Alison Mears

Persistent genital arousal disorder: a review of the literature and recommendations for management

Persistent genital arousal disorder is a newly recognized condition that is poorly understood. There is a paucity of research in this area and there are concerns as to the validity of the results of what little research there has been. This article aims to draw together current literature on this topic and provide readers with guidance on the management of this condition. This includes a working definition, an exploration of possible aetiologies within the confines of current knowledge, practical advice regarding assessment, management and auditable outcomes of practice.

A literature review and case reports series on the use of phosphodiesterase inhibitors in the treatment of female sexual dysfunction

Summary The term ‘female sexual dysfunction’ (FSD) encompasses a number of different disorders, and while their aetiologies are not fully understood, the sub-classifications of this broad umbrella term are increasingly becoming more established and accepted. However, there is less consensus regarding the optimal treatment of these conditions. While it is known that phosphodiesterase (PDE5) is involved in the female sexual response, the clinical and research evidence supporting the unlicensed use of PDE5 inhibitors (PDE5i) in women is inconclusive and at times contradictory. In this article we explore this further by means of a comprehensive literature review on the use of PDE5i in the treatment of FSD and we also present our clinical experience of using these drugs in this context.

A Phase I study to assess the safety, tolerability and pharmacokinetic profile of boceprevir and sildenafil when dosed separately and together, in healthy male volunteers

OBJECTIVES Boceprevir is a first-generation direct-acting antiviral licensed for the treatment of hepatitis C infection. Sildenafil is an oral therapy for erectile dysfunction. As boceprevir is a potent inhibitor of CYP3A4, potential pharmacokinetic interactions may occur when it is coadministered with sildenafil. The aim of this study was to assess the pharmacokinetic profile of sildenafil and boceprevir when dosed separately and together in healthy volunteers. METHODS Thirteen male subjects completed the following study procedures: phase 1 (Day 0), a single dose of 25 mg of sildenafil was administered; washout period (Days 1-9); phase 2 (Days 10-15), 800 mg of boceprevir three times a day was administered; and phase 3 (Day 16), 800 mg of boceprevir and 25 mg of sildenafil were administered. All drugs were administered in the fed state. Intensive pharmacokinetic sampling was undertaken on Days 0, 15 and 16. Differences in the pharmacokinetic parameters of sildenafil, N-desmethyl-sildenafil and boceprevir between phase 3 and the earlier phases were evaluated by changes in the geometric mean ratios (GMRs). RESULTS All the drugs were well tolerated with no safety concerns arising. In the presence of boceprevir (phase 3 versus phase 1), the GMR for the plasma Cmax and the AUC24 for sildenafil increased by 1.9-fold (95% CI 1.5-2.4) and 2.7-fold (95% CI 2.1-3.4), respectively, whereas a reduction in the Cmax of N-desmethyl-sildenafil was observed (GMR 0.5, 95% CI 0.4-0.7). No significant changes in boceprevir exposure were observed between phases 3 and 2. CONCLUSIONS Exposure of sildenafil is increased in the presence of boceprevir. A dose adjustment of sildenafil is therefore necessary. An initial dose of 25 mg of sildenafil is suggested.

P147 Adding a Domestic Abuse Routine Prompt to the GUM Proforma: But Are we Asking the Question?

Background/introduction In July 2015, a routine domestic abuse (DA) prompt was introduced in a busy, walk-in, inner-London, genitourinary medicine (GUM) clinic. DA guidelines, proforma and management flowchart were devised. Tiered training was/is provided at a basic level for all staff and in-depth for Sexual Health Information Protection team (SHIP) and DA champions.Auditable outcomes: DA question asked where safe (Target 100%), (SAFE: quiet/confidential space, seen alone, no child > 18 months present, professional interpreter if necessary), Complete DA proforma if DA disclosed (100%), Patient information leaflet (PIL) given if DA > 3/12 ago/no on-going risk (100%), Offered SHIP referral for risk assessment if DA < 3/12 or on-going risk (100%), DA disclosures correctly coded (100%). Aim(s)/objectives Audit whether DA routine prompt asked, proforma completed, initial management pathway followed and disclosures coded. Methods Data collected (notes review) on 100 consecutive, new, walk-in, GUM patients > 18 years-old, from 1st October 2015. Results 59 female, 41 male. 91% patients asked about DA. 9 not asked: 5/41 (12.1%) male, 4/59 (6.8%) female. 9/9: no reason documented explaining omission. 5/91 (5%) disclosed DA (all female). DA proforma completed in 3/5 (60%) (1 patient declined further discussion). 1/4 (25%) had current/on-going risk and referred to SHIP. 3/4 DA occurred > 3/12 ago/no on-going risk: 1 accepted, 1 declined, 1 not offered PIL. 2/5 (40%) DA disclosures coded correctly (using in-house code). Discussion/conclusion High enquiry rate (male patients less likely to be asked). DA protocol/flow chart followed in the majority of cases (proforma completion and referral to SHIP). There were low levels of accurate coding.