Rajul Patel

Performance of the Cepheid CT/NG Xpert Rapid PCR Test for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae

ABSTRACT Tests for Chlamydia trachomatis and Neisseria gonorrhoeae, which can provide results rapidly to guide therapeutic decision-making, offer patient care advantages over laboratory-based tests that require several days to provide results. We compared results from the Cepheid GeneXpert CT/NG (Xpert) assay to results from two currently approved nucleic acid amplification assays in 1,722 female and 1,387 male volunteers. Results for chlamydia in females demonstrated sensitivities for endocervical, vaginal, and urine samples of 97.4%, 98.7%, and 97.6%, respectively, and for urine samples from males, a sensitivity of 97.5%, with all specificity estimates being ≥99.4%. Results for gonorrhea in females demonstrated sensitivities for endocervical, vaginal, and urine samples of 100.0%, 100.0%, and 95.6%, respectively, and for urine samples from males, a sensitivity of 98.0%, with all estimates of specificity being ≥99.8%. These results indicate that this short-turnaround-time test can be used to accurately test patients and to possibly do so at the site of care, thus potentially improving chlamydia and gonorrhea control efforts.

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.

Current management and recommendations for access to antiviral therapy of herpes labialis.

Herpes labialis is a common skin infective condition, worldwide, which is primarily caused by HSV-1. Recurrent episodes of herpes labialis, also known as cold sores, can be frequent, painful, long-lasting and disfiguring for infected patients. At present, there are two types of antivirals for the treatment of herpes labialis, topical and oral, which are available over the counter or as prescription-only. The aim of antiviral therapy is to block viral replication to enable shortening the duration of symptoms and to accelerate healing of the lesions associated with herpes labialis. This review examines the evidence for the effectiveness of current topical and oral antivirals in the management of recurrent episodes of herpes labialis. In most countries, oral antivirals for herpes labialis are available as prescription-only. However, in early 2010, the oral antiviral famciclovir was reclassified from prescription-only medicine to pharmacist-controlled status in New Zealand. The benefits and risks associated with moving an antiviral therapy for herpes labialis from prescription-only to pharmacist-controlled status are reviewed here, and the implications for patients, general physicians and pharmacists are considered.

Apolipoprotein E-epsilon 4 and recurrent genital herpes in individuals co-infected with herpes simplex virus type 2 and HIV.

Apolipoprotein E (APOE) alleles have been associated with the severity of, or susceptibility to, infection by various microbes. We investigated the potential association between the APOE-ε4 allele and the rate of recurrence of genital herpes in patients who were HIV positive and herpes simplex virus type 2 (HSV-2) seropositive. The APOE-ε4 allele was significantly associated with recurrent genital ulceration independent of ethnicity, antiretroviral therapy and CD4 count (OR 8.3; 95% CI 2.4 to 28.5). To our knowledge, this is the first published study to demonstrate this association and suggests that APOE-ε4 may represent a future prognostic marker for symptomatic recurrence of genital herpes in individuals with HIV.

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.

Patient views on examinations as part of asymptomatic screening in sexual health clinics.

Examinations of asymptomatic patients (AP) do not always take place in sexual health clinics, partly due to the evidence that clinically significant findings (not identified by urine and blood tests) are rarely found on examination of these patients. However, it is unclear from the literature as to whether patients, given the option, would choose to be examined when fully aware of what may be identified on examination as well as the frequency of positive findings. A total of 110 men attending a sexual health clinic who self-identified as asymptomatic were given a patient information sheet (PIS) describing the place and value (if any) of examinations in AP and were asked if they would like an examination. Of the 83 truly asymptomatic men with low sexual risk involved, 86% expressed the intention of having an examination having read the PIS.

An Unusual Case of Pelvic Pain: Retention of Fetal Bone after Abortion:

We present a 21-year-old woman with a short history of pelvic pain. The history was unremarkable apart from that of undergoing a surgical termination of pregnancy (TOP) some three-and-half years ago. Examination revealed a foreign body at the cervical os. Subsequent investigations revealed more foreign bodies within the cervical canal and uterine cavity, which were removed. Histologically these were found to be bones. Removal of the bone fragment initially discovered lead to an improvement of symptoms. Although the patient was treated for pelvic-inflammatory disease, no infective cause could be established. The condition of intrauterine retained fetal bones is recognized, but rare. Patients experiencing pelvic pain usually present sooner after TOP than did this patient. Although rare, it is an important condition to diagnose as it represents a treatable cause of infertility.

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.

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.

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.