Emily Clarke

Guidance and practice on frequency of HIV and sexually transmitted infection testing in men who have sex with men – what is the European situation?

Men who have sex with men (MSM) are at particular risk for HIV/sexually transmitted infections (STI). To investigate the European guidance used for MSM STI and HIV screening, risk level profiling and how this translated to practice, we conducted a questionnaire survey of leading physicians in the European branch of the International Union against Sexually Transmitted Infections (IUSTI). We identified that most European countries have limited guidance on screening intervals for MSM. Where risk profiling is advised, it is often left to clinicians to weight different behaviours and decide on screening frequency. Our results suggest that European MSM STI and HIV testing guidelines be developed with clear and specific recommendations around screening intervals and risk profiling. These guidelines will be particularly helpful due to rapidly evolving models of sexual healthcare, and the emergence of new providers who may benefit from guidelines that require less interpretation.

2014 UK national guideline for the management of anogenital herpes

These guidelines concern the management of anogenital herpes simplex virus infections in adults and give advice on diagnosis, management, and counselling of patients. This guideline replaces the 2007 BASHH herpes guidelines and includes new sections on herpes proctitis, key points to cover with patients regarding transmission and removal of advice on the management of HSV in pregnancy which now has a separate joint BASHH/RCOG guideline.

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.

Why are anogenital warts diagnoses decreasing in the UK: bivalent human papillomavirus (HPV) vaccine cross-protection or failure to examine?

Rates of first episode anogenital warts diagnoses in the UK have fallen from a peak prevalence of 151.9/100 000 population in 2008 to 139.1/100 000 in 2012, an 8% reduction.1 In Australia, the quadrivalent human papillomavirus (HPV) vaccination strategy (against HPV16 and 18 causing cervical cancer, and HPV6 and 11 causing anogential warts) has led to an unexpected reduction in warts diagnoses in unvaccinated males and older people.2 This has contributed to speculation that the UK decrease in warts may be due to cross-protection from the bivalent HPV vaccination programme (against HPV16 and 18 …

Increasing screening frequency in men who have sex with men: impact of guidance on risk profiling on workload and earlier diagnosis of sexually transmitted infection and HIV

Summary Increasing screening frequency in men who have sex with men (MSM) engaging in high-risk behaviours can reduce prevalence of sexually transmitted infections (STIs). This evaluation investigated the impact of applying stricter screening guidelines for MSM on service workload and earlier STI diagnoses. A validated risk assessment tool (RAT) was distributed to MSM attending a level 3 sexual health service over three months. Australian screening guidelines were applied to the data to identify MSM requiring more frequent screening and data projected to the larger MSM population. The RAT identified a 2–5-fold increase in the number of STI and HIV screenings required based on six- and three-monthly screening intervals, respectively, in the MSM cohort. When screening intervals are reduced from three-monthly to six-monthly there is a potential loss of 66.7% of earlier HIV diagnoses. The use of RATs will increase workload in sexual health services, but potentially diagnose a large proportion of disease earlier.

Can an asymptomatic screening pathway for men-who-have sex-with-men be introduced safely at a level 3 sexual health service in the UK?

Summary To manage the rising demand on sexual health services in the UK, many clinics have introduced asymptomatic screening pathways for heterosexuals, which omit examination. In men who have sex with men however the screening of extragenital sites poses additional challenges. This study aimed to establish whether omitting examination of asymptomatic men who have sex with men would lead to clinically significant diagnoses being missed. The notes of all men who have sex with men who attended a UK level 3 sexual health clinic between 1 July 2011 and 30 June 2012 were retrospectively reviewed. Exclusion criteria included HIV-positive patients attending for HIV-related care, attendances for follow-up consultations not requiring a full sexual health screen, symptomatic patients, contacts of sexually transmitted infections and patients requesting an examination or a repeat prescription of a regularly used medication. In all, 920 consultations occurred during 12 months, of which 893 were reviewed; 476 (53.3%) consultations would have been eligible for screening on an asymptomatic pathway and, of these, 21 (4.4%) had abnormalities found at examination. Findings included genital warts, minor dermatological conditions and three cases of minor asymptomatic urological conditions. There were no clinically significant findings on examination of asymptomatic men who have sex with men requiring treatment, indicating that examination in this cohort may be of little benefit.

Genitourinary medicine clinics may not see young men who have sex with men before they become infected with human papillomavirus (HPV)

Stanley and colleagues discuss the need to vaccinate all young people against human papillomavirus (HPV).1 Genitourinary medicine clinics may help in preventing HPV infection by offering vaccination opportunistically to men who have sex with men (MSM), but they may miss many young MSM. An Australian study of 200 MSM aged 16-20 found that the proportion of men with HPV infection increased with …

Audit of the effect of electronic patient records on uptake of HIV testing in a level 3 genitourinary medicine service

This audit aimed to measure the impact of introducing and then modifying an electronic patient record (EPR) system on the uptake of HIV testing at a level 3 genitourinary medicine service. It was a retrospective case note review of all new and rebook patients attending our service in 2007 (paper records) and 2010 (EPR), and a prospective review in 2012 (following modification of the EPR). The uptake of HIV testing increased significantly from 72.8% to 78.1% following introduction of the EPR (p = 0.009), and increased further to 86.6% (p < 0.0001) following modification of the EPR. Clinics using paper notes should consider switching to EPR as a means of increasing HIV testing uptake.

Time for NHS policy on electronic cigarettes.

Little has changed since Borland’s editorial on the regulation of electronic cigarettes (e-cigarettes) last year.1 A recent interchange between a staff member and a patient regarding electronic smoking on hospital premises identified a lack of coherent local guidance. This prompted us to contact …

Sex post Golding

Time for a debate on whether the criminal law is the best way to deal with infectious diseases