British Association For Sexual Health And HIV Research Articles

Scratching beneath the surface: An evaluation of the management of scabies 2017-2023.

Possible resistance to recommended treatments for scabies has emerged recently. In response to anecdotal reports of a recent increase in treatment failure with permethrin, the British Association for Sexual Health and HIV (BASHH) released a statement alerting members to this. To examine attendances and the treatment pathways for scabies cases seen at local sexual health clinics. A case note review of scabies attendances between January 2017 and December 2023 was conducted. Data collected included patient demographics, clinical information, and scabies treatment histories. Statistical analysis was performed. 143 patients attended with scabies. The number of scabies cases did not appear to increase significantly from 2017 to 2023 (p = .09). There was significant increase in median number of treatments per case per year over time (p = .013). The number of individuals needing second-line treatments increased significantly over time (p-trend < 0.001). Individuals with scabies are requiring more treatments to clear infection. Use of ivermectin has risen in the last year suggesting that second-line treatment is increasingly needed for eradication. Whilst treatment failure may be due to non-compliance with treatment and decontamination efforts for both index and contacts, the more recent change in findings could be attributed to a fall in permethrin efficacy.

UK guideline for the use of HIV post-exposure prophylaxis2021.

We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.

Abstracts of the 5th Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH), Virtual, 19-21 April 2021.

Abstracts of the 5th Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH), Virtual, 19-21 April 2021.

Themed Posters

HIV MedicineVolume 22, Issue S2 p. 18-23 ABSTRACTS Themed Posters First published: 25 August 2021 https://doi.org/10.1111/hiv.13130Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume22, IssueS2Special Issue: Abstracts of the 5th Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH), Virtual, 19‐21 April 2021August 2021Pages 18-23 RelatedInformation

United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020.

The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.

Unintended consequences: the potential impacts of the British Association for Sexual Health and HIV (BASHH) 2019 gonorrhoea guidelines.

In 2019 the British Association for Sexual Health and HIV (BASHH) guidelines for the management of gonorrhoea were updated. Epidemiological treatment was reserved for sexual contacts presenting within 14 days of exposure only. The aim of this evaluation was to review the potential implications of the new guidelines on the management of gonorrhoea contacts. For this retrospective service evaluation, all gonorrhoea contacts presenting to two UK sexual health services in 2018 were identified using the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) code Partner notification: gonorrhoea contact (PNG). Demographics, clinical characteristics and outcome data were collected from the electronic patient records. The 2019 guidelines were retrospectively applied to evaluate impact. For 436 patients seen as gonorrhoea contacts, gonorrhoea prevalence was 36% (159/436), and chlamydia prevalence 19% (83/429). Gonorrhoea prevalence varied with sexual risk: women 57% (61/107), heterosexual men 20% (28/143), men who have sex with men (MSM) 38% (69/183, p < .001); and with time since exposure: prevalence 43% (114/267) in those presenting within 14 days, 28% (42/149) after 14 days (p = .003). Epidemiological treatment of contacts presenting within 14 days would result in the treatment of 73% (114/156) of confirmed cases, with 37% (153/416) contacts unnecessarily treated. The BASHH gonorrhoea guideline changes represent an opportunity to improve antibiotic stewardship by reducing unnecessary treatment of gonorrhoea negative contacts.

Epididymitis and its aetiologies in a central London sexual health clinic

Epididymitis is a common cause of scrotal pain presentation in sexual health clinics; however, it is unclear what fraction is attributable to transmissible infections. We, therefore, reviewed the aetiologies causing epididymitis. A retrospective data analysis of all cases of epididymitis diagnosed from January 2018 to December 2018 in three sexual health clinics was conducted, collecting demographics, results, management and symptom resolution at two weeks follow up. A total of 127 cases of epididymitis (mean age 32 years, heterosexual 97, MSM 30) were included. Among them 14 cases (11%) were caused by sexual transmitted infections (<35 years n = 9; >35 years n = 5): seven cases of chlamydia, six gonorrhoea, one syphilis and one trichomonas vaginalis. There were three cases of urinary tract infection diagnosed. All cases were treated with antibiotics recommended by the British Association for Sexual Health and HIV (BASHH). At two weeks follow up post-treatment 10 (7%) were symptomatic; 91% did not attend for follow up. Sexually transmitted infections were associated with acute epididymitis in 11% of this study cohort.

Kicking the habit - how can we improve the routine care for patients who are well controlled living with HIV?

The objective is to improve and standardise HIV care for people with well-controlled HIV across the region by comparing monitoring within services to UK audit standards. This was a retrospective case note review from 01.01.2018 to 31.12.2018. The standards were sourced from the British HIV Association (BHIVA), the British Association for Sexual Health and HIV (BASHH), and the Faculty of Sexual and Reproductive Health (FSRH). Six services took part with 228 patient records being audited. Two of the 5 national standards were met (blood pressure and medication review). From the 8 areas previously audited in 2014, 6 showed improvements (offer of STI screen, medication review, urinalysis, mental health screen and influenza vaccination documentation). Cardiovascular disease (CVD) risk and transmission risk had poorer documented outcomes. In addition, nearly one-third of patients were over-tested regarding their CD4 count. We recommend that letters should include a standard message about U = U (undetectable = untransmittable) and vaccinations; CVD risk and FRAX should be calculated once a year in place of a routine letter; an annual summary letter should be written in place of a letter after each clinic visit; and consistent use of a proforma, with BHIVA/BASHH/FSRH recommendations on monitoring included.

British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018).

This is the first British Association for Sexual Health and HIV (BASHH) guideline for the diagnosis and management of Mycoplasma genitalium in people aged 16 years and older. The guideline is primarily aimed at level 3 sexually transmitted infection (STI) management services within the UK, although it could also serve as a reference guide for STI services at other levels.

A clinical audit on management of first episode of anogenital w arts in Sexually Transmitted Disease (STD) clinic, Chilaw

Introduction: A clinical audit was carried out at STD clinic- Chilaw on management of first episode of anogenital warts. Objectives: The objective of the audit was to assess the management of patients with first episode of anogenital warts. Methods: The study population was all newly diagnosed patients with anogenital warts during 2016 in STD clinic, Chilaw (n=68). Patient management and documentation were assessed using a standard questionnaire from British Association for Sexual Health and HIV (BASHH) national audit group. Results: All patients were managed according to the clinic protocol. First line treatment option was trichloro acetic acid for 91 % of patients. None of the patients had documentation on factors that influenced the choice of treatment or offer of a self-applied method. Documentation of the site of warts was 88% at first visit. However, documentation on extent or description of warts was zero. Only seven percent of females were offered Pap smear. Follow up review was offered and documented in 12% of patients. Outcome of the patient after 3 months was documented in 19% of patients, whereas 53% of patients were loss to follow up. None of the patients had documentation on offering information on genital warts. Condom promotion was done on three percent of patients. No patient was offered partner notification for genital warts. All patients were offered the first line treatment according to the clinic protocol. However, documentation at first visit, offering follow up visits, health education and condom promotion were poor. Therefore, training of doctors to overcome the deficits and re-auditing is recommended. Conclusions: All patients were offered the first line treatment according to the clinic protocol. However, documentation at first visit, offering follow up visits, health education and condom promotion were poor. Therefore, training of doctors to overcome the deficits and re-auditing is recommended.

2016 United Kingdom national guideline on the sexual health care of men who have sex with men.

This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.

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.

Staff, associate specialist and specialty doctors' national audit on the management of gonorrhoea in the United Kingdom, 2015.

The British Association for Sexual Health and HIV (BASHH) revised United Kingdom national guideline for the management of gonorrhoea in adults, 2011, identified five auditable outcome measures, namely, that all patients should receive first-line treatment, be screened or treated for chlamydial infection, have a test of cure (TOC), be offered written information and have partner notification carried out. The UK National Guideline for Gonorrhoea Testing, Clinical Effectiveness Group, BASHH, 2012, recommended in addition that all reactive nucleic acid amplification tests (NAATs) from pharynx and rectum should be confirmed by supplementary testing, using a second NAAT which detects a different nucleic acid target, all those with a positive NAAT for gonorrhoea should have culture and antimicrobial susceptibility testing and that TOC should be done by two weeks. Staff, associate specialist and specialty doctors performed a national audit against these standards. Data from 3233 cases were submitted; 8% of cases of gonorrhoea diagnosed in England, Scotland and Wales over this period. We found that 83% patients received first-line treatment with a reason for not doing so provided for 11%. TOC was documented for 62% and written information was offered to 41%. Results about supplementary testing were inconsistent. The results for the other outcomes were satisfactory.

P127 HIV testing: are the targets off target?

Background/introduction The British Association for Sexual Health and HIV (BASHH) standards provide clear targets for HIV testing in genitourinary medicine (GUM). BASHH state that 97% of people with ‘needs relating to STIs’ are offered an HIV test at first attendance; and that 80% are recorded to have an HIV test. Public Health England place testing figures for our fully integrated sexual and reproductive health service consistently below recommended standards. Aim(s)/objectives To establish true HIV testing rates within an urban sexual health clinic, and to explore factors contributing to our performance. Methods Electronic patient records from all attendances to GUM or contraception and sexual health clinics between 02/03/2015 and 06/03/2015 were analysed to establish rates and patterns of HIV testing. Results 282 patients were included in analysis; 253 (89.7%) were offered an HIV test, and 176 (62.3%) had a test. 77 patients refused an HIV test; the most common documented reason was self/clinician perceived low risk (22). Within the ‘high risk’ cohort (52) only four refused and the reason was clearly noted. If patients attending primarily for contraceptive care were excluded from analysis, 225 patients remained; of these 211 (93.7%) were offered an HIV test and 164 (72.9%) had a test. Discussion/conclusion We suggest that our lower testing rates, in part, reflect the inclusion of patients attending primarily for contraceptive care. In all sexual health/contraceptive clinics it remains important to risk assess patients, and offer HIV testing where appropriate, but our analysis begs the question: should the targets be amended for fully integrated services?

P148 An audit on management of aftercare for victims of sexual assault attending a dedicated aftercare clinic

Background/introduction A dedicated sexual assault aftercare clinic was set up at the integrated sexual health service to provide care for the victims of sexual assault. British Association for Sexual Health and HIV (BASHH) guidelines provide auditable measures to compare standard of care provided by services. We wanted to assess and improve the service offered to victims by the dedicated clinic. Aim(s)/objectives To evaluate current clinical practice in the management of victims of sexual assault against the auditable outcome measures in the guidelines and improve the quality of care provided by communicating the findings, recommendations and action plans to team members. Methods Retrospective review of all victims who attended the clinic between January 2015 and 31st September 2015 was performed. Cases were identified from coding used in the clinic. A standard data collection sheet developed on the basis of the BASHH guidelines was used. Results Of the 53 victims identified, 96% were women, 83% were white, 13% were alcohol/drug related and 25% were under 18 years of age. 57% were referred by the sexual assault referral centre.96% reported one assailant and 55% were known to the victim. 100% had HIV risk assessment and were offered PEPSE if indicated. 98% were offered forensic examination if applicable, 93% emergency contraception if needed. Offer of prophylaxis against sexually transmitted infections: chlamydia 74%, gonorrhoea 62%, Trichomonas 49%. Offer of baseline testing for chlamydia 98%, gonorrhoea 100%, trichomonas 64%, syphilis HIV and hepatitis B & C 100%. Documentation of a plan for repeat STI testing 93%, documentation of offer of vaccination against hepatitis B 94% and assessment of child protection needs if under 18 years 77%. Discussion/conclusion Areas to improve: documentation of a self-harm risk assessment, offer of emergency contraception, recording of a discussion of need for pregnancy test in 3 weeks after emergency contraception, documentation of offer of prophylactic treatment for chlamydia, gonorrhoea and trichomonas and documentation of an assessment of child protection needs if the victim was under 18 years of age. This will be re-audited in 6 months.

P044 PEP/PEPSE reaudit - Whose notes are they anyway? – the data protection act restricting clinical audit

Background/introduction Post Exposure Prophylaxis (PEP) is prescribed to patients presenting with a history of occupational or sexual exposure to HIV infection. The British Association for Sexual Health and HIV (BASHH) published new clinical guidelines on PEP following Sexual Exposure (PEPSE) in 2015. Aim(s)/objectives To audit occupational PEP/PEPSE related attendances in a sexual health clinic (SHC) in 2015 and compare to a previous audit (2011–2013). Methods A retrospective case note review of patients attending in 2015 for PEP/PEPSE. Clinical records were unavailable for patients attending prior to April 2015 due to the SHC contract transferring to a new provider. Results A total of 8 patients attended for PEPSE, two were initiated in A&E, 1 in a Sexual Assault Referral Centre (SARC) and 4 in the SHC. All patients attended after sexual exposure, with none attending after needle stick injury. All patients were started on PEPSE within 72 hours, had baseline HIV test and STI screen. All had PEPSE prescribed within the recommended indications compared to 88% previously. Fifty percent finished PEP course whilst 25% had a documented HIV test 4–6 weeks post PEP. Discussion/conclusion Issues around clinical record ownership have been interpreted differently across trusts. Locally, when the provider for the SHC changed, minimal patient record information was transferred to the new trust. This limited access contributed to small audit numbers. Compared to previous audit smaller numbers of patients finished the PEP course and attended for follow up HIV test but clinicians have a greater understanding of recommended indications for PEPSE.

How to manage children with anogenital warts

Children found to have anogenital warts (AGW) are usually brought in the first instance to their general practitioners (GPs), who may assess and manage the children themselves or refer them...

Survey of genitourinary medicine specialist registrars in the United Kingdom regarding genital dermatology training.

The British Association for Sexual Health and HIV Genital Dermatology Special Interest Group (SIG) conducted a survey of specialist registrar training in genital dermatology (GD) to inform future training provision provided by the group and other services. The survey shows that training in GD is variable with most trainees receiving GD training through formal lectures or ad hoc clinical teaching, with fewer trainees having access to specialist GD clinics. There is mixed confidence in diagnosis and use of topical steroids, and few trainees are independent in GD practical procedures. Many trainees feel training could be improved with requests for a formalised attachment, formal qualification and greater training in practical procedures. The GD SIG, in liaison with British Association for Sexual Health and HIV (BASHH), aims to optimise GD training for registrars. Plans for improved resources are in progress, including a practical skills course and e-learning. It is hoped this survey will also inform GD training at both local and national levels.

P158 Exploring the feasibility of shortening the national chlamydia screening programme time to treatment standard: Abstract P158 Table 1

Background/introduction Timely treatment of sexually transmitted infections (STI) is an important factor in reducing sequelae and transmission. British Association for Sexual Health and HIV (BASHH) standards for the management of STIs recommends treatment “in as short a timescale as possible”. The National Chlamydia Screening Programme (NCSP) sets a key indicator of treating ≥95% of those testing positive within six weeks of test date. Aim(s)/objectives To explore the feasibility of services achieving a shorter time to treatment standard. Methods National audit data from the most recent NCSP turnaround time audit were used to explore how many services would meet treatment targets of three and two weeks from test date. Results The current time to treatment standard of ≥95% treated within six weeks was achieved by 39% of providers (91% of positive patients receiving treatment within six weeks, due to large services having a proportionately greater impact). Using the targets of three and two weeks this fell to 28% and 4% of providers, respectively. However, this represents 88% of patients treated within three weeks and 76% within two weeks (Table 1). Discussion/conclusion 88% of positive patients were treated within three weeks from test date even though only 28% of providers would have been able to meet this time to treatment standard. Meeting a shorter time to treatment standard would be challenging but could help to drive quality improvement and may form part of updated standards for the NCSP.

Does dropping day 5 PEP follow-up affect outcomes? An audit of HIV post-exposure prophylaxis at a central London sexual health clinic.

UK post-exposure prophylaxis (PEP) guidelines were updated by the British Association for Sexual Health and HIV (BASHH) in 2011. In 2013, we changed policy to omit day 5 PEP follow-up at 56 Dean Street as it was felt clinically unnecessary. This audit compares our performance against BASHH standards for PEP attenders during June 2012 and June 2013. We identified 162 PEP prescriptions; PEP assessment and appropriate sexually transmitted infection testing was done well. PEP completion rates and post-PEP HIV testing were lower than BASHH standards. Following omission of day 5 review, documentation that results have been checked was poor; however, attendance at follow-up was not adversely affected.