bluuebunny/crossref_metadata_2025_split huggingface dataset:
P63 Treatment of pelvic inflammatory disease using short-course azithromycin
Authors: Cunningham L , Murray A , Horner P J 
Published: May 2012

BackgroundIn our centre, a novel 5-day regimen of azithromycin (1 g stat then 500 mg daily for 4 days with or without metronidazole and/or ceftriaxone) is used and has been approved regionally. This is administered as an alternative regimen in selected cases of pelvic inflammatory disease (PID), usually those with milder symptoms and signs.Aims and ObjectivesWe assessed the use and efficacy of short course azithromycin in PID. We also assessed follow-up rates and adherence for all cases of PID.MethodsRetrospective case note review of 129 female patients coded as PID during the period 1 July to 31 December 2011. Data were collected and transferred to Excel for analysis.Results109/129 (84.5%) of women were diagnosed with PID based on symptoms and signs as described in the BASHH PID guideline. Chlamydia was subsequently diagnosed in 10/108 (9.3%) and gonorrhoea in 5/108 (4.6%). Chlamydia antibody titres of >1 in 256 were found in 20/65 (30.8%) of patients. Taking into account missing data, 39/51 (76.5%) patients completed the antibiotic course and 64/78 (82%) reported full or partial resolution of symptoms. 14/85 (16.5%) required further PID treatment, eight of whom had sexual intercourse with an untreated partner (see abstract P63 table 1).Abstract P63 Table 1Antibiotic regime for PID treatment and responsePrinciple antimicrobialTreated (%)Follow-up attended (%)Completed courseFull/partial clinical responseMissing dataMissing dataAzithromycin32 (29.4)215/81314/192Ofloxacin71 (65.1)5932/401946/554Doxycycline2 (1.8)20/2120Other4 (3.7)32121Total10985 (78)3934647DiscussionIn this study, 32/109 (29.4%) women were treated for PID with azithromycin either in combination or alone. Overall, the majority of women completed treatment and reported a full or partial improvement in symptoms. Follow-up rates were good but documentation was inadequate. Comparisons between regimens are limited due to missing data. Further work will look at novel follow-up methods such as routine telephone contact as well as standardisation of follow-up documentation.
P66 Testing forTrichomonas vaginalis(TV) by transcription mediated amplification (TMA). An evaluation in a large city clinic
Authors: Lawton M , Schembri G , Kingston M 
Published: May 2012

BackgroundTrichomonas is worldwide, the commonest curable STI. While it's prevalence in the UK is less than other areas of the world, it remains a common cause of vaginal symptoms in women. Although not routinely tested in men it can be a cause of discharge and dysuria. It may be asymptomatic in both sexes. There is debate about the significance of TV infection, over and above it's symptomatology. The majority of centres use wet-film microscopy and/or culture for the detection of TV. The sensitivity of wet-film is recognised to be low. Culture has been considered the gold standard for TV detection, but is slow and costly.MethodsSymptomatic female patients and men with recurrent/persistent NSU were tested for TV using the same sample as the Chlamydia/gonorrhoea specimen. They were analysed using the Gen-Probe APTIMA TV assay in addition to the usual Chlamydia/gonorrhoea AC2 assay. Patients symptomatic of discharge had wet-film microscopy done as per standard clinical practice. Demographic data and symptomatology were recorded. Comparison was made between results from TMA and wet-film.Results1457 patients were tested for TV using TMA. Almost all (97%) were women. The overall prevalence for Trichomonas, Chlamydia and gonorrhoea via TMA was 3%, 8%, 1% respectively. TMA identified significantly more cases of TV compared to wet-film (41 vs 20, p=0.009). The prevalence of TV was significantly higher than gonorrhoea (p=0.002). Subset analysis will be done prior to presentation.ConclusionTesting for TV via TMA identified significantly more infections compared with the current method of detection. It's overall prevalence was much higher than gonorrhoea which is routinely screened for in asymptomatic patients. Given the same sample is used for analysis, it does not add any additional clinic time or discomfort to the patient. Cost effectiveness of using TV TMA, particularly in asymptomatic patients has not yet been evaluated.
P71 Validation of an in house nucleic acid amplification (NAATs) PCR test forTrichomonas vaginalis
Authors: Appiah J , Saunders P , Yapa M , Tong C Y W , White J , Ison C , Alexander S 
Published: May 2012

BackgroundTrichomonas vaginalis, a flagellated protozoan, is transmitted through sexual contact that commonly manifests itself as symptomatic in more women than men. However, the true prevalence of infection and the proportion that is asymptomatic is not known because of the lack of good diagnostic tests. Microscopy is the most common method of detection used but this is known to have a low sensitivity. Other methods include culture, which is considered the gold standard, a point of care test and molecular methods, which have increased sensitivity but are more time consuming or expensive.AimTo validate an in-house nucleic acid amplification test (NAAT) test for the detection ofT vaginalis.MethodTwo methods were established In-house. The first NAATs detectedT vaginalisby amplification of a 92 bp segment of theT vaginalis-specific repeat DNA fragment and the second amplified a segment of the â-tubulin gene, and was used to confirm the positive results. A further control ran alongside the first NAATs to identify inhibition by targeting the ribonuclease P gene. Sensitivity was initially validated with a positive controlT vaginalisstrain S1 and then validated against anonimised clinical samples previously tested using the APTIMAT vaginalis(ATV) transcription mediated amplification (TMA) kit and an in-house real-time TV PCR (see abstract P71 table 1).Abstract P71 Table 1TV diagnosed according to testAssayAptima ATV TMAWT In-house PCRTV RT PCRTV confirmation PCRNumber of positives18 (18.75%)17 (17.9%)*17 (17.9%)17 (17.9%)*One sample was a low level positive/negative, but this was also positive on Aptima.ResultsA total of 96 samples were tested. 17 (17.9%) of the specimens tested resulted in positiveT vaginalisNAATs using bothT vaginalisreal-time PCR and the TV confirmatory real-time PCR.ConclusionsThese in house NAATs gave good concordance with the commercial assay. It would be useful to further compare detection between this and other methods including the culture and POCT in asymptomatic patients. The methods established could also be used in comparisons in clinical studies.
P72 Microscopy and culture forTrichomonas vaginalis(TV): are both tests required and should test of cures (TOC) be performed routinely?
Authors: Gilmour C , Jones L , Jones R , Cohen C E 
Published: May 2012

BackgroundTesting for TV has changed locally in recent years dependant upon whether the woman has symptoms. Microscopy and culture are now only performed in symptomatic women or in contacts of TV. All patients diagnosed with TV must be seen by the Health Advisers to discuss partner notification and to arrange a TOC within 2 weeks.AimTo ascertain if both microscopy and culture remain warranted for symptomatic women and those attending for TOC or whether microscopy alone is sufficient for diagnosis. To compare audit findings with previous audits using BASHH auditable standards.MethodCase notes of patients diagnosed with a KC60 code of C6A between 1 October 2009 and 31 October 2010 were reviewed.ResultsA total of 58 patients were included in the audit pertaining to 65 episodes. Largest ethnic group was Black/Black British Caribbean (34%). The majority (93%) were symptomatic. Nine (14%) patients had positive microscopy and negative culture, 10 (15%) had negative microscopy and positive culture and 46 (71%) had positive microscopy and culture results. The majority (97%) received Metronidazole therapy. 43 (74%) saw a Health Adviser after initial diagnosis. Almost all (88%) had documented partner notification and 27 contacts attended for treatment. 46 (79%) attended for TOC and of these 36 (78%) attended within 2 weeks. Of the 46 attending for TOC, 42 (91%) were symptomatic but only five (12%) were TV positive on TOC. Auditable standards comparison (see abstract P72 table 1).Abstract P72 Table 1Comparison of auditable standards and rateAuditable standardsBASHHLocalAudit 2011 n=58Audit 2006 n=94Patients diagnosed with TV should receive treatment with Metronidazole—either 400 mg twice daily 5/7 or 2 g stat100%–97%96%Symptomatic female patients at presentation should have a TV wet mount and culture–100%100%98%Those diagnosed with TV infection should have contact tracing performed100%–88%71%One or more traceable contacts should treated within 1 month60%–47%33%Women with TV on cervical cytology should be offered confirmation of diagnosis with a vaginal swab before treatment and offered100%–100%–Patients should return for a TOC within 2 weeks of treatment–50%78%71%DiscussionOverall the results from this audit have demonstrated an improvement in respect to previous audits in line with BASHH auditable standards. Findings related to microscopy and culture results do not appear to demonstrate a significant risk in missed diagnoses and those who were microscopy negative (subsequently culture positive) had Hay and Ison Grade 2/3 and treatment with Metronidazole. In skilled hands, microscopy alone may be sufficient to diagnose TV in those attending with symptoms.
P75 Do cash incentives increase the uptake of chlamydia testing in pharmacies?
Authors: Martin S J , Currie M J , Deeks L S , Cooper G M , Parker R M , Del Rosario R , Hocking J S , Bowden F J 
Published: May 2012

BackgroundChlamydia screening uptake rates in Australian and overseas pharmacies vary widely (11% to 58%).AimTo determine the effect on the uptake of chlamydia screening in community pharmacies when a cash reward is offered to young people and participating pharmacies.MethodsThe study was advertised in print and electronic media. People aged 16–30 years requested, or were offered, chlamydia testing kits by pharmacy staff (assistants and pharmacists). Participants who provided a urine sample and completed a questionnaire received AUD$10; pharmacies received AUD$10 per person recruited. Urine specimens were tested in pools using PCR, with reflex testing of individual samples when the pool tested positive. Positive cases were notified by sexual health nurses and offered treatment.ResultsSix urban community pharmacies took part in the study, each for 15 days. 979 testing kits were given out and 970 sample pots returned (99.1%); 66 (7%) did not contain urine. 74% (670/904) of the urine samples were determined to be from unique individuals, 65% of whom were male. 19 people (13 females and 6 males) tested positive; positivity rates were 5.2% (95% CI 2.8 to 8.8) for females and 1.4% for males. 11 (61%) of those testing positive were contacted and eight attended a local sexual health centre for treatment, three were treated elsewhere. Of the eight people treated at the sexual health centre, two females aged 15 and 20 years were diagnosed with pelvic inflammatory disease. Contact with the remaining eight positive individuals was not possible due to disconnected, incorrect or non-existent telephone numbers.ConclusionThe 68% specimen return rate found in this study significantly exceeds those reported elsewhere. Strategies to prevent repeat testing, non-urine specimens and incorrect contact numbers are needed to ensure good clinical care and optimum use of resources.
P78 The acceptability of digital self-examination in men who have sex with men (MSM) at risk of anal intraepithelial neoplasia (AIN)
Authors: Bayley J , Perry N , Shaw S , Campbell L , Richardson D 
Published: May 2012

BackgroundAIN is a pre-cancerous change in the anal mucosa caused by human papilloma virus (HPV) which untreated, may progress to anal squamous cell carcinoma with 500 new cases per year in the UK. There is currently no evidence about the efficacy of self-examination, but this may be a quick, cheap and effective screening tool to aid early diagnosis and prevent cancer.MethodsPatients attending a GU/HIV clinic were given a questionnaire exploring knowledge and risk factors of AIN and attitudes to self-examination. They were then given an educational leaflet on what to do and feel for. Inclusion criteria were males >18 years old who identified as MSM. Results on an SPSS database were analysed using standard statistical methods.Results103 questionnaires were returned, 60 (58%) were HIV positive. 10/103 (9.9%) were aware of AIN. 68/93 (73.1%) who were unaware of AIN wanted more information about the condition. 95/103 (92.2%) thought digital self-examination was acceptable. 55/103 (53.4%) self-examined regularly. Of people who self-examined 26/55 (47.3%) had a history of warts, compared to 12/48 (25%) with no history of warts (p=0.02). 38/48 (79.2%) who did not self-examine wanted more information compared to just 34/55 (61.8%) who regularly self-examined (p=0.06).DiscussionThis study highlights a lack of awareness about AIN and the acceptability of self-examination for this condition. Over half were regularly self-examining but only a small proportion had heard of AIN, suggesting that although they are happy to self-examine, they are unsure what to look for. Most MSM wanted more information. Digital self-examination may therefore provide a rapid, cheap, effective and acceptable screening tool. This may help to diagnose AIN earlier and allow education about self-examination and information regarding AIN to be regularly incorporated into clinic visits for MSM. Further research into the efficacy of this technique for detecting AIN is required.
P79 Colposcopic management of cervical warts
Authors: Nori A , Kola-Bankole S , Goh B T 
Published: May 2012

BackgroundThere is a paucity of evidence and guidance for genitourinary medicine (GUM) clinicians on the management of cervical warts (CW). These patients are either treated in a routine clinic without colposcopy examination (CE) or referred to gynaecology.AimTo describe the management of patients in a GUM diagnostic colposcopy service where a CE (×7 magnification) performed before and after application of 5% acetic acid to the cervix to identify flat acetowhite epithelium (AWE) in addition to the CW.MethodsNotes of patients who attended the service with a diagnosis code of C11 between June 2006 and December 2011 were reviewed and 48 patients with CW were identified. Details of demographics, presenting features, associated STI, cervical cytology, biopsy results, treatment and follow-up were analysed.ResultsMedian age of 48 patients was 24 years (range 16–63); 23 (47.9%) were Caucasians, 16 (33.3%) Afro-Caribbeans. 25 patients had no prior cervical cytology as they were under 25 years of age. Of the 23 patients who had a previous cervical cytology, six had a history of abnormal smears. 17 (35.4%) had CW alone, 31 (64.6%) also had vulvo-vaginal/perianal warts. Seven (14.3%) had other concomitant STIs.15 (30.6%) had AWE that on biopsy showed histopathological evidence of HPV and, 10/15 (66.7%) also had evidence of CIN1/2. Of the 33 patients with no AWE, histopathology was available on 23 CW which showed CIN1/2 in 16/23 (69.5%). 10/48 (20.8%) patients were treated with electrocautery, 11 (22.9%) with excision biopsy and 26 (54.2%), with both. 31 patients responded after the first treatment; nine had a further 1–3 treatments. One recurred after 6 months. 26 patients with associated CIN were referred to gynaecology.DiscussionWe report a high prevalence of CIN in CW and in associated subclinical lesions in this predominantly young cohort of women, suggesting the need for colposcopy to assess cervical warts or more careful follow-up with cervical cytology.
P8 Tests of recent HIV infection in clinical practice: the patient perspective
Authors: Anderson E R , Taegtmeyer M , Delpech V , Chawla A , Gilbart V 
Published: May 2012

BackgroundA test for recent infection (avidity test) is offered for all patients newly diagnosed with HIV in England and Wales as part of an HIV incidence surveillance programme. The UK is currently the only country to return these results to individual patients.ObjectivesTo determine the acceptability and patient experience of receiving a RITA test result soon after HIV diagnosis.MethodsThis was a qualitative study using semi-structured interviews. 14 people recently diagnosed with HIV who had a RITA result consented to participate. Analyses were based on the framework method using N-Vivo software. Interviews were transcribed, coded and emergent themes identified.ResultsAll participants agreed that the more information available to them about the possible duration of infection the better. Unsurprisingly the HIV diagnosis and the emotions and practical issues associated with it had far more impact than the RITA result. None of the participants experienced any problems with former partners as a consequence of their RITA result although some could see the theoretical potential for such problems. “Recently infected” RITA results were felt to be potentially useful for identifying “at risk” partners. However partner notification was not altered in the study group because the individuals concerned had other reasons to suspect recent infection. Other major themes identified were the perceived stigma; the difficulty of sharing the diagnosis of HIV with family and friends; and the many conflicting emotions that people had to deal with at diagnosis including anger, grief, self-blame, fear and depression.ConclusionRITA testing is a potentially useful epidemiological tool. These interviews demonstrated that receiving a RITA result, while useful to some people, is a minor issue compared with dealing with the HIV result itself. Reassuringly none of the participants reported negative outcomes from receiving the RITA result.
P81 Point (young person's) clinic audit
Authors: Chan S Y , Zhou J , Rashbrook S , Dragovic B 
Published: May 2012

BackgroundYoung people attending sexual health clinics should receive an adequate standard of care, according to BASHH clinical effectiveness group guidance.Aims/ObjectivesTo carry out an audit of clients attending the Point clinic—a sexual health clinic for clients aged ≤18. To describe client characteristics and compare practice against BASHH guidelines.MethodsWe carried out a retrospective case notes review of all clients attending the Point clinic from 1 November 2009 to 30 April 2010. Patients were only counted once (new/rebook). Only patients having sexually transmitted infection (STI) screens were included. Information was collected on demographics, risk assessment, STI screening, HIV testing and contraception.Results123 clients attended. 51 did not have a screen. Reasons were: not sexually active, requesting contraception/condoms only, attending for results. Included in the audit were 72 patients who had STI screens. 53 out of 72 (73.6%) were female with a mean age of 16.9. 10 out of 72 (13.9%) were <16. Fraser competence was assessed in all <16 years old. Risk assessment (age of partner/alcohol/drugs use/housing/mental health issues) was documented in 63/72 (87.5%) and in all <16 year olds. Contraception was reviewed in 64/72 (88.9%). Additional contraception advice was given to 36/72 (50%). Of the 34 not given additional contraceptive advice, six were not using any contraception. HIV test was offered to 71/72 and 35 accepted. 11/72 (15.3%) had an STI, most common beingChlamydia trachomatis(6/11).ConclusionWe are managing patients in accordance with BASHH guidelines. All <16 year olds (and those 16–18 where indicated) had a risk assessment completed. Offer of HIV tests was very good. It was identified that improvements were required with regards to provision of additional contraceptive advice.
P83 Review of the first attendances in under-16 year olds in a community based integrated sexual health service
Authors: Pal N , Ashby J 
Published: May 2012

AimTo analyse sexual and risk behaviour in under 16 year olds newly attending our services.MethodsComputer databases were used to identify the last 100 under 16 year olds who newly attended the sexual health services up until December 2011. Patient records were retrospectively reviewed and clinical, social, sexual and reproductive data were collated using excel.ResultsAge of the attendees ranged from 13 to 15 years; 95% were girls. 98% reported heterosexual orientation. Ethnicity and primary reason for attendance as shown in abstract P83 table 1. Fraser competence was documented as present in 100% of attendees. Vulnerability factors were assessed in all attendees. Age at coitarche ranged from 9 years of age upwards. 94% were sexually active and 91% reported unprotected sexual intercourse. Other than condoms, no other forms of contraception were in use. Contraception was discussed with 100% of attendees and 47% commenced contraception at first visit. 6% had at least one previous unplanned pregnancy. 9% reported symptoms of a sexually transmitted infection and 10% of attendees were diagnosed with at least one sexually transmitted infection at the first visit. 6% reported non-consensual sex of which 2/6 were reported to the Police. 45% reported partners over age 16. 15% had social services or other agencies input.Abstract P83 Table 1Ethnicity and primary reason for attendance% of attendeesEthnicity White UK81 White other7 Black African/Caribbean6 Asian5 Mixed1Primary reason for attendance Contraception planning41 Emergency contraception28 Sexual health screen19 Sexual health advice6 Termination of pregnancy4 Sexual assault2ConclusionsHigh rates of underage sexual activity and unsafe sex were observed in this group of young people attending clinic for the first time, with significant amounts of sexually transmitted infections identified and unplanned pregnancies seen. This highlights a need for earlier interventions, as often sexual risk had already occurred prior to the young people attending clinic.
P85 Congenital syphilis in the UK: results from enhanced surveillance, 2010/11
Authors: Simms I , Tookey P , Goh B , Lyall H G , Evans B , Ison C 
Published: May 2012

BackgroundSince 2001, rates of congenitally transmissible syphilis have increased amongst reproductive age women. Concerns have been raised about the effectiveness of intervention which has been restricted by an absence of national surveillance data. In 2010, a 3-year study was established to provide an evidence-base for control strategies.AimTo explore the epidemiology of congenital syphilis.MethodsThe surveillance dataset consisted of returns to the British Paediatric Surveillance Unit, diagnoses made in genitourinary medicine clinics (GUMCAD) and laboratory reports. Infants diagnosed with congenital syphilis under the age of 24 months were included (detailed methodology at:http://www.rcpch.ac.uk/).ResultsBetween 1 February 2010 and 1 November /2011, 11 cases (male=9, female=2) of congenital syphilis were confirmed, all reported from England. Most infants (6/10) were born at over 37 weeks: median birth weight was 2910 g (range: 1340 g to 3690 g). Clinical presentation varied from asymptomatic (1) to acute, including severe anaemia, hepatosplenomegaly, rhinitis, oedema, thrombocytopaenia and skeletal damage. Median maternal age at delivery was 19 (range: 17–28). Many of the infants' mothers were White and came from the UK and Eastern Europe. Where maternal stage of infection was recorded, 4/7 presented with primary and 3/7 with secondary syphilis. One infection diagnosed late in pregnancy was the result of re-infection acquired after effective screening and management in the first trimester. All diagnoses were managed according to BASHH Guidelines.ConclusionsCongenital syphilis presents a complex social, clinical and public health problem. Antenatal screening is largely effective in controlling congenital syphilis but delivering effective health care to women who are marginalised in society and at-risk of acquiring congenitally transmissible syphilis represents an emerging challenge.