bluuebunny/crossref_metadata_2025_split huggingface dataset:
P155 Super accelerated course of hepatitis B Vaccine—10 years on, is it working?
Authors: Suchak T , Sankar K N 
Published: May 2012

BackgroundIn 2002 the super-accelerated hepatitis B vaccination schedule was introduced in GUM clinics. At that time an audit was undertaken in our department to evaluate completion of the vaccination schedule.AimThis study aims to see if and why things have changed 10 years on?MethodsA computer search of those coded with P2 identified the first 100 patients who commenced hepatitis B vaccination from April 2011. Notes were analysed and data collected on indication for vaccination, number of vaccines administered and whether serological response to vaccine was measured. Results were then compared to the previous study done in 2002.ResultsIn 2002, 116 patients commenced hepatitis B vaccination over a 12-month period; in 2011 there were 298. Five patients were excluded from the study as serological testing showed they were already immune or had active infection. The abstract P155 table 1 below shows the number of vaccines each person received. The proportion of MSM receiving three vaccines was 51.6%.Abstract P155 Table 1Comparison of number of Hepatitis B vaccines completed200220111 vaccine only9.5%15.8%2 vaccines only18.1%24.2%3 vaccines72.4%60%Serological response measured33.6%29.4%DiscussionThe number of people being vaccinated against hepatitis B has increased significantly over 10 years in keeping with increased patient numbers. However the proportion of people completing three vaccines has significantly reduced, especially in MSM. This study has prompted us to look at the information and explanation given to patients before commencing an immunisation schedule. In addition, to improve compliance we will be encouraging each patient to make future appointments at initial visit. As automatic appointment SMS messages are sent out 24 h in advance, making appointments ensures a timely reminder of the due dose is sent. All patients should also receive written information about hepatitis B vaccination. With these measures in place we will hopefully improve patient uptake of all three hepatitis B vaccines. Future audit will see if we have been successful!
P157 Re-audit reflections: management of sexual assault attendances to GUM
Authors: Ackah F , Barrett A , Woodroffe T , Soni S 
Published: May 2012

IntroductionIn 2008 we showed that our management and documentation of sexual assault (SA) improved significantly with the introduction of a specific proforma and health advisor led care.AimTo describe SA attendances to our clinic, audit notes against new BASHH guidelines and compare with audit 2008 results.MethodsRetrospective case note review of all SA attendances in 2010. BASHH standards (2011) were used. Exclusion criteria: prior attendance at another GUM clinic post-SA, SA >1-year prior to attendance. Results were compared with previous audit and p values obtained using χ2and Fisher's exact tests.ResultsOf 84 attendances, 87% were female, 92% white, 88% heterosexual, median age was 23 years. 57% were self referrals. 42% had partial or no recollection of the SA. Abstract P157 Table 1 showing comparison of standards between audit 2008 ad 2010 Documentation of standards new since BASHH 2011 guidelines was poor: self harm risk assessment 3.4%, physical injuries 17% and bleeding 0%.Abstract P157 Table 1Audit 2008Audit 2010p Valuen=127 (%)n=84 (%)Proforma use79 (62)69 (82)0.002Assailant details asked123 (97)84 (100)0.159Anal/oral penetration asked86 (68)77 (92)0.001Condom use documented112 (88)84 (100)0.001Documented victim alcohol/drug use89 (70)65 (77)0.242Prophylactic antibiotics offered62 (49)44 (52)0.612Emergency contraception offered127 (100)82 (98)0.157DiscussionProforma use has continued to improve since 2008 and consequently documentation overall is better. Despite this we achieved less than the recommended 100% in some standards. Although adherence to newer BASHH standards was poor, revision of our current proforma to include these should lead to measurable improvement. SA victims were young and worryingly almost half had little or no recollection of the event. Several reported alcohol/drug use prior to assault but also expressed concern around drink spiking. GUM clinics should work closely with other organisations to raise awareness of alcohol misuse and vulnerability to assault.
P160 Complex GUM: an audit of a consultant led service
Authors: Mabonga E , Williams D , Collins E 
Published: May 2012

BackgroundA minority of patients present to GU services with complex, recurrent or chronic issues requiring senior review which is challenging in a busy walk-in service. A specialist clinic was set up to facilitate appropriate diagnosis and management.ObjectivesTo describe referral patterns, diagnoses and outcomes.MethodologyRetrospective case note review of booked patients between 2 September 2010 and 9 December 2010. Demographics, referrer, reason for referral, management and outcomes collected.Results102 appointments were made for 84 patients 65 attended, 82 reviewed. 55% were female. Average age 36. 94% referred from within the service, all staff groups represented including SpRs, nurses and clinical assistants. 20 patients had biopsies with 17/20, 85% providing a diagnosis. Of the 102 appointments 13% DNA; 11% cancelled by patient. Patients with vulval pain will be studied in more detail, data to follow (see abstract P160 table 1).Abstract P160 Table 1Diagnoses of patients with complex GU problemsPresentationDiagnosisWomen (n=36)Vulval pain-12Vulvodynia-5, dermatitis-2, lichen sclerosis-1, atrophic vulvitis-1, BV-1, psychological-1, endometriosis-1Recurrent thrush-11Recurrent thrush-9, C.glabrata-1, lichen planus-1Recurrent HSV-5Recurrent HSV-4, apthous ulceration-Vulval itching-4Lichen simplex-1, eczema-1, NAD-2Lichen planus-1Lichen sclerosis-1Genital ulceration-1Recurrent HSV-1Recurrent BV-1Recurrent BV-1Vaginal discharge-1Referred for TVUSS-1Men (n=29)Genital dermatoses-19Zoons balanitis-8, lichenoid reaction-2, infective balanitis-2, eczema-2, seborrheic dermatitis-1, lichen planus-1, lichen sclerosisPersistent HPV-3Persistent HPV-3Recurrent NSU-2Chronic prostatitis-1; recurrent NSU-1AIN-1Sebaceous cyst-1Folliculitis-1Recurrent HSV-1Recurrent HSV-1Recurrent HSV-1Haematoma-1Resolved-1ConclusionThe clinic was utilised by all staff groups, saw patients with a variety of conditions, predominantly dermatological and in the majority a definitive diagnosis was made. As well as improving patient management the clinic provided an excellent training opportunity and has resulted in improved links particularly with Dermatology and Histopathology.
P162 STD prevention online: a resource for the STD/STI professional community
Authors: Rietmeijer C 
Published: May 2012

BackgroundSTDPreventionOnline.org (STDPO) is an online professional networking site for the sexually transmitted diseases/infections (STD/STI) work force, including researchers, clinicians, epidemiologists, disease intervention specialists, and programme managers. The site was developed by the internet and STD Center of Excellence, originally funded by a grant from the US Centers for Disease Control and Prevention (CDC) and currently sponsored by the American Sexually Transmitted Disease Association (ASTDA). The site was conceived as two-way clearing house of current STD/STI information and resources, where members could both download and upload information in a variety of formats including text, audio, and video files as well as blog and forum postings. Membership is free.ObjectiveTo describe current users and usage of STPDPO.MethodsDescriptive statistics were obtained from embedded website metrics and Google Analytics©.ResultsSince its inception in 2007, the site has registered 3500 members and the site's monthly newsletter has over 4000 subscribers. The predominance of site members (92%) live/work in the US, however a substantial number (n=258 as of January 2012) are non-US users with 47 countries represented. Most members (58%) work in STD/HIV programmes in state/local health departments, 13% in community or private clinics, 11% in a university setting, 8% in federal government, and 8% in community organisations. During 2011, the site logged 14 778 individual site visits and 61 205 page views; respectively 284 and 1177 per week. To date, over 1150 resources have been uploaded to the site which, have been downloaded over 40 000 times, an average of 35 downloads per resource. Topics related to internet use and online interventions are particularly popular, followed by clinical slide sets, and podcasts.ConclusionDuring the 4 years of its existence, STDPO has demonstrated to meet a need in the STD/STI professional community for an interactive, two-way, clearing house of STD/STI-related information.
P173 Case report: rare cause of adult onset seizures identified in an HIV positive adult
Authors: Pease E , Dawson S , Quaghebeur G , Ashby J 
Published: May 2012

Case ReportA 63-year-old male with a long history of poor social interactions presented acutely confused. There was no alcohol or recreational drug use. Baseline bloods and routine microbiology were normal. CT and MRI of the brain found no causative pathology. Lumbar puncture (LP) only revealed a raised protein (1.47). An HIV test was positive; CD4 170 cells/μl, viral load (VL) 238 281 copies/ml. The patient refused antiretroviral (ARV) treatment, depressive episode was diagnosed and mirtazapine commenced. Three days later he went into status epilepticus. A repeat MRI brain was unchanged and LP showed: protein 0.84; glucose 4; WBC 5/cmm; India ink, CRAG, virology, acid fast bacilli and cytology were negative. Seizures were unremitting and nevirapine and truvada were commenced and mirtazapine withdrawn: seizure activity ceased. Gradually he improved and his CD4 rose to 280 cells/μl, HIV VL <50. Despite treatment, the patient re-presented with seizures on several occasions. No trigger was identified, and reported ARV adherence good. Repeat investigations revealed no new abnormality. In the absence of an adequate explanation for seizures, neuro-imaging was reviewed by a specialist neuroradiologist. Nodules within the frontal horns of the lateral ventricles were identified, indicating a diagnosis of subependymal nodular heterotopia (SNH).DiscussionThis is the first report of SNH in an HIV positive adult. SNH are congenital, occurring during foetal neuronal proliferation and have no known association with HIV. Patients usually present in their 2nd decade with seizures and exhibit cognitive difficulties. SNH presenting in the 7th decade of life with status epilepticus is rare and we postulate that the cerebral atrophy associated with untreated HIV infection may have precipitated seizures in a predisposed individual. This case described demonstrates the importance including non-HIV related causes, when considering the aetiology of seizures in patients with HIV.
P18 Post exposure prophylaxis following possible exposure to HIV infection: an evaluation of 391 attendances at three central London sexual health clinics
Authors: Janmohamed K , Bull L , Payne D , Cooper F , Lake C , Nwokolo N , Natha M 
Published: May 2012

BackgroundProviding post exposure prophylaxis (PEP) following possible HIV exposure is a common GU presentation. However, few studies have evaluated this practice.Aim(s)/Objective(s)To answer the following on PEP presentations: age, sex, nature of exposure to HIV, time to presentation for PEP, side effects, completion rates, presence of sexually transmitted infections (STIs), appropriateness of PEP dispensing and comparisons of findings with other published studies.MethodsGUM clinic attendances were evaluated from April 2009 to March 2010.ResultsThere were 391 PEP attendances: 373 males (96% MSM), 18 females. Age range 19–57 (mean 35.4) years. Presentation followed anal sex in 89%, vaginal sex in 5%. The remainder attended following oral sex, splash incidents, injecting drug use, or other exposure. Forty six percent attended within 24 h, in one instance PEP was dispensed beyond 72 h. The majority completed PEP (82%). GI side effects were experienced by 60%. Baseline screening for hepatitis B showed active infection in 1% and immunity in 74%. A baseline HIV test was conducted in all but one patient. An STI screen was conducted at or around day 14 in 69% of patients, with 12% testing positive for an STI in line with previously published data. Follow-up rate at 3–6 months was 52%: Of 203 patients tested for HIV at follow-up, 2 (1%) tested positive.ConclusionsPEP was dispensed appropriately in the majority of cases. The fact that 82% of individuals completed treatment despite side effects is likely to be due to the use of more tolerable regimens than were used historically. The presence of an STI in 12% of people tested highlights the importance of screening in individuals presenting for PEP. The fact that only 52% of patients attended for a follow-up HIV test at 3–6 months is of concern and warrants further exploration.
P180 Vulval pathology in HIV positive women attending a tertiary vulval dermatology clinic over a 5-year period
Authors: Dosekun O , Farrugia P , Lewis F , Sethi G 
Published: May 2012

BackgroundStudies have suggested that HIV infected women are at increased risk of developing invasive vulval carcinoma and recurrent herpes simplex type 2 (HSV-2) reactivation.ObjectiveTo describe the spectrum of HIV associated vulval disease in women attending a tertiary dermatology referral centre in a busy urban setting.MethodsA retrospective case note review of all HIV positive women seen in the vulval dermatology clinic from January 2007 to January 2012.Results11 women were identified (see abstract P180 table 1). 9 (81%) were black Africans. The mean age at vulval disease diagnosis was 37 years. Most (81%) were already known to be HIV infected and on combined antiretroviral therapy (cART). There were six cases of undifferentiated vulval intra-epithelial neoplasia (uVIN) (43%) with two cases being diagnosed prior to an HIV diagnosis. The three cases of HSV-2 occurred in women with near-complete immune restoration on cART. Six women remain under regular dermatology follow-up, a median of 20 months since diagnosis.Abstract P180 Table 1HIV positive women seen in vulval dermatology clinic 2007 to 2012CaseVulval diagnosisOn cART*CD4 (cells/μl)*VL (copies/ml)*1Multifocal uVINNANANA2Multifocal uVINYes7612353Multifocal uVINYes47997HSV-2Yes351204Lichen simplex chronicusYes502366CondylomaYes975205uVINNANANAVulval lichen simplexNANANA6SCC in situ outer aspect labium majusYes268407uVINYes318718Chronic hypertrophic HSV-2Yes590409Multifocal uVIN of Bowenoid typeYes8268810Recurrent HSV-2Yes7846311EczemaYes6230 441*At time of vulval diagnosis.ConclusionThere were no cases of invasive vulval carcinoma. HSV-2 may cause atypical disease even in the context of near-complete immune reconstitution on cART. Most women with vulval disease were already under HIV care, on cART and had a CD4 cell count above 200 cells/μl.
P188 Do genitourinary medicine physicians need to know about tropical diseases?
Authors: Loftus H , Powles E 
Published: May 2012

BackgroundMany individuals presenting to genitourinary medicine (GUM) clinics have travelled or may have been born outside the UK. A number of tropical infections can present with genitourinary symptoms.AimsTo investigate how many cases of schistosomiasis were diagnosed in a GUM clinic over a 3-year period, whether they were treated according to the European Association of Urology guidelines for the management of urogenital schistosomiasis and whether treatment led to symptomatic improvement.MethodsAll the schistosoma serology requests from our clinic in 2009–2011 were obtained and identified as positive, negative or equivocal results. The results were separated into those from our HIV clinic and those from GUM. The notes for all the positive and equivocal results were reviewed.Results182 tests were performed on 168 different individuals. 151 tests (83.0%) were carried out in HIV clinic, 31 tests (17.0%) in GUM. 4 (2.6%) of the tests carried out in HIV clinic were positive. 4 (12.9%) of tests carried out in GUM were positive. All positive results were non-British born males ranging in age from 28 to 42. All individuals with positive results had symptoms or signs that could have been attributed to urogenital schistosomiasis. Five of the 8 individuals had urine and stool sent to look for schistosome eggs, two had just urine analysed and 1 had neither. 6 individuals were referred to Infectious Diseases, two were managed in GUM. Seven of the 8 individuals were treated with praziquantel according to the guidelines. One individual declined treatment. Of those individuals treated, two had full resolution of signs and symptoms, three had partial resolution, one was followed-up in another department and one had no resolution of symptoms.DiscussionGenitourinary medicine physicians should consider a diagnosis of schistosomiasis in at-risk individuals when standard tests have not provided a diagnosis and resolution of symptoms.
P189 A national mentoring scheme within genitourinary medicine (GUM): is it working?
Authors: Cohen C E , Fox E , Fernando I , Dhar J , Singh G , Mullan H , Street E , Rooney G 
Published: May 2012

BackgroundCollaboration between BASHH and the Royal College of Physicians saw the development of a National mentoring scheme for newly qualified consultants in GUM. Mentors were recruited from senior GUM clinicians, and invited on a tailored mentoring course. On appointment, new consultants are offered and allocated a mentor for 18 months.ObjectivesTo determine the effectiveness of the mentoring scheme thus far.MethodsVoluntary interim questionnaires were distributed via Survey Monkey to mentor/mentee pairs who had joined the scheme for >3 months in January 2011. Responses were anonymous and quantitative data are presented.Results18 mentees and 17 mentors responded. The mean time from mentor allocation was 9.1 months (ranging 3–17). 80% of mentees found it easy to arrange their first meeting with their mentor, 72% had met their mentor between 1 and 4 times in person. Almost three-fourth (71%) felt they had received ample contact with their mentor, and in those who hadn't, time constraints and multiple competing service demands were repeatedly cited as barriers. Encouragingly, 69% of mentees felt the programme had helped them, with a further 25% responding, “not yet” as it was “too early in their mentorship”. 93% of mentors responded they felt confident to support their mentee, and 79% perceived the relationship with their mentee was going well. Mentee feedback particularly favoured greater structure, including alerts to encourage meeting prioritisation and further guidance on what could be covered within mentorship.DiscussionThe mentoring scheme, which now hosts 67 BASHH mentors and 41 mentees, is providing significant support to new GUM consultants. By developing a mentoring module with clear guidance for final year registrars, and opening the scheme to them prior to commencement of their substantive posts, we anticipate that these changes will bring further benefits to those in the mentoring programme.
P19 What's up? Erectile dysfunction (ED) in HIV positive men
Authors: Williams A , Dharmaratne S , Goh B T 
Published: May 2012

BackgroundAntiretroviral therapy in HIV positive patients has resulted in improvements in survival, quality of life and fulfilling sexual relationships. Treatment using phosphodiesterase type 5 inhibitors (PDE5i) for ED has simplified management. However nitrates, including “poppers”, and protease inhibitors (PIs) can interact with PDE5i leading to hypotension and high levels of PDE5i. Ethical issues are a consideration as treatments can lead to HIV transmission if safer sex is not practised. We reviewed our HIV positive men with ED and their outcomes after treatment.Methods94 HIV positive patients attending our ED clinics from 2006 to 2012 were identified. Data were collected by review of notes and databases. Patients on PIs were started on half of the lowest dose tablet of PDE5i and titrated upwards if no response. Safer sex was advised.ResultsOf 94 patients, 58 were Caucasian, 34 black; 58 were men who have sex with men, 35 heterosexual; 65 had a stable partner, 41 (47.8%) had >30 lifetime partners, 25 (26.5%) were >50 years; 36 (38.2%) used recreational drugs. Two were on therapeutic nitrates. Mean CD4 on presentation was 481 (range 35–1558); 60 (63.8%) had an undetectable VL at baseline. 30 (32%) had ED symptoms for >5 years. Risk factors: smokers 35 (37.2%); peripheral neuropathy 8; diabetic 2; abnormal cholesterol 44 (47%); abnormal hormone profiles 4. Sildenafil was the first agent in 55 (59%) patients and tadalafil in 28 (30%). 18 were on “poppers” and were told to stop before starting PDE5i. Improvement was noted in 51 (54%) after the first agent and 68 (72%) after the final agent. 36 (38%) had PDE5i side effects. 39 (41%) was on PI based Antiretroviral therapy. None reported priapism.ConclusionIt is safe to treat patients on PI with PDE5i by starting with half of the lowest dose tablet. Treatment of ED improves the quality of life in HIV positive patients but care must be taken to avoid serious drug interaction and safer sex practices should be emphasised.
P190 Barebacking: opinions of HIV negative men who have sex with men
Authors: Grundy-Bowers M , Black A 
Published: May 2012

BackgroundMen who have sex with men (MSM) remain disproportionately affected by HIV and sexual infections. 2010 saw the highest number of new UK HIV diagnoses, acquired predominately through condomless anal sex (CAS) with an estimated 67% acquired in relationships. To reduce risk taking behaviour, a deeper understanding of what influences MSM not to use condoms is required.AimTo explore the opinions and rationales for CAS in HIV negative MSM.MethodsMSM were targeted, via gay press and leafleting, to complete an online questionnaire exploring issues around CAS. Data were collected from November 2010 to October 2011 following ethical approval. Responses from HIV negative MSM were reviewed and themed to quantify opinions and motivations for CAS in this cohort.ResultsData are drawn from a larger study. A total of 158 males met the criteria; 73.4% (n=116) did not identify themselves as a barebacker, the remainder did. There was a mean age of 35.4 (range 18–72), with the majority being White British (48.7%, n=77). All participants had engaged in unprotected anal sex. Barebacking was identified as contextual (eg, only in relationship) by 36 or behavioural (eg, I bareback) by 28 respondents. Relationships (79, 50%), trust (44, 27.8%) and infection screening (42, 26.6%) featured most frequently as personal reasons for engaging in CAS. Alcohol (63, 39.9%), physical sensation (58, 36.7%) and the thrill of the risk (53, 33.5%) were the most common opinions on why others had unprotected sex.ConclusionsCAS remains a complex issue and the definition of “barebacker” varies. Perceptions why others engaged in CAS have more negative connotations, however individual rationales for engaging in CAS predominantly focussed around love and relationships. Given the significant number of MSM that acquire HIV in relationships there is a clear need to maintain safer sex messages that are contextualised for those in relationships to observe the principles of negotiated safety.