UK Genitourinary Medicine Clinics Research Articles

2016 United Kingdom national guideline on the sexual health care of men who have sex with men.

This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.

O11 Using a professional patient mystery shop to evaluate management of recently diagnosed HSV-2, compared with data from a national questionnaire

IntroductionIn 2014, the British Association of Sexual Health and HIV updated guidelines detailing the expected management of Anogenital Herpes type 2 (HSV-2). This study aims to evaluate counselling given to patients with HSV-2 and determine how clinicians are dealing with sensitive topics that arise during these consultations.Methods210 UK Genito-Urinary Medicine (GUM) clinics were sent an anonymous questionnaire, the results of which were analysed and compared with current guidelines. A pilot mystery shopping study, involving a patient with a reported recent HSV-2 diagnosis, was performed in 3 UK GUM Clinics. Details of each consultation were graded as A (acceptable), U (unacceptable) or C (a cause for concern) by a panel of 6 experts.ResultsAnalysis of the returned questionnaires showed inconsistencies in answers between clinicians and guidelines. The advice given during the visits was graded 69.7% A, 16.8% C and 13.5% U. Staff performed well with providing emotional support and guiding patients to extra materials (84.5% A) but did significantly less well on topics such as disclosure (65.9% A, p=0.0025), transmission (71.8% A, p=0.032) and pregnancy (53.9% A, p=0.000013) (Pearson’s Chi-squared test).DiscussionThe study has exposed some short falls in clinical practice, which should be addressed by future guidelines and education events at BASHH, should they be supported by a larger-scale study. Returning anonymised data to participating clinics may allow them to deal with discrepancies in their practice.

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

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

Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey

Study designThis study investigated whether access to genitourinary medicine (GUM) clinics meets UK-recommended standards.MethodsIn January 2014 and 2015, postal questionnaires about appointment and service characteristics were sent to lead clinicians...

Prevalence and characteristics of gastrointestinal infections in men who have sex with men diagnosed with rectal chlamydia infection in the UK: an ‘unlinked anonymous’ cross-sectional study

IntroductionGastrointestinal infections (GII) can cause serious ill health and morbidity. Although primarily transmitted through faecal contamination of food or water, transmission through sexual activity is well described, especially among men...

Prevalence of hepatitis B and hepatitis C in a UK genitourinary medicine clinic.

National guidelines state that hepatitis B and C testing should be targeted to those with risk factors. However, there is little data to support this recommendation. There is also limited data of viral hepatitis prevalence in attendees at genitourinary medicine clinics. We report the prevalence of hepatitis B infection in an unselected genitourinary medicine population, and hepatitis C directed by risk assessment including all men who have sex with men. Routinely collected clinic data from statutory returns was combined with laboratory test result data. Clinical notes of those testing positive were reviewed to determine risk factors and HIV status. HBsAg was positive in 13 (0.2%) of 6020 patients and hepatitis C Ab/Ag in 12 (1.0%) of 1153. All patients who tested positive for viral hepatitis infection had risk factors that would have prompted testing under national guidelines. Five of the 12 with positive hepatitis C Ab/Ag (0.4% of those tested) tested positive for hepatitis C RNA, indicating current infection. The prevalence of hepatitis B and C were in line with previously published data. Our results do provide support for the basis of targeted testing for viral hepatitis, as stipulated in national guidelines, in that all patients testing positive had risk factors.

P170 Risk factors forMycoplasma genitaliuminfection in symptomatic males, females and men who have sex with men from three clinical settings in London: Abstract P170 Table 1

Background/introduction Mycoplasma genitalium (MG), a sexually transmitted infection (STI), is increasingly recognised as a cause of major reproductive health sequelae. Treatment has become increasingly difficult due to macrolide and fluoroquinolone antibiotic resistance. MG is not routinely tested for in most UK genitourinary medicine (GUM) clinics, and limited risk-factor data exist for infection in at-risk populations and in different anatomical sites. Aim(s)/objectives To determine risk factors for MG infection in symptomatic male and female patients accessing three London GUM clinics. Methods Patients aged ≥16 years, symptomatic of an STI (or Chlamydia, Gonorrhoea, Trichomonas vaginalis, or non-specific urethritis contact) were consented. Additional-to-routine samples provided were vulvovaginal swab (VVS) (females), first void urine (FVU) (men-who-have-sex-with-women (MSW), (men-who-have-sex-with-men (MSM)), pharyngeal and rectal swabs (MSM). Samples were tested using the FTD Urethritis Plus Test kit and positives confirmed by Polymerase Chain Reaction. Risk factors were analysed using univariate and multivariate logistic regression. Results MG was detected in: 10.7% (95% CI 7.9%–13.5%) patients; 7.9% (95% CI 4.86%–10.94%) VVS; 19.4% (95% CI 11.76%–27.04%) MSW urine; 1.6% (95% CI 0%–4.72%) MSM urine; 0% MSM pharynx; 8.1% (95% CI 1.31%–14.89%) MSM rectum. Discussion/conclusion MG positivity was highest in MSW compared to the other patient groups, with younger age being the only risk factor for infection, remaining after multivariate analysis. The presence of rectal MG despite a lack of urogenital infection in MSMs warrants further investigation with a larger cohort. Overall the results indicate high MG positivity across symptomatic male and female populations.

Comparing swabs for diagnosing chlamydia and gonorrhea in women: recent findings

Journal of Comparative Effectiveness ResearchVol. 2, No. 5 EditorialComparing swabs for diagnosing chlamydia and gonorrhea in women: recent findingsCatherine MW Stewart, Sarah A Schoeman & Janet D WilsonCatherine MW StewartThe Goodman Centre, Lance Burn Health Centre, Churchill Way, Salford, M6 5QX, UKSearch for more papers by this author, Sarah A SchoemanDepartment of Genitourinary Medicine, Leeds General Infirmary, Leeds, LS1 3EX, UKSearch for more papers by this author & Janet D Wilson* Author for correspondenceDepartment of Genitourinary Medicine, Leeds General Infirmary, Leeds, LS1 3EX, UK. Search for more papers by this authorEmail the corresponding author at janet_d.wilson@leedsth.nhs.ukPublished Online:11 Sep 2013https://doi.org/10.2217/cer.13.52AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail View articleReferences1 Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ345,e8107 (2012).Crossref, Medline, Google Scholar2 Schoeman SA, Stewart CM, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ345,e8013 (2012).Crossref, Medline, Google Scholar3 LaMontagne DS, Fenton KA, Randall S, Anderson S, Carter P. Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening. Sex. Transm. Infect.80(5),335–341 (2004).Crossref, Medline, CAS, Google Scholar4 Gaydos CA, Dwyer K, Barnes M et al. Internet-based screening for Chlamydia trachomatis to reach non-clinic populations with mailed self-administered vaginal swabs. Sex. Transm. Dis.33,451–457 (2006).Crossref, Medline, Google Scholar5 Blake DR, Maldeis N, Barnes MR et al. Cost–effectiveness of screening strategies for Chlamydia trachomatis using cervical swabs, urine and self-obtained vaginal swabs in a sexually transmitted disease clinic setting. Sex. Transm. Dis.35,649–655 (2008).Crossref, Medline, Google Scholar6 Marions L, Rotzen-Ostlund M, Grillner L et al. High occurrence of a new variant of Chlamydia trachomatis escaping diagnostic tests among STI clinic patients in Stockholm, Sweden. Sex. Transm. Dis.35,61–64 (2008).Crossref, Medline, Google Scholar7 Ison CA, Golparian D, Saunders P, Chisholm S, Unemo M. Evolution of Neisseria gonorrhoeae is a continuing challenge for molecular detection of gonorrhoea: false negative gonococcal porA mutants are spreading internationally. Sex. Transm. Infect.89(3),197–201 (2013).Crossref, Medline, Google Scholar8 CDC. CDC grand rounds: the growing threat of multidrug-resistant gonorrhoea. MMWR Morb. Mortal Wkly Rep.62,103–106 (2013).Medline, Google Scholar9 Carne CA, McClean H, Sullivan AK et al. National audit of asymptomatic screening in UK genitourinary medicine clinics: clinic policies audit. Int. J. STD AIDS21,512–515 (2010).Crossref, Medline, CAS, Google Scholar10 Van Der Pol B, Taylor SN, Liesenfeld O, Williams JA, Hook EW 3rd. Vaginal swabs are the optimal specimen for detection of genital Chlamydia trachomatis or Neisseria gonorrhoeae using the Cobas 4800 CT/NG test. Sex. Transm. Dis.40(3),247–250 (2013).Crossref, Medline, Google Scholar101 Health Protection Agency. GRASP 2011 report: the Gonococcal Resistance to Antimicrobials Surveillance Programme (2012). www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136030908Google Scholar102 General Medical Council. Good medical practice (2013). www.gmc-uk.org/Good_medical_practice___English_0313.pdf_51527435.pdfGoogle ScholarFiguresReferencesRelatedDetails Vol. 2, No. 5 Follow us on social media for the latest updates Metrics Downloaded 27 times History Published online 11 September 2013 Published in print September 2013 Information© Future Medicine LtdFinancial & competing interests disclosureThe authors were coapplicants in an unconditional research grant from Gen-Probe. JD Wilson is the lead applicant of a National Institute for Health Research for Patient Benefit grant. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.PDF download

Assessing the sexual violence services currently provided in genitourinary medicine clinics

Patients attending genitourinary medicine (GUM) clinics may disclose sexual violence (SV), including sexual assault (SA), domestic violence (DV), sexual trafficking, sex work (SW) and female genital mutilation (FGM). A BASHH...

P3.138 Increasing Asymptomatic Lymphogranuloma Venereum Infection in the UK: Results from a National Case-Finding Study

BackgroundLymphogranuloma venereum (LGV) infection is now endemic among men who have sex with men (MSM) in the UK. Control of the outbreak has relied on LGV typing and treating of...

Access to genitourinary medicine clinics: how long does it take to book an appointment by telephone?

A unique feature of genitourinary (GU) medicine clinics is that patients can book appointments themselves. The aim of this study was to assess how long it takes and the barriers that exist when making an appointment in a UK GU medicine clinic. Male and female researchers recorded the number of attempts needed to make a successful contact, how the call was dealt with, and the time taken for the call to be initially answered and then completed; 72% (479/666) of the telephone contacts were answered on the first attempt (range: 1-17). The median length of the total call was one minute 51 seconds (range: 15 seconds to eight minutes, six seconds) but male callers took a mean of 40 seconds longer to complete a call (P < 0.001), reflecting additional and often intrusive questions they were asked compared with female researchers. Care should be taken to ensure that the first point of contact with a clinic is favourable as it reflects on how an entire service may be perceived.

P116 Assessing the sexual violence services currently provided in genitourinary medicine clinics

BackgroundMany patients present to Genitourinary medicine (GUM) clinics following sexual violence (SV) occurring in circumstances including sexual assault (SA), domestic violence (DV), sex work (SW) and trafficking. BASHH has guidelines...

Young persons' access to genitourinary medicine clinics in the UK: a cross-sectional survey: Table 1

This service evaluation of genitourinary medicine (GUM) clinics in the UK was designed to quantify access for young people requesting to be seen and to establish whether they could be seen outside school hours. In December 2009 postal questionnaires were sent to all lead clinicians in UK GUM clinics asking when they expected a young person would be offered an appointment and whether it could be outside school hours. Between January and March 2010 trained male and female medical students posing as 16 year olds telephoned all GUM clinics listed on the British Association for Sexual Health and HIV website with symptomatic and asymptomatic scenarios and requested an appointment after school hours. 99% of the 152 responding clinicians estimated that an appointment would be offered within 48 h for both male and female contacts and over 90% could be seen outside school hours whether symptomatic or not. Of the 666 clinic telephone contacts, 88% were offered an appointment within two working days, and 66% were offered an after school appointment within 2 days. There was no significant difference whether the 'patient' was symptomatic or not (87% vs 86%, respectively, p=0.784) in being offered an appointment within two working days. There was variation between countries, with England performing significantly better; 94% were offered an appointment within 2 days versus 58%, 55% and 67% for Wales, Scotland and Northern Ireland, respectively. The findings would support the impact and value of process targets on service delivery.

A national audit on the management of pelvic inflammatory disease in UK genitourinary medicine clinics

The prompt and effective treatment of pelvic inflammatory disease (PID) may reduce the risk of complications such as infertility, ectopic pregnancy and pelvic pain. We conducted a national audit to investigate the treatment of women diagnosed with PID and associated rates of partner notification in genitourinary (GU) medicine clinics during 2008 and compared our results with the British Association of Sexual Health and HIV (BASHH) 2005 national guideline. Among a total of 1,105,587 female attendees, national data showed 18,421 cases of PID diagnosed in GU medicine clinics, giving an incidence of 167 cases per 10,000 attendences. We audited a national sample of 1132 PID cases for review. Of those, 504 (44.5%) received a recommended treatment regimen and 447 (39%) of named male contacts were treated. Adherence to recommended treatment and partner notification did not reach national standards.

GUM trainees and workforce planning

Workforce planning is an inexact science. Crucial information such as consultant retirement plans and the actions of trusts in developing new posts, refilling vacancies and reconfiguring services in the face of financial pressures are unknowns. ‘Liberating the NHS’1 is likely to result in far-reaching consequences for the genitourinary medicine (GUM) workforce. Pension changes may result in more immediate workforce implications. Other variables such as ‘community working’, new commissioning arrangements, development of other specialties and actions of devolved nations will take time to impact. From the Health Protection Agency's 2010 data the number of sexually transmitted infections diagnosed in UK GUM clinics is 30% higher than a decade ago and the total number of services provided by clinics are four times higher than in 2001.2 The increasing workload has not resulted in equivalent GUM consultant expansion in the last 10 years. The 2010 Royal College of Physicians (RCP) data show a 5.4% increase from 2009 to 391 consultants. The RCP consultant census provides consultant workforce data and in 2009 was completed by only 45% …

Estimating the Likely Public Health Impact of Partner Notification for a Clinical Service: An Evidence-Based Algorithm

We present the first evidence-based method for estimating public health and cost impacts of partner notification (PN) that takes account of sexual partnership type. Our algorithm uses routine clinical data, probability survey data, and transmission parameters. We propose 2 new epidemiological concepts to quantify PN impact: "[the] absolute reduction in onward transmission" and its reciprocal, "[the] number needed to treat to interrupt transmission" (i.e., the number of partners who need to be treated to interrupt 1 onward transmission). We demonstrate these concepts for 273 chlamydia cases diagnosed at a UK genitourinary medicine clinic. The number needed to treat to interrupt transmission (overall, for casual partners, and for regular partners, respectively) was 1.47, 1.11, and 2.50, respectively, for men younger than 25 years; 1.60, 0.83, and 1.25, respectively, for women younger than 25 years; 2.35, 1.39, and 2.08, respectively, for men older than 25 years; and 2.14, 0.93, and 2.08, respectively, for women older than 25 years. PN that targets casual partners, rather than regular or live-in partners, prevents more secondary transmissions per partnership; it is also more resource intensive, but the public health benefit is greater.

P5-S6.38 NICE guidance on prevention of sexually transmitted infections and under 18 conceptions; has it influenced service providers?

BackgroundNational Institute of Health and Clinical Excellence (NICE) Public Health guidance on the prevention of sexually transmitted infections and under 18s conception was produced in 2007 for implementation in sexual...

Variation in partner notification outcomes for chlamydia in UK genitourinary medicine clinics: multilevel study

ObjectivesTo compare different ways of measuring partner notification (PN) outcomes with published audit standards, examine variability between clinics and examine factors contributing to variation in PN outcomes in genitourinary medicine...

Is screening for pharyngeal Chlamydia trachomatis warranted in high-risk groups?

A recent survey reported that 36% of UK genitourinary medicine clinics offer testing for pharyngeal Chlamydia trachomatis (CT). Screening at this site is targeted at high-risk groups attending our centre, including female sex workers (FSWs) and male sex workers (MSWs). A total of 2406 patients were screened between November 2006 and October 2007. A retrospective case-note review was performed for positive cases. The prevalence of pharyngeal CT was 1.9% in both men and women. The mean number of sexual partners reported in the preceding three months was 168 and 56 for FSWs and MSWs, respectively. Lack of consistent condom use and high numbers of sexual partners identify this population as potential core transmitters of infection. While the British Association of Sexual Health and HIV (BASHH) guidelines do not recommend routine screening for pharyngeal CT, there may be a role in selected high-risk populations.

National audit of asymptomatic screening in UK genitourinary medicine clinics: case-notes audit

A national audit of screening of asymptomatic patients seen in UK genitourinary medicine clinics in 2009 was conducted against the national guidelines. Data were aggregated by regions and clinics in regions, allowing practice to be compared within and between regions, as well as to national averages and against national guidelines. The case-notes of 4428 patients were audited. Performance was over 80% against the national guidelines for screening of asymptomatic heterosexual men, men who have sex with men (MSM) and women for chlamydial, gonorrhoeal, syphilis and HIV infections. However, the recommended method of endocervical culture for gonorrhoea was performed in only 65% of women, with a further one-quarter being screened with endocervical or vulvovaginal nucleic acid amplification tests (NAATs). Although significant NAAT use for gonorrhoea was seen in all groups, testing for gonorrhoea by culture is still recommended as a first-line test on invasive samples. Over 80% of MSM, who were not known to be immune, were screened for hepatitis B. Urethral microscopy was performed in 22% of heterosexual men and 17% of MSM, and cervical microscopy in 12% of women.