British Association Of Sexual Health And HIV Research Articles

British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023.

This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.

Editorial

Editorial

Compliance with the Updated BASHH Recurrent Vulvovaginal Candidiasis Guidelines Improves Patient Outcomes.

Recurrent vulvovaginal candidiasis (RVVC) is a debilitating, chronic condition that affects over 138 million (6%) women of reproductive age annually. We performed a retrospective audit of RVVC referrals to our tertiary care Candida clinic to evaluate the impact of the significantly updated British Association of Sexual Health and HIV (BASHH) 2019 vulvovaginal candidiasis guidelines on patient outcomes, the principles of which were implemented at our centre at the onset of the guideline revision process in 2017. A total of 78 women referred with suspected RVVC in 2017–2020 were included. Their mean symptom duration prior to referral was 6.7 years. RVVC was the definitive diagnosis in 73% of cases. In the 27% of patients without RVVC, the most common diagnoses were acute VVC (29%), vulval eczema (14%), dry skin (14%) and vulvodynia (10%). Of those with RVVC, 60% were diagnosed with an additional diagnosis, most commonly vulval eczema or vulvodynia. Only 12% of women had been counselled on appropriate vulval skin care, the mainstay of RVVC management. Long-term antifungal suppression was initiated in 68% of women. Azole-resistant Candida, for which there is no licensed treatment available in the UK, was identified in 23% of women with RVVC. In the follow-up, 82% of patients reported good control of symptoms using antifungal suppression therapy and recommended skin care, 16% had partial symptom control with some “flare-ups” responding to treatment, none reported poor control and for 2% this information was not available. RVVC-related morbidity can be reduced by following the principles outlined in the BASHH guidelines.

BASHH 2018 UK national audit of HIV partner notification

HIV partner notification (PN) is a highly effective strategy to identify people living with undiagnosed HIV infection. This national audit of HIV PN is against the 2015 British Association of Sexual Health and HIV (BASHH)/British HIV Association (BHIVA)/Society of Sexual Health Advisers (SHAA)/National AIDS Trust (NAT) HIV PN standards, developed in response to the 2013 BASHH/BHIVA national HIV PN audit. We report significant improvements in the number of contacts tested per index case, likely due, in part, to clearer definitions as well as better ascertainment and reporting. There remains scope for improvement with informing and testing contactable contacts. Recommendations from this audit include further refinement of definitions and development of a national proforma for HIV PN.

Audit on management of sexual assault victims attending an integrated sexual health service in Coventry.

The management of victims of sexual assault need a holistic approach. The British Association of Sexual Health and HIV (BASHH) has set up standards for the management of sexual assault victims attending Sexual Health Clinics. We audited the management of victims of sexual assault attending an integrated sexual health service against recommendations from the latest BASHH guidelines. We included the recommendations and implementations already in place following an earlier audit in 2013 using the same guideline. Sixty-seven individuals identified themselves as victims of sexual assault. Most were of white ethnic origin (78%), female (96%) and the commonest age group was 18–25 years (39%). We achieved the 100% target in recording the date of assault, offering baseline sexually transmitted infection (STI) screening, HIV risk assessment, offer of post-exposure prophylaxis (PEP) for HIV where applicable and offer of emergency contraception. We were below the 100% target for other categories but improved compared to the previous audit except in recording the time when the first dose of PEP for HIV was given. The BASHH guideline has 14 auditable standards, all with a target of 100%. Our audit cycle completed in three years showed considerable improvement in achieving the standards in the management of Sexual Assault Victims. We hope this will encourage other centres audit their practice against the standards set by BASHH.

Management of anogenital warts in STD clinic, Kalubowila: a clinical audit

<strong>Introduction:</strong><strong> </strong>Genital wart (GW) is the 3rd leading Sexually Transmitted disease (STD) in Sri Lanka which accounts for 23% of total reported STDs. <strong>Objective:</strong><strong> </strong>To describe the management of GW at STD clinic, Kalubowila in relation to the national guideline. <strong>Methods:</strong><strong> </strong>One hundred and thirty nine consecutive patient records during year 2016, with genital warts were analyzed using a data extraction sheet for auditable outcome variables adapted from the audit group of British Association of Sexual Health and HIV (BASHH). <strong>Results:</strong><strong> </strong>Out of 139 records, 86 were males and 53 were females. All the patients were managed according to the Sri Lankan national guideline. In almost all the cases (96%), site/location of the warts and extent/ distribution of the warts had been recorded using diagrams. However, the lesion was described in 50% of records. Out of female patients (53), cervical cytology was done in 31 patients (58%) and CIN 1 was reported in 2 cases. Pap smear had not been done in 40% of patients by the STD clinic due to pregnancy, total hysterectomy and availability of recent Pap test. All the patients were screened for HIV, syphilis and gonorrhoea. Trichloroacetic acid (90% TCA) and Cryo-theapy were the first line treatment among 75% and 25% of patients respectively. Three month treatment response rate was 74% while 9% did not show an adequate response and rest (17%) were defaulted treatment. <strong>Conclusion:</strong><strong> </strong>Almost all the patients were managed according to the national guideline and this should be continued. However, treatment response rate needs to be improved availing more treatment options.

P033 Improving clinical standards in GU medicine: a retrospective audit of neisseria gonorrhoeae

IntroductionWe present a retrospective analysis of clinic performance in the 5 domains of management and treatment of Neisseria gonorrhoeae (GC) according to current British Association of Sexual Health and HIV (BASHH) guidelines.MethodsAll cases of GC diagnosed at our clinic between 1stJanuary and 30thJune 2016 were identified. The case notes were reviewed and assessed against current BASHH criteria. This was compared with data from the same clinic for the same six months (1stJanuary to 30thJune) in 2007-2015.Results87% of patients treated for GC were recommended to have a test of cure (TOC) (61% had a TOC.). 100% of with GC were screened for Chlamydia trachomatis or received presumptive treatment for this. 88% of patients with GC had partner notification carried out. 56% of patient’s received written information about GC. 97% of patients with GC received 1stline treatment, or the reason for not doing so was documented.DiscussionWe have demonstrated consistent improvement in 2 of the 5 domains compared with previous years’ data. Recommending a test of cure, partner notification and offering patient information leaflets have decreased over the last year. To address this, teaching sessions were carried out and a quality improvement project to ensure patient information leaflets are offered is underway.Further staff training and awareness of management of N.gonorrhoeae will be addressed on a regular basis and a re-audit is recommended next year.

O20 Online prescribing for sexually transmitted infections – what’s on offer!

IntroductionIn 2016, The British Association of Sexual Health and HIV (BASHH) expressed concern over the use of medications purchased online to treat Sexually Transmitted Infections (STIs) ‘without full examination and...

P055 Improving Clinical Standards in GU Medicine: A retrospective audit of Neisseria gonorrhoea 2007 - 2015: Abstract P055 Table 1

Background/introduction This was a retrospective analysis of clinic performance in the management and treatment of Neisseria gonorrhoeae (GC) according to the current British Association of Sexual Health and HIV (BASHH) guidelines. Methods All cases of GC diagnosed in our clinic between 1st January and 30th June 2015 were identified. The case notes were reviewed and assessed against current BASHH criteria. This was compared to data collected at the same clinic for the same six months in 2007 to 2014. The total number of cases identified in 2015 were 151. Results Discussion/conclusion To my knowledge, this is the longest continuous audit of the management of N.gonorrhoea in the UK. I have seen continuous improvements in the performance of all five domains. We introduced an electronic reminder to provide patients with an information leaflet at the end of 2014. This has shown a marked improved from 27% to 74%. We aim to achieve full BASHH compliance in 2016.

P086 An audit of the management of persistent and recurrent non-gonococcal urethritis (pNGU) in a large London teaching hospital

Background/introduction The British Association of Sexual Health and HIV (BASHH) released a new national guideline on the management of non-gonococcal urethritis (NGU) in 2015. This audit was completed to assess compliance and identify areas for service improvement. Aim(s)/objectives To compare the management of pNGU against national guidelines. Methods A retrospective case note review was performed for all patients having two or more NGU code (C4N) over a 12-month period from 1 st April 2014. We collected demographic details, presenting symptoms, signs, investigations, management and number of visits. Results 130 patients were identified from three different clinics within the same Trust. A total of 282 visits were recorded. 35.4% of visits were diagnosed as NGU and 66.2% as pNGU. We achieved 100% compliance with all four of BASHH auditable out comes (i.e. screening for C. trachomatis (CT) and gonorrhoea, documented offer of written information, delivery of first-line therapy and partner notification). Only one patient was diagnosed with CT. In recurrent visits, only 31.0% of further investigations were done and 12.6% of them were treated as pNGU according to the guideline. 55.2% of the patients had 4 or more visits. Discussion/conclusion We demonstrated high levels of compliance with national guidelines for managing NGU. However, management of patients with pNGU was sub-optimal with a lack of appropriate investigations and incorrect treatment regimes. Low levels of CT positivity in this cohort demonstrate the importance of further investigations. Correct pNGU treatment may also lead to fewer visits and reduced burden on the service.

Sexual health provision in Defence Primary Health Care: a model for change?

IntroductionDefence Primary Health Care (DPHC) as an organisation has the responsibility for the provision of a basic level of sexual health service that every patient can access, regardless of their...

P08.28 Patients continue to engage in risky sexual behaviour in the time period between being tested for chlamydia and receiving test result and treatment

Introduction There is a lack of data on the sexual behaviour of patients between being tested for chlamydia, receiving the test result, and being treated. This time-period may be important in the transmission of chlamydia, as infection could continue to be spread to sexual partners whilst awaiting the test result and treatment. We aimed to investigate the sexual behaviours of patients in this time-period in order to investigate the benefits a point-of-care test (POCT) might bring to clinical practice. Methods A cross-sectional clinical audit of Genito-Urinary Medicine (GUM) clinic attendees in England. Clinic staff conducted a notes review of patients returning for chlamydia treatment following a positive chlamydia test result, and of age- and sex-matched chlamydia negatives attending for initial consultation. Initial consultation data were available for all patients; data on behaviour between test and treatment were available only for chlamydia-positives. The data also served as a sexual history taking audit for the GUM clinics, following British Association of Sexual Health and HIV (BASHH) guidelines. Results Five of nine GUM clinics approached participated (July–December 2014). The sexual history BASHH auditable outcomes completion rates varied from 0–100%. 775 patients (442 females, 353 males) were included in analyses. Males with 2–4 partners, and those who reported never using a condom, were more likely to be chlamydia positive. For 21/143 (14.7%) positive patients who provided data, last new sexual contact was in the period between test and treatment. Conclusion The BASHH 97% data recording target was only consistently met for one of six auditable outcomes, indicating required improvements in sexual history recording by GUM clinics. Patients continue to form new sexual partnerships whilst awaiting chlamydia test results, allowing for the possibility of infecting new sexual partners. POCTs which remove the test to treatment delay could prevent this onward transmission.

P74 Post exposure prophylaxis: bashh regional audit 2014

Background/introduction In 2011 British Association of Sexual Health and HIV (BASHH) updated their guidelines on HIV post-exposure prophylaxis (PEP). Aim(s)/objectives To audit the management of patients treated with PEP for both sexual and non-sexual risk in GUM clinics against BASHH PEP guidelines. Methods A retrospective case notes review was performed on patients attending for PEP following both sexual and non-sexual risk, in 7 GUM clinics in Wessex between January–December 2013. Data collected included indication for PEP, time to commence, STI screening, completion rates and HIV testing done at baseline and 3 months post-PEP. Results 98 case notes were reviewed. 77 patients had a sexual risk (47/77 men who have sex with men) and 21 a non-sexual risk. 92% of patients had a baseline HIV test at Conclusion This audit demonstrated some good management such as baseline HIV testing and the time to commence PEP. It also revealed areas to be improved, in particular PEP prescribing in a non-sexual risk situation, where often the risk was not a recommended indication. This highlights the importance of continued education to all PEP prescribers.

P10 A multicentre analysis of the management of gonorrhoea (GC): Abstract P10 Table 1

Background GC is the second most common sexually transmitted infections after chlamydia. The emergence of resistant strains has made it vital for each case to be managed according to national standards in order to reduce onward transmission. Aim To compare the current management of GC across five centres in Essex in accordance with the British Association of Sexual Health and HIV (BASHH) auditable outcomes. Methods 30 case notes of confirmed GC diagnosis from each centre between January–September 2013 were reviewed. Data collected included demographic, sites of infection, diagnostic methods, chlamydia testing, treatment protocol, test of cure (TOC), partner notification (PN) and health adviser (HA) referral. Results As illustrated in Table 1. 150 cases were analysed. Most infections were acquired locally, diagnosed clinically alongside microscopy with majority isolated from the urethra in male and cervix in female. 3 resistant strains were identified. Multiple sites of infection were also observed. 143(95.0%) cases were managed in accordance with all treatment and diagnostic standards but only 84.6% had TOC, 83.8% PN and 67.7% seen a HA. Conclusion Almost all GC cases in the region were well managed. However TOC, PN and HA referral standards were not met likely due to lack of resources and poor documentation.

P4 A critical comparison of three diagnostic techniques used for the detection oftrichomonas vaginalis(TV)

<h3>Background</h3> British Association of Sexual Health and HIV (BASHH) has recommended that nucleic acid amplification tests (NAAT) to become a gold standard method of TV detection in the 2014 guidelines. <h3>Aims</h3> To compare the efficacy of traditional wet mount microscopy (WMM), culture and TMA (Transcription Mediated Amplification) by Aptima assay for the detection of TV in our local population. The cost effectiveness of TMA and staffing requirements will also be assessed. <h3>Methods</h3> All female patients with vaginal discharge, male contact patients and males with persistent urethritis were included. Aptima high vaginal/cervical swabs routinely tested for chlamydia or gonorrhoea by TMA were used for Aptima TV testing, as were urines. All swabs and urine samples had WMM performed and cultured in modified diamonds media. Positivity rate, sensitivity, specificity, positive predictive value (PPV) and costs per test were calculated. The statistical significance was measured by McNemars test. <h3>Results</h3> 436 patients were included in the study, 64 male and 372 female. 11 were positive by at least one method, including one male. All TMA positive patients were also positive by urine except for 2. There is no statistical difference between WMM and culture (p = 0.25) but a highly significant difference between TMA and culture (p = 0.0124) and TMA and WMM (p = 0.0043). TMA is the most expensive test at &gt;£5 per test. <h3>Conclusions</h3> TMA is the most sensitive test for TV. It has fast turnaround time and suitable for female urine samples. Its use is limited due to cost and suitability for other samples e.g. in male patients.

A national audit of the management of young people in genitourinary medicine clinics (level 3 services) in the United Kingdom

Specialty and Associate Specialist (SAS) doctors in sexual health in the United Kingdom conducted this baseline audit against standards in the British Association of Sexual Health and HIV (BASHH) Management of STIs and related conditions in children and young people (2010) guideline: offer of screen (standard 90%), acceptance of screen (90%), completion of risk assessment proforma (100%), following a guideline (100%). Staff in 73 clinics submitted data for 2108 patient episodes. Of these clinics 68 (93%) follow BASHH guidelines and 68 (93%) use a record proforma. Of the 2108 patients 1732 (82%) were assessed using a proforma. Where a proforma was used the records were more complete: data were present for 82% of four selected characteristics when a proforma was used and 33% of these characteristics when not used. Of the 2108 patients 1946 were at risk of infection, 1871 (96%) were offered tests and 1692 (90%) accepted. Standards were met on offer and acceptance of tests. Most participating clinics follow guidelines, but the standard of 100% was not met. Use of a proforma was frequent and was shown to improve assessment; the standard of 100% use was not met. The main recommendation is to implement conscientious use of a proforma at all clinics.

Improved sexual history taking in the 2012 BASHH asymptomatic screening re-audit

Effective asymptomatic screening for sexually transmitted infections is an important public health service because a significant proportion of sexually transmitted infections do not present with symptoms. In 2009, the National Audit Group of the British Association of Sexual Health and HIV (BASHH) audited the management of asymptomatic patients and recommended increased documentation about oral and anal sex, regional strategies for nucleic acid amplification test (NAAT) use for gonorrhoea, improved screening for hepatitis B in men who have sex with men and an increase in screening for HIV. The 2012 audit used web-based forms to collect submissions from 180 consultant-led centres (65% response rate) that included episodes of care from 6669 asymptomatic patients. An improvement was demonstrated for all the areas measured during the 2009 audit. A doubling of gonorrhoea testing using NAATs was seen and yet 10% of asymptomatic patients continued to have microscopy despite these tests not being recommended by BASHH guidelines. This audit recommends universal adoption of gonorrhoea NAATs across the United Kingdom.

Trichomonas vaginalis: an audit of clinical practice and the demography of infected patients at three London genitourinary medicine clinics

This audit aimed to review clinical standards for Trichomonas vaginalis against British Association of Sexual Health and HIV (BASHH) guidelines. Case notes for patients who had a positive microscopy or culture result were reviewed retrospectively. There was a 0.23% positivity rate for T. vaginalis (n = 84 cases); 96% were female with an average age of 33 years, with proportionally more patients seen in the African/Caribbean population, despite the number of cases being comparable between white (n = 36) and African/Caribbean (n = 34) groups. Seventy percent of patients had both microscopy- and culture-positive results for T. vaginalis. Contact tracing occurred in 87% of patients; 56% of these patients confirmed at least one contact had been treated in the last month. Overall, our data demonstrated a lower positivity rate than expected. Wet microscopy and liquid medium cultures were both important in identifying the infection, but more needs to be done to ensure partner notification has been documented and contacts have been treated.

A national audit on the management of pelvic inflammatory disease in UK genitourinary medicine clinics

The prompt and effective treatment of pelvic inflammatory disease (PID) may reduce the risk of complications such as infertility, ectopic pregnancy and pelvic pain. We conducted a national audit to investigate the treatment of women diagnosed with PID and associated rates of partner notification in genitourinary (GU) medicine clinics during 2008 and compared our results with the British Association of Sexual Health and HIV (BASHH) 2005 national guideline. Among a total of 1,105,587 female attendees, national data showed 18,421 cases of PID diagnosed in GU medicine clinics, giving an incidence of 167 cases per 10,000 attendences. We audited a national sample of 1132 PID cases for review. Of those, 504 (44.5%) received a recommended treatment regimen and 447 (39%) of named male contacts were treated. Adherence to recommended treatment and partner notification did not reach national standards.

Tips for GP trainees working in genitourinary medicine.

A GP genitourinary medicine (GUM) post offers a valuable opportunity to develop skills in an area often poorly covered at medical school and elsewhere in the GP training programme. Within your GUM placement you can hope to develop your communication skills, improve your examination and diagnostic abilities, and learn how to recognise, screen, prevent, and treat sexually transmitted infections (STIs). You will also become comfortable in recognising and treating benign genital lumps, non-STI genital infections, and gain some valuable exposure to HIV diagnosis and management. The most common presenting symptoms in GUM are vaginal discharge, male dysuria, genital lumps, and genital sores, and you are likely to see cases of these on a daily basis. Be reassured, however, that no two cases are alike given the often complex emotional elements that accompany physical symptoms, and make the GUM consultation a sensitive event requiring good communication skills. A non-judgmental approach is essential to ensure the best outcome for the patient. If a GUM post is not offered as part of your GP training, strongly consider dedicating a week's study leave to attend GUM clinics, complimented by attending the British Association of Sexual Health and HIV (BASHH) Sexually Transmitted Infections Foundation (STIF) course.1 These two activities will provide a solid grounding in GUM, sufficient to deal with the most common presenting symptoms. Below you will find some useful tips to get you started in GUM and maximise the learning opportunities of your placement. 1. Review how …