Mannampallil Samuel

Adenovirus urethritis and concurrent conjunctivitis: a case series and review of the literature

We present eight cases and review the literature of concurrent urethritis and conjunctivitis where adenovirus was identified as the causative pathogen. The focus of this review concerns the identification of specific sexual practices, symptoms, signs and any serotypes that seem more commonly associated with such adenovirus infections. We discuss the seasonality of adenovirus infection and provide practical advice for clinicians to give to the patient.

Care of HIV-positive women aged 50 and over – can we do better?:

A sample of 123 HIV-positive women aged 50 years and over showed high rates of late diagnosis with CD4 count <350 (71%), significant co-morbidities (90%), high rates of premature menopause (6.8%) and early menopause (6.8%) and cervical cytological abnormalities (47%). Specific interventions to improve care in this group should include yearly cervical cytology, early counselling with regard to reproductive options, menopause management and screening for sexually transmitted infections (STIs).

An unusual and unsettling place for a worm

A 56-year-old man presented complaining of urinary frequency, passing urine eight times per day, urethral irritation and dysuria. Investigations showed no evidence of urinary tract infection or sexually transmitted infections. Three months later he presented, again complaining of increased urinary frequency and urethral irritation. He brought with him a urine specimen containing a small ‘worm’, 2 mm in length, identified as a drain fly (or moth fly) larva, of the genus Psychoda (dipterous flies). Psychoda lay eggs in organically polluted water such as sewage plants, sink drains or on decaying vegetables and fruits. Urogenital myiasis may arise from hatching of larvae near the urethral opening and ascending migration along the urethra with consequent urethritis. Following larval identification, ivermectin was prescribed and the mans symptoms improved after six weeks.

Contraception and medical gynaecology for HIV-positive women in a one-stop clinic.

HIV-positive women may be reluctant to attend gynaecology or family planning clinics for fear of divulging their condition. Therefore, a referral clinic was opened within the HIV clinic. Retrospective case-note reviews of 197 new patients revealed 109 with a variety of medical gynaecology conditions (menorrhagia being the commonest) and 88 sought contraception. The full range of contraceptives was used, including Mirena for the treatment of menorrhagia as well as contraception and the combined pill adjusted for interaction with liver enzyme-inducing antiretroviral drugs. The acceptance of contraceptive advice and gynaecological evaluation by the patients has resulted in improved reproductive health services for these HIV-positive women. In centres with large cohorts of HIV-positive women, this type of one-stop specialist clinic will be very effective in providing high-quality reproductive health care and hence, this type of clinic is recommended for such centres.

Use and acceptability of salivary hepatitis C virus testing in an English Young Offender Institution

People held in prison are at a high risk of having hepatitis C virus (HCV) and there is a public health drive in the UK to increase HCV testing in prisons and Young Offender Institutions (YOIs), with opt-out testing. There is an oral antibody test for HCV; this project aims to determine its acceptability in an English YOI setting. This project offered HCV oral point-of-care testing (POCT) using the OraQuick® test to 107 male young offenders attending a sexual health service at an English YOI, monitoring HCV positivity and evaluating acceptability. It also investigated young offenders’ histories of sexually transmitted infections (STIs) and drug use. Mean age was 19.1 years. A total of 80.4% reported lifetime drug use and 0.9% reported lifetime drug injection. A total of 19.6% reported previous STIs. One patient (0.9%) was positive for HCV on OraQuick® testing. All patients found the POCT acceptable and one stated he would have refused a fingerprick test had it been the only test available for HCV testing. Salivary rapid HCV testing is acceptable among English YOI inmates. It is not as sensitive or specific as standard HCV tests and is more expensive. In our cohort, HCV positivity was low.

Hygroscopic dilator (Dilapan-S™) and misoprostol combination for the early first-trimester termination of pregnancy: a pilot study

Background and methodology Uptake of the mifepristone/misoprostol combination to induce early medical abortion in England and Wales has been slow. Womens concern that early medical abortion is painful may be a contributory factor. This pilot study evaluated the pain experienced by women when Dilapan-S™, a synthetic hygroscopic dilator (polyacrylonitrile) is used instead of mifepristone as cervical preparation prior to administration of a misoprostol. Results Of 25 patients completing the trial, 17 aborted in a median of 6 hours with an interquartile range of 4.5–11.5 hours. Of these, 15 patients recorded mild discomfort only, 14 considered the procedure excellent and three good. Discussion and conclusions This study suggests that the Dilapan-S/misoprostol combination reduces the pain associated with early medical abortion. Further investigation of the protocol is merited.

Sexual health of women aged 40 and over attending an inner city integrated sexual health clinic

Sexual health policy remains focussed on younger adults. However, rates of sexually transmitted infections (STIs) in older people continue to increase. We explored the sexual healthcare needs of women aged 40 and over attending an integrated sexual health clinic in South London. We conducted a retrospective case note review and found that almost 20% of these women had STIs. These included genital herpes, trichomoniasis, genital warts, chlamydia and gonorrhoea. Less than a quarter of women reported use of condoms during most recent sexual contact, indicating sexual risk-taking behaviour. 38% of women attended for contraception. The sexual health needs of older people can only continue to increase, given our rapidly ageing population. Age-specific health promotion strategies are needed.

A rare case of acquired lymphangioma circumscriptum of the penis.

Acquired lymphangioma circumscriptum is a rare occurrence on the penis. We report a case of a 47-year-old man who presented with a single lesion of acquired lymphangioma circumscriptum on the penis resembling genital warts. We report the case to increase awareness of this rare condition which may mimic sexually transmitted infections such as genital warts.

P222 Does HIV infection increase complications after Intra Uterine contraception (IUC)

Background As estimated by World Health Organisation about 50% of all HIV infected individuals are women. Comparison data for complications after IUC in HIV positive and negative women are lacking. Aims The aim of our study is to compare short-term complications and side-effects after IUC in the above two groups. Methods Retrospective notes review of 76 patient records of HIV negative women who attended in 2013, for IUC and followed up for 3 months was carried out. All HIV positive women, who attended between 2012–2015, for IUC and followed up within 3 months were included. Data including demographics and complications were collected in addition to HIV related parameters. Results Among the 49 HIV positive women 46 were on treatment and was undetectable at the time of IUC insertion. Mean CD4 count was 589 cells/µL. Mean age was 38 years, and 30 in the negative women. Black ethnicity was common among both groups. Pelvic pain was reported in 6% of the HIV group vs 17% of the non-HIV group (P value = 0.034). Incidence of lost threads was also significantly high in HIV negative women (P value = 0.018). 31% of the HIV group reported heavy or prolonged bleeding vs 37% of the negative group. Discussion In HIV negative women, pelvic pain and incidence of lost threads were significantly high. Occurrence of any complication or side effect was also significantly high in HIV negative women (P value = 0.022).