bluuebunny/crossref_metadata_2025_split huggingface dataset:
P176 Scars of venus…and aesculapius
Authors: Stockwell S , van der Walt J , White J A 
Published: May 2012

BackgroundThe lymphogranuloma venereum (LGV) epidemic continues unabated in UK men who have sex with men (MSM). Whatever its presentation, prompt recognition of LGV can be challenging.AimWe describe a case of LGV inguinal syndrome identified too late to prevent major surgery.Case reportA 46-year-old HIV-positive MSM presented to A&E on a Saturday with a 3-day history of a painful left groin lump. He was stable on Atripla with CD4 count 400 cells/ml. He had a tender left inguinofemoral mass and the surgical team took him to theatre for suspected incarcerated femoral hernia. At operation they found instead a large necrotic lymph node and excised it. The patient self discharged the next day. Two weeks later he presented to the GU clinic as a syphilis contact. He mentioned his recent surgery and review of the histology report from the excised node showed “appearances consistent with LGV or cat scratch disease…also a vigorous periadenitis and syphilis should be considered.” Abdominal examination revealed a 25 cm recent surgical scar in the left iliac region. There was penile oedema with sclerosing lymphangitis. A small round subpreputial ulcer was found; it was non-tender and had a rolled edge. There was no perianal or anal lesion. Dark ground microscopy from the ulcer was negative. Rectal and urethral swabs showed no pus cells. The patient was treated with 21 days doxycycline for suspected LGV as well as to cover early syphilis.Chlamydia trachomatis: RNA was detected from the ulcer, first catch urine and rectal specimens. The ulcer tested negative for herpes simplex and TP DNA. All gonococcal tests were negative. LGV-specific DNA was detected from the ulcer but not the rectal swab. TP antibodies were positive with an RPR titre of 4. TP immunostaining of the node biopsy was negative. All clinical signs had resolved by the end of the 3-week doxycycline course.Conclusion/Learning pointsThis case highlights that LGV may still evade detection in both A&E and surgical departments. Awareness of LGV remains poor outside of GUM.
P177 Investigating the cost-effectiveness of integrated prenatal HIV/syphilis screening to prevent adverse pregnancy outcomes in China
Authors: Owusu-Edusei K , Tao G , Gift T L , Tun Y , Kamb M L , Wei X , Wang L M , Bulterys M 
Published: May 2012

BackgroundThe need to scale-up integrated prenatal HIV/syphilis screening in China has increased in the last decade owing to recent increases in syphilis and HIV cases.ObjectivesIn this study, we assess the health and economic outcomes of integrated HIV/syphilis screening to prevent adverse pregnancy outcomes in China.MethodsA Markov cohort decision analysis model was used to examine the health and economic outcomes of pregnancy using data from published literature and local data. Adverse pregnancy outcomes examined included miscarriage, induced abortion, congenital syphilis, stillbirth, low birth weight, mother-to-child HIV transmission and neonatal death. We examined four screening strategies; No-Screening, HIV-Only, Syphilis-Only and HIV-and-Syphilis. We estimated Disability-adjusted life years (DALYs) for all health outcomes. The life expectancy of the child and mother were the analytic horizon.ResultsPreliminary results indicated that for a cohort of 10 000 pregnant women (0.07% prevalence for HIV and 1.5% for syphilis; 20% of HIV+ had syphilis), the HIV-Only strategy prevented 1 case of mother-to-child HIV transmission and resulted in 2 induced abortions; the Syphilis-Only strategy prevented 3 stillbirths, 2 miscarriages, 15 cases of congenital syphilis, 6 cases of low birth weight and 1 neonatal death, but resulted in 35 induced abortions. The HIV-and-Syphilis strategy prevented the sum of the outcomes prevented by the HIV-Only and Syphilis-Only strategies. Estimated costs per DALYs prevented were: Syphilis-Only, $38; HIV-and-Syphilis, $122; HIV-Only, $5806.ConclusionsIntegrated prenatal HIV/syphilis screening is more cost-effective than HIV-Only screening. This is largely due to the relatively higher prevalence of syphilis and the substantially lower cost of treatment.
P178 Is punishment and criminalisation of HIV transmission justified?
Authors: Phillips M D , Clegg S 
Published: May 2012

AimTo examine why it may be acceptable to punish HIV positive individuals for unintentionally transmitting HIV through consensual sex.MethodKey issues for criminal punishment include deterrence, retribution, rehabilitation and incapacitation. This framework was applied to the justification of criminal prosecution for non-intentional transmission of HIV through consensual sexual intercourse.ResultsRetributionThis includes pain inflicted or rights removed (such as freedom) in response to an action. Criminal law is retributive. However, in England and Wales, prosecution occurs for “reckless transmission” not reckless endangerment. It is legal to take a chance, but illegal if a certain outcome occurs.DeterrenceA threatened legal sanction may prevent crime through fear of retribution. Criminalising transmission of HIV to an unknowing partner may increase disclosure. This approach is flawed. (1) The charge of reckless transmission needs the HIV positive person to know they are probably or definitely infected: criminalisation may prevent testing. (2) Criminalisation is counterintuitive to placing responsibility for an individual's sexual health with themselves, not with someone else. (3) Criminalisation stigmatises the HIV positive community.RehabilitationRehabilitation in prisons is not perfect, with 39.3% of those with convictions being re-convicted of crime in 2009. Any change in behaviour in the absence of specialised programmes may be due to deterrence.IncapacitationIt is difficult to practise safer sex in prison as there may be a higher risk of coercion, sex work and covert sex. Sexual healthcare in the prison setting is unlikely to be equal to community sexual healthcare. Incapacitation cannot justify criminalisation in this case.ConclusionProsecution for non-intentional transmission of HIV through consensual sexual intercourse satisfies few of the justifications for punishment. The case for criminal sanctions should be reconsidered.
P179 Life-time and recent recreational drug use is more common among men who have sex with Men compared to others attending sexual health clinics
Authors: Dargan P I , Hunter L , White J A , Benzie A , Wood D M 
Published: May 2012

BackgroundData on the frequency of recreational drug use (RDU) are collected at a population level through representative national surveys (eg, British Crime Survey). Anecdotally it appears that RDU is more common in men who have sex with men (MSM), but there are few systematic data to prove this. The aim of this study was to investigate the pattern of RDU in patients attending a sexual health clinic and to determine whether drug use was greater among MSM.MethodsWe administered a questionnaire to all patients attending the sexual health clinics at two inner-city London teaching hospitals over a 3-month period (July 2011–September 2011). The questionnaire was self-completed by patients while waiting to see a clinician. Data were collected on age, gender, gender of sexual partner(s) and previous/current RDU (type and frequency of drugs used).Results1328 questionnaires were completed (mean±SD age 30.5±8.5 years, 54.9% female); 254 (19.1%) were MSM. Life-time use of all drugs, except cannabis, was more common in MSM; last-month use of all drugs, except cannabis, cocaine powder and amphetamine, was more common in MSM (abstract P179 table 1).Abstract P179 Table 1Frequency of lifetime and last month use among the men who have sex with men (MSM) and non-MSM respondentsLifetime useLast-month useMSM (%)Non-MSM (%)p ValueMSM (%)Non-MSM (%)p ValueCannabis62.758.40.2310.29.20.62Cocaine (powder)48.632.8<0.0014.32.60.14MDMA (pill)40.830.80.0022.70.90.02Mephedrone23.912.2<0.0013.10.1<0.001Ketamine33.717.3<0.0013.50.5<0.001Volatile nitrites71.426.9<0.00118.40.4<0.001Sildenafil (Viagra)43.515.7<0.00111.80.5<0.001Amphetamine29.821.20.0030.80.30.23Gamma-hydroxybutyrate (GHB)22.711.1<0.0012.40.1<0.001Gamma-butyrolactone (GBL)16.18.8<0.0013.10.1<0.001Methamphetamine16.99.0<0.0011.20.20.02ConclusionSexual health clinics provide an ideal forum to identify individuals using recreational drugs and to implement behavioural interventions and education programmes to promote safer RDU, reduce drug-related harm and, in view of the association between RDU and high risk sexual behaviours, to decrease the risk of subsequent STIs. Our data show that both life-time and last-month use of most recreational drugs are more common in MSM and therefore interventions should be targeted to this population.
P182 Is it useful to perform a full physical examination in asymptomatic patients with late syphilis?
Authors: Dabis R , Radcliffe K 
Published: May 2012

BackgroundIn late and congenital syphilis a thorough physical examination should be undertaken for signs of syphilis as per British Association for Sexual Health and HIV guidelines. This should include examination of skin and mucosal surfaces, lymph nodes, the cardiovascular and neurological systems.AimsTo audit all cases of late syphilis at our centre to see if a full cardiovascular and neurological examination was documented and also to see if a full examination contributed to the management of asymptomatic patients.MethodsA total of 648 notes were identified as late syphilis from KC60 codes from our local database. Records were from the period 1994 to 2010.The following information was extracted from the clinical records: age, ethnicity, gender, sexuality, symptomatic/asymptomatic, cardiovascular and neurological examination findings and further action taken where applicable. 148 notes were unavailable. 20 notes were excluded. Therefore 480 notes in total were audited.ResultsOf the 480 patients, 262 (55%) were of Black Caribbean ethnicity, 75 (16%) White British, 68 (14%) Black African and 75 (16%) others. 240 (50%) were heterosexual males, 206 (43%) heterosexual females, 31 (6%) men who have sex with men. Information on sexual orientation was not available in 3 (1%). 295 patients were asymptomatic of which 288 (98%) had normal physical examinations. Seven asymptomatic patients had positive clinical findings but these did not lead to a diagnosis of cardiovascular or neurological syphilis. In 99 cases a full examination was not documented and in 21 cases patients declined or defaulted further follow-up. There were 65 symptomatic patients all had abnormal physical findings.ConclusionIn view of the absence of significant clinical examination findings in asymptomatic patients with late syphilis we believe that a physical examination is not a necessary element in the management of such cases and should be omitted.
P183 How likely is environmental contamination ofChlamydia trachomatisDNA to lead to false positive results in patients attending our clinic?
Authors: Chan S Y , King R , Borgulya G , Pakianathan M , Sadiq S T , Hay P , Planche T 
Published: May 2012

BackgroundEnvironmental contamination with DNA fromChlamydia trachomatis(CT) has been reported from GUM clinics, suggesting the possibility of cross contamination of specimens during sample processing or the environment. If it does occur, contamination is likely dependent to some degree on how busy patient throughput is in a clinic. Our GUM clinic sees over 29 000 patients a year.AimsTo investigate whether diagnostic samples could become contaminated from the environment in our clinic.MethodsWe investigated the potential for contamination in two ways. (1) A dummy run of 60 sterile water samples, as surrogates of urine and 10 sterile swabs during routine clinic times. (2) A patient throughput study using logistic regression analysis to see if patients positive for CT were associated with attendance numbers. We hypothesise that possible contamination increases after each infected patient and drops off to zero over the weekend. Our clinic is open from Monday to Friday and cleaned daily. Toilets are not cleaned between patients. Results were analysed for walk in clinics.ResultsNone of the dummy urine or swabs tested positive for CT over 6 months. In a year, 24 115 patients attended the walk in clinics with 2860 (11.9%) testing positive for CT. A logistic regression analysis was done on CT positivity on Mondays compared to Tuesdays to Fridays. This was adjusted for age, gender, sexuality and type of clinic. Rates of CT were 5% higher on Tuesdays through Fridays than on Mondays but the difference was not significant (95% CI 0.95 to 1.16).ConclusionThere was no evidence of dummy sample contamination during our study period. We found weak association between CT positivity and clinic attendance although it was not significant at the 5% level. Further studies with a larger sample size and analysis on within day trends could explore this in depth. Environmental CT is unlikely to lead to false positive results in our clinic.
P184 Peyronie's disease presenting to a sexual health clinic
Authors: Draeger E M , Dharmaratne S D , Goh B T 
Published: May 2012

BackgroundPeyronie's disease (PD) is an acquired inflammatory condition of the corpus cavernosum of unknown aetiology. This can lead to formation of a plaque within the tunica albuginea of the penis leading to curvature and pain of the erect penis and erectile dysfunction. Medical treatment options are with colchicine or pentoxifyline.AimTo characterise the patients who were seen between 1998 and 2011 with a diagnosis of PD.MethodRetrospective case notes review of 18 identified cases with history and signs consistent with PD.ResultsThe mean age of the 18 patients was 42 (range 20–63); six were Caucasians, six were from Indian subcontinent, five Africans and one Caribbean. All except one gave a history of change in penis shape during erection: six had upward curvature, seven bent to the left, one to the right, two had shortening of penis/distal flaccidity and one had no change. Seven had pain on erection, 10 had history of a penile lump, five had erectile dysfunction and two had difficulty in penetration. The mean duration of symptoms before presentation to the clinician was 64.1 months (range 3 weeks to 264 months), none had a history of penile trauma, intracavernosal injection or Dupuytren's contracture. Of four who had an ultrasound scan of the penis, two were confirmed to have lumps consistent with PD. Of 12 who had primary treatment with colchicine for 2–12 months; three showed improvement in symptoms, three no change and six unknown outcome. Of two who had primary treatment with pentoxifyline for 1–11 months one showed improvement in symptoms and one unknown. Of three who failed to respond to colchicine and were then treated with pentoxifyline, a further one showed improvement.Conclusion(1). 28% of cases had ED. (2). Overall, 33% of the patients had symptomatic improvement with treatment and none had worsened post treatment which is consistent with the findings of other studies.
P186 Should nursing staff in sexual and reproductive health (SRH) clinics wear a uniform?
Authors: Cunningham C , Stewart V , Emslie L , Davis T 
Published: May 2012

BackgroundThe NHS Scotland dress code policy was implemented in 2008 with the introduction of a national uniform in 2010. Historically nursing staff within SRH clinics have chosen not to wear a uniform to create a less formal environment. Within the policy it is stated that boards should conduct a full risk assessment to ensure that local policy is appropriate for different categories of staff.AimTo gather opinions from both patients and nursing staff about the impact of the introduction of the national uniform policy within the SRH service.MethodsA patient (n=224) and nursing staff (n=13) survey was undertaken over a 10-day period in January 2012.ResultsThe patient survey revealed that a minority (7%) of patients preferred that nursing staff wore their own clothes with the majority (54%) having no preference on staff dress code. The nursing staff surveys revealed that the majority work within a community health centre setting (46.2%) and were moderately happy with wearing a uniform (30.8%). Convenience was identified as a very important factor when choosing to wear a uniform (53.8%). The majority of staff agreed or strongly agreed that wearing a uniform made them more approachable (46.2%) and their role more identifiable to patients (71.6%) but they neither agreed or disagreed that it increased a patient's perception of their competency (46.2%) or enhanced professionalism (30.8%).DiscussionAlthough there was concern that the introduction of uniforms for sexual health nursing staff might interfere with the nurse–patient relationship this has not be realised.
P187 Workforce planning and SAS Doctors: a crisis in waiting
Authors: Lee J , Carlin E , Robinson A 
Published: May 2012

BackgroundThe importance of medical workforce planning is well recognised but it is an inexact science and has usually concentrated on consultant and trainee numbers. The difficulties in planning are complicated by a lack of information on specialty and associate specialist (SAS) doctors.AimsWe sought to aid workforce planning by collecting data from the SAS workforce to enable broader sexual health service planning.MethodsA survey monkey questionnaire was devised and sent to all SAS doctors in sexual health who were known to the British Association for Sexual Health and HIV (BASHH) or its members. The survey was open for completion for 3 months from March 2011.ResultsIn total, 227 SAS doctors (78% female, 22% male) completed the survey, 74% were on the new SAS contract, 44% as specialty doctors, 30% as associate specialists. Uptake was estimated at 40% on local assessment. According to the data in abstract P187 table 1, 1049–1253 genitourinary medicine (GUM) sessions/week are done by the respondents. Numbers are likely to be much higher given the estimated response rate. Significant numbers of HIV and sexual and reproductive health (SRH) sessions are also undertaken. Respondents indicated that 63% planned to retire within the next 15 years; 11% by 2013, 18% between 2014 and 2016, 20% between 2017 and 2022, 21% between 2022 and 2026, 29% were unsure when in the next 15 years they would retire.Abstract P187 Table 1Number of sessions performed by SAS doctors% of SAS doctors working these sessionsNumber of GUM sessions/week 1–220 3–420 5–617 7–815 9–1018 ≥103Number of HIV sessions/week None74 1–219 3–42 5–62 7–82 9–100.5Number of SRH sessions/week None49 1–224 3–410 5–67 7–84 9–105ConclusionSAS doctors provide a major contribution to sexual health service work and given that 63% plan to retire within the next 15 years this is a crisis in waiting. Failure to take this data into account when planning for the future may mean that the crisis will become a reality.
P193 A mixed-method study of how to increase STI screening among young people
Authors: Loades N , de Visser R 
Published: May 2012

BackgroundSTIs are a considerable problem, with diagnoses concentrated among young people. Although the Theory of Planned Behaviour (TPB) predicts many health behaviours, there is a lack of research into how well it explains STI testing. The original TPB emphasised the importance of intentions as the ultimate influence on behaviour. Subsequent research focuses on implementation intentions—people who make explicit plans for how to implement their intentions are more likely to do so. Although some studies have analysed barriers and facilitators in STI testing, no published research has examined what impact developing implementation plans has. This study was designed to address this knowledge gap.ObjectivesTo assess an extended TPB and implementation intention interventions on STI testing; to carry out a qualitative study of barriers and facilitators in those who intend to test.Methods371 participants completed an online baseline questionnaire and were randomly allocated to a control, information or implementation plan condition to examine differential effects on intentions to undergo STI testing. 172 completed a 6-week follow-up questionnaire to assess actual testing behaviour. In-depth interviews were conducted with a purposive selection of the sample and analysed using interpretative phenomenological analysis.ResultsMultivariate analysis revealed that TPB variables explained 20% of the variance in past testing behaviour (p<0.01) and 17% of variance in intention (p<0.01). No significant difference between intervention arms was found (p=0.90) (the intervention did not significantly strengthen intentions). Qualitative analysis revealed multiple perceived barriers to STI testing.ConclusionResults provide support for the utility of an extended TPB in predicting past behaviour and intentions to undergo STI testing. Although the implementation plan intervention was ineffective, qualitative data helped explain why a significant intervention effect was not found.
P195 Asking about sex in general health surveys: it can be done! Comparing data collected by the 2010 Health Survey for England with Natsal
Authors: Mercer C H , Robinson C , Craig R , Nardone A , Johnson A M 
Published: May 2012

ObjectivesThe HSE is administered annually to a probability sample of people in England. In 2010, the HSE included, for the first time, questions about sexual health, which previously were considered too sensitive for a general health survey. This paper compares the reporting of sexual behaviours by people aged 16–44 in HSE2010 with Natsal-2, Britain's national probability survey of sexual behaviour.MethodsHSE2010 interviewed 8420 people aged 16–69, of whom 2911 were 16–44. Natsal-2 interviewed 12 110 people aged 16–44 in 1999/2001. HSE2010 used pen-and-paper self-completion questionnaires for the sexual health questions, while Natsal-2 used computer-assisted self-interviews for the more sensitive questions.ResultsCollecting sexual behaviour data were acceptable to HSE2010 participants with low item non-response (5%–10%), albeit slightly higher than in Natsal-2 (<5%). Reported age at 1st intercourse was comparable in the two surveys: medians of 17 (men) and 16 (women) aged 16–24. However, for some very sensitive questions there were lower levels of reporting in HSE2010 than in Natsal-2: while the proportion reporting same-sex in the last 5 years was similar (2%–3%), reporting of ever having same-sex was lower in HSE2010 for men (2% vs 5% in Natsal-2). Similarly, the mean number of opposite-sex partners reported in HSE2010 was a little lower than in Natsal-2, particularly for men: 9.5 vs 12.7, respectively; (5.4 vs 6.5 for women, respectively). Men were also slightly less likely to report STI diagnoses in HSE2010 vs Natsal-2: 8.7% vs 11.1%, respectively; but this was reported by similar proportions of women (12%).DiscussionSexual behaviour data can be successfully collected by the HSE, albeit in less detail than in Natsal. HSE2010 has demonstrated the feasibility and utility of including such questions in general health surveys, providing a useful vehicle for monitoring sexual risk behaviour more frequently than is possible with decennial Natsal surveys.