British Cooperative Clinical Group Research Articles

P5.034 British Co-Operative Clinical Group (BCCG) Project - How Often Are Men Who Have Sex with Men (MSM) Advised to Attend For Repeat Sexual Health Screening in the UK?

BackgroundWithin the UK rates of HIV, STIs, and sexual risk taking behaviours are increasing in MSM. 24% of new UK HIV diagnoses in MSM are recently acquired. Increased frequency of...

Management of under-16-year olds in UK genitourinary medicine clinics: British Co-operative Clinical Group

In 2004, the management of under-16-year olds in UK genitourinary (GU) medicine clinics was surveyed. Questionnaires were sent to 185 lead GU medicine consultants. A total of 111 questionnaires were returned (60%). Ninety-eight percent of respondents managed young people aged 13-16. Fifty percent managed under 13-year-olds. Twenty-nine percent of respondents ran dedicated young people's clinics. Ninety-eight percent were aware of the National Guidelines, and 74% had adopted them. Fifty-seven percent had a named departmental child protection lead. Thirty-seven percent of consultants had received training specific to child protection issues in GU medicine. Improvements had been made since a similar survey published in 2001, but the need for further training was still apparent.

Contraceptive provision in genitourinary medicine clinics in the UK

The objective of this study was to assess current and future contraceptive provision in genitourinary (GU) medicine clinics in the United Kingdom. Questionnaires were sent to 18 British Co-Operative Clinical Group regional representatives for distribution to clinical leads. Of 185 clinics, 124 (67%) responded. All clinics provided condoms, 116 (94%) the 'morning after' pill and 31 (25%) would fit an intrauterine contraceptive device (IUCD) for emergency contraception. Twenty-three (18.5%) regarded their clinic as already providing a comprehensive service and most of these could provide a wide range of contraceptive methods. Of all clinics, which included eight (34%) clinics already providing a comprehensive service, 69 (56%) anticipated developing their contraceptive provision within the next five years. In conclusion, contraceptive provision varies between clinics. A reduction in unwanted pregnancies and sexually transmitted infections (STIs) would most likely be achieved if clinics expanded their provision of contraceptive services.

Survey of prioritizing/triaging of appointments in genitourinary medicine clinics in the UK: a British Co-operative Clinical Group survey

A questionnaire was circulated to all lead genitourinary (GU) medicine physicians in the UK in November 2003 to obtain data on access, waiting times and triaging. Of the 143 responders, 92.3% departments had limited access to some or all GU medicine clinics. Where access was limited, 5.3% had no identifiable process in place to see urgent patients. The mean waiting times in clinics with an open appointment system only for a routine female and male appointment were 2.9 weeks and 2.8 weeks (range 2 days-10 weeks), respectively, and for an urgent appointment, two days (range same day-14 days), for both sexes. The survey has raised concerns that a number of departments did not consider as urgent for prioritizing, patients with documented untreated gonorrhoea, syphilis, or HIV, or contacts of patients with these conditions. This survey has highlighted a need for the national specialist society to provide guidance on prioritizing patients where access is limited.

Genitourinary medicine/HIV services for persons with insecure immigration or seeking asylum in the United Kingdom: a British Co-operative Clinical Group survey.

Over the past three years many genitourinary medicine (GUM) clinics have anecdotally reported large numbers of persons with insecure immigration or seeking asylum (PIISA) attending their facilities. We conducted a national survey to assess the prevalence and demographic background of PIISA who were attending GUM clinics in the UK during 2001 and 2002 and the effect on service provision. A questionnaire was circulated in April 2003 to 182 consultants in the UK of whom 128 (70%) responded. Amongst those centres that responded, 89 (69%) had provided GUM/HIV services for PIISA in 2002. One-third of clinics had accurate data collection systems and less than a quarter used computerized databases in order to identify the associated workload. Of the HIV-positive patients attending these clinics during 2002, 1140 (42%) were identified as PIISA. Eighty-two (95.3%) and 62 (48.8%) clinics had cared for PIISA from Africa and Europe respectively. Co-infection with HIV and tuberculosis was higher in patients from the PIISA group compared with the non-PIISA group (85% vs 15%, P = 0.001) for both 2001 and 2002. Clinics reported many problems associated with the service for PIISA. Forty-five percent of the clinics reported difficulties with funding for the increased workload associated with PIISA. The survey shows that GUM services have an important role in the management of PIISA and that the programme of dispersal is having a significant impact on the workload of clinics outside London. Services report that they are significantly overstretched and underfunded. An immediate investment in GUM services is necessary to improve the health of this client group. Any delay in diagnosis of sexually transmitted infections and HIV will have implications for public health and acute services.

Screening for sexually transmitted infections in children and adolescents in the United Kingdom: British Co-operative Clinical Group.

Our objectives were (1) to assess the number of young people aged under 16 years attending genitourinary medicine (GUM) departments in the UK in 1998; (2) to identify clinical activity and policy; (3) to determine the knowledge and training needs of healthcare professionals within GUM providing care for this client group. In July 1999 a questionnaire was circulated via the 18 regional British Co-operative Clinical Group (BCCG) representatives to the consultants in charge of all 197 main GUM departments in the UK. One hundred and sixty out of 197 (81%) completed questionnaires were returned and analysed. The reported number of under-16-year-olds attending in 1998 varied considerably between clinics; for females ranging from 0 to 256 and for males between 0 and 50, with a male to female ratio of 1:4.4. The majority of responding clinics, 139/160 (87%) had been involved in the screening of abused children/adolescents for sexually transmitted infections (STIs). Most clinics were prepared to screen for STI (86%), HIV test (79%) and assess contraceptive needs (50%) in this age group. Staff involved in care included health advisers (74), nurses (59), and doctors (138) in the responding clinics. Only 31/160 clinics (19%) had a written policy for the management of children/adolescents attending their clinic. The majority of respondents were aware of their child protection policy [122/154 (79%)] and designated child sexual abuse doctor, [125/157 (80%)] in their district. When questioned on previous and current training needs, 134/160 (84%) respondents identified their need for further training in the area of adolescent sexual health and 124/160 (78%) in child sex abuse. The publication Physical Signs of Sexual Abuse in Children, was known to 112/160 (70%) respondents, of whom 58/112 (52%) who answered this question had read the publication. Genitourinary physicians in the UK are aware of the increasing number of children and adolescents accessing their services, and recognize the need to identify those in abusive situations. Written policies dealing with children and adolescents in GUM clinics in the UK are lacking. This needs to be rectified urgently. This survey identifies that further training in the field of child sexual abuse and adolescent sexual health would be welcomed by the respondents.

British Co-operative Clinical Group national survey on diagnostic issues surrounding genital herpes. MSSVD Special Interest Group on Genital Herpes and the British Co-operative Clinical Group.

OBJECTIVES: To investigate the current use of diagnostic methods for genital herpes simplex virus (HSV) infection, to determine how information from these tests influences clinical practice, and to identify areas...

Recalcitrant vaginal trichomoniasis.

As Trichomonas vaginalis infects the urethra, Bartholin’s and Skene’s glands, as well as the vagina systemic treatment for trichomoniasis is recommended. The only group of drugs with safe, proved, systemic...

Genitourinary physicians and vulval clinics: a UK survey.

Our objectives are to examine the extent to which genitourinary physicians participate in vulval clinics in the UK; to determine the geographic distribution of such clinics and to study aspects of clinical practice and staffing of the vulval clinics identified in the survey. In February/March 1998 a questionnaire on vulval clinics was distributed via regional representatives of the British Co-operative Clinical Group to all the 174 consultants in charge of genitourinary medicine clinics in the UK. One hundred and sixty-four replies were received which identified a total of 61 vulval clinics in the UK. All former health regions had at least one vulval clinic or equivalent. Three former regions had 7 vulval clinics each. Forty-six vulval clinics had a dermatologist, 38 a genitourinary physician, and 30 had a gynaecologist. Only 7 vulval clinics claimed to have a counsellor or health adviser present. Ninety-four per cent took biopsies but only half this proportion met with a pathologist to discuss the histology. Eighty per cent had colposcopes and cameras available but rather fewer actually used them. Twenty-nine per cent had performed research in the past 5 years and 24% had either published or presented this. The majority of vulval clinics would accept direct referrals from all the agencies. This survey has demonstrated an increased number of genitourinary physicians participating in vulval clinics. Other studies have demonstrated the value of such clinics in improving diagnosis and management. It is to be hoped that further such clinics will be set up, particularly in parts of the country which are poorly served at present.

Provision for sexual health care of adolescents in genitourinary medicine clinics in the United Kingdom. The British Cooperative Clinical Group.

OBJECTIVES: To investigate the provision for sexual health care of adolescents in genitourinary medicine clinics in the United Kingdom. METHODS: A questionnaire was sent to all 170 consultants in charge...

Survey of human immunodeficiency virus infection and sexually transmitted diseases in homosexual and bisexual men attending genitourinary medicine clinics in the UK during 1986-88. The British Cooperative Clinical Group.

A multicentre investigation was made into the prevalence of sexually transmitted diseases and HIV infection amongst homosexual/bisexual (HS/BS) men attending genitourinary medicine clinics in the UK during the final quarters of 1986, 1987, and 1988. The results from individual clinics have been collated into regional groupings in order to assess geographical and temporal trends. A statistical analysis has also been performed on the data from 19 large teaching hospital clinics which contributed to both the 1986 and 1988 studies. There was a marked decline in the numbers of HS/BS men attending clinics and a statistically significant decrease in the prevalence of infectious syphilis and gonorrhoea. Although there was a concomitant fall in HIV testing rates, the prevalence of newly detected HIV antibody positive patients remained virtually constant. In 1988, 12.2% of 544 HS/BS men attending clinics in the Thames regions compared with 5.9% of 895 attending clinics elsewhere in the UK were found to be seropositive. No less than 30% of the 122 newly diagnosed individuals had been seronegative at a previous test during 1987/88. In addition to these new diagnoses, there were 953 attenders who had been previously diagnosed as being HIV seropositive. Total HIV seropositivity rates amongst HS/BS attenders ranged from 15-29% in different regions. These overall figures may underestimate the true size of the seropositive HS/BS clinic population because of the large number of untested individuals which constituted 33-51% of clinic attenders. The proportion of seropositives with clinical manifestations of chronic HIV infection was 54% nationally and was highest in the Thames regions and lowest in North England. Despite changes in the sexual behaviour of HS/BS men in the UK during the mid-eighties, a large proportion have been infected with HIV which has become the most widespread and prevalent sexually transmitted disease in patients attending genitourinary medicine clinics.

Cervical cytology screening in sexually transmitted diseases clinics in the United Kingdom. British Co-operative Clinical Group.

During a three month prospective study in 116 sexually transmitted disease (STD) clinics throughout the United Kingdom, out of 17,261 women who underwent cervical cytology, 1167 had dysplastic smears and 115 had positive smears. Positive smears were more prevalent in women attending Welsh clinics than elsewhere in the United Kingdom and increased in incidence with rising patient age. Of all cytological abnormalities reported, 56% of dysplastic smears and 33% of positive smears were found in women aged under 25 years. A subsequent retrospective study in 10 teaching hospitals suggested that past or present genital warts were associated with these cytological abnormalities of the cervix, especially in younger women.

Survey of diagnostic facilities for Chlamydia trachomatis and herpes simplex virus, 1984. British Co-operative Clinical Group.

During 1984 the British Co-operative Clinical Group undertook a survey of genitourinary medicine clinics in the United Kingdom to assess the availability of laboratory diagnostic facilities for Chlamydia trachomatis and herpes simplex virus. Of the 115 clinics assessed, 68% (78) had adequate facilities for culture for C trachomatis and 87% (100) for herpes simplex virus.

Homosexuality and venereal disease in the United Kingdom. A second study. British Co-operative Clinical Group.

The proportion of homosexually acquired cases of primary and secondary syphilis in patients attending venereal disease clinics in the United Kingdom has risen from 42.4% to 54% over a six-year period. Similarly, over the same period, the proportion of homosexually acquired cases of gonorrhoea has risen from 9.8% to 10.9%. The increase in incidence of homosexually acquired infections in both diseases occurred in all areas but particularly in London. Thus the very considerable epidemiological importance of male homosexuals as a high-risk group should receive more, not less, emphasis.

Survey of gonorrhoea practices in Great Britain. British Cooperative Clinical Group.

Survey of gonorrhoea practices in Great Britain. British Cooperative Clinical Group.

Primary and secondary syphilis. Country of origin study, 1969. British Cooperative Clinical Group.

Primary and secondary syphilis. Country of origin study, 1969. British Cooperative Clinical Group.

Gonorrhoea study, 1969. British Cooperative Clinical Group.

Gonorrhoea study, 1969. British Cooperative Clinical Group.

Gonorrhoea study, 1968. British Cooperative Clinical Group.

Gonorrhoea study, 1968. British Cooperative Clinical Group.

Primary and secondary syphilis. Country of origin study, 1968. British Cooperative Clinical Group.

Primary and secondary syphilis. Country of origin study, 1968. British Cooperative Clinical Group.

Gonorrhoea study, 1967. British Cooperative Clinical Group.

Gonorrhoea study, 1967. British Cooperative Clinical Group.