Genitourinary Medicine Clinic Attenders Research Articles

Seroprevalence of human herpesvirus 8 in Ireland among blood donors, men who have sex with men, and heterosexual genitourinary medicine and infectious diseases clinic attendees.

Human herpesvirus 8 (HHV-8) seroprevalence varies geographically and between subpopulations. High seroprevalence rates have been ascribed to men who have sex with men (MSM), African migrants, and HIV-infected individuals. The objective of this study was to determine the seroprevalence of HHV-8 in an Irish population, including specific risk groups. A cross-sectional study of 200 blood donors and 200 genitourinary medicine (GUM) and infectious diseases (ID) clinic patients was performed, with testing for Immunoglobulin G(IgG) antibodies to HHV-8 lytic antigens using a commercial indirect fluorescence assay (Scimedx Corp.). Verification was performed at the Centers for Disease Control and Prevention (CDC). All 200 blood donor samples were negative for HHV-8 IgG antibodies. 21% of GUM and ID patients were positive for HHV-8 IgG antibodies. One hundredof these patients were MSM, 35% of whom were HHV-8 seropositive (46% of HIV-positive MSM and 24% of HIV-negative MSM). Of 100 heterosexual patients, only 7% were HHV-8 seropositive. The absence of seropositivity in 200 Irish blood donors may suggest that Ireland has a low overall population HHV-8 seroprevalence. The proportion of HHV-8 seropositivity in the MSM population was significantly higher than in the heterosexual population and most marked in HIV-positive MSM.

Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees

ObjectivesTo quantify the costs, benefits and cost-effectiveness of three multipathogen point-of-care (POC) testing strategies for detecting common sexually transmitted infections (STIs) compared with standard laboratory testing.DesignModelling study.SettingGenitourinary medicine (GUM) services...

Factors associated with repeat diagnosis of syphilis in genitourinary medicine (GUM) clinic attendees in the North East of England, 2002-2014.

This study aimed to identify factors associated with repeat syphilis infection in North East England, in order to inform local prevention and control opportunities. We undertook a case-case study comparing individuals diagnosed with single or multiple episodes of syphilis infection within genitourinary medicine (GUM) clinics in NE England (12 clinics serving a population of 2.5 million). Study cases were verified as having had true re-infection by a GUM clinician (using serological and/or clinical parameters) and control cases (3 per case) frequency matched to cases by age and year of presentation. The odds of exposure to sexual behavioural and clinical factors were compared for cases and control cases using stepwise multivariable logistic regression. We included 66 cases and 235 control cases. The majority of cases (62/66) and control cases (165/235) were men who had sex with men (MSM). Data were missing for 0-64% of cases across different variables. Following multivariable analysis HIV seropositivity (OR 23.3, 95% CI 4.32-125.9), failure to attend follow-up (OR 4.63, 95% CI 1.11-19.31), stage of infection and deprivation were associated with re-infection ( p < 0.001). In this study, HIV seropositivity and failure to attend follow-up were associated with re-infection with syphilis. Actions targeted at these groups may help to reduce ongoing transmission.

Clinically significant depressive symptoms and sexual behaviour among men who have sex with men.

BackgroundThe relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood.AimsTo investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex.MethodThe Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013–2014).ResultsAmong 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17–1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20–1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19–1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33–2.50; P<0.001).ConclusionsManagement of mental health may play a role in HIV and STI prevention.Declaration of interestA.N.P. has received payments for presentations made at meetings sponsored by Gilead in spring 2015. N.C.N. has received support for attendance at conferences, speaker fees and payments for attendance at advisory boards from Gilead Sciences, Viiv Healthcare, Janssen Pharmaceuticals and Bristol-Myers Squibb and a research grant from Gilead Sciences. D.A. served on the advisory board for Gilead in January 2016. M.M.G. has had sponsorship to attend conferences by Bristol-Myers Squibb, been on the BioCryst advisory board and run trials for Merck, Gilead, SSAT, BioCryst and Novartis.Copyright and usage© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Impact and cost-effectiveness of selective human papillomavirus vaccination of men who have sex with men

Men who have sex with men (MSM) have a high lifetime risk of anogenital warts and cancers related to infection with human papillomavirus (HPV). They also benefit less from herd protection than heterosexual males in settings with female-only HPV vaccination. We evaluated the potential health impact and cost-effectiveness of offering vaccination to MSM who visit genitourinary medicine (GUM) clinics. We used a mathematical model of HPV 6/11/16/18 sexual transmission within an MSM population in England, parameterized with sexual behaviour, GUM attendance, HPV prevalence, HIV prevalence, warts, and cancer incidence data. Interventions considered were offering HPV vaccination to either HIV-positive MSM or MSM regardless of HIV status, for age bands 16-25, 16-30, 16-35, and 16-40 years. Substantial declines in anogenital warts and male HPV-related cancer incidence are projected to occur following an offer of vaccination to MSM. MSM not attending GUM clinics will partially benefit from herd protection. Offering vaccination to HIV-positive MSM up to age 40 is likely to be cost-effective if vaccine procurement and administration costs are below £96.50 a dose. At £48 a dose, offering vaccination to all MSM up to age 40 is likely to be cost-effective. Quadrivalent HPV vaccination of MSM via GUM clinics is likely to be an effective and cost-effective way of reducing the burden of HPV-related disease in MSM.

P176 Are sexually transmitted infections associated with child sexual exploitation in under 16 year olds attending Genitourinary Medicine clinics in the UK?

Background Child sexual exploitation (CSE) is a challenging diagnosis to make, with few clinical signs or symptoms, and little evidence that markers such as sexually transmitted infections (STIs) are CSE predictors. Aim To investigate associations between STIs and CSE risk factors. Methods The genitourinary medicine clinic activity dataset (GUMCAD) was used to identify clinics with >18 STI diagnoses in 13–15 year-olds in 2012. Cases with confirmed bacterial or protozoal STIs were matched by age, gender and clinic with non-STI controls. Clinics provided details of CSE-related risk factors irrespective of STI presence through an on-line questionnaire. Associations between STI outcome and CSE-related risk factors were analysed using logistic regression. Results 18/44 (40.9%) clinics contacted provided data on 466 13–15 year-olds; 414 (88.8%) were female, and 52 (11.2%) male. 98.6% were heterosexual, and 66.7% white British. There were 18 (3.9%) 13, 108 (23.2%) 14 and 340 (80.0%) 15 year-olds. In univariate analysis an STI diagnosis was significantly associated with: ‘highly-likely’ CSE (OR 9.00, p = 0.037), >1 partner (OR 5.50, p = 0.000), >1 attendance in 2012 (OR 3.79, p = 0.0000), safeguarding referral (OR 1.94, p = 0.022), other service involvement (OR 1.72, p = 0.031) and vulnerability (OR 1.64, p = 0.026). After adjustment, STI diagnosis was significantly associated with: Health Advisor review (OR 6.78, p = 0.000), >1 partner (OR 5.82, p = 0.002), >1 attendance (OR 3.72, p = 0.000) and looked after child (OR 3.43, p = 0.039). Discussion The presence of a bacterial or protozoal STI is only weakly associated with CSE and should not be used to infer CSE in the absence of more compelling evidence.

O028 Low proportion of men who have sex with men (MSM) tested for hepatitis C despite high prevalence in 2 genito-urinary medicine (GUM) clinics

Background/introduction Screening for HIV and hepatitis B (HBV) is recommended for MSM attending GUM clinics. Hepatitis C testing is recommended for all HIV positive MSM. However, the PROUD pilot study reported an HCV incidence of 3.1% in high-risk, HIV negative MSM. Aim(s)/objectives To report on proportion tested and prevalence of blood-borne viruses (BBVs) amongst MSM attending GUM clinics Methods We collected demographic data and numbers tested for BBVs in all MSM attending 2 GUM clinics between 01/07/14 and 30/06/15 from electronic records. We compared proportion tested and prevalence in high-risk vs low-risk MSM and in HIV+ vs HIV- MSM. High-risk was defined as ≥1 sexually transmitted Infection (STI) i.e. Gonorrhoea, chlamydia and syphilis. Results 4,415 patients were included. 3,289 (88.0%) were tested for HIV, 2,162 (49.1%) for HBV, 794 (18.1%) for HCV. Positives: 48 (1.5%) HIV, 11 (0.5%) HBV and 18 (2.3%) HCV [9/16 (56.3%) viraemic]. 1,003 (22.7%) were diagnosed with an STI: Syphilis 159 (3.6%), Gonorrhoea 640 (14.5%), Chlamydia 398 (9.0%). BBV prevalence was higher in high-risk vs low-risk MSM: HIV 23 (3.4%) vs 25 (1.0%); HBV 4 (0.7%) vs 7 (0.4%); HCV 10 (3.5%) vs 8 (1.6%).More HIV+ MSM were tested for HCV; 198 (27.8%) vs 587 (16.9%) HIV- (crude OR 1.9 (95% CI 1.6–2.3). HCV prevalence in those tested was 12 (6.1%) in HIV+ and 6 (1.0%) in HIV–. Discussion/conclusion MSM were less likely to be tested for HCV than for HIV. Amongst those tested, HCV prevalence was 5x the national prevalence (0.4%). Prevalence of viral hepatitis was highest in HIV+ and in high-risk MSM suggesting that testing efforts should be increased.

P056 Influence of country of birth on risk of STI diagnosis among black Caribbeans in England in 2014

Background/introduction In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STIs), but it is unclear whether this is associated with their country of birth. Aim(s)/objectives To examine differences in STI diagnoses among UK- and Caribbean-born BC people. Methods Data on STI diagnoses in BC people attending genitourinary medicine (GUM) clinics and living in England were obtained from the GUM Clinic Activity Dataset (GUMCADv2). Associations between being UK- or Caribbean-born and diagnosis with an STI were derived using univariate and multivariable multilevel logistic regression models adjusted for age, gender/sexual-orientation, residence, and HIV status. Results BC people made 231,719 attendances in 2014; 81.9% were UK-born. The median age (years) was 25 for UK-born and 34 for Caribbean-born people (p ≤ 0.001). Chlamydia, non-specific genital infection and gonorrhoea were the most commonly diagnosed STIs among UK- (37.4%, 19.5% and 13.7%) and Caribbean-born attendees (32.1%, 25.2% and 13.1%). From the multilevel analysis, UK-born attendees were less likely to be diagnosed with chlamydia (aOR 0.87 [95%C.I. 0.81–0.94]) and trichomoniasis (0.83 [0.71–0.97]), and more likely to be diagnosed with genital warts (1.24 [1.07–1.45]) than Caribbean-born attendees. The adjusted odds of a gonorrhoea diagnosis did not vary by country of birth. Discussion/conclusion STI rates among black Caribbeans attending GUM clinics in England are high and might be influenced by STI epidemiology in their country of birth. Studies on the effectiveness of interventions aimed at reducing the burden of STIs in all black Caribbeans are urgently needed.

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.

O14.1 Is an automated online clinical care pathway for people with genital chlamydia (chlamydia-occp) within an esexual health clinic feasible and acceptable? proof of concept study

Introduction UK health strategy supports self- and internet-based care. Within the eSTI2 consortium (www.esti2.org.uk) we developed UK’s first automated Online Clinical Care Pathway for people with genital chlamydia (Chlamydia-OCCP) within an eSexual Health Clinic (eSHC). Chlamydia-OCCP includes: STI results service; clinical consultation; electronic prescription via community pharmacy; partner notification (PN); with integral telephone helpline support. It complies with regulatory, professional, prescribing and surveillance requirements. We report on a study to assess Chlamydia-OCCP feasibility and acceptability as an alternative to routine care. Methods Non-randomised, exploratory study to evaluate Chlamydia-OCCP: 21.07.14 -13.03.15. Participants: 1) chlamydia-positive untreated Genitourinary Medicine (GUM) clinic attenders; 2) people testing chlamydia-positive and negative through six National Chlamydia Screening Programme (NCSP) areas’ online postal self-sampling service. Exclusions: under 16 yrs; co-existing STIs, extra-genital chlamydia. Intervention: eligible people were sent an SMS message with a link to access results from eSHC via a password protected web-app, optimised for smartphone use. Having consented online chlamydia-positive users followed the automated Chlamydia-OCCP. Patients who declined received routine care. Evaluation: treatment rate; time to treatment; PN outcomes; engagement with clinical helpline and health promotion; safety; acceptability, costs. Results GUM: of 197 eligible patients, 161 accessed results online, 112 consented, 110/112 (98%) treated (72 exclusively via Chlamydia-OCCP, median 1 day). NCSP: of 145 eligible patients, 133 accessed results online, 104 consented, 92/104 (88%) treated (59 exclusively via Chlamydia-OCCP, median 1 day). 28/515 sexual partners were managed solely online. 1176/1936, (61%) NCSP chlamydia-negative people accessed results online, of whom 407 accessed online health promotion. All patients who didn’t access results online were managed routinely. Patients moved effectively between online, telephone and clinic-based care. Conclusion Chlamydia-OCCP is a feasible, acceptable, safe alternative to routine care for management of people with genital chlamydia. Preliminary evidence indicates comparable treatment outcomes. If linked to home testing, Chlamydia-OCCP offers potential for wholly remote care. Disclosure of interest statement Nothing to declare.

P07.14 Aptima tv naat test performance in gum clinics and primary care in the uk

Introduction The Aptima TV NAAT for the detection of Trichomonas vaginalis (TV) is ~100% sensitive compared to wet mount microscopy (50%) or culture (75%). Asymptomatic women attending genitourinary medicine (GUM) clinics and patients in primary care are often not tested for TV, as the prevalence and sensitivity of current tests is assumed to be too low for testing to be cost effective. Our aim was to determine how many additional cases were identified with the new test and whether self-taken and clinician-taken vaginal swabs are of equivalent sensitivity in symptomatic GUM patients. Methods Patients were tested using the Aptima TV NAAT alongside existing testing methods. Results The positivity of TV determined by TV NAAT was 4.8% (26/543) and 1.8% (28/1593) in women with and without symptoms attending GUM and 2.7% (95/3512) and 1.1% (41/3593) respectively in primary care. TV NAAT significantly outperformed our existing testing methods. In a subset of 491 GUM patients in whom all tests were performed, 14/23 (61%) TV NAAT positive patients were identified on wet prep or culture (p = 0.004). In a subset of 2930 primary care patients in whom all tests were performed, 19/74 (26%) TV NAAT positive patients were identified on wet prep or culture (p Self- taken vaginal swabs were equivalent in sensitivity to clinician taken swabs; of the 26 patients who tested positive on either NAAT test, 25 tested positive on self-taken swab and 21 tested positive on clinician taken swab (p = 0.51). Conclusion Testing women attending GUM clinics and in primary care with the Aptima TV NAAT test will identify additional cases and should replace conventional microbiological testing methods if found to be cost-effective. Disclosure of interest statement Hologic provided the tests for the Aptima TV NAAT research study and have sponsored the authors to present this data at ISSTDR.

Comparing risk behaviours of human papillomavirus-vaccinated and non-vaccinated women

BackgroundSince September 2008, a national vaccine programme in the UK has offered routine human papillomavirus (HPV) vaccination to young women aged 12–13 years. A catch-up programme also offered HPV vaccination...

Seven years of teenage pregnancy in an inner London genitourinary medicine service – a retrospective cohort study

Young people attending genitourinary medicine services are at high risk of unplanned pregnancy. We performed a retrospective cohort study to identify characteristics of pregnant teenagers accessing an inner London genitourinary medicine service. There were 481 pregnancies in 458 teenagers with 54 previous pregnancies and 46 previous terminations of pregnancy. The under-18 and under-16 teenage pregnancy rates were 92.1 and 85.8 per 1000 age-matched clinic attendees, respectively. Median age was 17.1 years. 'Black Other' teenagers ('Black British', 'Mixed White-Black Caribbean' and 'Mixed White-Black African') were over-represented, compared to our clinic population, while those of White ethnicity were under-represented. Few pregnancies (1.5%) were planned with the majority (64%) intending terminations of pregnancy. Most teenagers did not use consistent contraception. Two-thirds of patients had attended genitourinary medicine services in the past and sexually transmitted infection prevalence at presentation was high. Effectively targeting the sexual and reproductive health needs of teenage genitourinary medicine clinic attendees may have a significant impact on reducing sexually transmitted infections, unplanned pregnancy and terminations of pregnancy in this group.

Testicular self-examination amongst genitourinary medicine clinic attendees

Advancements in the diagnosis and treatment of testicular cancer now give a five-year survival rate of 97.2%. Delayed presentation remains the primary cause of poor outcome and recommendations have stressed that men, particularly those with risk factors, should undertake regular testicular self-examination. This study aimed to determine testicular self-examination knowledge and practices amongst 740 unselected men attending a genitourinary medicine clinic via questionnaire survey. Of respondents, 75.8% of men had heard of testicular cancer, and 79.9% had heard of testicular self-examination. Of these, 41% of men had been taught testicular self-examination; 73.9% of them by a doctor or nurse. Importantly, 79.2% had previously performed testicular self-examination. The most common reason for not performing testicular self-examination was 'Don't really know what to look for' (59.5%). Men previously taught testicular self-examination were 11.5 times more likely to perform the practice than those untaught. Of respondents, 74.1% wanted more information regarding testicular self-examination whilst attending the clinic. This study shows an increased level of testicular self-examination amongst genitourinary medicine attendees than has been previously demonstrated in other patient groups. There remains room for improvement via further health promotion and research on the effectiveness of testicular self-examination.

Text messaging to promote health

Douglas and Free’s qualitative study1 alongside a randomised controlled trial2 show that text messaging offers a valuable way of supporting people trying to give up smoking. Text messages may also have wider potential in health promotion, including within sexual health. In September 2013 we carried out a patient and public involvement user group to investigate what female genitourinary medicine clinic attendees thought about texts encouraging regular STI checks, use of long …

Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling

Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new interventions to enhance the outcomes of partner notification. To study the effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections (STIs). Secondary data analysis of clinical audit data; systematic reviews of randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA)] published from 1 January 1980 to 31 December 2011; static models of clinical effectiveness and cost-effectiveness; and dynamic modelling studies to improve parameter estimation and examine effectiveness. General population and genitourinary medicine clinic attenders. Heterosexual women and men. Traditional partner notification by patient or provider referral, and new partner notification by expedited partner therapy (EPT) or its UK equivalent, accelerated partner therapy (APT). Population prevalence; index case reinfection; and partners treated per index case. Enhanced partner therapy reduced reinfection in index cases with curable STIs more than simple patient referral [risk ratio (RR) 0.71; 95% confidence interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The median number of partners treated for chlamydia per index case in UK clinics was 0.60. The number of partners needed to treat to interrupt transmission of chlamydia was lower for casual than for regular partners. In dynamic model simulations, >10% of partners are chlamydia positive with look-back periods of up to 18 months. In the presence of a chlamydia screening programme that reduces population prevalence, treatment of current partners achieves most of the additional reduction in prevalence attributable to partner notification. Dynamic model simulations show that cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence of both STIs. APT has a limited additional effect on prevalence but reduces the rate of index case reinfection. Published quality-adjusted life-year (QALY) weights were of insufficient quality to be used in a cost-effectiveness study of partner notification in this project. Using an intermediate outcome of cost per infection diagnosed, doubling the efficacy of partner notification from 0.4 to 0.8 partners treated per index case was more cost-effective than increasing chlamydia screening coverage. There is evidence to support the improved clinical effectiveness of EPT in reducing index case reinfection. In a general heterosexual population, partner notification identifies new infected cases but the impact on chlamydia prevalence is limited. Partner notification to notify casual partners might have a greater impact than for regular partners in genitourinary clinic populations. Recommendations for future research are (1) to conduct randomised controlled trials using biological outcomes of the effectiveness of APT and of methods to increase testing for human immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data should be a priority to determine QALYs associated with the sequelae of curable STIs; and (3) standardised parameter sets for curable STIs should be developed for mathematical models of STI transmission that are used for policy-making. The National Institute for Health Research Health Technology Assessment programme.

An early evaluation of clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoea in genitourinary medicine clinics in England

ObjectivesTo estimate the costs and benefits of clinical pathways incorporating a point of care (POC) nucleic acid amplification test (NAAT) for chlamydia and gonorrhoea in genitourinary medicine (GUM) clinics compared...

The sexual health of male sex workers in England: analysis of cross-sectional data from genitourinary medicine clinics

ObjectivesMale sex workers (MSW) are thought to be at increased risk of sexually transmitted infections (STI), however, limited comparative data with other groups are available. Disparities among MSWs by migrant...

Factors associated with asymptomatic non-chlamydial non-gonococcal urethritis in heterosexual men: findings from a case-control study

The significance of asymptomatic non-chlamydial non-gonococcal urethritis (NCNGU) is unclear. Organisms associated with NCNGU, e.g. Mycoplasma genitalium, for which there is no widely available test, are linked to reproductive sequelae in women but UK guidance no longer recommends urethral smear microscopy to screen for asymptomatic NCNGU. This case-control study of heterosexual male genitourinary (GU) medicine clinic attenders aimed to identify clinical, demographic and sexual behaviour factors associated with asymptomatic NCNGU so that we could determine whether the presence or absence of symptoms provides a rational basis for deciding to whom we should offer microscopy and whom we should treat. Men with asymptomatic NCNGU were very similar to men with symptomatic NCNGU, except for more consistent condom use. Asymptomatic and symptomatic NCNGU could be different ends of the same clinical syndrome. Until the microbiological basis of NCNGU is understood, we recommend treatment of men with NCNGU irrespective of symptoms.

P5.082 What Are the Costs and Benefits of Implementing Point of Care Tests For Chlamydia Trachomatis and Neisseria Gonorrhoeae in Genitourinary Medicine Clinics?

BackgroundTo estimate the costs and benefits of new patient pathways in genitourinary medicine (GUM) clinics that incorporate a point of care (POC) nucleic acid amplification test (NAAT) for chlamydia and...