Elizabeth Foley

European guideline for the management of genital herpes, 2010

This is the guideline for genital herpes simplex virus (HSV) management for the IUSTI/WHO Europe, 2010. They describe the epidemiology, diagnosis, clinical features, treatment and prevention of genital HSV infection. They include details on the management of HSV in pregnancy, those who are immunocompromised and the clinical investigation and management of suspected HSV-resistant disease.

Destigmatising STIs: remaining challenges, new opportunities

The potential barriers to attendance at specialist sexually transmitted infection (STI) services have long been recognised. The Royal Commission report in 1916 advised that to be effective, services needed to be “skilled, free … and provided at the earliest possible moment.” In addition, clinicians needed to be aware of “the fear of disgrace and the consequent desire for concealment” that could hamper treatment delivery.1 In many respects the UK GUM services have risen to these challenges. The majority of clinics provide timely, effective care from easy to access and well located clinics.2 We are successful at attracting new referrals and have seen a year on year increase in voluntary attendances with a record 1.5 million consultations in 1999. With this level of success it would be easy to conclude that STI services are both accessible and acceptable for at least the majority of the UK population. However, it would appear that many patients with known or suspected STIs are still reluctant to attend genitourinary medicine (GUM) clinics for care. The principal suspected reason for this is the stigma associated with an STI diagnosis, which may be reinforced by the need for attendance at GUM clinics.3 In this regard, genitourinary medicine has much in common with mental health and cancer services. However, GUM specialists particularly value open access and strive to provide a confidential, non-judgmental, and supportive service, so it is particularly galling for them that …

2017 European guidelines for the management of genital herpes

Genital herpes is one of the commonest sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management, and follow-up of the condition as well as for minimising transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalisation with complications, including urinary retention, meningism, or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy, and co-infection with human immunodeficiency virus.

How normalised is HIV care in the UK? A survey of current practice and opinion.

Objectives: The prognosis for individuals infected with HIV has changed dramatically over the past 10 years, with patients living longer and requiring other specialist services. It is apparent that access of other healthcare professionals to clinical information about a patient’s HIV care differs between centres in the UK. Lack of awareness of an individual’s HIV status may compromise their clinical care. Aim: To establish current practice and identify the views of clinicians caring for patients infected with HIV. Methods: Lead consultants in all genitourinary medicine departments in the UK were invited to complete a questionnaire regarding use of combined HIV and hospital notes and ability of general practitioners and other hospital specialists to access information about individual patient’s HIV care. Clinician’s opinions on the “normalisation” of HIV management were also sought. Results: Combined notes (outpatient and inpatient) were used by 12% (16/130) of respondents. The patient’s identifying number was used to request blood tests in 86%. Of the respondents, 42% had encountered difficulties in communication that affected delivery of care for an HIV-positive patient. Conclusions: Centres using combined notes identified a higher frequency of communication with other doctors and specialties, suggesting a higher standard of care. Physicians involved in HIV care should consider combining patients’ HIV and hospital notes for improved clinical care.

Young persons' access to genitourinary medicine clinics in the UK: a cross-sectional survey

Study Design This service evaluation of genitourinary medicine (GUM) clinics in the UK was designed to quantify access for young people requesting to be seen and to establish whether they could be seen outside school hours. Methods In December 2009 postal questionnaires were sent to all lead clinicians in UK GUM clinics asking when they expected a young person would be offered an appointment and whether it could be outside school hours. Between January and March 2010 trained male and female medical students posing as 16 year olds telephoned all GUM clinics listed on the British Association for Sexual Health and HIV website with symptomatic and asymptomatic scenarios and requested an appointment after school hours. Results 99% of the 152 responding clinicians estimated that an appointment would be offered within 48 h for both male and female contacts and over 90% could be seen outside school hours whether symptomatic or not. Of the 666 clinic telephone contacts, 88% were offered an appointment within two working days, and 66% were offered an after school appointment within 2 days. There was no significant difference whether the ‘patient’ was symptomatic or not (87% vs 86%, respectively, p=0.784) in being offered an appointment within two working days. There was variation between countries, with England performing significantly better; 94% were offered an appointment within 2 days versus 58%, 55% and 67% for Wales, Scotland and Northern Ireland, respectively. Conclusion The findings would support the impact and value of process targets on service delivery.

Patient-initiated delay at a genitourinary medicine clinic: are there public health consequences?

Objectives: To assess the public health consequence of patients electing not to be seen within 48 hours in a genitourinary medicine (GUM) clinic. Methods: A 3-month retrospective case notes review was carried out for 310 new and re-book patients who chose to wait for more than 48 hours to be seen. Results: Altogether, 10% (310/3110) of patients opted to be seen beyond 48 h. Their median wait was 6 days including weekends and 4 days excluding weekends. Demographic details did not vary except for the male to female ratio of 1:1.7 (1:1 in patients seen within 48 h). We found that no symptomatic patients or asymptomatic contacts of those with known sexually transmitted infections (STIs) reported sex with a new partner after booking their appointment. No patient reported sex with a recently treated partner who consequently required re-treatment and none suffered a complication of a STI. In addition, there were no cases of new HIV infection in this group and the rates of STIs were similar compared with patients seen within 48 hours of contacting the unit. Conclusions: Despite 10% of patients choosing to delay attendance beyond 48 h, no adverse public health outcomes were demonstrated.

Midwives and HIV antibody testing: identifying the key factors for achieving the targets

A questionnaire study was designed to assess whether differences in knowledge and attitudes to HIV infection existed between midwives working in areas of higher and lower HIV prevalence, and the extent to which this influenced the uptake of HIV antibody testing by their clients. The response rate was 75% (219/292). Midwives in an area of a higher HIV prevalence had significantly greater experience with HIV-positive mothers, were more confident with HIV-related issues and were less judgemental in their attitudes than midwives in an area of lower HIV prevalence. However, midwives who had been offering HIV testing for more than 2 years were significantly less likely to achieve an HIV antibody test uptake rate of more than 75% than those who had been offering testing for less than 2 years, 35% (95% confidence interval [CI]: 22.2–48.6%) vs 67% (95% CI: 56.3–76.0%), respectively. This demonstrates the need for regular updating of midwives about HIV antibody testing.

Summary and highlights from the International Union against Sexually Transmitted Infections Congress 2014, Malta.

P52. 2. Arrey A, Deschepper R, Lacor P, et al. ‘‘People don’t know I’m HIV positive. I distance myself from them’’ Self-Stigma among Sub-Saharan African migrant women with HIV/AIDS in Belgium. IUSTI, Malta 2014. Poster Abstract P85. 3. Abdullah ASM, Ebrahim SH, Fielding R, et al. SexuallyP85. 3. Abdullah ASM, Ebrahim SH, Fielding R, et al. Sexually transmitted infections in travellers: implications for prevention and control. Clin Infect Dis 2004; 39: 533–538. 4. Matteelli A, Schlagenhauf P, Carvalho AC, et al. Travelassociated sexually transmitted infections: an observational cross-sectional study of the GeoSentinel surveillance database. Lancet Infect Dis 2013; 13: 205–213. 5. Whelan J, Belderok S, van den Hoek A, et al. Unprotected causal sex equally common with local and Western partners among long-term Dutch travellers to (sub)tropical countries. Sex Transmitted Dis 2013; 40: 797–800. 6. Qvarnström A and Oscarsson M, HIV/STI prevention among young adults. A qualitative study on experiences of prevention efforts prior to travelling abroad. IUSTI, Malta 2014. Poster Abstract P89. 7. Qvarnström A and Oscarsson M, An internet based survey on how Swedish me who have sex with men perceive pre-travel prevention efforts on HIV/STIs. IUSTI, Malta 2014. Poster Abstract P90. 8. Lewis N, Dube G, Carter C, et al. Chlamydia and gonorrhoea contamination of clinic surfaces. Sex Transmitted Infect 2012; 88: 418–421. 9. Andersson P, Tong SYC, Lilliebridgr RA, et al. Multisite determination of the potential for environmental contamination of urine samples used for diagnosis of sexually transmitted infections. IUSTI, Malta 2014. Oral Abstract O11. 10. Hocking J, Guy R, Walker J, et al. Advances in sampling and screening for Chlamydia. Future Microbiol 2013; 8: 367–386. 11. Adams E, Ehrilch A, Turner K, et al. Mapping patient pathways and estimating resource use of point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK. BMJ Open 2014; 4: 1–6. 12. Hislop J, Quayyum Z, Flett G, et al. Systematic review of the clinical effectiveness and cost-effectiveness of rapid point-of-care tests for the detection of genital chlamydia infection in women and men. Health Technol Assess 2010; 14: 1–97. 13. Cooper F, Appleby T, Chislett L, et al. ‘‘Innovative, rapid and effective: asymptomatic screening in 2014’. IUSTI, Malta 2014. Oral Abstract O4. Dyke et al. 217

Are there excess Sharons in genitourinary clinics

Most doctors believe that they can determine the age and social class of a patient merely from hearing their name—but this has not been proved. In the 1990s, paediatricians seldom encounter Hildas or Ethels, and Kylies and Bradleys are yet to call on the services of elderly medicine Stereotypes abound, but is it true that Camillas are more likely to have private medical insurance than Paulines? Above all, are those “Essex girls” Tracey, Sandra, and Sharon really women of easy virtue? With this in mind we set out to establish whether these names are overrepresented among attenders in …

What impact has tendering had on trainees? Results of a national survey by British Association for Sexual Health and HIV Trainees’ Collaborative for audit, research and quality improvement projects:

In April 2013, local authorities gained responsibility for commissioning sexual health services in England. With many services going out to tender and resultant change in services or service provider, there is anecdotal evidence that this has impacted on the education, training and morale of genitourinary medicine (GUM) trainees. The aim of this study was to evaluate the impact of tendering on GUM trainees. An electronic survey designed by the British Association for Sexual Health and HIV Trainees’ Collaborative for Audit, Research and Quality Improvement Projects (T-CARQ) was distributed to GUM trainees and newly appointed consultants. Eighty-two individuals responded (74% GUM trainees, 25% newly appointed consultants, 1% locum appointed for service). Sixty-three per cent (45/72) had experience of training within a service which was being tendered. Of these, 59% (24/41) felt their training was not considered during the tendering process and 20% (8/41) felt that it was. Forty-four per cent (18/41) felt adequately supported. Thirty per cent (12/40) reported active participation in the tendering process. On a scale of 0 (no impact) to 5 (major impact), the median score for impact of tendering on training was 2. The positive/negative impact of tendering on different training elements was rated: other than management experience the overall impact on all parameters was negative, namely morale, senior support and education. In conclusion, this survey describes the variable impact of service tendering on GUM training. Our recommendations for maintaining training standards despite tendering include actively involving trainees and education partners, inclusion of specialist GUM training in service specifications, development of guidance for commissioners and services for the management of GUM training within tendering.