bluuebunny/crossref_metadata_2025_split huggingface dataset:
P65 Serological response between HIV-positive and negative cohorts treated for early syphilis
Authors: Dhairyawan R , Almeida A , Gunathilake M , Goh B 
Published: May 2012

IntroductionSuccessful treatment response for early syphilis involves resolution of signs and a fourfold decrease in RPR/VDRL or sero-reversion between 3 and 6 months. However, in the HIV-positive population the serological response can be unusual.AimsTo compare serological response after treatment of early syphilis between HIV-positive and negative cohorts.MethodsRetrospective cohort study of 100 HIV positive (HP) and 92 negative (HN) patients with early syphilis at an inner city GUM clinic from 2002 to 2011. Data were collected on demographics, stage of syphilis, treatment and serological response.ResultsBoth HP and HN cohorts were mainly MSM (72 HN, 96 HP) and Caucasian (HN 76, HP 78). Median age 33 (range 20–63 years) in the HN and 37 (range 19–59 years) in the HP. Stage of syphilis: HN group, 22/92 primary, 26 secondary and 44 early latent (EL). HP group: 26/100 primary, 34 secondary and 39 EL. The HN group were treated with the standard regimen for their stage of disease. 49/100 of the HP group received treatment for neurosyphilis. 25/92 HN and 14/100 HP were lost to follow-up following treatment. Excluding these patients, by 6 months, 18/20 (90%) of the HP group with primary syphilis sero-reverted or had a fourfold decrease in RPR/VDRL compared to 17/17 (100%) of the HN. By 6 months, 51/55 (93%) of the HP group with secondary/EL syphilis had sero-reverted or had a fourfold decrease in RPR/VDRL compared to 41/45 (91%) of the HN. Median CD4 count in the HP group was 380 cells/μl prior to treatment and 518 after treatment. There were 4 reinfections in the HN group and 10 in the HP.ConclusionsThere were high rates of serological treatment success for early syphilis in both groups. However, the HP group were less likely to have a successful response by 6 months in primary syphilis. This study also demonstrates the need for strategies to address the large number of patients lost to follow-up.
P67 Estimation of population coverage of chlamydia testing among young adults in England in 2010
Authors: Nardone A , Robinson C , Craig R , Woodhall S , Talebi A , Mercer C , Johnson A M 
Published: May 2012

BackgroundThe National Chlamydia Screening Programme (NCSP), established nationally in England in 2008, aims to prevent and control chlamydia infection in young adults under 25 years of age through opportunistic community based testing.AimWe wished to validate the NCSP estimates of chlamydia screening coverage in the target population of young adults by comparing to self-reported chlamydia testing among participants to the Health Survey for England (HSE).MethodsChlamydia screening coverage is calculated centrally by combining the number of tests reported from three sources of data: NCSP; sexual health clinics; and laboratories. All three sources provide data by age and sex. HSE is an annual general health survey of a nationally representative selection of households in England. In 2010, questions on previous history of testing for chlamydia were asked of all 4259 individuals aged 16–54 who were interviewed. Analyses presented here are limited to the 725 young adults aged 16–24 years old.ResultsIn 2010, NCSP estimated that 2.2 million chlamydia tests were performed in England among young adults aged 15–24 years old, representing up to 33% of the target population (43% of females and 24% of males). In HSE 2010, 44% of females (177/402) and 27% of males (87/323) reported having ever had a chlamydia test. The proportion who reported having had chlamydia test in the last year was lower for both females (27%; 109/402) and males (17%; 55/323).ConclusionWe have demonstrated the progress made by NCSP in achieving high national levels of coverage. Estimated coverage rates in 2010 reported by NCSP were slightly higher than those recorded by HSE which may be in part due to the inclusion of those who have had repeat chlamydia tests. The data collected by HSE has proved a valuable source of data with which to monitor the progress of NCSP in achieving national targets for testing coverage and improve the delivery of the programme.
P69 In those with high white cell counts per high powered field does extended azithromycin affect persistence/recurrence
Authors: de Burgh-Thomas A , Russell A Ross , Maple K , Karunaratne I 
Published: May 2012

AimsWe will compare the effect of an extended azithromycin (2 g of over several days) vs 1 g stat for those where >50 WCs per hi power field were found.MethodsWe have reviewed all cases of NSU over a 3-month period following the introduction of extended treatment with azithromycin for those with hi levels of WCs per hpf. We will review the records of those patients diagnosed with NSU in previous years (over the same months) who were treated with regimes of either doxycycline 100 mg twice daily for 7 days or azithromycin 1 g stat.ResultsFollowing the change in policy half of all patients treated for NSU received an extended course. In the group who had hi levels of WC's 13% were subsequently found to be chlamydia positive by PCR and 87% were chlamydia negative. In the group with low levels of WC's 10% were chlamydia PCR positive and 90% were chlamydia negative. Of those with hi levels of WCs per HPF treated with a total of 2 g of azithromycin 18% returned to clinic complaining of continuing symptoms. This compares to 20% with low levels of WCs per hi powered treated with the standard 1 g of azithromycin who suffered persistence/recurrence following treatment We will present data on those patient treated in previous years with both doxycycline and azithromycin at a dose of 1 g.DiscussionSo far we have analysed only those cases following the change in policy. We will present data that will demonstrate any change in response to extended azithromycin. The results will demonstrate whether the extended course has any benefits and at what cost.
P7 A world record for HIV testing. Publicity stunt or effective outreach?
Authors: Jenkins J , McOwan A G , McCormack S , Chislett L J 
Published: May 2012

Background1 in 7 MSM in London are HIV positive, 1 of 5 of whom are unaware of this because they have never tested, or acquired HIV since their last test. Our service took the opportunity presented by World AIDS Day to promote the importance of regular HIV testing in MSM by staging a HIV testing world record attempt in a local gay bar.Aims/ObjectivesTo promote the importance of HIV testing, and to see if the outreach was successful in targeting a less tested population of MSM.MethodsThe promotion was determined by the “opportunities to view” key messages. Individuals tested in the bar completed a form collecting age, gender, orientation, time since last HIV test, unprotected anal (UAI) or vaginal sex. Similar information was collected from 100 patients walking into the generic service for an HIV test on the same day. Age groups <25, 26–30, 31–39, >40 were chosen.ResultsThere were 890 000 opportunities to view the key messages. 467 individuals tested in the gay bar, but only 441 forms were sufficiently complete for this analysis. MSM in the gay bar were younger than the clinic (54% and 44% respectively <30; p=0.027), and more likely to have never tested (18% and 6%; p=0.007). In the gay bar, only 9/89 (10%) of MSM aged 31–39 had never tested, only 2/9 (22%) reporting UAI. This contrasted to the 15%–24% of 54 MSM in the other age groups that had never tested, 60%–77% of whom reported UAI. Only five MSM attending clinic had never tested, 4 (80%) of whom were <25 (see abstract P7 table 1).Abstract P7 Table 1Demographic characteristics of individuals accepting HIV testingGay Bar (n=441)Clinic (n=100)Male379 (86%)91 (91%)MSM355 (80%)80 (80%)<25 years167 (38%)15 (15%)MSM <25131 (37%)12 (12%)No previous test101 (23%)15 (15%)Never tested, reporting UAI/UVI52 (51%)9 (60%)MSM never tested, reporting UAI39 (62%)2 (100%)DiscussionAs well as promoting the benefits of regular testing to the wider gay community, the event was successful in reaching a less tested, but nonetheless high risk population of MSM, in particular, those <25.
P70 Neisseria gonorrhoeaeST26; emergence of an MSM associated strain within a heterosexual population during an outbreak
Authors: Shone J , Orange G , Allstaff S , Cunningham C , Yirrell D , Eastick K 
Published: May 2012

BackgroundNeisseria gonorrhoeaesequence type (ST) 26 has been documented across Scotland since the introduction ofN gonorrhoeaemulti-antigen sequence typing (NG-MAST) in 2004. Scottish incidents of ST26 have historically been associated with men who have sex with men (MSM). In November 2010, it was noted that an increased proportion of ST26 isolates were documented among women within our local Health Board area.AimsTo explore the epidemiology of ScottishN gonorrhoeaeST26 strains, with reference to a rising incidence of gonococcal (GC) diagnoses within our local area.MethodsAll Scottish GC isolates (2004–2011), and nucleic acid amplification positive specimens where no isolate was available (2009–2011), were analysed by NG-MAST.ResultsAbstract P70 Table 1Scottish incidences ofNeisseria gonorrhoeaeST26 strainsLocal health boardLocal health boardNon-local health boardsNon-local health boardsTime periodTotal isolatesMale isolates (%)Total isolatesMale isolates (%)2004–20070–4591.120080–0–2009201006100January 2010–April 20103100683.3May 2010–October 20100–0–November 2010–September 20113256.3250Total5559DiscussionThese data describe that up until November 2010,N gonorrhoeaeST26 in Scotland was predominantly found in men, indicating its association with MSM networks. The spike of ST26 strains in 2010/2011 in both men and women within our local Health Board area imply its introduction to a heterosexual network. These data demonstrate the utility of NG-MAST for the epidemiological study of GC infection. In particular, the data describe the manner in which gonococcal STs can become established and transferred between different regions and population groups, which may be assumed to have separate sexual networks.
P73 A review of diagnostic tools used in the detection ofNeisseria gonorrhoeae(GC) in women attending a London sexual health clinic (SHC)
Authors: Rosenvinge M , Storrar N 
Published: May 2012

BackgroundNear-patient microscopy (NPM) has poor sensitivity in the identification of GC in women, with NPM of urethral (Ur) smears no longer recommended by BASHH.AimTo review the diagnosis of GC in women attending a London SHC and assess the relative merits of NPM, culture and Nucleic acid amplification tests (NAATs) in detecting GC.MethodFemale GC diagnoses from 1 January 2008 to 30 June 2011 were identified from the GU Medicine Clinic Activity Dataset and case notes reviewed. The results and sites of GC tests taken, were recorded. Slides stated as “suspicious” for GC on NPM were counted as positive. GC was cultured on selective medium. The Beckton Dickinson Probe Tec Strand Displacement Assay (dual NAAT for GC/CT) was used for endocervical (Cx) specimens from 22 June 2009.ResultsNotes were available in 334/369 (91%) of cases (317 women): median age 20 years (range 13–53); 92/334 (28%) White British; 87/334 (26%) Black Caribbean; 219/313 (70%) symptomatic; 160/321 (50%) had a previous STI; 42/317 (13%) had a history of GC; 58/334 (17%) were GC contacts. 289 cases had Ur/Cx cultures taken: 30 (10%) were positive on Ur culture; 148 (51%) on Ur and Cx culture; 88 (30%) on Cx culture. 11/142 (8%) Cx NAATs performed were negative for GC: 6/11 were positive on Ur culture; 5/11 on pharyngeal culture/NAAT; 1/11 on Cx culture. 104/125 (83%) with positive Cx NAATs were positive on Cx culture. 42 were diagnosed with GC on vaginal NAATs. 135/330 (41%) were also diagnosed withChlamydia trachomatis(CT) (see abstract P73 table 1).Abstract P73 Table 1Results of NPM for culture positivesUrethralEndocervicalNPM positive29 (12 Cx NPM negative)29 (12 Ur NPM negative)NPM negative99138NPM not done4969Sensitivity NPM29/128 (23%)29/167 (17%)False positives*313*NPM was positive for GC but samples were culture negativeConclusionCx NAAT was more sensitive than culture in detecting GC; supplementing Cx NAAT with Ur culture will reduce the potential for missed cases. Our data shows a poor sensitivity of Ur and Cx NPM for the detection of GC in women, highlighting a need to perform targeted training, review the criteria for NPM and develop additional point of care tests for GC.
P74 Epidemiology of anNeisseria gonorrhoeaeoutbreak in a low prevalence area
Authors: Shone J , Cunningham C , Orange G , Eastick K , Yirrell D , Allstaff S 
Published: May 2012

BackgroundIn January 2011, an increased number of gonococcal (GC) isolates was noted within the local bacteriology department. A “look back” exercise was initiated for all incidences of GC infections during the previous 13 months, while new episodes of GC infection were monitored to ascertain whether this increase represented an outbreak.AimsTo determine the epidemiology of GC infection observed during an outbreak ofNeisseria gonorrhoeaewithin the local area.MethodsCases of GC infection within our Health Board area were identified by culture or nucleic acid amplification test (NAAT) for the period December 2009 to April 2011.N gonorrhoeaemulti-antigen sequence typing (NG-MAST) was performed on positive isolates or NAAT samples. Patient demographics were gathered at the local sexual and reproductive health (SRH) clinic.Results73 episodes of GC infection were recorded in one geographically distinct area of our Health Board between December 2010 and April 2011 (the outbreak). Nineteen cases were documented for the same period the previous year. No similar increase in GC diagnoses was observed in neighbouring areas. Chlamydia cases remained relatively stable. Patient demographics were available for 62 of the 67 cases diagnosed at the local SRH clinic. Of these, the majority of cases were male (66.1%) (of which 22% were MSM), under 25 years of age (71%), heterosexual (78.5%) and of White Scottish ethnicity (95.2%). 40 (64.5%) patients (29 male and 11 female) presented with symptoms of GC infection and 19 (29.2%) as GC contacts. The predominant NG-MAST sequence type was ST26.DiscussionThe epidemiology of this outbreak is atypical, since GC infection and NG-MAST ST26 has been more commonly found in men who have sex with men in Scotland. Despite enhanced surveillance, no sexual networks or links to specific venues were identified. A gonorrhoea awareness campaign was launched in May 2011.
P76 Equivocal Aptima Combo 2 results: what do they mean in clinical practice?
Authors: Cassidy S , Artykov R , White J 
Published: May 2012

BackgroundMolecular diagnostic tests have become standard of care for detection of gonococcal (GC) and chlamydial (CT) infections. The Aptima Combo 2 (AC2) test is widely used and is highly sensitive and specific, even for non-genital specimens. Equivocal results occur when the initial AC2 assay detects target RNA but the confirmatory Aptima GC or CT assay fails to detect a different RNA sequence in the same specimen.AimTo determine whether equivocal AC2 (EAC2) results were predictive of subsequently confirmed infection in our GUM/HIV clinic population.MethodsRetrospective review of all EAC2 results for GC or CT at 3 urban UK GUM/HIV clinics from January to December 2011. Patients with EAC2 results were routinely recalled for repeat testing unless treated at the initial visit.ResultsFrom a total of approximately 38 000 AC2 tests performed in 2011, 3118 (8.2%) were confirmed positive: 1189 GC and 1929 CT infections. There were 222 EAC2 results in 2011 (0.6% of total AC2 tests); 45 (20.3%) occurred in women, the majority (73%) of which were equivocal genital CT results. Of the 177 EAC2 results in men (mostly MSM), 70% were non-genital specimens. Equivocal pharyngeal GC was common, comprising one-third of all male EAC2. Of 34 EAC2 patients analysed in more detail, 5 were GC/CT contacts and 24/34 reported unprotected sex at the site of the EAC2. None with equivocal GC had GC positive culture results, at the time or subsequently. Of 19 men with EAC2 GC results, 6 (all MSM) had confirmed GC at another mucosal site at that visit. 30/34 patients had the AC2 test repeated (range 7–24 days after initial test); 29 were AC2-negative and one remained equivocal (see abstract P76 table 1).Abstract P76 Table 1Rates of equivocal GC and CT results according to gender and siteGender and site of EAC2 test resultNo. of patients with equivocal GC resultNo. of patients with equivocal CT resultWomen EC618 SSVS215 RS10 TS11 Urine01Men RS2920 TS6014 Urine3022 Other11EC, endocervical; RS, rectal swab; SSVS, self-collected vaginal swab; TS, throat swab.ConclusionsEAC2 results are uncommon but seem to occur in those at higher risk for infection; yet the vast majority does not have infection confirmed on subsequent testing. This suggests that these are spurious results, possibly from contamination, or low organism load infections that do not persist; thus routine treatment is not necessarily warranted.
P77 Colposcopy of cervical warts
Authors: Evans J , Toeima E , Elsawy M 
Published: May 2012

BackgroundBASHH guidelines for the management of genital warts do not recommend colposcopy for women with cervical warts unless there is diagnostic uncertainty or clinical concern. Our local cervical cytology guidelines advise colposcopy regardless of cervical cytology result.AimTo review the colposcopic outcome of women referred from our genitourinary medicine department because of cervical warts.MethodRetrospective case note review of women referred for colposcopy because of cervical warts from December 2005 to November 2010.Results25 women with cervical warts underwent colposcopy. The median age was 22 years (range 17–52 years). Four of the 25 were found to have a normal cervix at the time of colposcopy. 21 of 25 had persistent cervical warts, three consistent with benign human papilloma virus (HPV) infection and in whom no further action was taken. 18 of 21 with persistent cervical warts underwent biopsy. Histological results indicated 10 had HPV only, six had CIN 1, one had CIN 2, and one had normal histology. The woman with CIN 2 and one with CIN 1 had a complete LLETZ excision of the lesion. All women with CIN were under 25 years old.ConclusionA third of the women biopsied had CIN, however only one had a high grade abnormality. No invasive cancers were found. Conservative management for young women with CIN 2 is acceptable in current colposcopic practice. Our study indicates unscheduled screening or referral to colposcopy is unrewarding.
P80 Genitourinary medicine physicians need further training in the management of HSV in late pregnancy
Authors: Fleury C , Clarke E , Baker A , Green J , Foley E , Patel R 
Published: May 2012

BackgroundTransmission rates of neonatal herpes simplex virus (HSV) infection varies from 30% to 50% if shedding with primary infection during the third trimester of pregnancy, to <3% with active recurrent genital infection. Despite the low transmission risk of recurrent HSV in pregnancy, there remains confusion regarding appropriate management.AimTo investigate the level of knowledge of BASHH guidelines regarding the management of GH in the third trimester of pregnancy amongst BASHH conference attendees.MethodsAttendees of two BASHH conferences completed a questionnaire consisting of case-scenarios regarding appropriate management of pregnant women and their partners with genital herpes infection. The first case-scenario was designed to assess familiarity with accepted guidance. The second was used to assess whether physicians followed RCOG or BASHH guidelines.Results94 attendees completed the survey. In line with current guidelines, 81 (74%) answered that primary HSV infection at term was an indication for Caesarian section (CS), and 37 (46%) of these 81 responders stated this CS should be carried out at 38 weeks gestation. Of these 37 responders, when questioned concerning recurrent genital infection at term, 27 (73%) believed that lesions present at delivery would necessitate a CS, and 35 (95%) felt that vaginal delivery was appropriate in the absence of lesions at delivery. Although there is specific guidance for the limited place of invasive techniques at term only 17% would advise avoidance of fetal scalp electrodes and artificial membrane rupture.ConclusionNo-one demonstrated complete familiarity with the BASHH guidelines surrounding appropriate management of HSV. Of most concern is the limited awareness of the management need of CS in third trimester first episode disease. Further training of GUM physicians is required in order to ensure practice is compatible with the best available advice.
P82 What do phase 1 microbicide trial participants really think? Are they “only in it for the money?”
Authors: Morris G , Douglas S , Woodhall S , Lacey C 
Published: May 2012

BackgroundEarly-phase trials require multiple visits and procedures, which can lead to difficulties with recruitment and compliance.AimsTo explore participants' experience of, and motivation for, taking part in a study of the safety and pharmacokinetics of an HIV microbicide.Methods28 women completed eight study visits including pelvic examinations, colposcopy, vaginal sampling (clinician performed and self-taken aspirate) and semi-structured, qualitative interviews. Additional requirements included daily vaginal gel use (12 doses) and sexual abstinence (16 days). Interviews were audio-recorded, transcribed, and analysed using a framework approach.ResultsAlthough renumeration was given by 64% of women as the main or a contributing reason for participating, 71% also stated that they had an interest in HIV or saw the value in the research. 46% volunteered after hearing positive reports from other participants. Difficulties included speculum examinations, sampling, and fitting study visits and gel use into a normal routine. Problems with self-sampling were identified by 12 women, including discomfort and concern about obtaining an adequate sample. 10 participants reported a preference for self-sampling, 11 for clinician sampling. Compliance with gel use was high. Leakage was common but varied with position and depth of insertion. Four women found abstinence difficult. Being single, or discussing the study with partners before enrolment made abstinence easier.ConclusionQualitative interviews in early-phase trials capture useful additional information and help determine acceptability of procedures and products. Healthy subjects commonly have multiple non-exclusive reasons for participating in research. Understanding participants' motivation and experiences can aid recruitment and facilitate compliance with study requirements.