Dan Clutterbuck

Sensitivity of microscopy for the rapid diagnosis of gonorrhoea in men and women and the role of gonorrhoea serovars

Auditing the sensitivity of microscopic diagnosis of gonorrhoea is recommended by the current guidelines. A retrospective study was performed of 596 cases of positive cultures for Neisseria gonorrhoeae in modified New York City culture (MNYC) media diagnosed from 1995 to 1999. The sensitivity of the cervical slides in women was 51% while in men who have sex with men (MSM) the sensitivity of urethral and rectal slides were 89% and 54% respectively. The sensitivity of urethral slides in heterosexual men was 84%. Neisseria serovar 1B02 among MSM and serovar 1B31 among women were mostly undiagnosed with microscopy. Serovars 1A05, 1A21, B08 among heterosexual men were exclusively associated with negative microscopy. Microscopy is important in the rapid detection and treatment of gonorrhoea. Infections with certain serovars are less likely to be detected by microscopy; making them more likely to spread within the community. Culture from different ano-genital sites is essential to maximize detection of gonorrhoea in all patients.

Genitourinary medicine clinic and general practitioner contact: what do patients want?

Objectives: While genitourinary medicine (GUM) records have historically been kept separate from other medical data, patient information is increasingly shared across the NHS. There are advantages to this in GUM: GPs are increasingly involved in delivering targets for STI screening and sexual health services. We ascertained patient attitudes to proposals to routinely send clinic letters to GPs and to share GUM data on common IT systems. Methods: Clinic attendees in the period 24 March to 5 April 2006 completed a questionnaire concerning their opinion on letters to GPs, GUM data sharing and personal presumptions about the implications of having HIV testing. Patient demographic data, clinic test results and questionnaire answers were analysed using SPSS. Results: Of 527 patients who completed the questionnaire, 187 (35%) agreed to GP contact, 337 (64%) declined and 3 (1%) failed to express a preference. Factors significantly associated with agreement to GP contact included heterosexual orientation (p<0.05), initial GP referral (p<0.001) and not considering HIV testing to have negative implications for future mortgage and life insurance applications (p<0.05). When questioned on attitudes to GP access of computerised results, 291 patients (55%) approved, 231 (44%) disagreed and 5 (1%) failed to reply; 128 patients (24%) said that they would be less likely to attend GUM if this occurred. Conclusions: Mode of referral and concerns about the implications of HIV testing affect patient preference on information sharing. A significant proportion of patients still want GUM visits to be anonymous and a policy of sharing GUM data on common IT systems may deter patient attendance.

Regular STI testing amongst men who have sex with men and use social media is suboptimal - a cross-sectional study.

Sexually transmitted infections (STIs) disproportionately affect men who have sex with men, with marked increases in most STIs in recent years. These are likely underpinned by coterminous increases in behavioural risks which have coincided with the development of Internet and geospatial sociosexual networking. Current guidelines advocate regular, annual sexually transmitted infection testing amongst sexually active men who have sex with men (MSM), as opposed to symptom-driven testing. This paper explores sexually transmitted infection testing regularity amongst MSM who use social and sociosexual media. Data were collected from 2668 men in Scotland, Wales, Northern Ireland and the Republic of Ireland, recruited via social and gay sociosexual media. Only one-third of participants report regular (yearly or more frequent) STI testing, despite relatively high levels of male sex partners, condomless anal intercourse and high-risk unprotected anal intercourse. The following variables were associated with regular STI testing; being more ‘out’ (adjusted odds ratio = 1.79; confidence interval = 1.20–2.68), HIV-positive (adjusted odds ratio = 14.11; confidence interval = 7.03–28.32); reporting ≥10 male sex partners (adjusted odds ratio = 2.15; confidence interval = 1.47–3.14) or regular HIV testing (adjusted odds ratio = 48.44; confidence interval = 28.27–83.01). Men reporting long-term sickness absence from work/carers (adjusted odds ratio = 0.03; confidence interval = 0.00–0.48) and men aged ≤25 years (adjusted odds ratio = 0.36; 95% confidence interval = 0.19–0.69) were less likely to test regularly for STIs. As such, we identify a complex interplay of social, health and behavioural factors that each contribute to men’s STI testing behaviours. In concert, these data suggest that the syndemics placing men at elevated risk may also mitigate against access to testing and prevention services. Moreover, successful reduction of STI transmission amongst MSM will necessitate a comprehensive range of approaches which address these multiple interrelated factors that underpin MSMs STI testing.

What does the latest research evidence mean for practitioners who work with gay and bisexual men engaging in chemsex

In this issue, Weatherburn et al and Pakianathan et al provide a combination of practical and empirical insights into ‘chemsex’. This is particularly relevant to clinicians working with gay and bisexual men who have sex with men (GBMSM). Here we outline further issues for practitioners working with GBMSM who engage in chemsex. Chemsex describes GBMSMs use of new recreational drugs (primarily mephedrone, crystal methamphetamine and γ-hydroxybutyric/γ-butyrolactone) to enable, enhance and prolong sexual interactions. Unlike alcohol and most other recreational substances, chemsex drugs provide men with the ability to improve their sexual performance and experiences, by increasing arousal, stamina and pleasure.1 Arising in tandem, the proliferation of geospatial sociosexual networking apps provide access to local sexual activities and drug procurement on demand.2 Together, these developments allow multiple and group sexual hook-ups to be arranged, outside the spatiotemporal constraints of the commercial (gay) scene, which usually last many hours or even several days. As well allowing increased partner numbers and turnover, chemsex users operate within a distinct cultural ‘bubble’, where risky sex and recreational drug use are normalised and advance negotiation of drug supply/use, intravenous drug taking, specific sexual behaviours, sexual safety, HIV serostatus, pre-exposure prophylaxis (PrEP) and condom use/non-use may all take place online. These online sociosexual networks and chemsex sexual cultures are disconnected from the commercial gay scene and, therefore, associated health promotion. In addition, difficulties in engaging men via sociosexual media—and in particular men within the chemsex culture—mean that presentations at sexual health and HIV care clinical interactions may provide the …

The BASHH MSM special interest group.

How do we tackle the poor sexual health of gay and bisexual men? The lives of many men-who-have-sex- with-men (MSM) in the UK, as in many other Western liberal democracies, have undergone the most extraordinary social changes in less than two decades. In the UK, these have included the legalisation of marriage, equality in health, parental and employment rights and an increasing mainstream acceptance of gay (and to a lesser extent bisexual) men that extends from sport to soap operas. In stark contrast, rates of Human Immunodeficiency Virus (HIV) infection in MSM, compared with most other groups, are stable or rising in almost allhigh, middle and low income nations including the UK. Sexually Transmitted Infections (STIs), in particular syphilis and gonorrhoea, continue to affect MSM disproportionately, and rates of other health problems, from tobacco use and depression to anal cancer, may be higher in MSM than in heterosexual men. The British association of Sexual Health and HIV (BASHH) MSM special interest group was formed in 2011 in response to this complex but fascinating challenge. We have addressed strategic priorities through co-ordinating BASHH feedback …

Learning from guidelines on the sexual healthcare of men who have sex with men

The British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the sexual health care of men who have sex with men (MSM) was published in electronic format in this journal in 2018. In common with other BASHH guidelines, the document fulfils the dual role of scrutinising and evaluating the available evidence according to the accredited Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, as well as the often more challenging job of codifying and summarising expert opinion in areas where the evidence base is incomplete or lacking. In addition to the learning gained from developing the recommendations included in the final document, further benefit was derived from the process through a number of learning and development actions for the writing group and through this the MSM special interest group and the wider sexual health community.

P015 BASHH MSM SIG Clinic Survey; Testing and vaccination

Background/introduction/Aim(s)/objectives Our aim was to investigate practice across the UK in aspects of the clinical care of MSM who are HIV negative or of unknown status where evidence is absent, or guidance varies. Methods An online questionnaire was drafted by the MSM SIG, tested by BASHH CGC members, revised and distributed to BASHH, FSRH members and CSP audit sites for one month to 31st October 2015. Results There were 149 complete responses. Only 40% of respondents had a written protocol or policy on recall for HIV/STI testing of which 23% had an automated system to recall patients for testing. 50% routinely test for HIV at syphilis follow up. 90% of respondents report using both NAAT and culture for GC in contacts of gonorrhoea and 20% use both in asymptomatic men. 33% test anatomical sites according to sexual contact history. Self-taken throat (rectal) swabs for GC/Ct NAAT were used never by 26% (3%) and routinely in 18% (22.5%). 100%’routinely test MSM for Hepatitis B exposure and over 50% for’Hepatitis C. 78% routinely check HepB sAb levels following vaccination. 79% routinely recall men for Hepatitis B vaccination. Discussion/conclusion There is evidence of variation in clinical practice between clinics in the UK, not all of which can be explained by variations in local epidemiology and some of which has significant cost implications. Results have generated debate in the MSM SIG on the rationale for local policies.