Sexually Transmitted Infections

de Burgh-Thomas, A; Hills, A; Medland, V

doi: 10.1136/sextrans-2012-050601d.4pmid: N/A

Objectives To review the management of PID in hospital inpatients and compare it to standards of care. Methods We reviewed the management of all those women admitted to hospital in Gloucestershire over a calendar year who were coded as having PID. We compared their management against BASHH and the RCOG standards (see abstract B4 table 1). Abstract B4 Table 1 Compliance of management of patients with PID with standards Target Achieved Adequate sexual history 95% 25% Chlamydia testing 100% 55% Gonorrhoea testing 100% 70% Appopriate antibiotics 100% 75% GUM follow-up arranged 95% 5% Contact tracing 6/12 pre 60% 0% Results 20 Patients were identified. Conclusions There is insufficient liaison between Gynaecology and GUM. We will discuss simple measures that have been introduced and planned changes to improve the management of PID.

Wayal, S; Hart, G; Copas, A; Edwards, S; Cassell, JA

doi: 10.1136/sextrans-2012-050601a.18pmid: N/A

Aims In the UK, HIV+ve men who have sex with men (MSM) are disproportionately affected with sexually transmitted infections (STIs). STIs can enhance HIV transmission. We examined factors associated with STIs diagnoses and partner notification, and explored preferred methods for STIs notification among HIV+ve MSM. Methods 429 HIV+ve MSM attending a central London HIV clinic completed a computer-assisted survey (May–September 2010). Multivariate logistic regression analyses were conducted. Results 86% men (368/429) were sexually active in the last year. Of these sexually active men, 84% (305/362) had tested for STIs. Among men who tested for STIs, 57% (174/305) reported engaging in unprotected anal intercourse (UAI) and 32% (98/305) were diagnosed with STIs. UAI, particularly non-concordant unprotected anal intercourse, age <35 years, concurrent sexual partnerships were independently associated with STIs diagnoses. 58% men had notified ¡Ý1 partner following STIs diagnosis. Being employed, born in the UK, concerns about breach of HIV confidentiality were negatively associated; while clinic advice and support were positively associated with partner notification following STIs diagnosis. 79% (339/429) men reported willingness to notify partners of STIs in the future. Of these, 76% men were willing to notify a boyfriend themselves. 11% men expressed preference for provider referral. Most men were willing to notify regular partners by phone. Men expressed willingness to notify casual partners by phone, text message, or anonymous provider-led methods. Conclusions The high level of risky sexual behaviour, STIs diagnosis and its association with non-concordant unprotected anal intercourse among HIV+ve MSM suggests that partner notification provides opportunities for HIV and STIs case-finding and treatment. The offer of a choice of notification methods to HIV+ve MSM, particularly young men and men with multiple/concurrent, casual partners, may override personal, partnership, and structural barriers to partner notification.

Yap, S Y

doi: 10.1136/sextrans-2012-050601c.170pmid: N/A

Background There 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. Aims The 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. Methods Intervention consisted of five individual sessions of MI with a Clinical Psychologist over a period of 3 months. Results After 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. Discussion This 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.

Gilbart, V; Town, K; Lowndes, C M

doi: 10.1136/sextrans-2012-050601c.39pmid: N/A

Background Partner notification is important for STI control. With developments in technology notifying partners is now easier. The HPA was keen to understand the acceptability and use of SMS texting for PRPN for STIs. Methods A questionnaire distributed to GUM colleagues, cascaded by the Society of Sexual Health Advisers and posted on their website. Results 65 sites responded. Most (61, 93%) use telephone for 1st attempt for PRPN with texting as preferred second choice (19, 29%). For 2nd attempt, telephone remained preferred method (51, 79%) but texting increased with 32 (49.2%) choosing this method; letter use also increased. Majority of sites used texting for PRPN (56, (86%); frequency varied—over half using it up to 50% of the time. 29 (45%) had texting guidelines and 31 (55%) used texting templates. Messages varied; 33 (59%) requesting partner make contact, 9 (16%) naming the infection. Six (11%) had contact with Information Governance Board about texting; no negative outcomes reported. Two partners complained, not about receiving a text but about being denied the identity of the index patient. 9 (14%) sites never used texting. Conclusion Telephone contact was the preferred option for 1st and 2nd attempt for PRPN. Texting was the 2nd most used method and was seen as acceptable within the clinic and also with Information Governance Board. Frequency varied considerably and message content differed but even if used infrequently, was seen as important if other methods failed. Reassuringly no complaints about texting were received from partners. A small number of sites never use texting.

Shone, J; Cunningham, C; Orange, G; Eastick, K; Yirrell, D; Allstaff, S

doi: 10.1136/sextrans-2012-050601c.74pmid: N/A

Background In January 2011, an increased number of gonococcal (GC) isolates was noted within the local bacteriology department. A “look back” exercise was initiated for all incidences of GC infections during the previous 13 months, while new episodes of GC infection were monitored to ascertain whether this increase represented an outbreak. Aims To determine the epidemiology of GC infection observed during an outbreak of Neisseria gonorrhoeae within the local area. Methods Cases of GC infection within our Health Board area were identified by culture or nucleic acid amplification test (NAAT) for the period December 2009 to April 2011. N gonorrhoeae multi-antigen sequence typing (NG-MAST) was performed on positive isolates or NAAT samples. Patient demographics were gathered at the local sexual and reproductive health (SRH) clinic. Results 73 episodes of GC infection were recorded in one geographically distinct area of our Health Board between December 2010 and April 2011 (the outbreak). Nineteen cases were documented for the same period the previous year. No similar increase in GC diagnoses was observed in neighbouring areas. Chlamydia cases remained relatively stable. Patient demographics were available for 62 of the 67 cases diagnosed at the local SRH clinic. Of these, the majority of cases were male (66.1%) (of which 22% were MSM), under 25 years of age (71%), heterosexual (78.5%) and of White Scottish ethnicity (95.2%). 40 (64.5%) patients (29 male and 11 female) presented with symptoms of GC infection and 19 (29.2%) as GC contacts. The predominant NG-MAST sequence type was ST26. Discussion The epidemiology of this outbreak is atypical, since GC infection and NG-MAST ST26 has been more commonly found in men who have sex with men in Scotland. Despite enhanced surveillance, no sexual networks or links to specific venues were identified. A gonorrhoea awareness campaign was launched in May 2011.

Warwick, Z; Wimpenny, T

doi: 10.1136/sextrans-2012-050601c.26pmid: N/A

Background The aim of partner notification (PN) in HIV is to diagnose the undiagnosed and reduce the risk of onward transmission. Plymouth is thought to be a low HIV prevalence area and as such routine testing across medical settings is unlikely to be cost effective or practical. As part of our attempts to target testing, we have concentrated and improved our HIV contact tracing. We describe how the recent infection testing algorithm (RITA) has allowed us to focus PN and identifies individuals early in infection (infectious, high behavioural risk, untested) therefore reducing onward transmission. Aim To describe the number of recent infections diagnosed in Plymouth using PN. Methods RITA is performed in all newly diagnosed patients. This information is taken into account during PN. A retrospective review of all RITA results done in 2011 and how this has contributed to PN in Plymouth GUM is described. Results Of the 20 new HIV diagnoses made in Plymouth, 7 (35%) were incident infections and six were diagnosed as a direct result of PN. Of those with prevalent infection (n=12), 5 were diagnosed as a direct result of PN. Conclusions In low prevalence areas targeted testing will yield the greatest number of positive individuals per test. Along with other targeting strategies, PN in those newly diagnosed is a way of reaching an at risk group within this setting. It is important to prioritise HIV PN through a dedicated Health Advising team.

Loades, N; de Visser, R

doi: 10.1136/sextrans-2012-050601c.193pmid: N/A

Background STIs 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. Objectives To 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. Methods 371 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. Results Multivariate 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. Conclusion Results 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.

Moby, T; Mwirigi, A; White, J

doi: 10.1136/sextrans-2012-050601c.175pmid: N/A

Background An 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. Case A 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. Conclusion This 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.

Rosenvinge, M; Storrar, N

doi: 10.1136/sextrans-2012-050601c.73pmid: N/A

Background Near-patient microscopy (NPM) has poor sensitivity in the identification of GC in women, with NPM of urethral (Ur) smears no longer recommended by BASHH. Aim To review the diagnosis of GC in women attending a London SHC and assess the relative merits of NPM, culture and Nucleic acid amplification tests (NAATs) in detecting GC. Method Female GC diagnoses from 1 January 2008 to 30 June 2011 were identified from the GU Medicine Clinic Activity Dataset and case notes reviewed. The results and sites of GC tests taken, were recorded. Slides stated as “suspicious” for GC on NPM were counted as positive. GC was cultured on selective medium. The Beckton Dickinson Probe Tec Strand Displacement Assay (dual NAAT for GC/CT) was used for endocervical (Cx) specimens from 22 June 2009. Results Notes were available in 334/369 (91%) of cases (317 women): median age 20 years (range 13–53); 92/334 (28%) White British; 87/334 (26%) Black Caribbean; 219/313 (70%) symptomatic; 160/321 (50%) had a previous STI; 42/317 (13%) had a history of GC; 58/334 (17%) were GC contacts. 289 cases had Ur/Cx cultures taken: 30 (10%) were positive on Ur culture; 148 (51%) on Ur and Cx culture; 88 (30%) on Cx culture. 11/142 (8%) Cx NAATs performed were negative for GC: 6/11 were positive on Ur culture; 5/11 on pharyngeal culture/NAAT; 1/11 on Cx culture. 104/125 (83%) with positive Cx NAATs were positive on Cx culture. 42 were diagnosed with GC on vaginal NAATs. 135/330 (41%) were also diagnosed with Chlamydia trachomatis (CT) (see abstract P73 table 1). Abstract P73 Table 1 Results of NPM for culture positives Urethral Endocervical NPM positive 29 (12 Cx NPM negative) 29 (12 Ur NPM negative) NPM negative 99 138 NPM not done 49 69 Sensitivity NPM 29/128 (23%) 29/167 (17%) False positives* 3 13 * NPM was positive for GC but samples were culture negative Conclusion Cx NAAT was more sensitive than culture in detecting GC; supplementing Cx NAAT with Ur culture will reduce the potential for missed cases. Our data shows a poor sensitivity of Ur and Cx NPM for the detection of GC in women, highlighting a need to perform targeted training, review the criteria for NPM and develop additional point of care tests for GC.

Baguley, S

doi: 10.1136/sextrans-2012-050601c.112pmid: N/A

Background Hazardous drinking is associated with an increased risk of catching an STI, getting pregnant unintentionally, being sexually assaulted and sexually assaulting someone else. An Alcohol Brief Intervention (ABI), a type of motivational interview, has been shown to reduce hazardous drinking in men over the age of 25. There is an paucity of evidence of the benefit in younger people or in women. Texting has been shown to be useful in supporting smoking cessation, weight reduction and diabetes control. There have been no studies of its potential value in reducing hazardous drinking or its consequences. Aim To compare the effect of texting vs an ABI on hazardous drinking and associated sexual illhealth amongst attendees at an urban sexual health clinic. Methods Potential subjects are being recruited from a city sexual health clinic. Initial screening is done using the Alcohol Use Disorder Identification Test - a self-completed questionnaire marked out of 40. Consenting subjects are then randomised to texting (12 texts over 4 months), an ABI or a leaflet and then followed up by phone at 4 months. At follow-up, subjects are rescreened for hazardous drinking and asked about incident STIs, regretted sex, sexual assault, use of emergency contraception and for their evaluation of the intervention method. Results To end of January 2012, 6279 attendees have been screened of whom 2554 were hazardous drinkers and 799 have consented to take part in the study. (The target sample size is 1090). By the time of the conference, all subjects will have been recruited and most results will be available. Conclusion This is the first RCT of texting for hazardous drinking and should inform national policy in this area.