Health Clinic In London Research Articles

Seroprevalence of immunity to hepatitis A and hepatitis B among gay, bisexual and other men who have sex with men (GBMSM) attending sexual health clinics in London and Leeds, England, 2017–2018

ObjectivesAlthough hepatitis A virus (HAV) and hepatitis B virus (HBV) immunisation is recommended in the UK for gay, bisexual and other men who have sex with men (GBMSM), data on...

Returning to Work After Sickness Absence Due to Low Back Pain: A Poetic Representation

The purpose of this project was to capture the voices of clients through a poetic representation of their experiences and perceptions as they shared their stories of returning to work after a period of sickness absence following an episode of LBP. A retrospective evaluation of electronic chart notes of clients at an occupational health clinic in London, United Kingdom presenting with LBP who were returning to work were reviewed over a six-month period from January 2023 to June 2023. Verbatim comments of clients about their experiences and perceptions were extracted from the electronic chart notes and analysed thematically. A total of 68 electronic chart notes were retrieved and reviewed by a senior physical therapist. A poem called “The struggle within” was developed to represent the experiences and perceptions of clients as they shared their stories. Healthcare professionals should engage not only in evidence-based interventions, but also with the narratives and stories of individuals to ensure a more holistic approach. A poetic representation is one way that healthcare professionals can frame these dialogues.

Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis

BackgroundHistorically, human monkeypox virus cases in the UK have been limited to imported infections from west Africa. Currently, the UK and several other countries are reporting a rapid increase in monkeypox cases among individuals attending sexual health clinics, with no apparent epidemiological links to endemic areas. We describe demographic and clinical characteristics of patients diagnosed with human monkeypox virus attending a sexual health centre.MethodsIn this observational analysis, we considered patients with confirmed monkeypox virus infection via PCR detection attending open-access sexual health clinics in London, UK, between May 14 and May 25, 2022. We report hospital admissions and concurrent sexually transmitted infection (STI) proportions, and describe our local response within the first 2 weeks of the outbreak.FindingsMonkeypox virus infection was confirmed in 54 individuals, all identifying as men who have sex with men (MSM), with a median age of 41 years (IQR 34–45). 38 (70%) of 54 individuals were White, 26 (48%) were born in the UK, and 13 (24%) were living with HIV. 36 (67%) of 54 individuals reported fatigue or lethargy, 31 (57%) reported fever, and ten (18%) had no prodromal symptoms. All patients presented with skin lesions, of which 51 (94%) were anogenital. 37 (89%) of 54 individuals had skin lesions affecting more than one anatomical site and four (7%) had oropharyngeal lesions. 30 (55%) of 54 individuals had lymphadenopathy. One in four patients had a concurrent STI. Five (9%) of 54 individuals required admission to hospital, mainly due to pain or localised bacterial cellulitis requiring antibiotic intervention or analgesia. We recorded no fatal outcomes.InterpretationAutochthonous community monkeypox virus transmission is currently observed among MSM in the UK. We found a high proportion of concomitant STIs and frequent anogenital symptoms, suggesting transmissibility through local inoculation during close skin-to-skin or mucosal contact, during sexual activity. Additional resources are required to support sexual health and other specialist services in managing this condition. A review of the case definition and better understanding of viral transmission routes are needed to shape infection control policies, education and prevention strategies, and contact tracing.FundingNone.

Survivors of domestic abuse and sexual violence within sexual health services, how we responded, who is missing and what should be done?

Reports of domestic abuse (DA) and sexual violence (SV) continue to rise across the UK, and sexual health services are well situated to offer a safe setting for disclosure. We performed a retrospective analysis of all safeguarding proformas completed between April and September 2019 across three sexual health clinics in London. 158 patients reported current and/or historical DA and/or SV during the collection period. 70% of cohort identified as female, 28% as male and 2% as transgender. 25% of the cohort identified as gay men. Black and Asian attendees were disproportionately represented in the survivor cohort. 86% were offered a same-day appointment with the health advisor team and assessment for onward referral to specialist services. Almost half of the cohort were asymptomatic at the time of attendance and disclosure. With changes to access due to ongoing COVID-19 restrictions, asymptomatic survivors may not receive opportunities to disclose as they are directed to online platforms. Healthcare services must adapt routine enquiry practices to ensure safe disclosure is possible to make all contacts count and expand these practices into other healthcare specialities to provide further disclosure opportunities for survivors not attending sexual health services.

HPV16 and HPV18 seropositivity and DNA detection among men who have sex with men: a cross-sectional study conducted in a sexual health clinic in London

ObjectivesMen who have sex with men (MSM) have an increased risk of human papillomavirus (HPV) infection and related diseases compared with men who have sex exclusively with women. From April...

Anogenital molluscum contagiosum: treatment choices

We conducted a retrospective audit in our large level 3 sexual health clinic in London on management options considered for molluscum contagiosum for the first hundred patients treated in 2019....

Post‐exposure prophylaxis in the era of pre‐exposure prophylaxis

56 Dean Street (56DS), a sexual health clinic in London, provides a quarter of England's HIV post-exposure prophylaxis following sexual exposure (PEPSE). Since the limited introduction of pre-exposure prophylaxis (PrEP) in 2015, PEPSE demand has fallen. We performed a case-note review of individuals who received PEPSE at 56DS in August 2018. Two hundred and forty three PEPSE were given; 97% (236) fitted recommended indications according to UK national guidance. Twenty-eight (12%) had documented prior PrEP use; the most common reason for not taking PrEP was lack of supply (15/28; 54%). Up to 1st April 2020, of 215 who had not previously used PrEP, 106 (49%) re-attended 56DS for PrEP initiation. At 56DS, PEPSE is appropriately given for high-risk HIV exposures. For those who use PrEP, It is important to support their adherence and ensure adequate supply. As PrEP uptake increases, the need for PEPSE may decrease.

High rates of unprotected anal sex and use of generic direct-acting antivirals in a cohort of MSM with acute HCV infection.

The role of condomless anal intercourse (CAI) as a driver for the epidemic of hepatitis C in MSM is still debated. Timely access to direct-acting antivirals (DAA) could represent an essential strategy to tackle this. Case notes of MSM diagnosed with acute hepatitis C (AHC) between July 2016 and June 2017 in a sexual health clinic in London were included. Behavioural data on sexual practices and STI monitoring in the 6months prior to AHC diagnosis were collected. DAA routes of access and timing from AHC diagnosis to start of treatment were analysed. A total of 60 individuals were enrolled (median age 39years, IQR=33-46, 62% HIV co-infected, 72% genotype 1a). CAI was reported by 97%, drug use prior to or during sex by 73%; 46% was diagnosed with a rectal STI and 29% with syphilis. About 37% did not report any HCV risk factors other than condomless anal sex. About 36% had a new rectal STI in the 6months following AHC. About 82% accessed DAA treatment and median time from AHC to DAA start was 278days for those following the NHS standard of care route, 132days for those accessing DAA via participation in trials and 114 for those who had self-sourced DAA online (P<0.0011). SVR12 was achieved in 100% of the patients who received DAA treatment.In conclusion, CAI is a significant risk factor for HCV acquisition in MSM, irrespective of their HIV status. Rapid and wider access to treatment with DAA could represent a powerful strategy to reduce onward transmission and risk of reinfection in MSM.

Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013–2016

ObjectivesThe objective of this study was to compare the prevalence of polydrug use, use of drugs associated with chemsex, specific drug use, and HIV-related behaviours, between two time periods, using...

Perceived need of, and interest in, HIV pre-exposure prophylaxis amongst men who have sex with men attending three sexual health clinics in London, UK.

HIV pre-exposure prophylaxis (PrEP) has proven efficacy in reducing the risk of HIV infection in men who have sex with men (MSM), but has not yet been commissioned in the UK. The aim of this study was to investigate perceived need and benefit (or experience of) PrEP among HIV-negative MSM attending sexual health clinics. HIV-negative MSM attending three sexual health centres in London, UK were opportunistically invited to complete a questionnaire. Data collected comprised demographic data and sexual and drug use behaviours as well as questions regarding perceptions of risk and need for PrEP. Logistic regression analysis was undertaken to identify variables predicting acceptability of, and intention to use, PrEP. In addition, data were gathered in respondents already taking PrEP. Eight hundred and thirty-nine questionnaires were analysed. The median age of respondents was 35 years (IQR 28-41, range 18-78), 650 (77%) were of white ethnicity and 649 (77%) had a university education. Four hundred and fifty-six (54%) reported at least one episode of condomless anal sex in the preceding three months, 437 (52%) reported recreational drug use in the preceding three months and 311 (37%) had been diagnosed with a sexually transmitted infection within the preceding six months. Four hundred and sixty-three (64%) of 726 strongly agreed with the statement 'I think I would benefit from PrEP'. Multivariate logistic regression analysis demonstrated that having receptive anal intercourse (RAI) without condoms, having an awareness of the risk of unprotected RAI and having belief in the effectiveness of PrEP were independent predictors for someone thinking they would benefit from taking PrEP. Eight percent of respondents (59/724) had already taken or were currently taking PrEP. The results suggest that individuals at risk are likely to perceive themselves as benefiting from PrEP. The majority perceived their risk of acquiring HIV and benefit from PrEP accurately. Overall they appeared to have little concern over the use of PrEP and generally positive attitudes. Further investigation is warranted to understand why those at risk do not perceive benefit from PrEP.

P103 A psychosexual needs assessment of patients attending five london sexual health clinics

IntroductionThe aim of this psychosexual needs assessment was to investigate the prevalence and range of sexual problems; to understand the distress, causal attributions and functional impairment associated with these; and to explore patients’ service-related needs, in a sample of patients attending sexual health clinics in London.MethodsQuestionnaires were disseminated to patients attending five sexual health clinics in London, over a one week period. Nine hundred and thirty four patients responded to the questionnaire. Patients were aged 29.4 years (SD=8.8) and predominantly female (61.4%).Results31.1% of patients indicated they were experiencing a sexual problem. Premature ejaculation, delayed ejaculation, or difficulty having an orgasm were the most prevalent problems reported by patients (13.5%). Female and male patients did not differ in their report of overall sexual problems (32.5% and 28.6%, respectively), however more women reported sexual pain (14.8%, X2=11.3,p=.001) and male patients reported difficulties with hypersexuality (9.5%, X2=25.2,p&lt;.001). The majority of sexual problems had commenced within the past year, however orgasm, chemsex and hypersexuality problems were longer-standing (&gt;1year). Associated distress was reported by 79.5% of patients. Emotional reasons were attributed as the most likely cause of sexual problems (21.1%). Male patients reported higher functional impairment (U=1862.0, z=2.3,p=.02). Patients were interested in a range of interventions, and expressed preference to be supported in a sexual health clinic (67.8%).DiscussionThe findings present implications for the provision of psychosexual services in sexual health clinics.

Outcomes of acutely HIV-1-infected individuals following rapid antiretroviral therapy initiation.

Few data exist on the benefits and acceptability of rapid initiation of antiretroviral treatment in acute HIV infection (AHI). We analysed a large cohort of acutely infected HIV patients starting antiretroviral therapy (ART) to determine uptake, linkage into care and time to achieve viral suppression. Case notes of all individuals diagnosed with AHI between May 2014 and October 2015 at 56 Dean Street, a sexual health clinic in London, UK were reviewed. AHI was defined through documentation of plasma HIV RNA positivity only, plasma HIV RNA and p24 antigen positivity with a negative HIV enzyme immunoassay (EIA) test or HIV EIA test switching from negative to positive within 6 weeks. Between-group comparisons of time to viral suppression according to ART chosen were performed using the log-rank test. We identified 113 individuals with AHI. Linkage to care was 95%. 77% of patients started ART at first medical appointment: all men who have sex with men, median age 35 years, median viral load (VL) log10 6.45, median CD4+ T-cell count 483 cells/mm3. Median time from diagnosis to ART initiation was 20 days. At 24 weeks, no patients had discontinued ART; 99% of patients achieved viral suppression by 24 weeks, with a median time to documented VL suppression of 74 days. Viral suppression was more rapid with integrase inhibitors compared with other regimens (median 41 versus 88.5 days, P<0.05). In acute HIV infection, individuals demonstrated high ART uptake and rapid VL suppression suggesting that early treatment with antiretrovirals is acceptable and efficacious.

Attitudes to and Understanding of Risk of Acquisition of HIV Over Time: Design and Methods for an Internet-based Prospective Cohort Study Among UK Men Who Have Sex With Men (the AURAH2 Study).

BackgroundThe annual number of new human immunodeficiency virus (HIV) infections among men who have sex with men (MSM) has risen in the United Kingdom and, of those who are HIV positive, the proportion undiagnosed is high.ObjectiveThe prospective AURAH2 study aims to assess factors associated with HIV acquisition among MSM in the United Kingdom and to investigate changes over time within individuals in sexual behavior and HIV-testing practices.MethodsAURAH2 is a prospective study among MSM without diagnosed HIV, aiming to recruit up to 1000 sexually active MSM attending sexual health clinics in London and Brighton in the United Kingdom. Participants complete an initial paper-based questionnaire, followed by online follow-up questionnaires every 4 months collecting sociodemographic, health and behavioral data, including sexual behavior, recreational and other drug use, HIV testing practices, and pre-exposure prophylaxis use, over a planned 3-year period.ResultsThe study is ongoing.ConclusionsThe results from AURAH2 study will provide important insight into established and emerging risk behaviors that may be associated with acquisition of HIV in MSM in the United Kingdom, changes over time within individuals in sexual behavior, and information on HIV testing practices. These data will be crucial to inform future HIV prevention strategies.

Domestic violence and abuse in gay and bisexual men attending a sexual health clinic: pilot testing of an educational support intervention for sexual health practitioners

BackgroundDomestic violence and abuse is recognised globally as a pervasive public health issue, but there is less research in relation to gay and bisexual men. This study aimed to measure the occurrence of negative and potentially abusive behaviour and associations with health problems in gay and bisexual men; and pilot test an educational intervention for practitioners to increase awareness of domestic violence and abuse and provide skills in inquiry and support. MethodsBetween Sept 21, 2010, and May 25, 2011, an anonymous Health and Relationships survey was administered to English-literate men (aged 18 years) attending a sexual health clinic in London, UK. Negative behaviour included: feeling frightened of the behaviour of a partner; having to ask permission (beyond being considerate to and checking with a partner); being slapped, hit, kicked, or physically hurt; and forced sex or sexual activity. Health problems included mental health, sexual health, and alcohol and illicit drug use. Sexual health practitioners received training on the educational intervention HERMES (HEalthcare Responding to MEn for Safety). 6 weeks after training, 21 semi-structured interviews were conducted with the practitioners to assess acceptability of HERMES, changes in awareness, and confidence in identifying and responding to gay and bisexual men who were experiencing domestic violence and abuse. FindingsOf 2657 men who attended the clinic, 1132 (42·4%) completed the survey. 532 (47·2%) self-identified as gay or bisexual. 33·9% (95% CI 24·9–37·9) of gay and bisexual men reported ever experiencing a negative and potentially abusive behaviour from a partner. Ever being frightened by a partner and having to ask a partner's permission were associated with increased odds of being anxious (odds ratio [OR] 2·5, 95% CI 2·0–3·1 and 2·7, 1·6–4·7, respectively). Being frightened of a partner, being physically hurt, and physically hurting a partner were associated with increased odds of using a class A drug in the previous 12 months (OR 2·2, 1·5–3·2; 2·3, 1·4–3·8; and 3·1, 2·3–4·2, respectively). Practitioners welcomed HERMES and felt that it raised their awareness and confidence in dealing with domestic violence and abuse among gay and bisexual men. InterpretationIn this clinical setting the occurrence of potentially abusive behaviours in gay and bisexual men was high. HERMES increased sexual health practitioners’ awareness of domestic violence and abuse and confidence in asking about abuse. The results can only be interpreted within the context of the sexual health clinic. Because of the cross-sectional design, it is not possible to determine the temporal direction of the associations between negative behaviour and health problems. FundingThis report presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0108-10084).

Oral human papillomavirus (HPV) infection in men who have sex with men: prevalence and lack of anogenital concordance.

ObjectivesTo estimate the prevalence of oral detectable human papillomavirus (HPV) DNA in HIV-negative men who have sex with men (MSM) attending a sexual health clinic in London and concordance with anogenital HPV infection. Such data are important to improve our understanding of the epidemiology of oral HPV and the potential use of vaccines to prevent oropharyngeal cancers.MethodsPaired oral rinse samples and anogenital samples were available from 151 HIV-negative MSM within a larger cross-sectional survey. All samples were tested in parallel for 21 types of HPV DNA using an in-house assay.ResultsThe median age of participants was 30 (IQR 25–35). The prevalence of any oral HPV and of high-risk HPV (HR-HPV) was 13.7% (n=21; 95% CI 8.7 to 20.2) and 5.9% (n=9; 95% CI 2.7 to 10.9) compared with 64.9% (n=98; 95% CI 56.7 to 72.5) and 34.4% (n=52; 95% CI 26.9 to 42.6) in any anogenital sample, respectively. The prevalence of types prevented by the bivalent (HPV16/18), quadrivalent (HPV6/11/16/18) and nonavalent (HPV6/11/16/18/31/33/45/52/58) vaccines was 1.3% (95% CI 0.2 to 4.7), 2.6% (95% CI 0.7 to 6.6) and 4.6% (95% CI 1.9 to 9.3), respectively. There was no concordance between HPV genotypes detected in oral and anogenital sites.ConclusionsHR-HPV DNA, including HPV 16/18, was detected in oral specimens from HIV-negative MSM attending sexual health clinics, suggesting a potential role for vaccination, but is far less common than anogenital infection. How this relates to the risk and natural history of HPV-related head and neck cancers warrants further study. Lack of concordance with anogenital infection also suggests that oral HPV infection should be considered separately when estimating potential vaccine impact.

Olympics and Paralympics 2012 mass gathering in London: time-series analysis shows no increase in attendances at sexual health clinics

ObjectiveTo determine whether the 2012 Olympic and Paralympic Games were associated with a change in the number of patients attending or diagnosed with a new sexually transmitted infection (STI) at...

Beryl Benacerraf: new AIUM President gets the picture

Beryl Benacerraf: new AIUM President gets the picture

Brief intervention for alcohol misuse in people attending sexual health clinics: study protocol for a randomized controlled trial

BackgroundOver the last 30 years the number of people who drink alcohol at harmful levels has increased in many countries. There have also been large increases in rates of sexually transmitted infections. Available evidence suggests that excessive alcohol consumption and poor sexual health may be linked. The prevalence of harmful alcohol use is higher among people attending sexual health clinics than in the general population, and a third of those attending clinics state that alcohol use affects whether they have unprotected sex. Previous research has demonstrated that brief intervention for alcohol misuse in other medical settings can lead to behavioral change, but the clinical- and cost-effectiveness of this intervention on sexual behavior have not been examined.MethodsWe will conduct a two parallel-arm, randomized trial. A consecutive sample of people attending three sexual health clinics in London and willing to participate in the study will be screened for excessive alcohol consumption. Participants identified as drinking excessively will then be allocated to either active treatment (Brief Advice and referral for Brief Intervention) or control treatment (a leaflet on healthy living). Randomization will be via an independent and remote telephone randomization service and will be stratified by study clinic. Brief Advice will comprise feedback on the possible health consequences of excessive alcohol consumption, written information about alcohol and the offer of an appointment for further assessment and Brief Intervention. Follow-up data on alcohol use, sexual behavior, health related quality of life and service use will be collected by a researcher masked to allocation status six months later. The primary outcome for the study is mean weekly alcohol consumption during the previous three months, and the main secondary outcome is the proportion of participants who report unprotected sex during this period.DiscussionOpportunistic intervention for excessive alcohol use has been shown to be effective in a range of medical settings. The SHEAR study will examine whether delivering such interventions in sexual health clinics results in reductions in alcohol consumption and will explore whether this is associated with changes in sexual behavior.

Text Message Reminders of Appointments: A Pilot Intervention at Four Community Mental Health Clinics in London

Forgetting is commonly stated as a reason for missing mental health appointments. The authors examined the effect of short message service (SMS), or text message, reminders on the attendance of appointments at four community mental health clinics in London. Attendance of outpatient appointments roughly between March and June of 2008 (N=648), 2009 (N=1,081), and 2010 (N=1,088) was examined. Reminder messages were sent seven and five days before an appointment in 2009 and seven and three days before an appointment in 2010; patients in the 2008 sample received no reminder messages. Appointment attendance during the sample periods was compared by using multiple logistic regression analysis and adjusting for sociodemographic and clinical confounders. Missed appointments accounted for 36% of appointments in 2008, 26% of appointments in 2009, and 27% of appointments in 2010. The relative risk reduction in failed attendance was 28% between the 2008 and 2009 samples and 25% between the 2008 and 2010 samples. Attendance rates were significantly higher for the 2009 and 2010 samples than for the 2008 sample (p<.001) but did not differ between the two intervention periods. SMS-based technology can offer a time-, labor-, and cost-efficient strategy for encouraging engagement with psychiatric outpatient services. In England alone, a reduction of 25% to 28% in missed outpatient clinic appointments would translate to national cost savings of more than £150 million, or $245 million, per year, and likely have clinical benefits as well.

An audit on the management of lymphogranuloma venereum in a sexual health clinic in London, UK

We performed an audit on the management of lymphogranuloma venereum (LGV) against the British Association of Sexual Health and HIV (BASHH) guidelines. Sixty-three cases of LGV were diagnosed in 60 men who have sex with men (MSM). Fifty-six out of 63 (89%) episodes were treated in accordance with the guidelines. Although all eligible patients were offered an HIV test, 10% and 29% of patients were not offered syphilis or hepatitis C tests, respectively, at the time of LGV diagnosis. Partner notification was not possible in a third of cases. Several patients were re-infected with rectal Chlamydia trachomatis in the three months following LGV diagnosis, emphasizing the importance of rescreening to detect new infections as well as treatment failures in MSM at ongoing high risk of sexually transmitted infection acquisition.