG was also measured to assess sample adequacy. Participant recruitment was two-pronged: community based (BA) or via an HIV clinic (PPP). For BA recruitment, home sampling kits were actively promoted at relevant social events and venues by trained African volunteers from July to December 2010. 19 free condom distribution points were also utilised to provide information about HIV and the testing kits. From September to December 2011, PPPs of unknown current HIV status were contacted and offered the option of attending clinic or receiving an oral fluid home sampling kit by post.ResultsDespite intense promotional activity, only 12 kits from 11 individuals in the BA community project were returned: 5 male; 6 female. Two of these participants were not African. In the PPP clinic based study, of 46 partners offered a kit, 38 (83%) accepted, and 34 (89%) returned a sample. BA partners were less likely to accept a home sampling kit (9/13; 69%) than white partners (29/33; 88%) in the PPP group. Participant feedback was favourable in both studies.DiscussionFurther evaluation is needed to understand the difference in acceptability of this method of HIV testing in specific at-risk groups (MSM, BA and PPP) in community and clinic settings.