bluuebunny/crossref_metadata_2025_split huggingface dataset:
P156 Survivors of male sexual assault attending an inner city sexual assault referral centre (SARC)
Authors: Williams A , McManus T , Noonan M , Forster G E 
Published: May 2012

BackgroundMale sexual assault (SA) is a widely unreported crime. Published data demonstrate that male victims are often lost to follow-up. We need to understand this group better in order that we target their specific needs.MethodsCase notes of men attending an inner city SARC for a forensic medical examination (FME) between 1 January 2011 and 31 December 2011 were identified. A detailed notes review was performed and we report the findings.Results21 males received an FME in this time period, of whom 3 were <13. 18 men were aged 18–97 years (94%, 18–40). 50% were white, 28% black and 22% Asian. Of those who were sexually active, 56% were homosexual and 44% were heterosexual. 78% were referred by the police and attended within 72 h of the alleged assault. A third reported a suspected drug facilitated sexual assault. 78% reported factors increasing their vulnerability. 94% reported anal penetration. Receptive oral and digital penetration was also reported. No condom was used in 50% of incidents; in 39% condom use was unknown. 28% were assaulted in public, 44% in the assailants home and 22% in their home. 61% of assailants were strangers. One assailant was reported by 50% and two or more by 39%. The SA was accompanied by physical assault in 22%. Non-genital injuries were documented in 61%. PEP against HIV was commenced in 61%. 33% were followed-up at SARCs, 39% in sexual health clinics and three declined follow-up. Within the SARCs one client tested positive for Hepatitis C, one had latent syphilis and two were known to have pre-exisiting HIV.ConclusionWhen compared with published data regarding female SA, males are experiencing more assault from strangers, more extra genital injuries, higher numbers with multiple suspects and have higher rates of vulnerability. Small numbers of men are attending SARCs compared to females; this may in part be due to lack of awareness on the part of the victim. Increased help is needed from external agencies for aftercare and publicity campaigns.
P159 On the road: delivering sexual health services to vulnerable populations in hard-to-reach areas
Authors: McMillan S , Scott P , Ormerod D , Jones R 
Published: May 2012

BackgroundStudies show a correlation between poor general and sexual ill health. These health inequalities are not evenly distributed within the population. Hammersmith & Fulham (H&F) houses some of the most deprived areas in England, many of which have high rates of ill health. Barriers to successful community healthcare engagement are manifold and encompass access, stigma and social issues.Aims/ObjectivesIn order to tackle these barriers, increase engagement and subsequent uptake of screening we deliverwellpersonscreens, incorporating sexual health checks, in a purpose builthealthbustargeting the most economically challenged areas of H&F. The service was designed to normalise sexual health screening in the context of a routine“check-up.”MethodIn 2011, 15 clinics were provided. Data were collected pertaining to gender, ethnicity, screening/service provision, well-being parameters, referrals and follow-up.Results243 patients attended the health bus, 145 were male. Almost half (46.9%) accepted sexual health screening leading to the identification of HIV (one), Syphilis (one) and Chlamydia (five). Wellperson checks led to 59 referrals to allied services, pertaining to 52 individuals. One third (19) of those referrals were to level three sexual health services, just under two-thirds (37) were referred to their GP (25 for hypertension, one for glucosuria and 11 for other medical reasons) and three were referred to smoking cessation services.Discussion/ConclusionLinking sexual health with general well-being checks has shown to be an acceptable way to increase screening uptake in our local community. The clinic has also highlighted the extent of ill health in H&F, continued health promotion via innovative strategies such as the healthbus may help to tackle these health inequalities.
P163 Patient choice: is the local HIV service preferred?
Authors: Andrews S , Howard L 
Published: May 2012

AimTo investigate the distance travelled by patient to a specialist HIV clinic in the Home Counties.MethodsRetrospective review of the electronic database of HIV patients attending the clinic from January 2011 to January 2012. Data on gender, ethnicity, sexual orientation, age and residential postcode was collected. The distance to our service was compared to that of the nearest available specialist clinic HIV clinic for each patient. Demographic data were also collected. χ2Tests were performed to compare categorical data.Results220 patients attended. The median age was 41 years, range 15–74. Our clinic was the closest HIV service for 89 (40%) patients. Of the 131 who selected our service in preference to their local service, 50% travelled up to 10 miles, 15% 11–20 miles, 14% 21–30 miles and 21% more than 30 miles. Interestingly the nearest service for 13 (10%) of these patients was an inner city teaching hospital. There was no significant difference in age, gender or sexual orientation between those who lived locally or travelled further, except for ethnicity. 66% of White British men and women were prepared to travel further for their HIV care compared to 51% for other ethnic groups (p=0.02) (see abstract P163 table 1).Abstract P163 Table 1Demographics of HIV cohortMen (n=141)Women (n=79)Sexual orientation (%) Heterosexual64 (46)79 (100) Bisexual6 (4) Homosexual71 (50)Ethnicity (%) White British108 (77)16 (23) Black African24 (17)58 (73) Other9 (6)5 (4)ConclusionsMore than half our HIV patient cohort elected to travel further rather than utilise their local HIV services. The reason for this choice is unclear. However this study highlights the importance of considering patient choice when commissioning, planning and providing HIV services. Further research exploring the reasons for patient preference may aid our understanding of the aspects of HIV care that are particularly valued by our patients.
P164 Which aspects of stigma are most important in an integrated sexual health service?
Authors: Sauer U , Singh A , Pittrof R 
Published: May 2012

BackgroundThe stigma of sexual health services is pervasive and affects all user groups. It is likely to affect access to and satisfaction with the service. Reducing stigma has to be an essential aspect of improving sexual healthcare. Stigma has four domains: disclosure concerns, negative self-image, public attitudes and positive (non-stigmatising) aspects. It is currently not known which of these domains is perceived as most relevant by service users.ObjectiveTo determine which aspect of stigma of the service was felt most intensely by service users in a level 3 integrated sexual health service (ISHS).MethodApplication of a validated 15 item quantitative tool to assess stigma among 200 unselected patients attending an ISHS in outer London.ResultsA total of 77 strong agreement with a statement describing stigma of the service were recorded. Of them nearly half were given in response to two statements: statement (S) 5: “I am careful whom I tell that I have been in this clinic” (14) and S 10 “I am concerned that I bump into someone I know when I am at this clinic” (16). No other statement attracted >6 positive strong responses. Of the 171 responses indicating a moderate stigma of the service 24 were given to the S1 “I won't tell anyone that I came to this clinic because I am concerned about their reaction”. Statement 5 and S10 received 22 moderate agreements each while S6 “I worry that people who know that I have been here tell others that I have been to this clinic” attracted 17 moderate positive responses.DiscussionOur research indicates that disclosure concerns are the key source of stigma for the ISHS. Other aspects like self-image or public attitudes were less relevant. The high level of concerns expressed in S10 throws a new light on the issue of time spent in the waiting room. It suggests that waiting can be very stressful as stigmatising encounters are anticipated.
P166 Increasing screening frequency in men who have sex with men (MSM): impact of explicit guidance on risk profiling on UK service
Authors: Baker A , Fleury C , Foley E , Samraj S , Rowen D , Patel R 
Published: May 2012

BackgroundSTI and HIV diagnoses are increasing among MSM. Mathematical modelling shows increasing screening frequency can reduce STI prevalence, especially targeting MSM engaging in risk behaviours. International guidelines from both the CDC and Australasian Society for HIV Medicine clearly define risk behaviours with adapted screening intervals—contrary to the UK where NICE guidance is vague.ObjectivesTo investigate impact of applying stricter international screening guidelines for MSM, on service workload and earlier STI diagnosis in a UK level 3 service [L-3S].MethodsA validated risk questionnaire distributed to MSM attending a large provincial L-3S over a 3-month period explored their actual screening frequency, STI diagnoses and risk behaviours in the prior 12 months. Australian screening guidelines were applied to the data to identify MSM needing more frequent screening. Projections to the larger MSM population attending over 12 months were modelled, based on the demographics of the respondents.Results126/357 completed the questionnaire, 89 were identifiable. There was no statistically significant difference between STI rates (p=0.18) and HIV diagnoses (p=0.62) between identifiable questionnaire respondents and other MSM clinic attendees. Demographic analysis showed the sample group was representative of the larger cohort. In 2011, applying Australasian Society for HIV Medicine risk profiling for the 793 MSM who attended the unit, 26% would require one additional 6-monthly attendance for HIV screening, while 6% would require two visits. Additional STI screening visits would be needed by 25% (1 visit) and 10% (2 visits). 29% of STI diagnoses were in infrequent attendees.ConclusionsStricter UK screening guidelines for MSM defining and weighting risk behaviours explicitly in line with other international guidelines, would increase L-3S MSM visits by 30% and potentially diagnose a large proportion of disease earlier. In light of the results UK guidelines may benefit from review.
P168 Acute generalised exanthematous pustulosis induced by pneumocystis carinii pneumonia (PCP) prophylaxis with dapsone
Authors: Vas A , Laws P M , Marsland A M , McQuillan O 
Published: May 2012

BackgroundAcute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction. Most cases are drug related, however the condition has been associated with viral infections.ObjectiveAGEP in the setting of HIV is uncommon. We report a case of AGEP induced by PCP prophylaxis with dapsone.ResultsA 34-year-old HIV-infected Nigerian woman was admitted to hospital with a 2-week history of a progressing pustular skin rash. CD4 count 1 month prior to admission was 176 cells/mm3and she had not been taking antiretrovirals since 2008. Three weeks prior to presentation she had commenced Dapsone for PCP prophylaxis. Admission to hospital revealed a fever of 40°C, tachycardia, hypotension and a widespread erythematous papular eruption with overlying pustules. Laboratory investigations revealed; haemoglobin 7.6 g/dl, raised oeosinophils of 0.67×109/l, C reactive protein 144 mg/l and Direct Coombs test was positive. A venous metheamoglobin level was raised at 3.5% and chest radiography revealed subtle consolidation at the left base. Broad spectrum antibiotics and fluids were initiated and Dapsone was withdrawn. Dermatology review raised the clinical suspicion of drug rash with oeosinophilia and systemic symptoms (DRESS) or AGEP. Skin biopsy supported the clinical diagnosis of AGEP. She remained systemically unwell and intravenous hydrocortisone was commenced. Subsequent infective screen for viral and bacterial pathogens was negative. Over the following week the pustular rash began to desquamate with significant improvement. She made a full clinical recovery and subsequently started antiretroviral therapy and atovaquone for PCP prophylaxis.DiscussionDrug reactions in the setting of HIV and its treatment are common. AGEP in the setting of HIV has rarely been reported. This case illustrates a less common but important severe cutaneous adverse reaction to recognise in our HIV cohort.
P169 Don't whip it out until syphilis is ruled out
Authors: Teo S Y , Fairley I 
Published: May 2012

IntroductionDiscrete syphilitic lesions mimicking testicular tumours are reported in the literature but usually diagnosed after removal of the testes in conjunction with positive syphilis serology. We present the first case, to our knowledge, in which a discrete testicular mass in the context of positive syphilis serology has been spared surgery and resolved both clinically and on serial ultrasound scans following antibiotic therapy.CaseA 47-year-old gentleman attended GUM clinic with inflammation under his foreskin and was found to have painless testicular lump on examination. Initial ultrasound revealed a 2 cm well defined, hypoechoic mass within the right testes. He was referred to urology on suspicion of malignancy. Subsequent Syphilis serology was positive and the penile lesion and testicular mass were felt to be consistent with syphilis. After liaising with the urology department, and in view of negative tumour markers (LDH, AFP and HCG) and known penicillin allergy, he was managed conservatively with doxycycline. Follow-up ultrasound scans at 1 month and 4 months revealed good resolution of the testicular mass. The last scan performed at 10 months after treatment revealed complete resolution.ConclusionThe case illustrates that syphilis needs to be considered in the differential diagnosis of testicular lumps and that conservative management with close follow-up can spare the patient radical orchidectomy.
P170 A clinical case study of the use of motivational interviewing (MI) to address a HIV+ gay man's sexual risk taking and recreational drug use
Authors: Yap S Y 
Published: May 2012

BackgroundThere is an increased prevalence of many sexually transmitted infections (STIs) among HIV+ gay men. In addition, the increase of the use of recreational drugs within this population is associated with increased sexual risk taking. There is a need for specific services to address sexual risk taking within this population. A clinic was set up to deliver an MI based intervention to gay men who engage in “high risk” sexual activity, including unprotected anal intercourse. This is a case study of one of the patients referred to this clinic.AimsThe patient is a 47-year-old gay man with a long standing diagnosis of HIV; he has had a number of other STI's in the past. He was engaging in a high frequency of unprotected anal intercourse (both single partner and group sex) with partners he met on the internet. He reported always using recreational drugs during sex sessions. The aim of the intervention was to reduce the frequency of the patient's unprotected sex, thereby reducing patient's risk of acquiring and/or transmitting STIs.MethodsIntervention consisted of five individual sessions of MI with a Clinical Psychologist over a period of 3 months.ResultsAfter five sessions, the patient reported discontinuation of all recreational drugs, a reduction in the volume of sexual encounters, an improvement in mood and increased satisfaction with his sex life.DiscussionThis clinical case study provides preliminary data to support the value and the appropriateness of MI for sexual risk reduction coupled with recreational drug use. Despite the level of complexity of the patient's presenting problems, MI proved to be an effective intervention. Further research is needed to investigate the efficacy of MI for sexual risk reduction with this population.
P172 Transmitted drug resistant HIV presenting as severe encephalitis
Authors: Singh S , Fox J , Teague A 
Published: May 2012

BackgroundSelection of the K103N mutation is associated with a small but significant reduction in viral replicative fitness. Therefore it could be hypothesised that transmission of this strain could be associated with minimal symptoms and low level viraemia at HIV seroconversion.CaseWe present the case of a 41-year-old MSM who was admitted with fever, confusion and agitation following unprotected anal sex 6 weeks earlier with a man of unknown HIV status. He required intubation due to the level of agitation. Admission CT and MRI brain were unremarkable. The first test HIV test was weakly antibody positive; a repeat 6 days later showed a stronger antibody response consistent with HIV seroconversion. His baseline CD4 count was 138 (18%); HIV viral load was 929 000 copies/ml. CSF analysis showed 4 white blood cells, elevated protein at 1.2 g/dl, and a normal CSF to plasma glucose ratio. There was insufficient CSF sample for HIV viral load testing. A diagnosis of encephalitis secondary to HIV seroconversion was made and antiretroviral therapy (ART) with five drugs was started on day 3 of admission. The patient remained agitated for several days. By day 21 the seroconversion symptoms had fully resolved, and by day 28 the plasma HIV viral load was undetectable. Viral genotyping showed the K103N mutation only. The patient remains on ART; now simplified to Kivexa, Darunavir and Ritonavir. This is to continue for 48 weeks at which point a decision will be made to either stop treatment or to continue lifelong ART.ConclusionTransmitted drug resistant HIV can cause severe seroconversion illness and high levels of viraemia despite lower viral fitness. To our knowledge, this is the first report of viral encephalitis at HIV seroconversion caused by drug resistant HIV. The role of entry inhibitors and integrase inhibitors for the treatment of severe seroconversion symptoms to prevent viral entry into cells and aid rapid decline in viraemia are currently under evaluation.
P174 The tangled mesh of lymphogranuloma venereum
Authors: Okpaluba I , Dunham R J C , Evans A 
Published: May 2012

IntroductionThe HPA report an epidemic of lymphogranuloma venereum (LGV) among men who have sex with men in the UK since 2003. Untreated LGV may lead to chronic or irreversible complications with disabling anatomic defects. Reports suggest surgical intervention is rarely required.Case45-year-old man who has sex with men, diagnosed HIV positive in 1995, not on antiretroviral therapy due to patient reluctance, following intolerance to several previous regimens. He had spent the summer in Egypt and on return to the UK had a brief spell as an inpatient with campylobacter and norovirus diarrhoea. He presented to the GUM clinic reporting multiple high risk partners and was treated as a gonorrhoea, chlamydia and syphilis contact; STI screen negative. He re-presented a month later with severe proctitis; pain and blood per rectum and frequent small volume stool. Rectal chlamydia was positive and subsequently LGV serovars confirmed. He tested positive for hepatitis C, retrospective sampling of stored blood samples suggested that this had been recently acquired. Hepatitis C treatment was unsuccessful due to lack of virological response and he suffered acute psychosis likely secondary to pegylated interferon. Despite 3 weeks of doxycyline and negative chlamydia retesting he persisted with severe proctalgia and constipation and was referred to gastroenterology. Flexible sigmoidoscopy showed a single ulcer in the upper third of the rectum with the remainder of the colon looking normal. He received empirical retreatment of LGV, rectal predfoam and laxatives. Symptoms worsened and a defecating proctogram (video of proctogram available) identified marked ano-rectal intussusception. This was surgically managed with a mesh support inserted laparoscopically.ConclusionDespite early recognition, treatment and apparent clearance of LGV infection complications can occur. This is the first report of complicating anorectal intussusception requiring surgical intervention with a mesh support.
P175 The great pretender strikes again
Authors: Moby T , Mwirigi A , White J 
Published: May 2012

BackgroundAn epidemic of syphilis persists in UK men who have sex with men (MSM), often with unusual manifestations. We report a case of syphilis mimicking a lymphoproliferative disorder.CaseA 29-year-old previously well MSM was admitted with 3 weeks of generalised painless lymphadenopathy. He reported malaise, night sweats and joint pain while travelling recently in the Middle East. He was apyrexial and routine bloods were normal apart from mildly raised liver enzymes. Paul Bunnell and HIV antibody tests were negative. His GP screened for STIs but did not include syphilis serology despite the patient describing penile lesions. Clinicians felt that the presentation was highly suggestive of lymphoma. A CT scan showed multiple enlarged lymph nodes in the neck and small bowel mesentery. An open cervical lymph node biopsy was performed. Histopathology showed suppurating granuloma in a reactive lymph node with no evidence of lymphoma. Stains for HIV p24, acid-fast bacilli and fungi were negative. The suggested differential included lymphogranuloma venereum (LGV), cat scratch disease and melioidosis. At GU medicine review he reported sex with multiple partners in the preceding 6 months. He had a blotchy maculopapular rash on his penis and scrotum, though this was treated as “fungal” by junior staff. Molecular tests for chlamydial and gonococcal infections were negative, including throat swabs. Treponema pallidum (TP) antibodies were positive, RPR = 1:256. He was recalled and started on doxycycline for both secondary syphilis and possible LGV. Two weeks later his lymphadenopathy had greatly reduced in size. His original lymph node biopsy was retrieved and TP immunostaining was performed, which revealed a profuse infiltrate of spirochetes.ConclusionThis case highlights the need for clinicians from all specialities to be alert for the many clinical manifestations of syphilis currently prevalent in MSM. Wider use of TP immunostaining in relevant specimens is warranted.