Test Of Cure Research Articles

Macrolide therapy for community-acquired pneumonia due to atypical pathogens: outcome assessment at an early time point

BackgroundTherapy directed against atypical pathogens in patients with community-acquired pneumonia (CAP) is often recommended. This post-hoc analysis evaluated the effect of addition of a macrolide to ceftaroline fosamil or ceftriaxone treatment in atypical CAP. MethodsTwo phase 3, double-blind, comparative safety and efficacy studies of ceftaroline fosamil vs. ceftriaxone, FOCUS 1 and FOCUS 2, enrolled adults with CAP. Only FOCUS 1 included 24-h adjunctive clarithromycin therapy for all patients on day 1. Day 4 and test-of-cure (TOC) outcomes were compared for adjunctive vs. no adjunctive therapy. ResultsOf 1240 enrolled patients, 130 patients with CAP due to atypical pathogens alone were included (FOCUS 1, n = 64; FOCUS 2, n = 66). Among patients infected with Mycoplasma pneumoniae and/or Chlamydophila pneumoniae alone, a higher clinical response rate was observed with clarithromycin plus ceftaroline fosamil or ceftriaxone compared with treatment without additional clarithromycin at day 4 [38/49 (77.6%; FOCUS 1) vs. 24/43 (55.8%; FOCUS 2)], but not at the TOC assessment [42/49 (85.7%; FOCUS 1) vs. 41/43 (95.3%; FOCUS 2)]. In patients infected with Legionella pneumophila alone, a higher clinical response rate with adjunctive clarithromycin therapy was observed at the TOC assessment alone [12/12 (100%; FOCUS 1) vs. 14/19 (73.7%; FOCUS 2)]. The unadjusted odds ratio of a favourable clinical response at day 4 with adjunctive clarithromycin vs. no adjunctive clarithromycin was 2.4 (95% confidence interval 1.1–5.1; P = 0.0299) for all pathogens combined. ConclusionsThese results suggest that empirical antibiotic therapy against atypical pathogens may improve early clinical response rate. This hypothesis is best evaluated in a prospective trial.

P147 An audit into the optimum time for neisseria gonorrhoeae test of cure following treatment in sexual health centres

IntroductionNeisseria gonorrhoeaeis the second most common bacterial sexually transmitted infection worldwide and has evolved resistance to several antibiotic classes. BASHH Guidelines 2011 currently recommend ceftriaxone 500mg IM plus azithromycin 1g stat as first line treatment and also recommend a test of cure (TOC) at 14 days. In our centre the time period between treatment and TOC was reduced to 14 days in July 2016. Anecdotal evidence suggests that this may be producing a higher false positive rate.MethodsClinical notes for all positive gonorrhoea tests (pharyngeal, rectal, urethral, cervical) in a 3-month period were reviewed. Positive TOC were identified and reasons for these assessed (reinfection, treatment failure, false positive). Cycle threshold (CT) values were used to help identify false positives.Results7.5% of TOC results performed at 14 days were likely false positive (no risk of reinfection or treatment failure, high CT values), compared with 2.7% of TOC performed after 14 days. 8.3% of pharyngeal samples and 12.5% of urinary samples were false positive. There were no false positives found for rectal and vulvovaginal samples.DiscussionThere is a significantly higher rate of false positives when a TOC is performed at 14 days and they are more prevalent in pharyngeal and urinary samples. This has a negative impact on both patient and health care provider time and can lead to unnecessary retreatment. Potential interventions could be to extend the TOC time period, include CT values for all TOC results or move to a less sensitive NAAT for TOC.

P135 A review of local test of cure (TOC) practice following treatment for rectal chlamydia and lymphogranuloma venereum

IntroductionPrevious reports of up to 22% treatment failure in rectal Chlamydia informed our local clinic policy of routine test of cure (TOC) following rectal chlamydia or lymphogranuloma venereum (LGV) treatment. We set out to review our local TOC practice and treatment failure rates for both chlamydia and LGV.MethodsCase notes of patients diagnosed with rectal chlamydia and LGV between 01/07/15 and 01/07/16 were reviewed. Data was collected on symptoms, antibiotic choice, compliance and TOC.ResultsThere were 89 patients identified with rectal chlamydia; 7 (8%) were confirmed LGV. Median age was 30 years; 69 (78%) men who have sex with men (MSM) and 20 (22%) female. Treatment was primarily with 1 week of doxycycline (81/89; 91%).Of 89 patients, 53 (60%) attended for a TOC with the remainder (36; 40%) lost to follow-up. There were 3/48 (6%) positive TOC results in those with non-LGV rectal chlamydia with one reporting sexual contact during treatment giving a failure rate of 4% (2/48). Of those with LGV 5/7 (71%) attended for a TOC and all were negative. Of those with a negative TOC 3/45 (6%) patients reported sexual contact during treatment.DiscussionOver a 12-month period our local treatment failure rate was low at 4% for rectal chlamydia and 0% for LGV. A significant proportion of patients failed to return for TOC. These results suggest that removal of routine TOC would be locally acceptable, reduce health advisor workload and be in line with current BASHH guidance.

O30 Treatment failure in mycoplasma genitalium among gum clinic attendees

IntroductionMacrolide resistance inMycoplasma genitalium(MG) is of growing concern in countries where azithromycin is used to treat non-gonococcal urethritis(NGU) but UK data is lacking. Patients with NGU or pelvic inflammatory disease (PID) are routinely tested for MG at our clinic and offered test of cure (TOC) 4 weeks post-treatment. We aim to determine rates of MG-positivity 4 weeks after treatment and their associations.MethodsNotes of MG-positive cases between December 2015 and November 2016 were reviewed and data collected on management.Results114 cases of MG were identified. 91(80%) were symptomatic and 12(11%) were MG contacts. Should be 52/339(15%) men with NGU and 15/160(9.4%) women with PID were MG-positive.80/114(78%) were given an azithromycin regimen first line. 59/114(53%) returned for TOC and 24/59(40%) were positive (23 following azithromycin; 1 following moxifloxacin). 19 returned for a second TOC and 14 were negative (1 following azithromycin and 13 following moxifloxacin second line). 5/19(26%) were positive (3 following azithromycin and 2 following moxifloxacin second line). One male patient with confirmed resistance to macrolide and quinolone therapy achieved microbiological cure with pristinamycin.Having a positive TOC was significantly associated with risk of reinfection (p=0.01) and being symptomatic at TOC (p<0.001), but not significantly associated with gender, sexual orientation, HIV status, concurrent STI (p=0.053) and azithromycin use.DiscussionMG-positivity rates at 4 week TOC are high raising concerns of treatment failure although re-infection may also contribute. As commercial assays are imminently available, diagnoses of MG will increase and where possible should be accompanied by antimicrobial resistance testing.

P028 Characterising neisseria gonorrhoeae (NG) infections and treatment in a large, urban cohort

IntroductionBetter detection and more frequent testing may explain increases in NG. We wished to characterise patients attending our clinics with NG, and audit management against BASHH standards.Methods300 sequential NG patients attending in 2016 were reviewed. Data collected: demographics, NAAT/culture positivity (per site), antimicrobial treatment and resistance, and test of cure (TOC).ResultsMean age was 34 (17–65); 92% male; 75% white; 86% MSM. 415 site specific infections captured. Site distribution by NAAT, culture concordance/sensitivities, and TOC are presented below:Abstract P028 Table 1Gonorhoea infectionsSexualityCulture resultsTest of CureNAAT+ by SITEMSMHetero – MaleHetero – FemaleCultures takenCulture negativeCiprofloxacin resistanceTOC DoneTOC FailureVVSNANA7%(21/300)76%(16/21)19%(3/16)7.6%(1/13)76%(16/21)0%(0/16)Urethra42%(126/300)7%(21/300)NA90%(132/147)3.7%(5/132)33%(43/127)53%(78/147)2.6%(2/78)Pharynx37%(111/300)0.7%(2/300)1%(3/300)68%(79/116)51%(37/72)43%(18/42)66%(77/116)5.2%(4/77)Rectum43%(128/300)0.3%(1/300)0.7%(2/300)63%(83/131)12%(10/83)48%(35/73)65%(85/131)3.5%(3/85)75% NAAT+ patients (310/415) had cultures performed. There was one case of ciprofloxacin and azithromycin resistance (MSM). 96% (287/300) received ceftriaxone plus azithromycin. Reasons for alternatives related to penicillin allergy. Median time to treatment 0 days (0-45d). 63% (189/300) attended for TOC (median time: 21d (7-188d)) and 94% (177/189) patients tested negative. Failed TOC was due to reinfection in 92%.DiscussionOur clinics maintain reasonable adherence to BASHH standards. Cephalosporin resistance was not observed. TOC times can be lengthy.

P030 Management of rectal chlamydia in an urban sexual health centre

IntroductionWe reviewed management of rectal chlamydia in our clinic and adherence to 2015 BASHH audit standards.MethodsElectronic patient records of 100 consecutive patients diagnosed with rectal chlamydia prior to 31 July 2016 were reviewed with respect to gender, sexuality, HIV status, symptoms, STI screening, treatment, test of cure (TOC) and partner notification (PN).Results64% were female (all heterosexual). 94% males were MSM; 18% were HIV positive. 1 male presented with rectal symptoms (pain). 23% patients had other genital symptoms. 76% were asymptomatic. 71% had concomitant STIs (including chlamydia at other sites). 90% received doxycycline 100mg bd for at least 1 week. 24% were treated with azithromycin before being recalled for doxycycline. Reasons included; not initially tested for rectal infection, attendance as a contact, initial treatment for presumed GC. All patients were advised to attend for TOC; 58% attended. All TOC were negative. All HIV positive patients were tested for LGV (1 positive). 1 MSM with rectal pain was not tested for LGV but subsequent TOC was negative. 36% received written information. PN was performed in 99% of cases with 81% of traceable contacts reported as attended and 47% of contacts being verified as attended.DiscussionHigh numbers of patients were issued with azithromycin as initial treatment requiring recall for doxycycline. This is concerning, particularly in an era of increasing antibiotic resistance. Education sessions have been provided, highlighting the importance of sexual history taking and use of doxycycline as first line chlamydia treatment where rectal infection is possible.

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

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

P090 Formalised look-back in newly diagnosed hiv to identify missed opportunities in other clinical settings: first get our own house in order!

IntroductionHIV late diagnosis is one of three key indicators on sexual health in the Public Health Outcomes Framework. The British HIV Association (BHIVA) Standards of Care for People Living with HIV advocates the use of ‘look backs’ in the case of late and very late diagnosis of previous engagement with health care services to identify missed opportunities and areas for shared learning and development.MethodsFurther to the look-back exercise undertaken on late and very late diagnoses presenting 2012–2016, we extended the use of the standardised look-back tool to ALL new diagnoses from late 2016 onwards.ResultsIn addition to anticipated missed opportunities being identified in the late and very late presentations, we identified 2 missed opportunities in much earlier presentations from within our own service! They related to failure to repeat the HIV test at test of cure (TOC) for gonorrhoea and subsequent Hepatitis vaccination appointments. In both cases the initial negative HIV test had been within the potential window period.DiscussionAs a result of the look-back exercise we have learnt a valuable lesson about the fallibility of our own service and shared the learning within our multi-disciplinary team. We have encouraged all to remember to re-visit the sexual history and timing of sex in relation to testing at ‘quickie’ follow up visits for vaccination or TOC and repeated education about window periods.We shall continue to utilise the look-back tool in all new HIV presentations and encourage colleagues to do likewise to maximise on identifying learning opportunities.

P046 3 cases of trichomonas vaginalis infection in pregnancy

IntroductionTrichomonas vaginalis (TV) is not common in the UK, with under 7,000 cases in 2015. It is associated with poor pregnancy outcomes, and consensus on treatment pathways in persistent infection is needed. We present 3 cases of TV infection in pregnancy from 2 UK centres.MethodsA retrospective review of electronic case records was performed.ResultsThe median age was 21 years (range 20–31), with a median presentation at 13 weeks (range 7–22). Discharge was the main presenting symptom. Initial microscopy was performed in 2/3 and was positive; culture was positive in 3/3. All patients initially received oral Metronidazole 400mg twice daily for 5–7 days. At test of cure (TOC), one patient (Pt 1) remained positive, the second (Pt 2) did not attend, and the third (Pt 3) was negative. However, Pt 2 and Pt 3 re-presented after 5 weeks and 3 months, respectively: Pt 2 reported poor adherence; Pt 3 denied poor adherence or re-infection risk. All underwent further treatment. Pt 1 required 3 treatment courses before cure was achieved, with Metronidazole 800mg tds for 1 week. Pt 2 received 4 courses of oral or IV Metronidazole; she awaits TOC. Pt 3 received 5 different antibiotic courses, then opted to deliver and wean her baby before re-engaging with care. All denied re-infection risk after the second treatment.DiscussionFactors that contribute to persistent TV infection in pregnancy include re-infection, poor adherence, resistance, poor engagement, and concerns about teratogenicity. Further research is needed to identify the optimal treatment strategy.

Staff, associate specialist and specialty doctors' national audit on the management of gonorrhoea in the United Kingdom, 2015.

The British Association for Sexual Health and HIV (BASHH) revised United Kingdom national guideline for the management of gonorrhoea in adults, 2011, identified five auditable outcome measures, namely, that all patients should receive first-line treatment, be screened or treated for chlamydial infection, have a test of cure (TOC), be offered written information and have partner notification carried out. The UK National Guideline for Gonorrhoea Testing, Clinical Effectiveness Group, BASHH, 2012, recommended in addition that all reactive nucleic acid amplification tests (NAATs) from pharynx and rectum should be confirmed by supplementary testing, using a second NAAT which detects a different nucleic acid target, all those with a positive NAAT for gonorrhoea should have culture and antimicrobial susceptibility testing and that TOC should be done by two weeks. Staff, associate specialist and specialty doctors performed a national audit against these standards. Data from 3233 cases were submitted; 8% of cases of gonorrhoea diagnosed in England, Scotland and Wales over this period. We found that 83% patients received first-line treatment with a reason for not doing so provided for 11%. TOC was documented for 62% and written information was offered to 41%. Results about supplementary testing were inconsistent. The results for the other outcomes were satisfactory.

An evaluation study of the Becton-Dickinson ProbeTec Qx (BDQx) Trichomonas vaginalis trichomoniasis molecular diagnostic test in two large, urban STD services

ObjectivesThe BASHH guidelines recommend molecular tests to aid diagnosis of Trichomonas vaginalis (TV) infection; however many clinics continue to use relatively insensitive techniques (pH, wet-prep microscopy (WPM) and culture). Our...

Intravenous Fosfomycin (ZTI-01) for the Treatment of Complicated Urinary Tract Infections (cUTI) Including Acute Pyelonephritis (AP): Results from a Multi-center, Randomized, Double-Blind Phase 2/3 Study in Hospitalized Adults (ZEUS)

ZTI-01 (fosfomycin for injection) is a novel injectable epoxide antibiotic with a unique mechanism of action (MOA) inhibiting an early step in bacterial cell wall synthesis. ZTI-01 has a broad in vitro spectrum of activity, including multidrug-resistant (MDR) Gram-negative pathogens, and is being developed for the treatment of complicated urinary tract infections (cUTI) and acute pyelonephritis (AP) in the USA. The ZEUS study was a multicenter, randomized, double-blind Phase 2/3 trial designed to evaluate safety and efficacy of ZTI-01 in the treatment of hospitalized adults with cUTI or AP vs. piperacillin/tazobactam (P-T). The primary endpoint of overall success was defined as clinical cure plus microbiologic eradication in the microbiologic modified intent-to-treat (m-MITT) population at the test-of-cure (TOC) visit (Day 19). Patients enrolled (n = 465) were randomized to receive 6 g ZTI-01 as a one-hour IV infusion q8h (18 g total daily dose) or 4.5 g IV P-T as a one-hour infusion q8h (13.5 g total daily dose) for a fixed 7 days, except patients with concurrent bacteremia received up to 14 days. Oral step-down therapy was prohibited. In the m-MITT population, ZTI-01 met the primary objective of non-inferiority compared with P-T with an overall success rate of 64.7% (119/184 patients) vs. 54.5% (97/178 patients), respectively; treatment difference was 10.2% (95% CI: −0.4, 20.8). Clinical cure rates at TOC were high and similar between treatment groups (90.8% vs. 91.6%, respectively). ZTI-01 was generally well tolerated. In the safety population (n = 464), treatment-emergent adverse events (TEAEs) were observed in 42.1% and 32.0% of patients in the ZTI-01 and P-T groups, respectively. Most TEAEs were mild and transient; premature discontinuation of study drug was uncommon. The most frequent clinical TEAEs were gastrointestinal in nature. Serious adverse events were uncommon (5 ZTI-01, 6 P-T), with no deaths reported during the study. These results demonstrate efficacy and tolerability of ZTI-01 in patients with cUTI and AP. If approved in the US, ZTI-01 would provide a new IV therapeutic option with a unique MOA for patients with difficult to treat Gram-negative infections. K. S. Kaye, Zavante Therapeutics, Inc.: Scientific Advisor, Consulting fee; L. B. Rice, Zavante Therapeutics, Inc.: Scientific Advisor, Consulting fee; A. Dane, Zavante Therapeutics, Inc.: Consultant, Consulting fee; V. Stus, Zavante Therapeutics, Inc.: Investigator, Research support; O. Sagan, Zavante Therapeutics, Inc.: Investigator, Research support; E. Fedosiuk, Zavante Therapeutics, Inc.: Investigator, Research support; A. Das, Zavante Therapeutics, Inc.: Consultant, Consulting fee; D. Skarinsky, Zavante Therapeutics, Inc.: Employee and Shareholder, Salary; P. B. Eckburg, Zavante Therapeutics, Inc.: Consultant and Shareholder, Consulting fee; E. J. Ellis-Grosse, Zavante Therapeutics: Employee and Shareholder, Salary

Time to clearance of Chlamydia trachomatis RNA and DNA after treatment in patients coinfected with Neisseria gonorrhoeae - a prospective cohort study.

BackgroundPerforming a test of cure (TOC) could demonstrate success or failure of antimicrobial treatment of Chlamydia trachomatis infection, but recommendations for the timing of a TOC using nucleic acid amplification tests (NAATs) are inconsistent. We assessed time to clearance of C. trachomatis after treatment, using modern RNA- and DNA-based NAATs.MethodsWe analysed data from patients with a C. trachomatis and Neisseria gonorrhoeae coinfection who visited the STI Clinic Amsterdam, The Netherlands, from March through October 2014. After treatment with ceftriaxone plus either azithromycin or doxycycline, patients self-collected anal, vaginal or urine samples during 28 consecutive days. Samples were analysed using an RNA-based NAAT (Aptima Combo 2) and a DNA-based NAAT (Cobas 4800 CT/NG). We defined clearance as three consecutive negative results, and defined “blips” as isolated positive results following clearance.ResultsWe included 23 patients with C. trachomatis and N. gonorrhoeae coinfection. All patients cleared C. trachomatis during follow-up, and we observed no reinfections. The median time to clearance (range) was 7 days (1–13) for RNA, and 6 days (1–15) for DNA. Ninety-five per cent of patients cleared RNA at day 13, and DNA at day 14. The risk of a blip after clearance was 4.4 % (RNA) and 1.7 % (DNA).ConclusionsIf a TOC for anogenital chlamydia is indicated, we recommend performing it at least 14 days after initiation of treatment, when using modern RNA- and DNA-based assays. A positive result shortly after 14 days probably indicates a blip, rather than a treatment failure or a reinfection.

Azithromycin Treatment Failure for Chlamydia trachomatis Among Heterosexual Men With Nongonococcal Urethritis.

Three recent prospective studies have suggested that the 1-g dose of azithromycin for Chlamydia trachomatis (Ct) was less effective than expected, reporting a wide range of treatment failure rates (5.8%-22.6%). Reasons for the disparate results could be attributed to geographic or methodological differences. The purpose of this study was to reexamine the studies and attempt to harmonize methodologies to reduce misclassification as a result of false positives from early test-of-cure (TOC) or reinfection as a result of sexual exposure rather than treatment failure. Men who had sex with women, who received 1-g azithromycin under directly observed therapy for presumptive treatment of nongonococcal urethritis with confirmed Ct were included. Baseline screening was performed on urethral swabs or urine, and TOC screening was performed on urine using nucleic acid amplification tests. Posttreatment vaginal sexual exposure was elicited at TOC. Data from the 3 studies were obtained and reanalyzed. Rates of Ct retest positive were examined for all cases, and a sensitivity analysis was conducted to either reclassify potential false positives/reinfections as negative or remove them from the analysis. The crude treatment failure rate was 12.8% (31/242). The rate when potential false positives/reinfections were reclassified as negative was 6.2% (15/242) or when these were excluded from analysis was 10.9% (15/138). In these samples of men who have sex with women with Ct-related nongonococcal urethritis, azithromycin treatment failure was between 6.2% and 12.8%. This range of failure is lower than previously published but higher than the desired World Health Organization's target chlamydia treatment failure rate of < 5%.

Testing for Cure of Anogenital Gonorrhea

Diagnosis of gonorrhea is recommended to be based not on culture, but on nucleic acid amplification tests (NAATs). Concerns about antimicrobial resistance and asymptomatic infection have led to a call for a test of cure (TOC) to monitor treatment outcome. Because data using NAATs to ascertain TOC are limited, Dutch investigators conducted a prospective cohort study to assess the …

O024 Trichomonas vaginalis– treatment and test of cure analysis in a GUM clinic population

Background/introduction Trichomonas vaginalis is prevalent in patients of black ethnicity in our south London population. Nucleic acid amplification testing (NAAT) is the diagnostic gold standard, and first-line treatment with metronidazole or tinidazole regimens thought to achieve comparable cure rates >90%. Test of cure (TOC) is recommended if symptoms persist following treatment, but this overlooks persistent asymptomatic infection and optimal timing and testing modality are uncertain. Aim(s)/objectives To estimate clinical cure and TV eradication rates in a large cohort of T. vaginalis cases. Methods All positive T. vaginalis NAAT results (TV TMA, Hologic) were identified between January 2013 and September 2015. Data were collected from our electronic patient record system, including clinical features, treatment regimen and TOC results, if performed. Results 557 cases were identified in 500 patients (78.2% female; 82.2% Black African/Caribbean/mixed ethnicity; 8.8% HIV+). Infection was symptomatic in 47.3% (53.7% females, 24.5% males). Baseline wet mount microscopy was positive in 65.6%.TOC was performed in 72.4% (median time to TOC 4.1 weeks, IQR 2.3–7.6 weeks). 77.2% demonstrated parasitological clearance following a single treatment course. Cure rates were 70–80 for all regimens, significantly higher in males (85.5% vs 66.9%, p Discussion/conclusion We see a significant asymptomatic, microscopy-negative burden of T. vaginalis infection. Lower clearance rates in women suggest azole-resistant strains may be prevalent. Based on NAAT results, cure rates are lower than expected, and relatively constant TMA positivity rate beyond 2 weeks suggests treatment failure is responsible rather than re-infection or timing of TOC. Further UK studies on treatment efficacy and molecular epidemiology are warranted.

P136 Is 7 days of doxycycline enough for the treatment of LGV?

Background Current treatment recommendations for lymphogranuloma venereum (LGV) are for 21 days of doxycycline but the evidence is limited. Aims To describe clinical outcomes in MSM treated with short-course doxycycline for rectal Chlamydia, subsequently proven to be LGV. Methods We reviewed all MSM who received 7–14 days of doxycycline but tested positive for LGV between Dec 2012 – Jan 2016. Clinical features and test of cure (TOC) results were tabulated. Results Thirty-three MSM with LGV were included. Median age was 35 (range 25–57), 88% were HIV positive and all tested positive for LGV-specific DNA in the rectum. Only 18/33 (55%) had ano-rectal symptoms including pain, bleeding, tenesmus, discharge, constipation, diarrhoea and ulceration. The remainder were asymptomatic or had genital symptoms. 24/33 (73%) were treated with 7 days of doxycycline, 8 (25%) with 14 days, and 1 patient received azithromycin 1g stat; 20 patients also received ceftriaxone 500mg. 100% (32/32) of patients treated with doxycycline had a negative TOC at a median 28 days (range 14–200). Of these, 1 patient had an initial positive rectal chlamydia TOC but this was LGV negative. The patient treated with azithromycin had a positive TOC at 24 days and remained symptomatic, representing treatment failure. Discussion/conclusion This case series suggests efficacy for short-course doxycycline for both symptomatic and asymptomatic rectal LGV with no treatment failures seen. Current BASHH Chlamydia guidelines suggest 21 days of doxycycline should be considered if no LGV test is done. Our data suggest this is not warranted but further prospective studies are needed.

P057 Neisseria gonorrhoea (GC): Persistence of DNA detection after successful therapy and changing pattern of antibiotic sensitivity, 2007–2015: Abstract P057 Table 1

Background/introduction Nucleic acid amplification testing (NAAT) is widely used in GUM clinics to diagnose GC infection; its in-built high sensitivity may potentially detect DNA from non-viable organisms following successful treatment. The BASHH national guidelines stipulate that test-of-cure (TOC) with NAAT should take place 2 weeks post-treatment. The purpose of this study was to determine whether this is an adequate time interval to perform TOC. We also analysed the changing pattern of antibiotic sensitivity between 2007–2015. Aim(s)/objectives All GC cases at our clinic between 1st January and 30th June in 2007–2015 were identified and assessed for antibiotic sensitivity and TOC. Methods In 2015 there were 151 cases; culture and sensitivity results were available for 99 cases. TOC with NAAT was done in 81 cases. There were 10 cases where the NAAT was SDA positive but PCR negative. Overall a TOC with NAAT was performed between 7 and 50 days post-treatment with a mean, median and mode of 17, 14 and 14 days respectively. Conclusion None of the cultures were resistant to ceftriaxone. However prevalence of multi-drug resistance in N.gonorrhoea has shown gradual decline from 27% in 2007 to 8% in 2013. The trend has reversed in 2014 with increasing multi-drug resistance to 26% in 2015. Since 2013 I have also looked at the persistence of DNA detection following successful therapy and this supports the BASHH Guidelines of TOC 2 weeks post treatment.

P197 Evaluation of the clinical utility of the Becton Dickinson ProbeTec Qx (BDQ)Trichomonas vaginalismolecular detection test in two large, urban GU medicine services

Background BASHH guidelines recommend molecular tests to aid diagnosis of Trichomonas vaginalis (TV), but many clinics use relatively insensitive techniques (pH, wet-prep microscopy (WPM) and culture). Objectives To establish a laboratory pathway for TV testing with the BDQ assay, determine TV prevalence, and identify variables associated with TV detection. Methods A prospective study of 900 women attending clinics for STI testing was undertaken. All were offered TV BDQ tests. Data collected: demographics, symptoms, results of near-patient tests and BDQ for TV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Women with any positive TV result were treated and invited to attend for test of cure (TOC). Data were collected in Excel and analysed in SPSS. Results 891 women had a TV BDQ test. 472 (53%) were white, 143 (16%) black; median age 28yrs. 499 (55%) were symptomatic. Infections detected by BDQ: 11 TV (1.2%), 3 GC (0.3%) and 44 CT (4.9%). Of BDQ+ TV infections: 8 (73%) black, 7 (64%) symptomatic, 4/7 (57%) WPM+, 4/4 (100%) pH > 4.5, 7/7 (100%) Hay-Ison Grade 2, and 1/3 (33%) TV culture+. Mean BDQ turn-around time: 3.44 days. All received treatment. 9/9 (100%) were BDQ negative at TOC (mean time to TOC 15 days (range: 7–42). In univariate analysis, only black ethnicity was associated with likelihood of TV BDQ+ (RR 10.2 [95%CI 2.15–48.4]). Discussion The use of the BDQ enhanced detection of TV in asymptomatic and symptomatic populations. Cost effective implementation of the test will rely upon further work to reliably detect demographic and clinical variables that predict positivity.

Colposcopists’ experiences of HPV Test of Cure for the follow up of cervical intra-epithelial neoplasia

ObjectiveTo survey lead colposcopists in England to explore their views on the recently introduced HPV Test of Cure (TOC) following treatment for cervical intra-epithelial neoplasia (CIN) and to determine the extent to which it has impacted their clinical practice and affected their patients. MethodsAn online survey was sent to lead colposcopists across England. Questions were asked focusing on the clinicians’ confidence in the ability of TOC to guide follow up in various clinical scenarios and how the implementation of TOC had changed patient management. ResultsThere was a 50% (N=88) response rate. 90% of respondents indicated they were happy with the new procedure. In the follow-up questions, 20% indicated they were uncomfortable with the procedure when it was applied to women who were CIN2+ with incomplete excision at the endocervical margin. Open-ended questions elicited positive aspects of TOC including reduced follow-up, increased reassurance for patients and clinicians and a faster return to the call–recall system. Negative observations included concerns around HPV positive cases, possible false negatives and anxiety in those women who were originally subject to the pre-TOC guidelines and were now returned to call–recall “earlier” than originally indicated to them. 11% of respondents also indicated they work around the new guidelines to some extent. ConclusionAlthough clinicians are on the whole positive towards the introduction of TOC, concerns were raised which centre primarily around those patients with CIN2+ combined with positive endocervical margins, issues related to HPV positive cases and the possibility of a false negative HPV result. The possibility of patient anxiety due to return to routine screening earlier than originally expected was also identified as a concern.