bluuebunny/crossref_metadata_2025_split huggingface dataset:
P26 The effectiveness of partner notification in diagnosing early HIV infection in Plymouth, UK
Authors: Warwick Z , Wimpenny T 
Published: May 2012

BackgroundThe aim of partner notification (PN) in HIV is to diagnose the undiagnosed and reduce the risk of onward transmission. Plymouth is thought to be a low HIV prevalence area and as such routine testing across medical settings is unlikely to be cost effective or practical. As part of our attempts to target testing, we have concentrated and improved our HIV contact tracing. We describe how the recent infection testing algorithm (RITA) has allowed us to focus PN and identifies individuals early in infection (infectious, high behavioural risk, untested) therefore reducing onward transmission.AimTo describe the number of recent infections diagnosed in Plymouth using PN.MethodsRITA is performed in all newly diagnosed patients. This information is taken into account during PN. A retrospective review of all RITA results done in 2011 and how this has contributed to PN in Plymouth GUM is described.ResultsOf the 20 new HIV diagnoses made in Plymouth, 7 (35%) were incident infections and six were diagnosed as a direct result of PN. Of those with prevalent infection (n=12), 5 were diagnosed as a direct result of PN.ConclusionsIn low prevalence areas targeted testing will yield the greatest number of positive individuals per test. Along with other targeting strategies, PN in those newly diagnosed is a way of reaching an at risk group within this setting. It is important to prioritise HIV PN through a dedicated Health Advising team.
P34 Partner notification for HIV: a regional outcome audit
Authors: Bell G , Green S , Cox T , Naylor S , Bennett P , Dudley S , Martin J , Parsons S , Rothwell J , Allen D , Beckett W 
Published: May 2012

BackgroundPartner notification (PN) for HIV facilitates early diagnosis among those at highest risk. Health advisers and HIV nurses from eight clinics (7 GUM, 1 ID) formed a regional HIV network public health group to optimise PN across the region by sharing intelligence of local HIV transmission and monitoring practice against national guidelines and standards. Since there is no national standard for HIV PN outcomes, we undertook a baseline local audit to inform discussion on the possibility of setting a regional standard.ObjectiveTo conduct a baseline audit for HIV PN outcomes across the regional HIV network.MethodsHIV services across the network undertook a retrospective case note review of all patients newly diagnosed with HIV in 2011. Data were collected on the number of partners verified/reported as tested negative/positive before the index, or within 90, 180 or 360 days, following patient or provider referral.ResultsResults received from 7/8 clinics are presented below (see abstract P34 table 1).Abstract P34 Table 1HIV partner notificationRange per clinicOverallNumber partners verified tested per case <90 days0.17–1.31.05 (118/112)Number partners verified or reported tested per case <90 days0.66–1.331.15 (129/112)Number partners verified tested per case <1 year0.17–1.381.17 (131/112)Number partners verified or reported tested per case <1 year0.66–1.531.27 (142/112)ConclusionsOverall PN outcomes are good across the region, although there was wide variation between clinics which makes it difficult to set a single regional standard that is both challenging and achievable for all. Outcomes were verified for most partners, but not possible if tested at an unknown clinic or abroad. The majority of tested partners attended within 3 months, but a small number took up to a year, suggesting PN efforts should continue until the partner is deemed untraceable.
P35 A collaborative approach to controlling an HIV outbreak among intravenous drug users
Authors: Bell G , Devey T , Cope A , Evans C , Hughes C , Naylor S , Greig J M , Tunbridge A J , Lagundoye O , McNaught R 
Published: May 2012

BackgroundIn 2008 an intravenous drug user (IVDU) admitted to the infectious diseases unit was diagnosed with late-stage HIV. He named five injecting partners, of whom three tested negative for HIV, one refused, and one was untraced. In early 2010 another IVDU was diagnosed, naming two injecting partners of the previous case who had either declined or tested negative in 2008.ObjectiveTo control an outbreak of HIV among IVDUsInterventionsA multidisciplinary outbreak control team was convened in 2008 and 2010 with representation from the Health Protection Unit, the Drug and Alcohol Action Team, Genitourinary Medicine, Infectious Diseases, and Virology to develop a control strategy. Traditional partner notification was supplemented by cluster testing among associates in housing projects and drop in centres used by IVDUs. Opportunistic screening of IVDUs attending health services was promoted. Laboratory investigations included phylogenetic analysis and the recent infection testing algorithm.OutcomesA further 6 cases were identified in 2010: two through hospital screening and four through partner notification. Cluster testing did not yield any further cases among associates (0/29), but presented an opportunity to raise awareness of local HIV risk among IVDUs. Joint working between services was a feature of all interventions. All 8 cases 2008–2010 are the same strain, and 7/8 are linked to at least one other case. Despite extended surveillance at centres providing treatment for substance misuse, no further new cases have been identified since September 2010.ConclusionAn HIV outbreak among a hard-to-reach population has been successfully controlled by a prompt and close collaboration between services to deliver a range of complementary control strategies. We remain vigilant to the possibility of further cases since the source of one case has not been identified.
P39 The acceptability and use of SMS text messaging for provider referral partner notification (PRPN)
Authors: Gilbart V , Town K , Lowndes C M 
Published: May 2012

BackgroundPartner notification is important for STI control. With developments in technology notifying partners is now easier. The HPA was keen to understand the acceptability and use of SMS texting for PRPN for STIs.MethodsA questionnaire distributed to GUM colleagues, cascaded by the Society of Sexual Health Advisers and posted on their website.Results65 sites responded. Most (61, 93%) use telephone for 1st attempt for PRPN with texting as preferred second choice (19, 29%). For 2nd attempt, telephone remained preferred method (51, 79%) but texting increased with 32 (49.2%) choosing this method; letter use also increased. Majority of sites used texting for PRPN (56, (86%); frequency varied—over half using it up to 50% of the time. 29 (45%) had texting guidelines and 31 (55%) used texting templates. Messages varied; 33 (59%) requesting partner make contact, 9 (16%) naming the infection. Six (11%) had contact with Information Governance Board about texting; no negative outcomes reported. Two partners complained, not about receiving a text but about being denied the identity of the index patient. 9 (14%) sites never used texting.ConclusionTelephone contact was the preferred option for 1st and 2nd attempt for PRPN. Texting was the 2nd most used method and was seen as acceptable within the clinic and also with Information Governance Board. Frequency varied considerably and message content differed but even if used infrequently, was seen as important if other methods failed. Reassuringly no complaints about texting were received from partners. A small number of sites never use texting.
P47 Systematic recall vs standard care, addressing the increased risk of re-infection in patients presenting with gonorrhoea
Authors: Fernando K , Flew S , Phattey J , Harding J , Fowler T , Caley M , Ross J 
Published: May 2012

BackgroundGonorrhoea is of increasing concern in UK, with the gonococcal resistance to antimicrobials surveillance programme reporting high levels of resistance to antibiotics. Prior history of gonorrhoea is a strong predictor of current infection, supporting the concept of a group of “core transmitters.” The US Center for Disease Control advises retesting of patients with gonorrhoea 3 months after treatment to identify repeat infections. Current UK guidelines only recommend a test of cure at 2–4 weeks.AimTo assess the feasibility, acceptability and effectiveness of routine retesting at a 3-month interval, in UK sexual health clinic attendees diagnosed with gonorrhoea.MethodsAttendees between November 2010 and June 2011 diagnosed with gonorrhoea were offered retesting 3–6 months after treatment, with a subsequent reminder to attend (recall arm). Re-attendance rates and frequency of gonorrhoea diagnosis were compared to a historic group who attended between October 2006 and April 2007, controlling for age, sex, sexual orientation and history of STI (control arm).Results242 patients were assessed in the recall arm. 95 (39%) re-attended within 6 months of initial attendance and 15 (6%) were positive for gonorrhoea. Of 202 controls, 44 (22%) re-attended within 6 months and 12 (6%) tested positive for gonorrhoea. Being actively recalled increased re-attendance at the clinic (β=2.2, p=0.001) but did not detect additional cases of gonorrhoea (β=1.2, p=0.9).ConclusionThese results strongly suggest that the CDC recommendation for re-testing for infection after 3 months is not an effective approach for unselected patients with gonorrhoea in the UK.
P49 Otosyphilis: missed opportunities for early treatment?
Authors: Bradshaw D , Pallawela S , Scott C , Asboe D , Nelson M , Day S 
Published: May 2012

BackgroundOtosyphilis (OS) is one of the few reversible causes of hearing loss. Audiological symptoms and positive syphilis (SP) serology can be diagnostic of OS. Hearing outcome after treatment is poor and evidence for optimal management is lacking.AimTo identify how OS is managed in our unit.MethodCase collection and notes review.ResultsSeven (6 male, 1 female) patients (pts) with OS were identified between 2007 and 2011, of median age 34 yrs. Of these 7 pts: 6 (86%) had secondary stage and 1 (14%) late stage SP; 6 (86%) were coinfected with HIV (2 testing HIV+ at SP diagnosis); all presented with deafness (bilaterally in 3 pts); all had other symptoms of SP (commonly rash (4, 57%) and ocular involvement (3, 43%)). Of 6/7 pts consenting to lumbar puncture, neurosyphilis was probable in 1 (17%), excluded in 2 (33%) and considered possible in 3 (50%) pts. Median time from audiological symptoms to treatment was 2 months (range 2 days to 6 m). Four (57%) had previously visited a health care professional who failed to diagnose OS. Six (86%) and 5 (71%) pts received a neurological regimen and steroid cover respectively. Overall, hearing improved in 3 (43%) and stabilised in 4 (57%) pts. An improved audiological outcome was seen in 2/3 (67%) pts receiving early treatment (within 1-month of hearing loss) vs 1/4 (25%) of those receiving late treatment and in 3/6 (50%) pts receiving a neurological regimen vs 0/1 pts receiving standard treatment. Median time to treatment was shorter in pts with established HIV infection (2 months) than those testing HIV+ at SP diagnosis or testing HIV neg (3.5 months).ConclusionThis small study identifies a delay to treatment in many cases. Early treatment and treating with a neurological regimen may improve outcome. HIV+ pts may have more regular SP testing, reducing the delay to treatment. OS is uncommon, but with increasing rates of SP nationally, we must be alert to its manifestations and promptly initiate treatment.
P50 Chlamydia surveillance in the USA: the need for new strategies
Authors: Torrone E , Weinstock H S 
Published: May 2012

BackgroundPreventing infertility through the prevention and control of chlamydia is a priority in the USA. Valid and timely surveillance data on chlamydial infections are needed to estimate disease burden, monitor trends, and inform and evaluate chlamydia prevention strategies.MethodsWe assessed the strengths and weaknesses of the US chlamydia surveillance system, including notifiable disease reports, opportunistic data from screening programs, and national surveys.ResultsNotifiable disease report data are heavily influenced by changes in screening coverage, empiric treatment, diagnostic test technology, and reporting practices. Although test positivity data from federally-funded screening programs can account for the number of tests conducted, data are affected by changes in clinics participating in the program, differences in screening criteria between clinics, and demographic shifts in clinic populations. National survey data are representative of the general population and estimate point prevalence. However, data are not timely and low national chlamydia prevalence (estimated prevalence in 2009–2010 was 1.7%, 95% CI 1.0% to 2.3%) combined with small survey sample sizes results in unstable estimates limiting the ability to monitor trends in demographic subpopulations.DiscussionThe current US chlamydia surveillance system does not provide valid and timely data to estimate disease burden and monitor trends in chlamydial infection. The use of multiple data sources is not sufficient to offset inherent biases in each surveillance method. Consequently, new approaches to monitoring chlamydia morbidity are needed. Sentinel surveillance may provide higher quality data and a more comprehensive understanding of chlamydia trends.
P53 PCR screening tests forChlamydia trachomatisorNeisseria gonorrhoeaedo not require a second test to confirm: an audit of patients issued with equivocal results
Authors: Hopkins M , Smith G , Hart I J , Alloba F 
Published: May 2012

BackgroundUK testing algorithms for chlamydia or gonorrhoea should have a positive predicative value (PPV) >90%. Repeat of testing of screen positive samples might be required to achieve this. Patients issued with unconfirmed positive (equivocal) results are recalled to clinic to submit another sample.ObjectivesTo assess the clinical utility of supplementary PCRs following a positive PCR screening test result.MethodsLaboratory reports forChlamydia trachomatisorNeisseria gonorrhoeaeissued to GUM patients between April 2010 and April 2011 were reviewed retrospectively. Positive reports were routinely confirmed by supplementary PCRs andN gonorrhoeaeculture. Clinical records of patients with equivocal reports were retrieved to determine if infection was confirmed by a second sample on patient recall and the impact of this process on antibiotic management.ResultsOver 15 000 patients were tested during the study period. The prevalence of chlamydia and gonorrhoea was 972 (5.75%) and 76 (0.50%), respectively. A further 78 chlamydia and 2 gonorrhoea equivocal reports were issued. Only 56 (72%) patients with an equivocal chlamydia report returned to clinic, and of these, only 41 (73%) gave a second sample to retest. PPV of the PCR screening test was calculated at 98.0% and 97.5% for detection of chlamydia infection from urine and rectal swabs, respectively. Most patients accepted antibiotic treatment before infection status had been confirmed. Prevalence of gonorrhoea infection was low but PPV of the screening PCR remained high (98.75%).ConclusionsEquivocal reports introduce delays to patient management while the risk of unnecessary antibiotic therapy appears acceptable to most patients. The cobas 4800 CT/NG PCR screening assay can achieve UK testing standards (PPV >90%) in extra-genital swabs and low prevalence gonorrhoea population without supplementary tests. A patient-led confirmation algorithm is proposed.
P54 Ocular syphilis: lessons from 4 decades of experience
Authors: Draeger E M , Durani Z K , Hitch G , Goh B T 
Published: May 2012

BackgroundOcular syphilis can affect most eye structures and can be the result of congenital and acquired infection. Many ocular signs are not specific to syphilis and it can be difficult to make the diagnosis.AimThis study aims to investigate the epidemiology of ocular syphilis presenting to an oculogenital clinic.MethodRetrospective case notes review of ocular syphilis cases seen between 1965 and 2011. Of 307 cases with ocular signs and positive treponemal serology, 85 cases with a history of yaws were excluded, leaving 222.ResultsOf the 222 cases, 93 (42%) were late congenital (CS), and 129 (58%) were acquired (AS). Of the CS cases, the mean age was 47.5 (range 7–86), 37 (40%) were male, of whom 1 was MSM. 55 (59%) were from the UK, 19 (20%) from the Caribbean, 9 (10%) from Europe. Eye signs were as follows: interstitial keratitis 73, anterior uveitis 23, posterior uveitis 10, panuveitis 3, Argyll-Robertson pupils (ARP) 1 and optic neuritis (ON) 1. Of the AS cases, the mean age was 50.9 (range 17–85), 99 (77%) were male, of whom 15 were MSM. 31 (24%) were from the UK, 15 (12%) from Europe, 51 (40%) from the Caribbean and 16 (12%) from Africa. 17 (13%) were early syphilis (secondary/early latent) and 112 (87%) were late latent or tertiary syphilis. Eye signs were as follows: anterior uveitis 63, posterior uveitis 21, panuveitis 13, optic atrophy 9, ON 8 and ARP 5. 35 (38%) of CS cases and 8 (6%) of the AS cases had extra-ocular signs of syphilis. Treatment was with a neurosyphilis regimen. STI screen were offered to all patients. Concomitant STIs are shown in the abstract P54 table 1.Abstract P54 Table 1Number of patients presenting with concomitant STIsCongenitalAcquired-earlyAcquired-lateGonorrhoea239Chlamydia227NSU103PID600Herpes214HIV011TV215Scabies301Warts041Any STI17725Conclusions(1) Ocular syphilis has varied presentations. (2) Screening for other STIs is important even in late CS and AS. (3) Ocular syphilis can be the only sign of syphilis: clinicians should consider syphilis as a cause of undiagnosed eye signs.
P57 To treat or not to treat
Authors: Thomas J , Mathew T , Carey P B 
Published: May 2012

BackgroundThe BASHH guidelines recommend offering full STI screening and epidemiological treatment to sexual contacts of those with confirmed Chlamydia infection. However, many patients attend sexual health clinics reporting to be contacts of Chamydia, but unable to give details of the index case. The management of these unverified Chlamydia contacts is unclear. Most clinics pragmatically treat contacts during their first visit; however some clinics may choose to wait for results before treating. This study was aimed at establishing current practice of management of Chlamydia contacts both verified and unverified, in a large inner city GUM clinic.MethodHealth care practitioners were requested to fill in a questionnaire when patients who reported to be contacts ofChlamydia trachomatisattended the clinic over a 6-month period.Results59 Questionnaires were returned. In 76% (45/59) of patients attending as contacts of Chlamydia, details of index case could not be verified. 62% of these patients were asymptomatic and 56% (25/45) treated on first visit. Subsequently 27% (12/45) had a positive Chlamydia test whereas 36% of Chlamydia tests were positive in the cases where details of index case could be verified. The difference the positive rates of verified and unverified Chlamydia contacts is not significant (p=0.51).ConclusionDespite acknowledging that our numbers are small, a high percentage of unverified Chlamydia contacts had positive Chlamydia tests. Given this we recommend that all patients attending STI clinics reporting to be contacts must be treated at first visit to avoid complications, losses to follow-up and decrease patient anxiety.
P61 IM ceftriaxone for all pelvic inflammatory disease: to give or not to give?
Authors: Lee P H , McQuillan O 
Published: May 2012

AimTo audit the care of Pelvic Inflammatory Disease (PID) in a city centre Genitourinary medicine clinic.Objectives(1) To assess the effectiveness of PID treatment offered by evaluating the auditable outcomes recommended within BASHH treatment guidelines. (2) To ascertain the level of detected infection withNeisseria gonorrhoeaein order to decide whether to implement IM ceftriaxone 500 mg stat as part of all PID treatment as per latest BASHH 2011 treatment guidelines.MethodA retrospective review of patient case notes coded with B4/B5, C4A and C5 from June 2010 till December 2010. A proforma was formulated and results then analysed using SPSS.ResultsA total of 87 case notes were analysed. 100% of the patients were offered microbiological investigations (target—>95%) and 87.4% of the patients were treated with recommended regimens (target—>95%). 89.7% of the patients were referred for contact tracing (target—>95%) and the ratio of number of contacts screened/treated was 0.21 (target 0.4).DiscussionOnly one audit outcome (>95%—microbiological investigations) was achieved. Gonococcal PID was confirmed on microbiological testing in only 2/87 patients (2.3%).ConclusionWe propose the introduction of a PID proforma to ensure greater uniformity of management and improve auditable outcomes. A local PID clinical guideline was adopted advising treating those at low risk of gonoccocal infection and mild to moderate PID with doxycycline plus metronidazole; and to add in IM ceftriaxone 500 mg stat to those with moderate to severe PID and/or those at high risk of gonoccocal disease. Re-audit will be conducted after the introduction of these measures.
P62 Managing the cardiovascular complications of late syphilis
Authors: Sacks R , Tipple C , Goldmeier D 
Published: May 2012

BackgroundBASHH recommends full clinical examination and chest radiography (CXR) for patients with late syphilis. Steroid cover and cardiology referral are advised for cardiovascular involvement. Recent literature suggests variation in the clinical management of suspected cardiovascular syphilis.AimTo explore variations in the management of late syphilis in UK GUM clinics and to compare this with current BASHH guidelines.MethodLead clinicians of UK GUM clinics were invited to complete an electronic survey between November and December 2010 to establish management of late syphilis in their centre. Data collected using the online Survey Monkey system were analysed with Microsoft Excel and SPSS V.18.ResultsIn total, 34% (53/156) of clinicians approached responded fully or partially to the survey (93% were consultants). An average of nine cases (n=45, SD 10.8) of late syphilis (KC60 codes A4, A5, A6) per clinic were seen between November 2009 and November 2010. Of these, 76% (n=42, range 0–100%) were estimated to have had a full clinical examination (and the use of CXR is described in abstract P62 table 1). *Other includes: older patients; HIV+ve patients; those with higher RPR; clinician dependent An ECG or ECHO was ordered routinely, or if the patient has symptoms or signs of cardiovascular syphilis, in 90% and 76% respectively. Cardiology referral was routinely made by 58% (18/31) and 35% (9/26) always used steroids, when managing cardiovascular syphilis.Abstract P62 Table 1Q: Under which circumstances is a CXR requested?Routinely performedIf patient symptomaticIf patient has clinical signsIf routine, symptoms or signsOther*Mean % (no of respondents) n=4448% (21)41% (18)36% (16)89% (39)25% (11)*Other includes: older patients; HIV+ve patients; those with higher RPR; clinician dependent.DiscussionManagement of late syphilis varies both between clinics and compared with BASHH guidelines. Not all patients are examined or offered a CXR, and in cases with suspected cardiovascular involvement, cardiology referral and use of steroids are variable. Conversely, many patients are over-investigated in the GUM clinic.