bluuebunny/crossref_metadata_2025_split huggingface dataset:
P191 Demonstrating performance of a low-cost ultra-rapid PCR assay forTrichomonas vaginaliswith point-of-care applications
Authors: Pearce D M , Styles D N 
Published: May 2012

ObjectivesWe have developed a novel Point-of-Care (PoC) system, Velox, comprising an assay-specific cartridge and instrument with a turnaround time of 25 min. The system has been developed forChlamydia trachomatisandChlamydia/Gonorrhoea. We have now developed aTrichomonas vaginalis(TV) test suitable for integration onto the cartridge. The assay utilises a novel electrochemical detection method to demonstrate low copy number amplification and detection of TV in <25 min.MethodsThe method employs prototype PCR cartridges in conjunction with an ultra-rapid thermocycler. All reagents necessary to perform the extraction, amplification and detection are deposited into the cards and air dried at the point of manufacture. A sample is added to the card and DNA extracted from the sample. The resulting eluate reconstitutes dried PCR reagents and PCR is performed using rapid thermocycling. Amplified target is detected using electrochemically-labelled TV target-specific probes and a double-stranded DNA-specific exonuclease to release the electrochemical label. Released label is read by applying a voltage to a screen printed carbon electrode and at a known oxidation potential the label is oxidised producing a measurable current.ResultsAnalytical sensitivity of the TV assay was evaluated by testing dilutions of the organism in the presence of Internal Control (IC) DNA. The results show a TV limit of detection of 50 copies when co-extracted, amplified in duplex and detected electrochemically with the IC DNA. Tests on the reagents dried into the device showed stability for 18 months when stored at ambient temperature (20–25°C).ConclusionsThe results show that in conjunction with the instrument, the TV assay could be used to perform ultra-rapid PCR with no user intervention after sample addition. This allows minimally-trained staff to carry out the assay in <25 min, meeting the needs of a PoC device.
P23 ‘This is a policy not a pilot’: how to implement routine opt-out HIV testing for acute medical admissions in an NHS trust in a high prevalence area
Authors: Barbour A , Elgalib A , Draper S , Phillips D R 
Published: May 2012

Background and AimsFeasibility and acceptability of HIV testing in acute medical settings has been demonstrated in pilot studies. Whereas we report our success of embedding HIV testing in routine clinical care, delivered and sustained by medical staff in an NHS trust.MethodsFrom July 2011 all patients aged 16–79 years, attending the Acute Medical Unit (AMU), have had a standard HIV test unless they decline. Laboratory costs are funded by the local NHS. Literature was produced for staff and patients. Verbal consent and test ordering is carried out by general medical doctors and AMU nurses, all had training by the local HIV team. AMU proformas were updated with sections for HIV test offer and reason for refusal. The HIV team made regular AMU visits to motivate, troubleshoot and feedback progress. From the outset, nurses were more proactive than doctors in applying the policy. Building on their enthusiasm, nurses were empowered so that by October 2011 AMU visits were weaned as nurses took the lead to enforce the policy.Results3709 attendees in the first 6 months, median age 57 years, 50% female, 54.7% Caucasian, 6% Black African. 1390 (37.5%) had samples for HIV testing; their demographic profile is comparable to that for all attendees. HIV test rate went from 33.2% July–September to 41.3% October–December (p<0.005 χ2). For a random sample (n=396), HIV test uptake was 84%. Detailed analysis on offer rate and factors associated with uptake will be presented at the conference. Seven new HIV diagnoses were made, all but one had CD4 >200.ConclusionA routine opt-out HIV testing policy can be delivered by frontline medical staff in an acute setting with no extra resource requirement beyond laboratory costs. Such a policy identifies new HIV patients who would not otherwise have tested and reduces late diagnosis. We believe that policy ownership by nurse champions, with the HIV team as background advisors, is key to achieving and sustaining high test rates.
P28 A Re-audit of partner notification in HIV positive individuals in Plymouth
Authors: Wimpenny T , Warwick Z 
Published: May 2012

AimsFollowing an audit in 2010 we wanted to establish whether changes in our approach to PN in newly diagnosed HIV patients or patients seen for the first time had improved our HIV PN outcomes and documentation.MethodsA retrospective case note review was carried out in patients attending the clinic for the first time in 2011. We looked at whether patients had a partner history completed for the look back period, how many partners were contactable and whether the outcome of the PN was recorded. These results were compared with a similar audit carried out in 2010.Results31 patients were included in the re-audit, 12 transfers into Plymouth GUM and 19 newly diagnosed HIV positive patients. 77% were male and 23% were MSM. 100% of patients had a contact tracing proforma in their notes and 97% (30/31) had been completed. 36 (40%) partners were untraceable. Of those which were contactable13 were current partners and HIV+; 16 ex-partners who were HIV+; 15 ex-partners verified as HIV−; 7 current partners tested HIV−; two partners remain untested. There were 13 patients who transferred into the department in 2010, three of whom had PN performed since joining our clinic. There were 13 new diagnoses, 10 of whom had documented CT.ConclusionPN can be significantly improved using audit in this way. A dedicated Health Advising team is essential where targeted testing for HIV is likely to be the most efficient way of detecting undiagnosed HIV.
P30 An analysis of patient characteristics associated with gonococcal resistance to past therapeutic agents in England and Wales
Authors: Town K , Lowndes C M , Chisholm S , Kall M , Webster E , Nichols T , Anderson J , Obi C , Willey B , Ison C 
Published: May 2012

BackgroundAntimicrobial resistance inNeisseria gonorrhoeaerestricts effective treatment options. Recent UK treatment guidelines recommend ceftriaxone as first line treatment. If ceftriaxone becomes unsuitable for treating gonorrhoea there are no suitable available alternatives. The potential for using past therapeutic agents for gonorrhoea treatment should be assessed.Aim(s)/Objective(s)Identify risk factors associated with antimicrobial resistance to penicillin, tetracycline and ciprofloxacin.MethodsData from the Gonococcal Resistance to Antimicrobials Surveillance Programme were analysed for trends in antimicrobial resistance across sub-groups of the Gonococcal Resistance to Antimicrobials Surveillance Programme population. Using 2010 data patient variables associated with penicillin, tetracycline and ciprofloxacin resistance were identified using univariate and multivariable analyses of ORS.ResultsRates of penicillin, tetracycline and ciprofloxacin resistance have increased across all regions in England and Wales in recent years, with very high levels found in white MSM. Lower rates of resistance, with <15% prevalence, indicating a susceptible population, are found in women (penicillin 6.4%, ciprofloxacin 12.8%), black ethnicity (penicillin 6.1%, ciprofloxacin 13.4%), and in some cases heterosexual men (penicillin 13.2%) and those aged under 24 (penicillin 12.6%). Univariate and multivariable analysis identified patient variables, including sexual orientation, ethnicity and age as strongly associated with penicillin, tetracycline and ciprofloxacin resistance.ConclusionsBy using sub-group population prevalence data on resistance, as well as information about patient variables strongly associated with resistance, it may be possible in some cases to adapt treatment regimens to make use of previously recommended antimicrobials and preserve the use of ceftriaxone for high-risk groups.
P31 How important is it to know where index patients meet their sexual partners in order to control the transmission of sexually transmitted infections?
Authors: Ford R , Clarke M , Lloyd I , Speare N , Maleham K , Robertshaw R , Morgan C 
Published: May 2012

BackgroundLearning where people have met their sexual partners has previously been acknowledged as a way of identifying key locations that are functional to sexually transmitted infection transmission.AimsTo gather local data on where patients diagnosed with chlamydia, gonorrhoea, syphilis, HIV, trichomonas and hepatitis B have met their partners. This is the first stage of an on-going project which aims to develop a more targeted health promotion intervention(s) for key locations in Bristol identified as being important for STI transmission. The ultimate aim is that this intervention(s) will contribute to a reduction in STI transmission rates and therefore STI prevalence(s) in Bristol.MethodPatients were asked where they met their sexual partners during all health adviser partner notification interviews conducted in 2011. 2052 interviews were conducted and data were collected from 1257 patients.ResultsAcross all patients, the most regularly cited meeting place was in a bar or club (29%) This was followed by “through friends/ old friends” (28%). 12% met their sexual contacts via the internet. The most common mode of meeting contacts in heterosexual patients was via friends (31%) while for gay men it was via the internet (36%).DiscussionThe data provides the names of key locations in Bristol and a number of internet sites that are important for transmission. These locations can now be targeted by health promotion and outreach work in order to contribute to a reduction in STI transmission and prevalence. Over a quarter of all sexual contacts were met via friends or they were a friend of the patient. It is likely that the perception of STI risk diminishes if a contact is known or if they share the same social network. As well as targeting locations and internet sites, further research is now needed to explore patient's perception of STI risk, alongside health promotion work that highlights potential misperceptions.
P38 Quantifying the public health value of provider-led partner notification using an evidence-based algorithm with routinely-collected data
Authors: Mercer C , Bell G , Low N , Estcourt C S , Brook G , Cassell J A 
Published: May 2012

ObjectivesTo assess (i) the public health benefit of provider-led partner notification (PN) and (ii) the importance of taking into account the number and types of partners when assessing the cost-benefit of provider-led PN.MethodWe used data on 346 partners reported by 220 chlamydia index patients (n=127 men) seen by a PN professional at one GUM clinic, April–June 2011. We used a published, evidence-based algorithm to quantify PN impact, including the measure the “Number Needed to Treat to Interrupt Transmission” (NNTIT), defined as the number of partners who need to be treated to interrupt 1 onward (secondary) transmission. A lower NNTIT indicates less PN effort is required to prevent onward transmission.ResultsMen reported 216/346 partners and women 130/346. Men more often described partners as casual (56% vs 28%), while women more often reported regular (40% vs 30%) and ex-partners (23% vs 12%). For traceable partners (73% of men's; 88% of women's), 9/157 men's partners and 16/114 women's partners required provider-led PN. Almost all were casual or ex-partners (8/9 men's; 13/16 women's). NNTITs were lowest for ex-partners: 0.6 and 0.45 for men and women, respectively, followed by casual partners: 0.8 and 0.6, then regular partners: 1.80 and 0.9.DiscussionProvider-led PN is required more often with casual and ex-partners than with regular partners. This may have greater cost implications for services, but, as casual and ex-partners are likely to have greater numbers of partners themselves, the potential for preventing onward transmission is greater, yielding greater public health benefit. Services should collect data from their index patients on the number and type(s) of partners, as well as the PN method(s) required (patient vs provider referral). Together with cost data, these data were key for demonstrating the cost-benefit of provider-led PN.
P42 An audit ofNeisseria gonorrhoeaedetection methods in a district general hospital genitourinary medicine service
Authors: Phillips M D , Davies A , Hewart R , Acladious N , Morgan E 
Published: May 2012

BackgroundThis service is located in a large district general hospital bordering a large UK city. It was noticed over a short period that there were several discrepant results returned for detection ofNeisseria gonorrhoeae(GC) using PCR technologies and traditional culture.AimWe performed a 3-month look back at all samples sent for GC detection, in order to define local incidence of GC and discrepant results.MethodsAll samples sent over the preceding 3 months from this service, either as local testing or as part of the national programme, were identified using computer records and then recorded into an excel spreadsheet for comparisons (see abstract P42 table 1).Abstract P42 Table 1Comparison of programme and methodology for GC collectionProgrammeSite of collectionCollection kitMachine for analysisLocalUrethra or endocervixBD ProbetecBD ViperNational (R U Clear)Urethra (urine)Aptima comboGenprobe TigrisResults1245 cases were identified during the 3-month period. The total number of cases with at least one positive GC result from culture and PCR was 41 (3.29% of tested). 902 patients (72.5% of those tested) had samples sent for culture. Culture was on vancomycin-colistin-nystatin-trimethoprim enriched agar. 24 (2.7%) were reported positive for GC. There was a total of 1225 PCR based tests collected between the local and national programmes (98.4% of all cases). Abstract P42 Table 1 shows the specific methods of these two programmes. Of the 1225, 39 tests were positive (3%). All cases with a positive result were then further analysed. 27 had concordant results, that is, either the culture and PCR matched, or only one of the two tests was performed. This gave 14 patients with discordant results (1.1% of all tested, 34% of all positive results). 13 cases had a positive PCR but negative culture (93%), and one patient had a positive culture but negative PCR.DiscussionThe overall numbers are too low for accurate statistical analysis, but our incidence of GC is around 3%. PCR detected many more cases than culture would alone, although there was a single case of culture positive and PCR negative. We plan to perform a 1-year analysis to obtain sufficient cases for statistical analysis.
P43 RPR titres following syphilis treatment: does HIV status affect the magnitude or rate of response?
Authors: Drayton R , Johnston C E 
Published: May 2012

AimsCo-infection with HIV has been shown to alter the serological response to, and the course of, infection withTreponema pallidum. We aimed to determine whether the rate or magnitude of response to treatment, as measured by falling Rapid Plasma Reagin (RPR) titres, was different in HIV positive compared to HIV negative patients in the modern era.MethodsA retrospective case note review was undertaken of patients who were diagnosed with syphilis between 1 January and 31 December 2008. The change in RPR titre at 1, 3, 6 and 12 months post-treatment was determined. Statistical analysis was performed using Microsoft excel; p values were calculated using χ2or Student t test.ResultsDuring the study period, 57 HIV negative and 23 HIV positive patients were diagnosed with syphilis. Of the patients with a RPR titre greater than neat at diagnosis, 30/40 (75%) HIV negative patients and 12/15 (80%) HIV positive patients showed a two dilution or greater fall in RPR titre 3 months following treatment (p=0.72), with 36/39 (92%) and 16/16 (100%) achieving a two dilution drop by 6 months, respectively (p=0.24). There was no significant difference in the median RPR titre at diagnosis between HIV positive and negative patients at all stages of syphilis infection. 3/16 (19%) HIV positive patients and 3/38 (8%) HIV negative patients, who were not thought to have been reinfected, continued to have a RPR titre of 1:16 or greater at 6 months post treatment (p=0.26). Where data were available, all these patients achieved a RPR titre of less than 1:16 by 12 months post treatment. Two patients, both HIV positive, were re-infected during the study period, one patient being re-infected twice.ConclusionsOverall, treatment appeared to be effective and the majority of patients showed a two dilution or greater fall in RPR by 6 months post-treatment. There was no significant difference in the rate or magnitude of response in HIV positive compared to HIV negative patients.
P46 Pelvic inflammatory disease diagnosis, treatment and contact tracing in a fully integrated sexual health centre
Authors: Goodall L , Oroz C 
Published: May 2012

BackgroundBASHH guidelines on pelvic inflammatory disease (PID) were updated in 2011. A recent national audit of PID management in UK GUM clinics suggested that adherence to BASHH guidelines in terms of treatment regimen and partner notification was below national standards. Our GUM service has recently integrated with family planning to form a fully integrated sexual health centre. We were interested to see how our PID management compared to national findings.AimsTo determine whether our management of PID was in line with current UK guidance.MethodsA prospective audit of all cases of PID seen at our sexual health centre over a 6-month period was performed by asking all clinicians to report suspected cases of PID and by review of our clinic database to identify any further patients treated for PID. The audit determined criteria for PID diagnosis, treatment regimen, follow-up plans and partner notification.ResultsThere was some variation in criteria used to make a clinical diagnosis of PID. However, all patients treated for PID complained of lower abdominal pain and most had adnexal tenderness or cervical excitation on examination. Most women were treated with ofloxacin and metronidazole although there was variation in the duration of metronidazole therapy prescribed. All women were offered a follow-up appointment, most of which were 1–2 weeks from initial diagnosis. Partner notification was poor and fell below current UK targets.DiscussionUnfortunately, despite the benefits of skill sharing of family planning and GUM professionals within a fully integrated sexual health centre our management of PID in terms of drug regimen, follow-up and partner notification did not meet recommended national standards. Workshops on PID have been built into our protected teaching time to explore reasons for non-adherence to current national guidelines and to try and improve our standards of care.
P5 Changing trends in HIV diagnosis in an inner city London teaching hospital between 2007 and 2011
Authors: Wilkin-Crowe H , Lau R , Pakianathan M 
Published: May 2012

BackgroundIn 2008, guidelines were published by the British Association for Sexual Health and HIV, British HIV Association and British Infection Society recommending normalisation of HIV testing to reduce stigma and to increase the number of early diagnoses. The guidelines aimed at reducing morbidity, mortality and reducing the risk of onward transmission of HIV. Local initiatives were carried out in South West London to achieve this by extensive general practice education programmes to raise HIV testing awareness in non-sexual health (SH) settings.AimsTo establish the effect of a number of local initiatives to promote HIV testing in non-SH settings at a large South West London hospital.MethodsData on all new diagnoses referred to the HIV outpatient were collected and analysed from electronic patient records, including ethnodemographic data, place of diagnosis and clinical data including baseline CD4 count. Previously diagnosed patients having received HIV care elsewhere transferring into the service were excluded. Fisher's exact t-test was used for statistical analysis.Results and discussionThere were 394 patients with a new diagnosis of HIV between 2007 and 2011. Diagnosis by primary care and other non-SH settings increased by 184%. There was an increase of 37% in the median CD4 count at diagnosis, taking the median count to 372 cells/mm3in 2011, showing the majority of patients to have been diagnosed at an early stage. The proportion of very late presenters decreased by 24%.ConclusionsThe evidence suggests that local initiatives are successfully implementing National guidelines. More work is needed to increase HIV testing and reduce the number of late diagnoses.
P51 Patient-reported effects of vaginal lactose as a prebiotic for bacterial vaginosis
Authors: Emery S J , Tomlinson M J , Hansen I D 
Published: May 2012

BackgroundBacterial vaginosis (BV) is a common, frequently recurrent condition typically treated with oral metronidazole. Using lactose as a vaginal prebiotic to support Lactobacilli growth and lactic acid production is a new approach to treating and preventing overgrowth of vaginal pathogens. A vaginal tablet containing lactose 1.2 mg (LadyBalance ApS, Denmark) has been available in Denmark since 2004. For the treatment of BV, it is administered once daily for 1-week; it can subsequently be used on alternate days to prevent recurrence and to maintain the vaginal environment.AimsTo evaluate the perceived effect of a lactose vaginal tablet (LVT) on vaginal health.MethodsWomen who had used the LVT between 2005 and 2009 were invited to complete a web-based questionnaire.ResultsIn the 728 responders who had used the LVT, the most commonly reported reasons for use were vaginal discharge with/without malodour (73%/18%), vaginal itching or irritation (37%), and vaginal dryness (16%). 90% of women with self-reported vaginal discharge with offensive odour reported improvement within 1 week. Improvement of symptoms within 1 week was also reported by 81% of women with vaginal discharge without odour, 83% with vaginal itching and irritation, and 76% with vaginal dryness. These effects were generally maintained in women who continued to use the product over longer periods (up to 1 year). Reported side effects were minor and included clear or powdery discharge.DiscussionAn LVT offers the potential of a natural treatment for BV, vaginal itching, irritation and dryness and for protection against recurrent BV or vaginal candidiasis. Its lack of serious side effects and drug interactions could make it an attractive alternative to standard therapies. The clinical effectiveness and tolerability of the LVT require further investigation.ConclusionsThe LVT was perceived as highly effective in treating a range of vaginal symptoms.