Clinical round-up
Prescribers’ perspectives of pre-exposure prophylaxis Our first paper looks at what pre-exposure prophylaxis (PrEP) prescribers think about risk compensation. Calabrese et al1 undertook a qualitative study in 2014/2015 interviewing 18 clinicians with PrEP prescribing experience in the USA. Three main themes emerged: (1) the role of the provider in supporting patients to make informed decisions about PrEP; (2) risk behaviour while taking PrEP does not fully offset PrEP’s protective benefit and (3) PrEP-related risk compensation is unduly stigmatised within the healthcare community and beyond. Part...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Herbert, S. Tags: Clinical round-up Source Type: research

How many MSM are taking PrEP: a service evaluation
In England, pre-exposure prophylaxis (PrEP) will shortly be available through the NHS-funded PrEP trial which hopes to address the number of men-who-have-sex-with-men (MSM) who will take up PrEP.1 56 Dean Street, and several other sexual health services, are already monitoring those sourcing generic tenofovir/emtricitabine as PrEP. In March 2017, we introduced an additional question in the sexual history for all MSM attending Dean Street Express (DSE) for asymptomatic screening in order to estimate the number eligible for PrEP, promote discussion and offer monitoring where required: ‘Are you currently taking PrEP?&rs...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Whitlock, G. G., Douglas, A., Adesara, S., McCormack, S., Nwokolo, N., McOwan, A. Tags: Miscellaneous Source Type: research

A cross-sectional analysis of Trichomonas vaginalis infection among heterosexual HIV-1 serodiscordant African couples
Conclusions We found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners of T. vaginalis-infected individuals, suggesting that partner services could play an important role identifying additional cases and preventing reinfection. Our results also suggest that male circumcision may reduce the risk of male-to-female T. vaginalis transmission. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Bochner, A. F., Baeten, J. M., Rustagi, A. S., Nakku-Joloba, E., Lingappa, J. R., Mugo, N. R., Bukusi, E. A., Kapiga, S., Delany-Moretlwe, S., Celum, C., Barnabas, R. V., for the Partners in Prevention HSV/HIV Transmission Study and Partners PrEP Study Te Tags: Epidemiology Source Type: research

Correction: Identifying factors that lead to the persistence of imported gonorrhoeae strains: a modelling study
Hui BB, Whiley DM, Donavon B, et al. Sex Transm Infect 2016; doi: 10.1136/sextrans-2016-052738 The correct title of this paper is as follows: Identifying factors that lead to the persistence of imported gonorrhoea strains: a modelling study (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Tags: Miscellaneous Source Type: research

Concordance between self-reported STI history and biomedical results among men who have sex with men in Los Angeles, California
Conclusions This is the first study that attempts to evaluate the validity of self-reported STI history among MSM. We found that self-reported STI history may not be an appropriate proxy for true STI history in certain settings and minority populations. Clinical guidelines and research studies that rely on self-reported STI history will need to modify their recommendations in light of the limited validity of these data. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Cunningham, N. J., Beymer, M. R., Javanbakht, M., Shover, C. L., Bolan, R. K. Tags: Epidemiology Source Type: research

HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities
Conclusions Among GBM in England, HIV prevalence continues to be higher among black men and other white men compared with the white British. The protective effect of being from an Asian background appears no longer to pertain. Sexual risk behaviours may account for some of these differences. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Hickson, F., Melendez-Torres, G. J., Reid, D., Weatherburn, P. Tags: Epidemiology Source Type: research

Resistant herpes simplex type 2 treated with varicella zoster vaccination
A 27-year-old British male presented with a 1-day history of balanoposthitis and penile discharge. He disclosed multiple, unprotected male partners over preceding months. He had no significant medical history, no history of herpes simplex virus (HSV) and no previous STI screen. Examination revealed extensive ulceration and swelling of the prepuce, with purulent discharge. He was treated for gonorrhoea, identified on microscopy. Empirical treatment for HSV was also commenced (aciclovir for 10 days). A sexual health screen detected gonorrhoea, HSV-2 and new HIV infection (CD4 150 cells/μL (9%), viral load 124 77...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Cochrane, S., Gompels, M. Tags: Miscellaneous Source Type: research

Prevalence and risk factors associated with STIs among women initiating contraceptive implants in Kingston, Jamaica
Conclusions Although the prevalence of laboratory-confirmed STIs was high, the immediate initiation of a contraceptive implant was not associated with higher STI prevalence rates over 3 months. Trial registration number NCT01684358. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Snead, M. C., Wiener, J., Ewumi, S., Phillips, C., Flowers, L., Hylton-Kong, T., Medley-Singh, N., Legardy-Williams, J., Costenbader, E., Papp, J., Warner, L., Black, C., Kourtis, A. P. Tags: Behaviour Source Type: research

Willingness to change behaviours to reduce the risk of pharyngeal gonorrhoea transmission and acquisition in men who have sex with men: a cross-sectional survey
Conclusions The practices MSM are willing to change to reduce the risk of pharyngeal gonorrhoea transmission and acquisition vary greatly; however, the majority of men are likely to use mouthwash daily to reduce the risk of pharyngeal gonorrhoea. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Chow, E. P., Walker, S., Phillips, T., Fairley, C. K. Tags: Behaviour Source Type: research

Experiences of HIV postexposure prophylaxis (PEP) among highly exposed men who have sex with men (MSM)
Conclusion Our data highlight PEP management failures among its target population that may have compromised any subsequent attempts to seek out PEP. Practitioners should be more aware of MSM sexual contexts and practices. PEP consultations should provide the opportunity to discuss prevention strategies with highly exposed HIV-negative subjects, which may include pre-exposure prophylaxis. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Palich, R., Martin-Blondel, G., Cuzin, L., Le Talec, J.-Y., Boyer, P., Massip, P., Delobel, P. Tags: Health services research Source Type: research

A systematic review and appraisal of the quality of practice guidelines for the management of Neisseria gonorrhoeae infections
Conclusions and implications of key findings Gonorrhoea treatment guidelines may slow antimicrobial resistance. Many current guidelines are not in line with the current guideline development best practices; this might undermine the perceived trustworthiness of guidelines. By identifying current limitations, this study can help improve the quality of future guidelines. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Dickson, C., Arnason, T., Friedman, D. S., Metz, G., Grimshaw, J. M. Tags: Health services research Source Type: research

A comparative analysis of costs of single and dual rapid HIV and syphilis diagnostics: results from a randomised controlled trial in Colombia
Background HIV and congenital syphilis are major public health burdens contributing to substantial perinatal morbidity and mortality globally. Although studies have reported on the costs and cost-effectiveness of rapid diagnostic tests (RDTs) for syphilis screening within antenatal care in a number of resource-constrained settings, empirical evidence on country-specific cost and estimates of single RDTs compared with dual RDTs for HIV and syphilis are limited. Methods A cluster randomised controlled study design was used to compare the incremental costs of two testing algorithms: (1) single RDTs for HIV and syphilis and (...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Obure, C. D., Gaitan-Duarte, H., Losada Saenz, R., Gonzalez, L., Angel-Muller, E., Laverty, M., Perez, F. Tags: Open access Health services research Source Type: research

HIV videos on YouTube: helpful or harmful?
Social media is an often-used source of information regarding HIV/AIDS.1 YouTube is the most popular video sharing site on the internet, which allows users to share unregulated medical information. Given the popularity and the potential to influence the general public behaviour of this website, the spread misleading content could be dangerous.2 However, to date, the content of HIV-related videos on YouTube has not been analysed. The purpose of this descriptive study was to address this need by conducting a content analysis of the most widely viewed YouTube videos addressing HIV. A YouTube search was conducted using the key...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Ortiz-Martinez, Y., Ali-Salloum, W., Gonzalez-Ferreira, F., Molinas-Argüello, J. Tags: Miscellaneous Source Type: research

Neisseria gonorrhoeae DNA bacterial load in men with symptomatic and asymptomatic gonococcal urethritis
Conclusions Gonococcal loads in men with urethral discharge were higher than loads seen with asymptomatic urethral gonorrhoea and loads seen in asymptomatic pharyngeal and rectal gonorrhoea infections in previous studies. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Priest, D., Ong, J. J., Chow, E. P. F., Tabrizi, S., Phillips, S., Bissessor, M., Fairley, C. K., Bradshaw, C. S., Read, T. R. H., Garland, S., Chen, M. Tags: Health services research Source Type: research

How to assess and manage frailty in patients with HIV
As a result of the successful treatment of HIV over the last four decades, people living with HIV (PLWH) can now expect a near-normal life expectancy.1 This change in demographics, alongside later life acquisition of HIV,2 has resulted in clinical services now seeing an older HIV cohort, with patients experiencing many of the problems of an older HIV-negative cohort such as multiple medical diagnoses, polypharmacy and frailty. An example case: A 70-year-old man with ‘well-controlled’ chronic HIV infection, presents to his routine HIV clinic appointment complaining of recurrent falls, fatigue, low mood, self-rep...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Levett, T., Wright, J. Tags: How to do it Source Type: research

Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey
This study investigated whether access to genitourinary medicine (GUM) clinics meets UK-recommended standards. Methods In January 2014 and 2015, postal questionnaires about appointment and service characteristics were sent to lead clinicians of UK GUM clinics. In February 2014 and 2015, researchers posing as symptomatic and asymptomatic ‘patients’ contacted clinics by telephone, requesting to be seen. Clinic and patient characteristics associated with the offer of an appointment within 48 hours were examined using unadjusted and UK country and patient gender adjusted multivariable logistic regression anal...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Foley, E., Furegato, M., Hughes, G., Board, C., Hayden, V., Prescott, T., Shone, E., Patel, R. Tags: Press releases Clinical Source Type: research

Increases in gonorrhoea incidence and GUM clinic waiting times: are we in a vicious circle like the late 1990s and early 2000s, but now exacerbated by drug resistance?
I read the paper of Foley et al (Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey. Sex Trans Infect Sex Online First: 04 April 2017) with concern. Delays in treating symptomatic patients typically indicate insufficient service capacity, creating a vicious circle where delayed (or lack of) treatment causes onward transmission, increasedincidence and continuing unmet treatment need.1 Increased treatment capacity (complemented by condom promotion and other prevention activity) is required to break the vicious circle and enter a virtuous circle where prompt treatment ave...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: White, P. J. Tags: Public health Clinical Source Type: research

Persistence after treatment of pharyngeal gonococcal infections in patients of the STI clinic, Amsterdam, the Netherlands, 2012-2015: a retrospective cohort study
Conclusion A small proportion of pharyngeal Ng persists despite appropriate treatment. Combining ceftriaxone with other antibiotics appears to lead to faster clearance. A TOC for pharyngeal Ng 7 days after treatment may be too soon. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Hananta, I. P. Y., De Vries, H. J. C., van Dam, A. P., van Rooijen, M. S., Soebono, H., Schim van der Loeff, M. F. Tags: Open access Clinical Source Type: research

Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study
Objectives Genital herpes simplex virus-2 (HSV-2) shedding in pregnant women in association with neonatal herpes infection has been widely studied but there is limited evidence of its association with pregnancy outcomes. Methods In this retrospective observational study, we included a subgroup of pregnant women who were enrolled in a randomized control behavioural intervention study that was conducted in South Africa in 2008-2010. In pregnancy, women had a HIV rapid test done and a genital swab taken to test for curable STIs and HSV-2 DNA. Subsequent visits were scheduled for 6, 10, 14 weeks and 9 months post-delivery. Pr...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Moodley, D., Sartorius, B., Madurai, S., Chetty, V., Maman, S. Tags: Editor's choice Clinical Source Type: research

Role of dual HIV/syphilis test kits in expanding syphilis screening
Screening pregnant women for HIV and syphilis is a critical component of national programming to achieve elimination of mother to child transmission (EMTCT) for the two diseases. Many countries have well-resourced programmes for HIV screening in pregnant women and key populations (men who have sex with men and sex workers), but screening for syphilis in these same risk groups is seldom centralised and often falls within the responsibilities but outside the priorities of reproductive health, antenatal care and sexually transmitted infection (STI) control programmes. The tragedy of babies avoiding HIV and dying of syphilis a...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Taylor, M. M., Peeling, R. W., Toskin, I., Ghinidelli, M. Tags: Editorial Source Type: research

Language matters: a linguists view on medicine
Language matters. I have seen this simple statement more times than I care to remember. It is used by patients, nurses, psychologists, doctors and many other healthcare professionals. In this editorial I would like to offer a view of what a statement means to a linguist. And so, first, what we say does not just mean, it means something in a particular context; second, even more importantly, language does not consist only of words, and this is why medicine and medics should focus on their ‘way of speaking’. Context Let me first explain the issue of context. Take the word ‘evidence’. It is very l...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Galasinski, D. Tags: Editorial Source Type: research

Anal cancer in women: are we appropriately identifying the risks?
This summer, the much-discussed human papilloma virus (HPV) vaccine entered a new phase of utilisation across the UK. In response to a report by the Joint Committee on Vaccination and Immunisation,1 Public Health England has initiated a pilot in which 42 genitourinary medicine and HIV clinics will provide the Gardasil vaccine to men who have sex with men (MSM). This pilot is supported by the evidence: MSM have a higher incidence of HPV than heterosexual men2 and the virus is linked to around 85% of anal cancers.3 Among the general population, however, it is also important to remember the burden of anal cancer among women. ...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Solomon, D., Stanley, M., Robinson, A. J. Tags: Editorial Source Type: research

BASHH HealthUnlocked
The HealthUnlocked BASHH community is a social network forum for sexual health, moderated and administered by BASHH. It can be found embedded on the National Health Service (NHS) Choices Sexual Health pages as well as on the BASHH website homepage (http://www.bashh.org). It is a public forum and provides a platform where individuals can discuss and ask questions about all aspects of sexual health and responses can be posted by other members. It was created to encourage people to share experiences, give advice and support and is one of many HealthUnlocked health communities. Professionals can also respond to posts offering ...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Thomson-Glover, R., Pintilie, H., Dhingra, J., Wood, M. Tags: BASHH Column Source Type: research

Highlights from this issue
Over three decades after the first recognition of HIV related disease, we are in a completely different place. HIV is no longer the harbinger of almost inevitable decline and death, and our patients are getting older. This success story brings with it new challenges for genitourinary medicine and beyond in the UK. Many patients who had a close brush with death at the tipping point, as highly active antiretroviral therapy was rolled out in 1996–1997 are now close to or after retirement, looking forward to years they never expected to have. Frailty is a term that few of today’s senior physicians learnt in their e...
Source: Sexually Transmitted Infections - October 23, 2017 Category: Sexual Medicine Authors: Cassell, J. A. Tags: Whistlestop tour Source Type: research

Microbiological techniques
Microbiological detection of the causative agents of STI underpins the clinical diagnosis and supports the provision of surveillance information for use in public health control. The range of microbiological techniques available has increased significantly over the last 10 decades, particularly in recent years, with a concomitant improvement in the sensitivity, specificity and usefulness of the tests. The evolution spans from detection of the host response, through microscopy and culture of the infecting organisms to identification of specific genetic markers both for diagnostic purposes and to enable molecular typing for ...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Ison, C. A. Tags: Miscellaneous Source Type: research

A cross-sectional study of HIV and STIs among male sex workers attending Australian sexual health clinics
Conclusions These findings provide estimates of HIV and STI prevalence among men who sell sex in Australia and they challenge assumptions of sex work as inherently risky to the sexual health of gay bisexual and other men who have sex with men. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Callander, D., Read, P., Prestage, G., Minichiello, V., Chow, E. P. F., Lewis, D. A., McNulty, A., Ali, H., Hellard, M., Guy, R., Donovan, B. Tags: Epidemiology Source Type: research

Then and now: a vignette
The first issue of the British Journal of Venereal Diseases appeared in January 1925. It declared its aims and ideals, Colonel Harrison described the new clinic system, there were articles on the use of bismuth in the treatment of syphilis and even on the use of diathermy to treat gonorrhoea! An introduction was written by Sir Humphry Rolleston, President of the Royal College of Physicians (PRCP). He said that, until recent times, the study and management of venereal diseases were usually under the wing of surgeons and that physicians had ‘often stood afar off.’ But in many other countries syphilis had become a...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Bingham, J. S. Tags: Miscellaneous Source Type: research

Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa: findings from a respondent-driven sampling study
Conclusions HIV testing and awareness of HIV status were high, but substantial losses in the cascade occur at treatment initiation. Given that FSWs engaged in mobile HIV testing and peer education programmes have unmet HIV treatment needs, models of decentralised treatment provision such as mobile-based ART care should be evaluated. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Schwartz, S., Lambert, A., Phaswana-Mafuya, N., Kose, Z., Mcingana, M., Holland, C., Ketende, S., Yah, C., Sweitzer, S., Hausler, H., Baral, S. Tags: Epidemiology Source Type: research

Use of injectable hormonal contraception and HSV-2 acquisition in a cohort of female sex workers in Vancouver, Canada
Conclusions The high observed incidence rates of HSV-2, together with a strong association between DMPA exposure and HSV-2 acquisition, raise serious concerns about the provision of optimal reproductive and sexual healthcare to sex workers in this setting. Given the known links between HSV-2 and HIV, our findings underscore the need for further research to better understand the potential association between DMPA and increased risk of HSV-2 and other STIs to help inform the development of safer reproductive choices for women worldwide. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Socias, M. E., Duff, P., Shoveller, J., Montaner, J. S. G., Nguyen, P., Ogilvie, G., Shannon, K. Tags: Epidemiology Source Type: research

Pilot study for the 'Test n Treat trial of on-site rapid chlamydia/gonorrhoea tests and same day treatment
Outreach sexual health services usually target hard to reach, higher risk populations who are not accessing mainstream services. These include some black minority ethnic groups and young people.1 In May 2016, we carried out a pilot study in a Further Education (FE) college to explore the feasibility of providing rapid, on-site chlamydia/gonorrhoea testing with results within 2 hours, and same day treatment if required (‘Test n Treat’). Consecutive students were approached and asked if they were willing to complete a questionnaire and provide a genitourinary sample for rapid chlamydia/gonorrhoea testing. St...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Balendra, A., Cousins, E., Lamplough, H., Oakeshott, P., Majewska, W., Kerry, S. R. Tags: Miscellaneous Source Type: research

Patterns of chlamydia testing in different settings and implications for wider STI diagnosis and care: a probability sample survey of the British population
Conclusions Most chlamydia testing occurred in non-GUM settings, among populations reporting fewer risk behaviours. However, there is a need to provide pathways to comprehensive STI care to the sizeable minority at higher risk. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Clifton, S., Mercer, C. H., Woodhall, S. C., Sonnenberg, P., Field, N., Lu, L., Johnson, A. M., Cassell, J. A. Tags: Open access Epidemiology Source Type: research

What explains anorectal chlamydia infection in women? Implications of a mathematical model for test and treatment strategies
Conclusions Autoinoculation between anatomic sites in women might play a role in sustaining high chlamydia prevalence. A shift to more anorectal testing of female STI clinic attendees may be considered for its (albeit modest) impact on reducing prevalence. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Heijne, J. C. M., van Liere, G. A. F. S., Hoebe, C. J. P. A., Bogaards, J. A., van Benthem, B. H. B., Dukers-Muijrers, N. H. T. M. Tags: Open access Epidemiology Source Type: research

How to manage children with anogenital warts
Introduction Children found to have anogenital warts (AGW) are usually brought in the first instance to their general practitioners (GPs), who may assess and manage the children themselves or refer them onto a specialist from one of several disciplines including paediatricians, dermatologists, paediatric surgeons or genitourinary medicine (GUM) physicians. In addition, if child sexual abuse (CSA) is considered advice may be sought from a sexual assault referral centre (SARC), and if so referral to children's social care and police would be advised. The authors have all been contacted for advice regarding the management of ...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Kingston, M., Smurthwaite, D., Dixon, S., White, C. Tags: Editor's choice Education Source Type: research

Sustained effect of couples' HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples
We present temporal trends in self-reported and biological markers of unprotected sex and sex with concurrent partners in discordant couples receiving couples' voluntary HIV counselling and testing (CVCT). Methods Heterosexual Zambian HIV-serodiscordant couples were enrolled into longitudinal follow-up in an open cohort (1994–2012). Multivariable Anderson-Gill models explored predictors of self-report and biological indicators of unprotected sex within (including sperm on a vaginal swab, incident pregnancy or incident linked HIV infection) and outside (including self-report, STI and unlinked HIV infection) the union...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Wall, K. M., Kilembe, W., Vwalika, B., Haddad, L. B., Lakhi, S., Onwubiko, U., Htee Khu, N., Brill, I., Chavuma, R., Vwalika, C., Mwananyanda, L., Chomba, E., Mulenga, J., Tichacek, A., Allen, S. Tags: Open access Behaviour Source Type: research

Reciprocal physical intimate partner violence is associated with prevalent STI/HIV among male Tanzanian migrant workers: a cross-sectional study
Discussion Men's physical IPV experience and enactment was common among these migrant plantation residents. Men reporting reciprocal physical IPV had significantly increased odds of prevalent STI/IPV, and we hypothesise that they have unstable relationships. Physical IPV is an important risk factor for STI/HIV transmission, and programmatic activities are needed to prevent both. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Norris, A. H., Decker, M. R., Weisband, Y. L., Hindin, M. J. Tags: Behaviour Source Type: research

A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa
Conclusions This evaluation of STI services across South Africa found gaps in the availability of medications, adherence to STI guidelines, condom provision and prevention messaging. Limited integration with HIV services for this high-risk population was a missed opportunity. Quality of STI care should continue to be monitored, and interventions to improve quality should be prioritised as part of national strategic HIV and primary healthcare agendas. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Kohler, P. K., Marumo, E., Jed, S. L., Mema, G., Galagan, S., Tapia, K., Pillay, E., DeKadt, J., Naidoo, E., Dombrowski, J. C., Holmes, K. K. Tags: Health services research Source Type: research

Overlapping HIV prevention strategies; case report of pre-exposure and postexposure prophylaxes used for a single risk event between two men
We report a case of the contemporaneous use of PEP and PrEP in a sexual liaison between two men. In an attempt to reduce the number of new cases of HIV infection, a range of prevention strategies have been advocated. Prior to the availability of ARV therapy, the key prevention measure was condom promotion and modifying sexual behaviour such as partner number reduction within high-risk groups. This was followed by: the introduction of PEP, treating all HIV cases with ARVs to reduce the probability of transmission (treatment as prevention) and in the past few years the use of PrEP. Case-control, observational and randomised ...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Smith, D. E., Gardiner, J., Oliver, R., Fagan, D. Tags: Clinical Source Type: research

What does Chlamydia trachomatis detection in a urogenital specimen from a young child mean?
The notion that sexually transmitted infections (STIs) can be acquired through non-sexual means is a well-established meme in the public consciousness. The public toilet seat is the most commonly blamed vector. This is despite the lack of evidence for acquisition of STIs from toilet seats, and the ready availability of reputable advice to this effect.1 While the ‘toilet seat hypothesis’ is not currently regarded as supported by data, other modes of non-sexual acquisition of STIs, though rare, have been reported. Examples include pharyngeal gonorrhoea by sharing of confectionery,2 transmission of urogenital (UGT...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Giffard, P. M., Singh, G., Garland, S. M. Tags: Editorial Source Type: research

The role of digital interventions in sexual health
Approximately 1 million people worldwide acquire an STI each day.1 There is an urgent need for comprehensive education and behavioural support for sexual health using the most effective communication channels. Digital interventions such as interactive websites and mobile phone applications (apps) provide valuable opportunities to raise awareness about STIs and available sexual health services to supplement standard health education delivered at schools and within the community or clinical settings. With increasing rates of daily internet access (82%), smartphone ownership (71%) and the use of social networking sites (SNS) ...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Nadarzynski, T., Morrison, L., Bayley, J., Llewellyn, C. Tags: Editorial Source Type: research

'Can you recommend any good STI apps? A review of content, accuracy and comprehensiveness of current mobile medical applications for STIs and related genital infections
Conclusions Marked variation in content, quality and accuracy of available apps combined with the nearly one-third containing potentially harmful information risks undermining potential benefits of an e-Health approach to sexual health and well-being. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Gibbs, J., Gkatzidou, V., Tickle, L., Manning, S. R., Tilakkumar, T., Hone, K., Ashcroft, R. E., Sonnenberg, P., Sadiq, S. T., Estcourt, C. S. Tags: Open access Health services research Source Type: research

Chlamydia trachomatis-induced reactive arthritis in India: frequency and clinical presentation
Chlamydia trachomatis (C. trachomatis)-induced reactive arthritis (ReA)/undifferentiated spondyloarthropathy (uSpA) are unrecognised/underestimated entities, and clinicians often fail to recognise them. In India, our group was the first to report intra-articular C. trachomatis infection in patients with ReA/uSpA having genitourinary symptoms.1 Males were predominant (78%) and majority of patients presented with an oligoarthritic profile (80%), enthesitis (11%) and human leukocyte antigen (HLA) B27 (40%); however, none reported ocular infection. Despite this observation, it is also very likely that C. trachomatis-induced Re...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Kumar, P., Bhakuni, D. S., Khanna, G., Batra, S., Sharma, V. K., Rastogi, S. Tags: Miscellaneous Source Type: research

Patient confidentiality and autonomy: how do we account for coercive control?
October 2016 saw the launch of the BASHH Toolkit to assist routine enquiry on domestic abuse within sexual health.1 It is anticipated that many services nationally will have begun this process or may have reflected on the content of the toolkit to improve their enquiry and referral pathways. We wish to draw clinician's attention to the new General Medical Council (GMC) guidance on confidentiality, which comes into effect on 25 April 2017.2 The guidance gives due consideration to issues of patient confidentiality and autonomy, however, we believe further understanding and consideration of coercive control is needed. We remi...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Cohen, C. E., Caswell, R. J., on behalf of the BASHH Sexual Violence Special Interest Group Tags: BASHH Column Source Type: research

Highlights from this issue
In recent years, we have published a growing variety of material on digital health. Though the healthcare sector is perhaps slow on the uptake, we increasingly manage our health, financial and entertainment choices online. Reflecting this, we have decided to establish a new ‘Digital’ theme in the journal, introduced below by Prof Claudia Estcourt who will lead its establishment. The Digital Health theme will allow us to highlight work that reflects digital innovation in healthcare. It will also enable us to nurture a multidisciplinary community of researchers whose skills go beyond our traditional base, reachin...
Source: Sexually Transmitted Infections - June 2, 2017 Category: Sexual Medicine Authors: Cassell, J. A., Estcourt, C. Tags: Whistlestop tour Source Type: research

Clinical round-up
‘Flourishing’ with HIV In our first paper this month, Lyons et al1 in Australia take a closer look at positive mental health in HIV-positive men who have sex with men (MSM), for example, sense of meaning, optimism and regular experiences of positive affect. They aimed to identify potential factors that could be used to optimise well-being and support programmes for HIV-positive MSM. Using a ‘flourishing scale’ they assessed eight items looking at social-psychological functioning. Four hundred and two people living with HIV completed the questionnaire, 387 participants self-identifying as MSM. Flouri...
Source: Sexually Transmitted Infections - April 20, 2017 Category: Sexual Medicine Authors: Herbert, S. Tags: Clinical round-up Source Type: research

Partner notification: harmonising the old with the new
In ‘27 years of uninterrupted contact tracing. The ‘Tyneside Scheme’’, Wigfield1 describes the first co-ordinated regional partner notification (PN) programme in the UK. Set up in 1943 to control gonorrhoea and syphilis, the approach provides a blueprint for good practice that is still pertinent today: a specialist team of contact—tracers supporting both patient and provider referral; diligent record keeping; co-operation between services to treat those out of area; prompt follow-up and evaluation of outcomes. A public health ethos underpinned their proactive approach: particular effort w...
Source: Sexually Transmitted Infections - April 20, 2017 Category: Sexual Medicine Authors: Bell, G. Tags: Miscellaneous Source Type: research

Response to imiquimod 5% cream as treatment for condyloma and anal intraepithelial neoplasia in HIV-positive and HIV-negative patients
Treatments for anal intraepithelial neoplasia (AIN) include non-operative options and more invasive treatments, such as wide local excision.1 Unfortunately, recurrence rates remain high regardless of treatment and therefore surveillance is paramount.2 We performed a study of patients who underwent treatment of condyloma and AIN using imiquimod 5% cream and compared outcomes in those patients with and without HIV. We retrospectively reviewed patients who underwent anal cancer screening between October 2010 and October 2015 (5 years) at the University of Perugia Medical Centre, Italy. Local institutional approval was ga...
Source: Sexually Transmitted Infections - April 20, 2017 Category: Sexual Medicine Authors: Santorelli, C., Leo, C. A., Baldelli, F., Cavazzoni, E. Tags: Miscellaneous Source Type: research

Chlamydia diagnosis rate in England in 2012: an ecological study of local authorities
Conclusions Chlamydia diagnosis rate recommendations that reflect local area deprivation (as a proxy for disease burden) may be more appropriate than a single national target if the aim is to reduce health inequalities nationally. We suggest LAs monitor their chlamydia diagnosis rate, test coverage and test positivity across a range of measures (including setting and sex) and pre/post changes to commissioned services. Critical evaluation of performance against the recommendation should be reflected in local commissioning decisions. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - April 20, 2017 Category: Sexual Medicine Authors: Chandrasekaran, L., Davies, B., Eaton, J. W., Ward, H. Tags: Health policy, Epidemiologic studies, Open access, Screening (epidemiology), Health service research, Screening (public health) Source Type: research

Identifying factors that lead to the persistence of imported gonorrhoeae strains: a modelling study
Conclusion The imported NG strain is unlikely to persist as a result of a single importation event. However, the probability of persistence increases if the imported NG strain is resistant to treatment, can form mixed infections with the local NG strain or there are frequent importation events. Identification of the factors that determine the likelihood of persistence of an imported NG strain could contribute to our capacity to respond appropriately and in a timely fashion. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - April 20, 2017 Category: Sexual Medicine Authors: Hui, B. B., Whiley, D. M., Donovan, B., Law, M. G., Regan, D. G., on behalf of the GRAND Study Investigators, Chen, Guy, Lahra Tags: Gonorrhoea Epidemiology Source Type: research

Bacterial vaginosis: going full circle?
In 1955, Gardner and Dukes1 claimed that a single aetiological agent caused bacterial vaginosis (BV). This bacterium is now called Gardnerella vaginalis. In their experiments, 11 of 15 women developed BV symptoms after direct inoculation with vaginal secretions from women with BV. This, and the isolation of G. vaginalis from 45 of 47 husbands of women with BV, led them to suggest it was sexually transmitted.1 Many questioned this single-agent aetiology because anaerobic bacteria were cultured in association with G. vaginalisW1 and BV responded to metronidazole.W2 Some proposed that the anaerobes acted synergistically with ...
Source: Sexually Transmitted Infections - April 20, 2017 Category: Sexual Medicine Authors: Wilson, J. D. Tags: Miscellaneous Source Type: research

Refusal of HIV testing among black Africans attending sexual health clinics in England, 2014: a review of surveillance data
Conclusions Targeted interventions are needed to improve HIV testing uptake and reduce undiagnosed HIV infection among black Africans attending SHCs, especially heterosexuals residing in deprived areas. (Source: Sexually Transmitted Infections)
Source: Sexually Transmitted Infections - April 20, 2017 Category: Sexual Medicine Authors: Mohammed, H., Dabrera, G., Furegato, M., Yin, Z., Nardone, A., Hughes, G. Tags: Drugs: infectious diseases, HIV/AIDS, HIV / AIDS, HIV infections, Confidentiality Epidemiology Source Type: research