Sexually Transmitted Infections Clinic Research Articles

Prevalence and Pattern of Sexually Transmitted Infections/HIV among the High Risk Groups in Dakshina Kannada District (Rural), India

Introduction: Human Deficiency Virus and other sexually transmitted infections (STIs) often coexist and share common modes of transmission. High risk groups (HRGs) under National AIDS Control Programme in India include Female Sex Workers (FSWs), Men having Sex with Men (MSMs) and Intravenous Drug Users (IDUs). Objectives: This study assessed the pattern of Sexually Transmitted Infections (STIs) among the high risk groups including Female Sex Workers (FSWs) and Men Having Sex with Men (MSMs) using the syndromic management approach. Methodology: STI clinics were conducted on a monthly basis by a NGO working in 100 high risk villages in Dakshina Kannada district. These HRGs were treated using syndromic management for STIs and also provided referral to Integrated Counseling and Testing Centres (ICTCs) for HIV/ AIDS. Syndromic management is a comprehensive approach for STI/RTI control endorsed by the World Health Organization. A questionnaire was used to include the socio-demographic characteristics of HRGs and the diagnoses made. The data sheet did not contain any personal details, maintaining complete anonymity of the study participants. Statistical tests used were proportions to assess proportion and patterns; t-test for difference in proportions among the subgroups of HRGs. Results: The most common diagnosis was vaginitis followed by urethritis, cervicitis, PID and inguinal bubo. The prevalence of STIs was significantly higher among FSWs than MSMs. Conclusion: Sexually transmitted infections continue to persist in high risk groups and hence require sustained strategies for prevention under the framework of existing national programmes.

Missed opportunities to offer HIV tests to high-risk groups during general practitioners’ STI-related consultations: an observational study

ObjectivesPrior research has shown that Dutch general practitioners (GPs) do not always offer HIV testing and the number of undiagnosed HIV patients remains high. We aimed to further investigate the...

A Retrospective Study of the Pattern of Sexually Transmitted Infections in Males: Viral Infections in Emerging Trend.

Sexually transmitted infections (STIs) continue to be a major public health problem with significant burden on the society even after so many health care programmes being organized by the governmental and non-governmental organizations and awareness created among general public about STIs. Male patients are common visitors to STI clinic than females who are generally traced as a contact in our society. The aim of this study was to give an overview of the pattern of STIs among males at a tertiary care teaching hospital over a period of 5 years. A retrospective chart review of the data collected from the clinical records of all male patients, who had attended the STI clinic of Chengalpattu Medical College Hospital, Chengalpattu, Tamil Nadu, for various complaints during the 5 year period from 2010 to 2014 was carried out. All male patients with confirmed STIs were included in the study and those patients without any evidence of STIs either clinically or serologically were excluded from the study. Out of the 4454 male cases who had attended the STI clinic, 175 (3.93%) patients had STIs. Genital wart accounted for the maximum number among the STIs with 61 cases (34.86%), followed by genital herpes 56 (32%), urethral discharge 19(10.86%), non-herpetic genital ulcerative diseases 17(9.71%) and serological test for syphilis (RPR) was reactive in 22 (12.57%) patients. HIV was positive in 68 (1.53%) among the total 4454 male patients attended the clinic. Viral STIs occur significantly more than the bacterial STIs because of its incurable and recurrent nature. Health programmes should be still more focused on creating awareness about the minor STIs and to remove the stigma so that the patients attend the proper health care facilities in the early stage itself for treatment thereby, complications and further transmission of the STIs can be avoided.

Study of socio-demographic profile and morbidity pattern of women of reproductive age group attending sexually transmitted infections clinic at an urban health centre in Mumbai, Maharashtra, India

Background: Morbidities related to reproductive health in women are largely under reported or tends to be reported at a late stage in the sexually transmitted infections (STI) clinic. Social stigma, cultural factors and non-priority to reproductive health in the family and non-involvement of the spouse are amongst the factors in the family affecting the compliance for treatment amongst women. Moreover women in most cases are deprived of their own decision-making autonomy with reference to STIs & RTIs. In most cases the woman is the passive empowered partner in acquiring STIs and RTIs. The present study was designed to understand the dynamics of the epidemiological factors compared with extent of compliance to treatment sought amongst women at the RTI/STI Clinic. Methods: A cross-sectional study was carried out at STI clinic located in urban health centre of field practice area of Department of Community Medicine of a tertiary care teaching hospital i.e. Seth G. S. Medical College and KEM Hospital, Mumbai during the period of January 2014 to December 2015. A total of 306 reproductive women were included and a pre-designed and pre-tested questionnaire was used for the study. Data was analyzed by using statistical package of social sciences (SPSS) version 17.0. Results: The morbidity pattern ranking from highest to lowest order showed that 171 (55.9%) women had white discharge, while 46 (15.1%) reported to have burning or pain during urination, 118 (38.6%) were having lower abdominal pain, 32 (10.5%) of women complained of dyspareunia, 12 (3.9%), and 9 (2.9%) women diagnosed as having bleeding after sex and prolapse and 5 (1.6%) had herpetic ulcer & inguinal bubo respectively. The associated medical conditions identified were 20 (6.5%) of women had diabetes, 18 (5.9%) were having hypertension, 21 (6.9%) women were having tuberculosis and 9 (2.9%) were HIV positive. Conclusions: Almost 63% of the women were married before 18 years of age. Most of these married women were homemakers and were literate upto primary and secondary level. Early diagnosis and adequate treatment of STIs/RTIs at the first contact between patients and health care providers is therefore an important public health measure. There is a need to promote, educate and increase the awareness regarding the RTIs/STIs at the community level.

Sexual abstinence and other behaviours immediately following a new STI diagnosis among STI clinic patients: Findings from the Safe in the City trial

BackgroundFew studies have assessed patients’ sexual behaviours during the period immediately following a new diagnosis of a curable sexually transmitted infection (STI).MethodsData were analysed from a behavioural study nested within...

Young male sex workers are at high risk for sexually transmitted infections, a cross-sectional study from Dutch STI clinics, the Netherlands, 2006-2012.

BackgroundMale sex workers (MSW) are particularly exposed to sexually transmitted infections (STI) including HIV. In the Netherlands, data about STI among MSW are scarce. We estimated chlamydia, gonorrhoea, syphilis and HIV diagnoses among MSW attending STI clinics and determined associated factors to guide prevention policies.MethodsUsing 2006–2012 cross-sectional national surveillance data from Dutch STI clinics, we calculated the proportion of consultations with a positive test for any of three bacterial STI or HIV among MSW. Associated factors were determined by using Poisson logistic regression with robust variance.ResultsWe identified 3,053 consultations involving MSW, of which 18.1 % included at least one positive bacterial STI test and 2.5 % a positive HIV test. Factors associated with bacterial STI and/or HIV diagnoses were respectively age groups < 35 y.o. and self-reporting homo- or bisexual preferences (aRR = 1.6; 95 % CI: 1.3–2.1), and age group 25–34 y.o. (aRR = 2.7; 95 % CI: 1.2–6.5) and self-reporting homo- or bisexual preferences (aRR = 24.4; 95 % CI: 3.4–176.9). Newly diagnosed and pre-existing HIV infection were associated with an increased risk for bacterial STI (aRR = 2.7, 95 % CI: 1.7–2.6 and aRR = 2.1, 95 % CI: 2.2–3.4 respectively). MSW with no history of HIV screening were more likely to be tested positive for HIV compared to those with a previous HIV-negative test (aRR = 2.6, 95 % CI: 1.6–4.3).ConclusionHealth promotion activities should target MSW who are young, homo- or bisexual, those who are HIV-infected or who have never been tested for HIV, to increase early diagnosis, prevention and treatment.

Epidemiology of Sexually Transmitted Infections in Visitors for the London 2012 Olympic Games: A Review of Attendees at Sexual Health Services.

Mass gatherings and large sporting events, such as the Olympics, may potentially pose a risk of increased sexually transmitted infection (STI) transmission and increase burden on local STI services. The objectives of this analysis were to assess whether the STI profile of Olympic visitors differed from that of the local STI clinic population and to investigate what impact these visitors had on local STI services. Self-administered questionnaires (completed by 29,292 patients) were used to determine the visitor status of patients attending 20 STI clinics, between July 20, 2012, and September 16, 2012, in the host cities, London and Weymouth. Using routine surveillance data from the Genitourinary Medicine Clinic Activity Dataset version 2, Olympic visitors were compared with usual attendees (local residents and non-Olympic visitors) in terms of their demographic characteristics, services utilized, and STIs diagnosed using univariate and multivariate methods. Compared with usual attendees, Olympic visitors were more likely to be heterosexual males (56.0% vs. 34.9%, P = 0.001), aged between 15 and 24 years of age (47.1% vs. 34.0%, P = 0.001), of white ethnicity (81.9% vs. 66.4%, P = 0.001), and born in Australasia, Asia, North America, or South America (18.8% vs. 12.0%, P = 0.006). Olympic visitors constituted 1% of new clinic attendances and were less likely to be diagnosed as having a new STI (adjusted odds ratio, 0.69; 95% confidence interval, 0.48-0.98; P = 0.040). In this first multisite study to examine the effect of Olympic visitors on local sexual health services, the 2012 Olympic Games was found to have minimal impact. This suggests that a "business as usual" approach would have been sufficient.

Impact of Introducing Triage Criteria for Express Testing at a Canadian Sexually Transmitted Infection Clinic.

The implementation of express testing in an sexually transmitted infection (STI) clinic reduced the length of visit time compared with other visit types and increased the proportion of STIs diagnosed at clinic visits. Express testing did not impact the time to treatment for asymptomatic patients diagnosed as having an STI.

Performance of the NG OligoGen kit for the diagnosis of Neisseria gonorrhoeae: comparison with cobas 4800 assay

PCR assays are nowadays between the most sensitive and reliable methods for screening and diagnosing sexually transmitted infections (STIs). The aim of this study was to analyze the reliability, accuracy, and usefulness of the new NG OligoGen kit in comparison with the cobas 4800 assay for the detection of Neisseria gonorrhoeae in clinical samples. A prospective study was designed for detection of N. gonorrhoeae including urine samples (n=152), rectal (n=80), endocervical (n=67), pharyngeal (n=41), and urethral swabs (n=5) that were sent from a regional STI clinic in Seville, Spain. Samples were collected from 255 (73.9%) men and 90 women. Sensitivity, specificity, positive and negative predicative values, and kappa value for N. gonorrhoeae detection using the NG OligoGen kit were 99.6%, 100%, 100%, 99.1%, and 0.99, respectively. Statistical data obtained in this study confirm the usefulness and reliable results of this new assay.

A Novel Public Library-Based Sexually Transmitted Infection Screening Program for Younger High-Risk Groups in Omaha, Nebraska, USA

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the two most commonly reported sexually transmitted infections (STIs) in the United States (U.S.) and Douglas County, Nebraska has STI rates consistently above the U.S. average. The Douglas County Health Department (DCHD) developed an outreach CT and NG screening program in public libraries to address the problem beyond the traditional STI clinic setting. This study evaluates the effectiveness of the program and identifies factors predictive of CT and NG infections. A retrospective review of surveys of library patrons and DCHD traditional STI clinic clients who submitted urine tests for CT and NG from June 2010 through April 2014 was done. Chi square, Fisher exact, Student's t tests, univariate and multivariate logistic regression were conducted. A total of 977 library records and 4871 DCHD clinic records were reviewed. The percent positive was lower in the library than in the traditional clinic for CT (9.9 vs. 11.2 %) and NG (2.74 vs. 5.3 %) (p = 0.039 and p < 0.001, respectively). Library clients were more likely to be 19 years and younger (OR 6.14, 95 % CI: 5.0, 7.5), Black (OR 3.4, 95 % CI: 2.8, 4.1), and asymptomatic (OR 12.4, 95 % CI: 9.9, 15.5) compared to traditional clinic clients. The library STI screening program effectively reaches a younger, asymptomatic, and predominantly Black population compared to a traditional health department clinic site.

Brief condom interventions targeting males in clinical settings: a meta-analysis

ObjectiveThe objective of this study is to assess the effectiveness of brief clinic-based condom skills interventions that target males. Study designWe searched PubMed, Cumulative Index of Nursing and Allied Health Literature and PsychInfo for studies published from January 1980 through September 2014, using relevant search terms. We included studies if interventions taught about condoms lasting 60min or shorter, used randomized or quasiexperimental design, were conducted in a clinical setting and targeted males. Two investigators sequentially reviewed abstracts. We abstracted and reviewed data from 16 studies that met the selection criteria. Where outcomes were poolable, we conducted meta-analyses using a random-effects model and I2 index to assess heterogeneity. Outcome measures included condom knowledge, attitudes, behaviors, sexually transmitted infections (STIs)/human immunodeficiency virus and unintended pregnancy. ResultsAcross studies, teaching about condoms was nested within sexual risk reduction curricula. Most interventions were one on one and conducted in STI clinics. Pooled analyses indicated that intervention receipt was associated with increases in percent of sex acts with condoms (standardized mean difference=0.29 [0.18, 0.41]; 0.19 [0.06, 0.33]) and reductions in STIs at 12-month follow-up or longer {odds ratio (OR)=0.82 [95% confidence interval: 0.67, 0.99]}. One study assessed unintended pregnancy and did not find an intervention effect. ConclusionsStudy findings hold promise for considering brief condom skills interventions in clinical settings that can result in improvements in males’ condom behaviors and possibly biological outcomes.

Retesting young STI clinic visitors with urogenital Chlamydia trachomatis infection in the Netherlands; response to a text message reminder and reinfection rates: a prospective study with historical controls

ObjectivesThe objective of this study is to assess the effect of reminder text messages 6 months after the initial treatment on retest and chlamydia reinfection rates in young heterosexuals compared...

Group Sex and Prevalent Sexually Transmitted Infections Among Men Who Have Sex with Men

We evaluated the direct relation between group sex and prevalent sexually transmitted infections (STI) in a cross-sectional study of men who have sex with men (MSM) presenting at an urban STI clinic in the Midwestern US. Among 231 men who enrolled and reported that they have sex with men, we collected behavioral data using a combination of interviewer and self-administered surveys and extracted STI data from electronic health records. We used modified Poisson regression to examine the unadjusted and adjusted associations between group sex participation and prevalent STI. One-quarter of participants (n=58) reported group sex participation in the last 3months. Eighteen percent of participants (n=42) had gonorrhea and 19% (n=45) had chlamydial infection. Men who reported recent group sex were more likely to be HIV-positive, to report recent drug use, and to report unprotected receptive anal intercourse in the past 3months. After adjustment for age, race, and recent drug use, recent participation in group sex was associated with prevalent gonorrhea infection (prevalence ratio [PR]=2.11, 95% confidence interval [CI]=[1.13, 3.95]) but not chlamydia infection (PR=1.03, 95% CI=[0.58, 1.84]). We performed a sensitivity analysis in which we also adjusted for unprotected receptive anal intercourse and the results were not substantively changed. In summary, participation in group sex in the past 3months was associated with a more than twofold increased prevalence of gonorrhea, but not with chlamydia. These findings support group sex participation as a potential contributor to increased STI prevalence.

P05.05 Neisseria gonorrhoeae in indonesia: prevalenceand antimicrobial susceptibility among sti clinics patients in jakarta, yogyakarta and denpasar

Introduction In Indonesia, syndromic management is used for diagnosis and treatment of sexually transmitted infections (STIs), but this approach does not provide accurate data to assess the epidemiology of gonorrhoea and antimicrobial susceptibility of circulating Neisseria gonorrhoeae strains. We studied gonorrhoea prevalence and antimicrobial resistance of N. gonorrhoeae among patients of STI clinics in 3 large cities in Indonesia. Methods In 2014, urogenital swabs were obtained from sexually active adults, mainly female sex workers, men who have sex with men, and male-to-female transgenders attending STI clinics in Jakarta, Yogyakarta, and Denpasar. In some patients additional rectal and pharyngeal swabs were taken. Diagnosis of N. gonorrhoeae infection was established by real time PCR targeting Opa genes. Culture isolates of N. gonorrhoeae were tested for antimicrobial susceptibility against doxycyclin, ciprofloxacin, azithromycin, ceftriaxone and cefixime by E-test™ using EUCAST breakpoints. Results We included 764 participants: 346 (45.3%) males, 321 (42.0%) females and 97 (12.7%) transgenders (median ages 27, 30, and 38 years). In total, 800 samples were collected: 443 urethral, 321 cervical, 23 rectal, and 13 pharyngeal swabs. In 215 (28.1%) participants N. gonorrhoeae infection was detected by PCR. Prevalence varied significantly by gender (26.0% in males, 32.1% in females, and 22.7% in transgenders, p = 0.04); and varied significantly by city: 14.5% in Denpasar, 31.5% in Jakarta and 27.5% in Yogyakarta (p = 0.015). Of 77 isolates tested for antimicrobial susceptibility, all were sensitive to azithromycin, ceftriaxone, and cefixime. In contrast, resistance to doxycyclin (98.7%) and ciprofloxacin (100%) was very common. Conclusion This is the first study since 2004 describing the epidemiology of gonorrhoea and antimicrobial resistant strains in Indonesia. Prevalence of gonorrhoea is very high among STI clinic visitors. In view of the extensive resistance against doxycyclin and ciprofloxacin, these antibiotics are not appropriate treatment options for gonorrhoea; instead, extended spectrum cephalosporins are advised. Disclosure of interest statement The study is funded by Indonesian government through Beasiswa Unggulan (The Excellence Scholarship Program), Ministry of Education and Culture Republic of Indonesia and Public Health Service (GGD) of Amsterdam, The Netherlands. The authors declare that there is no conflict of interest.

P12.16 Older patients attending sexually transmitted infections clinics

Background Many older patients remain sexually active well into their eighth decade of life. Surveillance data suggest that rates of sexually transmitted infections (STIs) in this age group may be increasing. We sought to compare demographics, risk behaviours and predictors of acute infections in patients 50 years and older versus younger patients attending STI clinics in Baltimore, Maryland. Methods Retrospective study from a large electronic database of all visits to two urban STI clinics between 2005 and 2010. Proportions were compared using the c2 test. Logistic regression was used to assess predictors of acute STIs in older versus younger groups. Results 4461 first visits for patients over 50 and 4893 visits for patients under 50 were included in the analysis. Patients over 50 frequently reported high-risk behaviours [35.4% (CI 0.34–0.37) vs. 52.7% (CI 0.51–0.54) in those Conclusion Older patients who seek care at STI clinics engage in significant risk behaviours. Race, a factor strongly predictive of acute STIs in young men and women is not a significant predictor of STIs in older persons. Disclosure of interest statement No sources of funding or conflicts of interest to disclose.

P17.05 Hiv test refusals among black africans attending sexually transmitted infection clinics in england, 2013

<h3>Introduction</h3> Black Africans comprise the second largest group affected by HIV in England, but it is estimated that 34% are &nbsp;undiagnosed. We identified factors associated with HIV test refusals among Black African sexually transmitted infection (STI) clinic attendees. <h3>Methods</h3> Data on all STI clinic attendances in England in 2013 were obtained from the genitourinary medicine clinic activity dataset (GUMCADv2). Individuals diagnosed with HIV on or before 31^st December 2012 were excluded from analysis. Ethnic variations in HIV test refusal at an attendance were determined. Further analyses were restricted to Black Africans, and bivariate and multivariate associations between demographic and clinical characteristics and HIV test refusal were assessed. All associations were determined using generalised estimating equations regression and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) are reported. <h3>Results</h3> Black Africans made 92,331 attendances at STI clinics in 2013 and refused an HIV test on 7,666 (8.3%) occasions. After adjusting for gender/sexual orientation, Black Africans were least likely to have refused an HIV test [aOR (95% CI): 0.503 (0.490–0.517)] (<i>vs. </i>White British persons). Among Black Africans, the odds of refusing an HIV test decreased with age [0.983 (0.980–0.986)] and were lower among those born outside the UK [0.676 (0.637–0.717)], those who were tested for HIV within the last year [0.802 (0.762–0.845)] and in men who have sex with men [0.307 (0.235–0.402)] (<i>vs. </i>heterosexual men and all women), while the odds were higher among those diagnosed with a new STI at the same attendance [1.272 (1.193–1.357)]. <h3>Conclusion</h3> Among Black Africans, targeted health promotion may be needed to improve HIV testing rates and decrease the proportion undiagnosed, especially for heterosexual men, women, younger, UK-born persons and those newly diagnosed with an STI. <h3>Disclosure of interest statement</h3> There are no conflicts of interest.

P12.12 Bacteria aetiology of sexually transmitted infections at sexually transmitted infection clinic in kumasi, ghana; use of multiplex real time polymerase chain reaction

Introduction Most sexually transmitted infection (STI) management efforts focus on the syndrome approach to diagnose and treat patients who are symptomatic. However, most women with STIs are known to be entirely asymptomatic or if symptoms exist are often unrecognised either clinically or bacteriologically. We determine the true prevalence and aetiology of STIs among these women in Ghana. Methods This cross sectional study conducted between February and April 2014 employed a sensitive multiplex real time Polymerase chain reaction (PCR) assay that simultaneously detects seven STI bacteria pathogens in 200 women attending a Specialist STI clinic at Suntreso Government Hospital in Kumasi, Ghana. Data was captured and analysed using Stata version 12. Results A total 156 (78.00%) of the women were asymptomatic. Overall, 175 (87.5%) of the women tested positive for at least one bacteria STI pathogen of which 50 (25.0%) had single infections, 76 (38.0%) and 39 (19.5%) had double and triple infections respectively. Mycoplasma hominis was the most commonly detectable pathogen present in 135 (67.5%) women. Altogether, 135 (86.54%) and 40 (90.91%) of the symptomatic and asymptomatic women tested positive for at least one pathogen (p < 0.05). There were no significant associations (p < 0.05) between the clinical manifestations as presented by the symptomatic women and the pathogens detected in their samples. Conclusion Our study confirmed the importance of complementing the syndromic approach with pathogen detection and most importantly recognise that STIs in women are asymptomatic and regular empirical testing even for both symptomatic and asymptomatic patients is. Disclosure of interest statement No conflict of interest.

P05.06 Prolonged infection of pharyngeal gonorrhoea after treatment with ceftriaxone

Introduction Previous studies reported that in a considerable proportion of pharyngeal gonorrhoea cases treated with extended-spectrum cephalosporins, the infection remains detectable after several weeks. We examined the occurrence of prolonged pharyngeal gonorrhoea infections after treatment with ceftriaxone at a sexually transmitted infection (STI) outpatient clinic in Amsterdam. Methods A retrospective cohort study was conducted based on routine electronic medical records at the STI clinic of the Public Health Service (GGD) of Amsterdam. Eligible for inclusion were: adults diagnosed with pharyngeal gonorrhoea between January 2012 and July 2013, who were treated with ceftriaxone (500 mg IM), and who returned for a test of cure (TOC) between 7 and 21 days after treatment. Definitive diagnosis of gonorrhoea was based on Gen-Probe Aptima-Combo 2 Assay™ using Tigris DTS™ system. Some patients also received additional antibiotics with ceftriaxone. Information on patients’ characteristics and clinical history were available, but data on sexual re-exposure after treatment were not. Results In the study period, 880 pharyngeal gonorrhoea cases were diagnosed; 290 cases (32.9%) returned for a TOC visit and were eligible (255 males and 35 females, median age 34 and 25 years, respectively). In 17 cases (5.9%) N. gonorrhoeae infection was detected again. Prolonged infection was not associated with gender (p = 0.49) or age (p = 0.87), but appeared to be associated with sex work (OR = 3.24 [95% CI 0.83–12.45], p = 0.07). Prolonged infection was significantly more common among those who were treated with ceftriaxone only vs a combined-regimen (OR = 4.07, [95% CI 0.90–18.39]; p = 0.048). Conclusion Prolonged pharyngeal gonorrhoea infection after appropriate treatment was not uncommon, and was more often observed in those who were treated with ceftriaxone only. This could be the result of re-infection after treatment or of treatment failure possibly due to poor tissue penetration. Treatment failure due to antimicrobial resistance seems unlikely. Disclosure of interest The study is fully funded by Public Health Service (GGD) of Amsterdam, The Netherlands. The authors declare that there is no conflict of interest.

P04.01 Similarities and differences in perceptions of models for online partner notification for sexually transmitted infections: potential users versus care providers

Background Online partner notification (OPN) services are used by a subset of patients diagnosed with sexually transmitted infections (STI); however, less is known about their perception by care providers. We compared opinions of potential users and providers with respect to different OPN models including email vs text, and open (anyone can access) vs closed models (provider controls access via e-mail invitation or access code). Methods We conducted five focus groups with potential users (youth, men who have sex with men (MSM), STI clinic clients), community agencies, and public health nurses, and interviewed family physicians, recruited through multiple methods. Participants were shown visual depictions of OPN models and examples of existing services, and opinions elicited using discussion guides that probed acceptability, advantages, and challenges of differing models. Notes taken were supplemented by review of audio recordings and analysed thematically. Results We spoke with 16 potential users (6 youth, 6 MSM, 4 clients), 4 agency staff, 11 nurses, and 8 physicians. Older and younger users preferred OPN through e-mail and texting respectively, each perceiving the chosen modality as more serious and private. Participant points of convergence included: OPN are beneficial; need for two-stage messaging (initial generic, followed by detailed disease and contact information); few concerns regarding misuse; limitations given online sex-seeking without contact information. Most users preferred OPN for all possible STI while providers more commonly emphasised reportable or treatable infections. Users preferred closed access models which were perceived as more serious and secure. Providers preferred open models, perceiving closed models to create barriers for clients and difficult to integrate into clinical practice. Conclusion We found overall support for OPN, but key differences between client and provider perceptions may pose challenges to uptake. As OPN are best promoted by providers giving an STI diagnosis, understanding and addressing provider concerns is important. Disclosure of interest statement The authors have no conflicts of interest to disclose.

Alcohol Use Predicts Number of Sexual Partners for Female but not Male STI Clinic Patients.

This study tested the hypothesis that greater alcohol involvement will predict number of sexual partners to a greater extent for women than for men, and that the hypothesized sex-specific, alcohol-sexual partner associations will hold when controlling for alternative sex-linked explanations (i.e., depression and drug use). We recruited 508 patients (46 % female, 67 % African American) from a public sexually transmitted infections (STI) clinic. Participants reported number of sexual partners, drinks per week, maximum drinks per day, frequency of heavy drinking; they also completed the AUDIT-C and a measure of alcohol problems. As expected, men reported more drinking and sexual partners. Also as expected, the association between alcohol use and number of partners was significant for women but not for men, and these associations were not explained by drug use or depression. A comprehensive prevention strategy for women attending STI clinics might include alcohol use reduction.