bluuebunny/crossref_metadata_2025_split huggingface dataset:
P109 Routine hepatitis C antibody testing in MSM – are we overtesting?
Authors: Robinson Michael , Jeffery Katie , Edwards Anne 
Published: May 2024

IntroductionThe hepatitis C virus (HCV) is rarely transmitted sexually. MSM with HIV are at increased transmission risk. Debate exists regarding sexual transmissibility of HCV in those without HIV or additional risk factors beyond receptive anal intercourse. Following outbreaks of HCV in Europe and London in MSM, Oxfordshire Sexual Health Services introduced annual unselected HCV antibody testing as a screening minimum for all MSM. Evidence now suggests this may not be necessary. We set out to audit our HCV testing to assess this and identify potential policy modification.MethodsWe reviewed all HCV antibody tests undertaken in a 12 month period. We identified all HCV positive patients to determine risk factors for infection in order to establish whether these patients were identified through annual screening or would have been identified using a selective basic risk analysis.ResultsWe found 13 positive results out of 1351 tests. 6 had previously known HCV, 4 were co-infected with HIV. 2 were heterosexual men with additional risk factors, one was an MSM with additional risk factors. No HIV negative MSM with HCV infection were identified through annual screening alone. Approximately 3.5% of tests undertaken were based on recognised risk factors for HCV, 96.5% were undertaken as part of annual screening. This equated to £1486 per new diagnosis, excluding service costs.DiscussionRoutine annual screening of HIV negative MSM in this study did not pick up any new HCV diagnoses. Cost per diagnosis may be reduced with targeted testing. The annual screening policy needs modification.
P110 Working smarter by incorporating online testing: maximising self-management or opening an additional channel? a twelve month review
Authors: Spelman Kez , Hughs Taylor 
Published: May 2024

IntroductionWe reviewed how the introduction of online access to sexually transmitted infection (STI) testing for a county wide sexual health service has affected face to face (F2F) attendances, and overall attendance numbers.MethodsAs part of managing a large county wide integrated-sexual health service we have based our planned attendance numbers on actual activity data from previous years to forecast service activity. In April 2016 we introduced the option of online STI access alongside a complementing triage system. Using electronic record and online access data we compared actual to projected activity, and established the effect of the online service in terms of overall activity for 2016/17.ResultsThe introduction of an online channel together with a reviewed triage system appears to have directly reduced F2F attendances. The overall activity level including both F2F and online for the service did rise, but based on the cost of F2F attendance compared with theaverage cost of online tests, there are still estimated savings of over £500,000 and predicted reduction of around 10,000 F2F attendances.Abstract P110 Table 1F2F and Online testingServiceActivity plan 2016–17Activity actual 2016–17 (based on quarters 2 and 3 extrapolated)F2F5941049398Online access465417118Total6406466516DiscussionPeople have been satisfied with the online service and it appears to be an acceptable and popular alternative and not and addition to F2F. The reduction in F2F attendances (10,000) frees up clinical time enabling improved and increased resource for complex care and staff and service development.
P114 Sensitivity and cost-effectiveness of trichomonas vaginalis naat (nucleic acid amplification) assay in symptomatic female patients attending a genitourinary medicine clinic
Authors: Swaris Beruwalage , Partridge David , Dewsnap Claire , Taylor Cheryl , Sahib Sura 
Published: May 2024

IntroductionTrichomonas vaginalis is the commonest curable sexually transmitted infection worldwide. Diagnosis is by detecting Trichomonas organisms or its DNA. Sensitivity of microscopy in females is 45–60%. Culture has a higher sensitivity than microscopy but molecular detection offers the highest sensitivity and is considered gold standard. We currently use only microscopy and this may lead to false negatives. This study assesses sensitivity and cost-effectiveness of TV NAAT assay compared with microscopy and acridine orange (AO) staining in symptomatic female patients.MethodsProspective study looking at symptomatic female patients attending sexual health clinic during the period from 05/10/2015 to 17/05/2016.Female patients with one or more of the following symptoms; vulval soreness, itchiness, ulceration or abnormal discharge were included. Wet microscopy was performed and dried slide was sent to the lab for AO staining. TV NAAT was added to the Chlamydia/Gonorrhoea dual testing swab.Results452 patients were included. Age ranged from 14–65 years. 31,18 and 8 patients had positive NAAT, microscopy and AO respectively. Considering NAAT as the gold standard; sensitivity, specificity, PPV and NPV of microscopy and AO was 48%, 100%, 100%, 95% and 28%, 100%, 100%, 94% respectively. 51.6% of the cases would have been missed if only the microscopy was used to diagnose TV.DiscussionOverall prevalence of TV positivity in our study population was 7.52%.Microscopy provided the advantage of rapid result but failed to identify half the positives.TV NAAT testing in carefully selected symptomatic women will be of value to provide better patient care.
P115 Six years of outreach testing- does it work?
Authors: Emerson Carol , Wilson Yvonne 
Published: May 2024

IntroductionWe have been running an outreach program since January 2009 in order to target high-risk MSM using sex on premise venues.MethodsMonthly outreach sessions to high-risk venues, inc annual pride events, run in conjunction with a LGBT organisation. Patients offered serological testing for HIV, syphilis, hepatitis B and C, triple site testing for Chlamydia/Gonorrhoea PCR and vaccination for hepatitis A and B.ResultsOver 6years, 79 outreach sessions held, with 1305 assessments. 226 patients have attended more than once. 424 (68%) patients had never previously attended GUM and 391 (62%) had never had HIV testing. Testing found 13 HIV, 61 untreated syphilis (46 early), 4 chronic active hepatitis B, 63 Chlamydia (21 UR, 36 rec, 6 Th), 48 gonorrhoea (3 UR,18 rec, 27 Th). All patients attended for follow up at GUM clinic. HIV never testers decreased from 34% 2009 to 14% 2014. Vaccines given 160 in 2009, 40 in 2014.DiscussionThe outreach program is a very important initiative, reaching high risk men who very often would not have been tested (34% in 2009). There was a high rate of infection diagnosed. Over time less vaccines required, percentage of HIV ‘never testers’ dropped 34–14% and 6mthly testing increased 13–45%. The outreach has increased access and raised the profile of the health services offered by GUM.
P116 Our new statutory obligations under the amended female genital mutilation act 2003 (sections 70–75 of the serious crime act 2015); one year on
Authors: Howe Alice 
Published: May 2024

IntroductionThe UN estimates 200 million women and girls worldwide are living with the effects of female genital mutilation (FGM), with 137,000 victims in England and Wales. Following the introduction of the amended FGM Act 2003 in October 2015, I reported that 1385 new cases were identified in England in the quarter before the new law and 1316 in the quarter following. In keeping with my aim, I have reviewed the data from the year following the new legislation, to determine its effect.MethodsUsing hscic and NHS digital data, combined with reports from UN and WHO, I analysed the 12 months following the legislation change. I also searched Ministry of Justice reports to study how many FGM protection orders (FGMPOs) and convictions have been made.ResultsData revealed similar numbers of new cases of FGM reported in each 3-month period since October 2015 (1242, 1293 and 1204 respectively). However, there are large gaps in the data. Since July 2015, there have been 97 applications for FGMPOs and 79 orders. There have still been no FGM related convictions in the UK, despite 32 cases being reported to have happened in the UK between January and September 2016.DiscussionThe results are disappointing and we are yet to see substantial change. £4million has been spent and 22,000 FGM training sessions have been delivered but we are still failing to report properly and prosecute offenders. To achieve 2015’s Sustainable Development Goals, the UK must play its part to help end FGM.
P117 A review of sexual health provision at coastline homeless day centre
Authors: Sidebotham Charlotte , Haddon Lisa , Gates Pam 
Published: May 2024

IntroductionHomelessness goes beyond rooflessnessIt is isolating and destructive. The government recognises the homeless are more vulnerable to sexual health risks and need targeted interventions. Cornwall’s sexual health outreach is limited.MethodsA fortnightly afternoon drop-in sexual health clinic, run by a senior nurse and healthcare assistant, was established in a Health-for-the-Homeless (HFH) General Practice service in a socially deprived area of Cornwall. Shared-care with the HFH service whereby patients gave permission for results to be copied to the GP service.ResultsBetween September 2013 and January 2017, there were 498 clinic attendances, with 109 (22%) females, and 389 (78%) male clients. Of all attendances, 181 (36%) accepted sexual health screening. Of these, 17 (9.4%) were diagnosed with a sexual infection and/or hepatitis C, including 7 (3.9%) of chlamydia; 4 (2.2%) of new hepatitis C infection; 3 (1.6%) of genital warts; and 1 (0.6%) of: gonorrhoea, herpes and molluscum contagiosum. All infections were treated. 5 (5%) females had cervical cytological assessment. A 140-strong sample of notes were scrutinised to ascertain examination uptake. Of 82 indicated examinations, 26 (32%) accepted, 56 (68%) clients declined. Poor uptake may account for the low rate of skin conditions diagnosed. 20 (4%) attendances culminated in vaccination. The clinic managed 3 (0.6%) recent sexual assault cases.DiscussionClient feedback suggests that medical help would not have been sought elsewhere. Meeting in a safe environment, we believe we have broken down barriers. An increasing number of returning clients we hope reflects trust in the service. Service costing will be discussed to develop contraception provision.
P118 Patients’ satisfaction with medication information provided by nurses using independent nurse prescribing (INP) or patient group directions (PGDS) in uk sexual health services
Authors: Black Adam , Courtenay Molly , Gage Heather , Norton Christine , Franklin Bryony Dean 
Published: May 2024

IntroductionNurses’ ability to independently deliver medication was introduced to improve patients’ access to medication and experience of healthcare services. INP and PGDs are used frequently in sexual health services; however, there is limited evidence of patients’ satisfaction with medication information provided.MethodsNurses (INP or using PGD) from five UK sexual health services distributed a questionnaire to patients with whom they had consulted and delivered medication, Sept 2015 – Aug 2016. The questionnaire was informed by Birmingham’s sexual health service satisfaction questionnaire and the Satisfaction with Information about Medicines Scale (SIMS).ResultsOf the 393 patients who received a questionnaire, 92% (n=360) responded. Patients who had received medicines via a PGD and INP reported nurses to be friendly and approachable (n=359/360, 99%); that they installed confidence and trust (n=357/360, 99%); explained the reasons for medications clearly (n=349/360, 97%); and suitably answered questions (n=335/360, 93%). Of the 89% (n=348/360) of respondents who completed the SIMS, an overall score of 13.3/16 was achieved: the higher the score, the greater the satisfaction. The largest points of dissatisfaction related to not receiving information on whether they could drink alcohol (n=58/348, 17%), potential for drowsiness (n=54/348, 16%) or side effects (n=37/348, 11%).DiscussionPatients predominantly provided positive feedback regarding their medication consultations with nurses. High SIMS scores identified overall satisfaction with medication information. Further consideration may be needed on the potential problems medications can cause to further improve patient satisfaction (e.g. advice on alcohol consumption, side effects and drowsiness potential).
P135 A review of local test of cure (TOC) practice following treatment for rectal chlamydia and lymphogranuloma venereum
Authors: Fauzi Mohd , Ahmad Sameena , Saxon Cara 
Published: May 2024

IntroductionPrevious reports of up to 22% treatment failure in rectal Chlamydia informed our local clinic policy of routine test of cure (TOC) following rectal chlamydia or lymphogranuloma venereum (LGV) treatment. We set out to review our local TOC practice and treatment failure rates for both chlamydia and LGV.MethodsCase notes of patients diagnosed with rectal chlamydia and LGV between 01/07/15 and 01/07/16 were reviewed. Data was collected on symptoms, antibiotic choice, compliance and TOC.ResultsThere were 89 patients identified with rectal chlamydia; 7 (8%) were confirmed LGV. Median age was 30 years; 69 (78%) men who have sex with men (MSM) and 20 (22%) female. Treatment was primarily with 1 week of doxycycline (81/89; 91%).Of 89 patients, 53 (60%) attended for a TOC with the remainder (36; 40%) lost to follow-up. There were 3/48 (6%) positive TOC results in those with non-LGV rectal chlamydia with one reporting sexual contact during treatment giving a failure rate of 4% (2/48). Of those with LGV 5/7 (71%) attended for a TOC and all were negative. Of those with a negative TOC 3/45 (6%) patients reported sexual contact during treatment.DiscussionOver a 12-month period our local treatment failure rate was low at 4% for rectal chlamydia and 0% for LGV. A significant proportion of patients failed to return for TOC. These results suggest that removal of routine TOC would be locally acceptable, reduce health advisor workload and be in line with current BASHH guidance.
O18 Internet testing for chlamydia reported through national surveillance in england
Authors: Hollis Emma , Harb Ana , Talebi Alireza , Shah Ammi , Connor Nicky 
Published: May 2024

IntroductionTo support and monitor growth of online testing, the National Chlamydia Screening Programme published guidance on commissioning online testing services. Coding was amended in national surveillance systems to differentiate tests requested online from testing in other venues.MethodsNational surveillance data from January 2015–September 2016 were linked to the IMD 2015 and ONS urban rural classification indices to analyse the trends in online testing and test positivity by gender for 15–24 year olds. Patterns of repeat testing were explored.Results163,062 tests and 13,422 diagnoses were reported from online services covering 89% of local authorities in England. Test positivity was higher in men (10% vs. 7.6% women; RR 0.80,p<0.0005), residents of urban areas (8.4% vs. 7.4% rural; RR 1.08,p=0.002) and those living in the most deprived areas of England (9.6% vs 7.0% least deprived; RR 0.79,p<0.0005). Test positivity online was higher than in general practice (8.2% vs GP 6.1% p<0.0005) and lower than in specialised sexual health services (8.2% vs 9.9% GUM and 9.5% SRH p<0.0005). In 2015, 18% of online testers had a subsequent online test within 6 months. Test positivity was higher at first than subsequent test (8.5% vs 7.3%).DiscussionPatterns in online test positivity were comparable with those found in other services suggesting that they are used by the population at risk not just the ‘worried well’. Around 1-in-5 of those testing online had subsequent online tests. These findings support the provision of online testing services as well as face-to-face venues.
P137 Burden of chronic liver disease in an hiv cohort
Authors: Bell Laura , Megarity Stephen , McIntyre Michelle , Wilson Yvonne , Cash Johnny , McDougall Neil , Hunter Michael 
Published: May 2024

IntroductionHIV monitoring guidelines recommend 3-to-12 monthly monitoring of LFTs in HIV-infected patients. Liver-related deaths account for 10–15% of mortality in patients with HIV-infection. Draft NICE guidance, covering the identification of chronic liver disease, is under consultation.Methods200 HIV-infected patients were randomly selected from a cohort of 1000 patients. Those patients who were not engaged in care (i.e. less than 2 out-patient appointments in the past 12 months) or not on ARVs were excluded. Demographics, lifestyle factors and laboratory parameters were recorded. Patients at greatest risk of liver cirrhosis were screened using transient elastography.ResultsOf the 161 HIV-infected patients on ARVs, 49 (30%) had a raised AST or ALT within the preceding year. Only 105 (65%) had a documented alcohol history. Of patients with elevated transaminases, the cause was already established in 21/49 (43%). Factors included alcohol, IM testosterone, viral hepatitis, cryptosporidium infection and hepatotoxic medication. 12 patients were found to have an AST-to-platelet ratio index (APRI) of greater than 0.7. Of these the causes identified included: 4 hepatitis C co-infected, 1 hepatitis B co-infected, 2 alcohol related, 1 Budd Chiari awaiting liver transplant, 2 medication related and 2 not established. Patients with raised transaminases were offered metabolic risk factors screening and transient elastography.DiscussionThere is a small but significant burden of liver disease in patients on ARVs. Lifestyle counselling, to reduce harmful alcohol consumption and viral hepatitis infection could be improved. Implementation of NICE guidelines may improve the diagnosis of cirrhosis.
P139 Sexual risk profiles, and sti testing behaviour among users of a postal home sampling sti testing service (PHSSTS)
Authors: Chirwa Mimie , Ume Uchenna , Hardie Jamie , Nulty Kate , Jensen Sigrid , Doku Eric , Hall Angela , Pickard Graham , Merritt Jeremy , Day Sara 
Published: May 2024

IntroductionThe London Sexual Health Transformation Programme promises an online Postal Home sampling STI testing services (PHSSTS) for asymptomatic patients. Our aims were to pilot a PHSSTS, determine the STI prevalence, sexual risk profiles and STI testing behaviours.MethodsNovember 2015 – October 2016, adult patients visiting our clinic website had the opportunity to complete an online sexual health questionnaire and order a home sampling kit (HSK). Tests; Gonorrhoea, Chlamydia, Syphilis and HIV. Results were sent via SMS plus recommendations about their sexual health.Results946 HSK were ordered by 871 users. 650 (69%) samples were returned. Mean age 30 years; 58% female; 62% white British; 73% heterosexual: 20% MSM. 8% reused PHSSTS. 34% and 23% of users had never tested for STIs and HIV respectively. Median of 2 partners (<3 months).43% reported condomless sex (<2 weeks) and 62% of MSM reported high risk behaviour. 29% women were not using contraception at all or correctly.25%, 3% and 8% of all patients were eligible for Hepatitis B/C testing and Hepatitis vaccination respectively. 38% of eligible patients required Hepatitis B vaccination.STI prevalence was 3%;1 HIV, 5 syphilis, 14 chlamydia and 1 gonorrhoea.All were recalled for treatment. Median return time for samples was 6 days.DiscussionPHSSTS proved acceptable, enhanced access and was a preferred method of testing. Additional sexual health needs could not be directly met by an online service. PHSSTS therefore must work collaboratively with GUM clinics to meet the full needs of PHSSTS users.
O19 Who uses online services where? a comparison of online sti testing service use across england
Authors: Parry Glyn , Clune Mark , Sa Joia de , Baraitser Paula , Holdsworth Gillian 
Published: May 2024

IntroductionOnline sexual health testing services may enable access to testing by different sectors of the population. An innovative online sexual health service designed to improve access to and availability of sexual health services in partnership with terrestrial services is commissioned in seven areas across England. This study compares use across commissioned areas.MethodsWe used routinely collected testing data to analyse use of the service in different areas. We included cumulative data on use of the service since roll-out.ResultsIn areas outside London, fewer users had been to a clinic before (66.5%–73.1% vs 81.1%). Positivity rate was also generally higher outside London (6.8 – 11.0% vs 6.8%). The majority of users were asymptomatic, which is appropriate for the service. Within the London boroughs, the majority of users (51.8%) were in the 25–34 age bracket while in all other areas there was a higher proportion of younger users. In all areas, females used the service more than males. Use by ethnicity was related to local area demographics.Abstract O19 Table 1Use of service as of end November 2016Area 1Area 2Area 3 (London)Area 4Area 5Area 6Orders to date976046215,9247131,0481,726Return rate68.8%58.9%71.1%76.9%76.7%78.9%Positivity rate7.6%11.0%6.8%6.8%9.0%10.4%% asymptomatic90.1%89.2%90.8%85.6%86.6%85.5%Clinic visited before66.5%67.1%81.1%73.1%66.7%67.1%DiscussionThe online service increased access to STI testing in all commissioned areas and shows important differences in online service use in different geographical regions. This may reflect differences in unmet need and access to terrestrial services. Further work is needed to understand these differences.
P147 An audit into the optimum time for neisseria gonorrhoeae test of cure following treatment in sexual health centres
Authors: Slack Daniel , Gilson Rebecca 
Published: May 2024

IntroductionNeisseria gonorrhoeaeis the second most common bacterial sexually transmitted infection worldwide and has evolved resistance to several antibiotic classes. BASHH Guidelines 2011 currently recommend ceftriaxone 500mg IM plus azithromycin 1g stat as first line treatment and also recommend a test of cure (TOC) at 14 days. In our centre the time period between treatment and TOC was reduced to 14 days in July 2016. Anecdotal evidence suggests that this may be producing a higher false positive rate.MethodsClinical notes for all positive gonorrhoea tests (pharyngeal, rectal, urethral, cervical) in a 3-month period were reviewed. Positive TOC were identified and reasons for these assessed (reinfection, treatment failure, false positive). Cycle threshold (CT) values were used to help identify false positives.Results7.5% of TOC results performed at 14 days were likely false positive (no risk of reinfection or treatment failure, high CT values), compared with 2.7% of TOC performed after 14 days. 8.3% of pharyngeal samples and 12.5% of urinary samples were false positive. There were no false positives found for rectal and vulvovaginal samples.DiscussionThere is a significantly higher rate of false positives when a TOC is performed at 14 days and they are more prevalent in pharyngeal and urinary samples. This has a negative impact on both patient and health care provider time and can lead to unnecessary retreatment. Potential interventions could be to extend the TOC time period, include CT values for all TOC results or move to a less sensitive NAAT for TOC.