bluuebunny/crossref_metadata_2025_split huggingface dataset:
P153 Using information technology to improve linkage into sexual health care in patients receiving hiv post exposure prophylaxis for sexual exposure (PEPSE) in emergency departments
Authors: Metcalfe Rebecca , Gaughan Claire , Kilmurray Kim , Carroll Louise , Pollock Kay , Murchie Martin , Smith Hannah 
Published: May 2024

IntroductionHIV PEPSE should be commenced within 72 hours (ideally 24) after possible exposure to HIV. Patient education on PEPSE includes advice on attendance at Emergency Department (ED) if outside opening hours of local sexual health services (SHS). Our healthboard serves a population of 1.2 million with four EDs. An initial four month audit revealed 12 patients who received a 5-day starter pack of PEPSE at ED and no communication between departments; patients were told to self-refer to SHS. We recognised there was no robust mechanism to ensure these high risk patients were not lost to follow up (LTFU). HIV testing at baseline was also poor in this setting, highlighting importance of linkage into SHS.MethodsHIV PEPSE 5 day pack leaflets were altered to ask the dispensing clinican to refer patient via secure email or telephone message to the sexual health advisers.ResultsProspective four month re-audit revealed 19 patients attended ED for PEPSE and all subsequently attended SHS for follow up(100%). 12/19(63%) were referred by email, 6/19(32%) via answering machine, 1/19(5%) self referred. 11/19(60%) reported unprotected receptive anal intercourse with someone from a high risk group.DiscussionFollowing implementation of the email/telephone referral intervention, we found an increased number of patients received HIV PEPSE from EDs in the health board area and all were successfully linked into sexual health services. We cannot be sure that this increase is due to the prevention of patients being LTFU; other reasons include an increased awareness of PEPSE and where to obtain.
O20 Online prescribing for sexually transmitted infections – what’s on offer!
Authors: Okecha Elizabeth , Patel Saleha , Boardman Emily , Morgan Emile 
Published: May 2024

IntroductionIn 2016, The British Association of Sexual Health and HIV (BASHH) expressed concern over the use of medications purchased online to treat Sexually Transmitted Infections (STIs) ‘without full examination and specialist input’. Few studies have investigated the extent of this practice; our service wanted to establish availability of treatment and determine if patients are managed according to BASHH guidelines.MethodsA prospective internet search was performed using the keywords ‘STI treatment online’. UK based internet pharmacies offering treatment for Gonorrhoea, Chlamydia, Herpes and Trichomonas were included in the study.Results30 websites were identified; 5 were excluded. 25(100%) required assessment by a Doctor/Pharmacist Prescriber. 5(20%) offered Gonorrhoea treatment; of these, only one offered Ceftriaxone 500mg/Azithromycin 1 gram and no websites made customers aware that Gonorrhoea cultures were required prior to treatment.23(92%) websites offered Chlamydia treatment as Azithromycin 1 gram stat and/or Doxycycline 100mg twice daily for seven days however, none of the websites asked whether treatment was required for patients at risk of rectal Chlamydia or Lymphogranuloma Venereum. Patients seeking Chlamydia treatment were advised to abstain from sex on 16(64%) websites and partner notification was advised on 18(72%) websites.22 (88%) websites offered treatment for Herpes. 6(27%) required no photographic/laboratory diagnosis of Herpes before purchase. 15(68%) did not discuss partner disclosure of a Herpes diagnosis.DiscussionOnline pharmacies have established a niche market for patients who are reluctant to access clinic based healthcare. Our results show variable adherence to BASHH guidelines which may compromise health outcomes for patients seeking internet based therapy.
P159 Audits of both management of chlamydia and also emergency contraception provision as a marker of quality in an integrated service
Authors: Bhaduri Sumit , Mann Melanie 
Published: May 2024

IntroductionThe county wide sexual health service has been integrated long-term as regards health care worker (HCW) training and governance. Service delivery still remains in some units geared to towards either contraception (C+RHC) or sexually transmitted infections (STIs) management although all patient needs are addressed holistically. Is there equitable service delivery in all units?MethodsAudits of both chlamydia management and emergency contraception provision was carried out across all subunits regardless of subspecialisation.ResultsIn the chlamydia audit, standards were achieved for offering anti-chlamydial treatment (100% achieved) and partner notification verified by HCW (0.47 in STI units, 0.58 C+RHC units). Standards were suboptimal for a) the offer of written information (45% for STI units 18% for C+RHC units and b) offer of retesting for under 25s (61% for STI units, 68% for C+RHC units.) Emergency contraception audit standards were achieved in offering quick start contraception (96%) but suboptimal a) for IUCD offer (73% for STI based units, 57% for C+RHC units), b) documentation of hours since last unprotected sex (58% for STI units 89% for contraception based units), c) documentation of day of cycle (69% for STI units, 89% for contraception units and d) offer of STI screens (82% in STI based units, 76% in contraception units)DiscussionAlthough variation between units exists it is noteworthy that partner notification was best delivered in C+RHC unit setting and IUCD offer in STI unit setting. Emphasis on documentation was made to staff with reaudit planned.
P162 NHS GGC staff HIV anti-stigma campaign
Authors: Zinger Jo , Carroll Louise 
Published: May 2024

IntroductionPeople living with HIV, and maintained on ARVs, can live long and healthy lives.Consequently, there is a growing cohort of people living and ageing with HIV, who are attending NHSGGC for non-HIV related conditions. However, many patients report experiencing stigma and discrimination within these services. NHSGGC responded to this by creating a HIV anti-stigma campaign.MethodsA baseline staff survey was conducted to ascertain knowledge, attitudes and training needs. These results and input from the HIV Patient Forum shaped the campaign, which consisted of: A range of materials, merchandise and activity including posters, road shows, factsheets; training, digital updates and direct messaging to service managers; A patient toolkit which empowers them to challenge stigma and discrimination; Short dramatic videos illustrating patient experience; A repeat staff survey was carried out in 2016Results4000 responses to the baseline survey; 9,325 unique website hits; 300+ staff engaged at road shows; 15 delegates attending training; 1,521 responses to the repeat survey; excellent partnership working between NHSGGC staff and members of the patient forum.DiscussionThe campaign was successful in raising HIV with non-specialist staff. However, uptake of training was low despite an expressed need. Lack of time to train in non-mandatory areas was an issue. Those that did attend training evaluated it well. Results from the repeat survey will shape future interventions for staff.
P166 Partner notification: are australian approaches feasible for the chilean context?
Authors: Iturrieta-Guaita Nicole , Temple-Smith Meredith , Tomnay Jane 
Published: May 2024

IntroductionPartner Notification (PN) in Australia has been studied and improved in recent decades. International researchers have highlighted the use of new technology as an alternative approach for PN. Using the Australian experience as an example, we aim to explore clinicians’ perspectives about the use of specialised websites, such as ‘Let them know’ and professional counselling support, to facilitate PN in the Chilean context.Methods58 semi-structured interviews were conducted with health care providers (HCP) and key informants. A third of the interviews were transcribed verbatim and translated from Spanish to English for thematic analysis, which followed an inductive approach based on grounded theory. Following the identification of themes, remaining interviews were coded utilising a method of constant comparison to highlight concordance and dissonance of participant views.ResultsThe majority of participants were unaware of the use of new technologies for PN, and demonstrated a high interest. Many agreed this could be a feasible strategy considering the high use of mobile technologies and the Internet in Chile. Participants’ primary concerns around this approach were confidentiality, privacy and efficacy, given the local cultural context. The creation of a counsellor position for professional support and guidance was identified as essential to strengthen PN in Chile.DiscussionThe use of new technologies for contacting sexual partners with professional counselling support could be an alternative PN strategy for Chile. However, the involvement of local staff will be essential in tailoring interventions.
P171 Drug-drug interactions in hiv patients taking pharmacokinetic enhancers
Authors: MacCann Rachel , Hollywood Paul , McConkey Samuel , Lorigan David 
Published: May 2024

IntroductionAntiretroviral medications have the potential to produce serious drug interactions by interfering with the hepatic cytochrome P450 cascade. Ritonavir, a protease inhibitor, is a known CYP450 inhibitor that is commonly used in the treatment of HIV1. Iatrogenic Cushing’s syndrome is caused by exposure to glucocorticoids and may be promoted by interaction with additional drugs that result in hypothalamic-pituitary adrenal axis suppression2. It is well documented in HIV patients receiving inhaled steroids in combination with a ritonavir-containing antiretroviral regimen3. Following one such severe drug-drug interaction in a patient, a clinical audit was conducted to identify potential drug-drug interactions in a HIV clinic at Beaumont Hospital, Dublin.Methods200 patients receiving Ritonavir were interviewed and screened for harmful prescribed and non-prescribed co-medications. Patients receiving regular steroid doses and Ritonavir were identified and all drugs were cross-referenced to the Liverpool Drug Interactions website to highlight any dangerous drug interactions.Results86% of patients had concomitant prescribed medications, three-quarters of which were undocumented. Furthermore, 45% of patients used regular over the counter-medication and 2.7% used recreational drugs. 8% of patients were flagged for potentially dangerous drug-drug interactions and of these, 15% contained steroids.DiscussionThe interaction between corticosteroids and PIs is significant and deserves close attention and evaluation. Timely communication among all prescribing physicians for a given patient is indicated in order to proactively detect significant interactions before they manifest themselves clinically.
P183 Retrospective analysis of the utilisation of scrotal ultrasound scan in sexual health clinic
Authors: Ramogi Malaki 
Published: May 2024

IntroductionMost scrotal/testicular symptoms and signs are benign. US Scan is investigation of choice in these patients. However, several studies have shown ultrasound scan findings rarely changes management of these patients. Our aim was to understand how ultrasound scan influenced the diagnosis and management of men with scrotal or testicular symptoms seen in our sexual health clinic.MethodsRetrospective data collected from clinical records of all men seen in sexual health clinic and referred for US scan between 2010 and 2016. Data collected include age, presenting symptoms, STI screen, clinical and ultrasound finding.166 men had ultrasound scan. 23 men excluded due to incomplete data. Data collected and analysed for 143 men.ResultsMedian age was 33 years (range 15 – 72 years). Common scrotal/testicular symptoms were: lump 72 (50%), aches/pain 45 (31.5%), others 15 (10.5%). Ultrasound scan diagnoses were: Benign epidydimal or tunica albuginea cyst 40 (28%), Varicocele 25 (17.5%), Hydrocele 15 (10.5%), Normal 34 (24%), other 26 (18%), Cancers (testicular 2 and sarcoma 1) (2%). 7 men were referred to urologist for cancer treatment and embolization of varicocele.DiscussionMost men had benign scrotal conditions or normal findings confirmed on scan. This did not change their management plan. Two cases of testicular cancers were initially suspected on clinical examination.
P188 An audit of management of patients presenting with urinary tract infection (UTI) in a sexual health clinic
Authors: Vijayappa Shashirekha , Narayana Srinivasulu , Browne Rita 
Published: May 2024

IntroductionPatients with symptoms suggestive of UTI is a common presentation in sexual health clinics.MethodsLaboratory data retrospectively identified all patients who had a MSU sent from May 2015 to October 2015. Data was retrieved from Electronic patient records and analysed using Excel.ResultsThere were 150 patients, 107 females and 43 males. Median age 32 years and range 16 – 74 years. Ethnicity: 36% were White British and 22% black Afro-Caribbean. 5 were female sex workers, 3 MSM and the rest heterosexual. 98% were symptomatic (104 had dysuria and 43 increased urinary frequency). 92% had 1 partner in the preceding 3 months.Urinalysis was positive for leucocytes in 71, Nitrites in 55 and blood in 38 patients.The audit standards our service achieved were: 84% of all patients who had symptoms suggestive of UTI had Urinalysis, 88% received appropriate first line antibiotics, 63% of women with pelvic pain had a pregnancy test and 100% of all male patients with a UTI were referred to Urology. 40% of MSU were positive and bacteria isolated were 73% E coli, 15% Coliform and 6% Proteus.The table below shows sensitivities to antibiotics:Abstract P188 Table 1UTI antimicrobial sensitivityTrimethoprim sensitivityNitrofurantoin sensitiveSensitive80%91%Resistant17%9%Intermittent3%0%DiscussionWe are currently discussing with our local microbiologists about stopping routine MSU in line with NICE guidance and a change to nitrofurantoin as first line treatment. Staff training has been done to remind staff about the need to do a pregnancy test in women with pelvic pain.
P193 Making online contact count: addressing health needs in under 18s attending srh
Authors: Forbes Kimberley , West Richard , Cassidy Seán , Daniels David 
Published: May 2024

IntroductionThe Five Year Forward Review calls for an upgrade in prevention and public health and Making Every Contact Count suggests utilisation of provider encounters to enable positive behavioural change. The London Sexual Health Transformation Programme will be implemented in April 2017 and it is proposed that asymptomatic patients will access services online rather than attending a clinic.MethodsIn the financial year 2015 – 16 there were 1975 attendances of 998 individuals <18 at a sexual & reproductive health service. A risk assessment proforma was used in 98.82% (n=505/511) of those 16 or under and 72.9% (n=355/487) of those aged 17. These were analysed using an electronic report.ResultsCurrent mental health problems, smoking, drug and alcohol use was recorded in 837 (97%), 694 (81%) and 818 (95%) records respectively.Abstract P193 Table 1Under 18s attending SRHUnder 16 n=205Age 16 n=300Age 17 n=355Mental health difficulties47 (23%)63 (21%)93 (26%)Smoking70 (34%)85 (28%)122 (34%)Alcohol use alone67 (32.7%)124 (41.3%)128 (36%)Drug use alone5 (2.4%)12 (4%)10 (2.8%)Drug + alcohol use14 (6.8%)18 (6%)31 (8.7%)DiscussionMental health difficulties, smoking, drug and alcohol use are common across all ages. Assessment enables health promotion through brief interventions and is important to identify young people at risk; commissioners should ensure that opportunities are not lost with online access. We suggest commissioning of a one stop shop model for under 18s or robust online screening protocols to ensure opportunities for intervention are not lost.
O24 Which sexually transmitted infections do gay and bisexual men find most scary and why? a qualitative focus group study in four cities in england
Authors: Reid David , Datta Jessica , Wayal Sonali , Mercer Cath , Hughes Gwenda , Weatherburn Peter 
Published: May 2024

IntroductionMen who have sex with men (MSM) are a priority for STI prevention interventions including the promotion of regular testing and condom use. Effective intervention design requires understanding of MSM’s knowledge and fear of STIs, which may affect attitudes and behaviour related to risk, testing and treatment.MethodsWe recruited a diverse sample of MSM in four English cities, through social networking sites and community organisations. 61 men attended eight focus group discussions. Topics included knowledge and attitudes towards 11 STIs. Discussions were audio recorded, transcribed and analysed thematically.ResultsParticipants demonstrated variable knowledge and awareness of STIs. No focus groups were unanimous in their ranking of fear of STIs, although HIV and HCV were considered the most ‘scary’ in all groups. Fear of syphilis and herpes was also considerable. Gonorrhoea was considered a ‘rite of passage’ and was not widely feared. Other infections showed no clear patterning within or between groups. Participants suggested a complex range of explanations for fear of particular STIs. Participants weighed up the scary and less scary attributes depending on the extent of their knowledge and experience, their prevalence among MSM, associated stigma, transmission mechanisms, contagiousness, symptoms, severity, and the availability, effectiveness and ease of use of vaccines, treatment and/or cure.DiscussionParticipants expressed a range of nuanced fears and concerns related to individual STIs and STI testing and treatment. Understanding these fears, and how they might be mitigated, will help improve the impact of interventions promoting STI testing and treatment.
P206 Prevalence and risk factors associated with chlamydia trachomatis (CT), mycoplasma genitalium (MG) and neisseria gonorrhoeae(NG): cross-sectional study in three sexual health clinics
Authors: Broad Claire , Harding-Esch Emma , Harrison Mark , Pond Marcus , Tan NgeeKeong , Soares Clare , Fuller Sebastian , Okala Sandra , Sadiq Syed Tariq 
Published: May 2024

IntroductionChlamydia trachomatis(CT),Mycoplasma genitalium(MG), andNeisseria gonorrhoeae(NG) infections contribute to major reproductive health sequelae. CT and NG are routinely tested for in sexual health clinics (SHCs), whereas MG is not. Population prevalence estimates for males and females for CT and MG are >1% and <0.1% for NG infection. Risk factor data, which help target control interventions, are limited in men-who-have-sex-with-men (MSM). We assessed prevalence and risk factor data in symptomatic patients accessing SHCs.MethodsPatients aged ≥16 years with symptoms of an STI provided: vulvovaginal swabs (females), first void urine (men-who-have-sex-with-women (MSW) and MSM) and pharyngeal and rectal swabs (MSM). Routine clinic results were obtained and FTD Urethritis Plus kit used to detect MG. Risk factors (RFs) were analysed using univariate (UV) and multivariate (MV) logistic regression.ResultsAbstract P206 Table 1Prevelance and risk factors associated with STIsFemales n=305MSW n=174MSMUrine n=79Rectal n=80Pharynx n=87CT% (95%CI)8.20(5.61–11.82)20.96(15.43–27.47)6.33(2.73–13.97)7.50(3.48–15.40)1.18(0.21–26.80)MG% (95%CI)7.54(5.08–11.06)17.82(12.84-24.18)1.27(0.22–6.83)8.75(4.30–16.98)0.00(0.00–4.23)NG% (95%CI)1.31(0.51–3.32)6.32(3.57-10.96)13.92 (7.96–23.24)27.50(18.92–38.14)17.44(10.86–26.80)The only RFs associated with any organism in MV analyses was in females. Being aged 16–19, a contact of someone with an STI, and not bleeding were associated with CT and being a contact was the only RF for NG.DiscussionCT and MG positivity were highest in MSW compared with other patient groups, whereas NG positivity was highest in MSM, especially rectal samples. In the absence of routine MG testing, NG-positive MSM would be treated with 1 g azithromycin, (combined with 500 mg ceftriaxone) which could result in MG antimicrobial resistance development. From our study population, with no RFs for CT, NG or MG, a targeted test and treat approach would not be beneficial in MSW or MSM.
P210 A cluster of infectious syphilis cases
Authors: Goodall Lisa , Rehman Yasmin , Coetzee Nic 
Published: May 2024

IntroductionIn 2016 the Field Epidemiology Service (FES) noted an increase in cases of infectious syphilis reported to the Enhanced Syphilis Surveillance Scheme (ESSS) from our clinic. From 01 January 2016 to 31 December 2016, 55 cases were reported to ESSS; compared with 12 cases from January to December 2015.MethodsData was extracted from GUMCAD and the ESSS. FES collated and analysed the data using appropriate measures of disease frequency, central tendency and spread in order to describe the epidemiological characteristics of the cluster.ResultsAll cases were maleThe median age was 37 years (range 16 to 74). 75% were men who have sex with men (MSM), 18% heterosexual and 7% bisexual. 89% were of white British ethnicity. 64% were HIV negative. 18% reported chem-sex.38% were diagnosed as primary syphilis, 36% secondary syphilis and 27% early latent syphilis.Venue and/or web application information was recorded for 71% of cases. GRINDR was the most commonly mentioned application (48% of cases mentioning use).DiscussionIn order to reduce syphilis transmission it is vital that new cases are identified and treated and strategies put in place to target populations at higher risk. Incident Management Team meetings were held in 2016 including representatives from Public Health England, GUM, sexual health promotion team and commissioners. Education and awareness programmes have been implemented focussing on specific websites, apps and venues such as bars and clubs popular among MSM. We continue to monitor cases of infectious syphilis on a monthly basis.
O27 Beyond sexual health: identifying healthcare needs of trans and gender variant people in a specialist clinic service
Authors: Nambiar Kate , Davies Julia , Woodroffe Tamara , Sander Nicolas Pinto , Richardson Daniel 
Published: May 2024

IntroductionSexual health services targeted towards specific populations have been an effective way of responding to complex needs. As demand for gender identity services increases, a trend in hormone self-medicating has become more apparent with patients obtaining treatment from internet pharmacies, friends or illicit sources. This study highlights the healthcare needs of patients attending a clinic service for transgender patients.MethodsClinical audit of a sexual health service for transgender people in 2015 and 2016.Results81 attendances were recorded (56 unique patients). Median age was 32 (IQR 24–41). Reported gender identity: Trans male (Assigned Female At Birth [AFAB]) 29 (51.8%), Trans female (Assigned Male at Birth [AMAB]) 15 (26.8%), Non-Binary (AFAB) 9 (16.1%), Non-Binary (AMAB) 3 (5.4%). AMAB patients were older than AFAB – Median age 39 vs. 29 years (p=0.03). Most attendances were for STI screening or genital health issues – 47 (58%). 6 (7.4%) attended for psychosexual assessment. 31 (38.3%) attended for endocrine advice and monitoring of hormone therapy. 13 (38.3%) patients were self-medicating (10 Trans male/Non-Binary AFAB, 3 Trans female/Non-Binary AMAB). 7 of the trans male and 1 of the trans female patients were using intramuscular hormones. Only 2 of the patients self-medicating had informed another healthcare professional.DiscussionThe number of patients self-medicating without medical supervision raises concerns about adverse effects and unsafe injecting practice. Identifying such patients and meeting their needs raises novel issues for sexual health services. The study highlights the need for additional education for clinicians working with transgender patients.