This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of human papillomavirus (HPV)-related warts at anogenital sites including the external genitals, vagina, cervix, urethra, perianus and anal canal. The guideline is aimed primarily at patients aged 16 years or older presenting to healthcare professionals working in level 3 sexual health services in the United Kingdom. However, the principles of the recommendations may be applied in other care settings, including in primary care, using locally adapted care pathways where appropriate. The management of HPV-related anogenital dysplasia or warts at other extragenital sites is outside the scope of this guideline.

Background: One of the features of the BHIVA national standards of care for people living with HIV is the provision of equity of access. There is little research into patient preferences for outpatient clinic appointments however and this has been brought into sharp focus by the changes to service delivery due to the COVID-19 pandemic lockdown. This study aims to identify patient preferences for routine HIV outpatient appointments. Method: We undertook semi-structured interviews with a representative sample of current HIV patients registered with the service between March & April 2020 collecting information on preferences for attending appointments. Demographic information was obtained from clinic records. Results: 50 patients (10% of total) were randomly selected for interview. In total 41 (82%) of interviews were completed. Demographic data (Age, sex, ethnicity and sexual orientation) of those interviewed were representative of the total clinic population. The median age of respondents was 47 years (range 24-76), 23 (56%) were male, 25 (61%) were heterosexual and 25 (61%) were white British. 38 (92.7%) patients had access to a smartphone or computer with a webcam. 5 (12.2%) had difficulties travelling to clinic for outpatient appointments. Respondents also had to choose a preferred medium for consultations. 14 (34.1%) patients were happy with face to face, video or telephone modalities and had no preference. The results for the remaining 27 patients (65.8%) are tabulated below There was no significant difference in preference for virtual or face to face appointment by univariate analysis by age (above/below median), sex, ethnicity (white British vs others) Conclusion: More than half of respondents who expressed a preference preferred a virtual (telephone / video) outpatient appointment to a face-to- face appointment. Further work is required in looking at the reasons behind patient preferences and if these might change once the pandemic has ceased. HIV outpatient services should endeavour to provide a mixture of virtual and face to face appointments in future. (Table Presented).

Background/introduction Throughout healthcare settings ‘did not attend’ (DNA) rates impact heavily on service efficacy and are estimated to cost the NHS £600 m per year. Short message service (SMS) texts have been shown to reduce the DNA rates amongst Sexual Health patients. Aim(s)/objectives The aim of this project was to assess the optimum timing of SMS appointment reminders and its impact on the non-attendance rates in our HIV and Sexual Health service. Methods For three consecutive four week periods between 30/12/2013 and 06/04/2014, in addition to the routine ‘on the day’ SMS reminder an extra reminder was sent 1, 2 or 3 days prior to patient appointments. Data was collected concerning patient attendances during these periods for pre-booked appointments for HIV and Sexual Health patients. Statistical significance was calculated using Fisher’s Exact test and Pearson’s correlation coefficient as appropriate. Results Attendance was monitored for 1,271, 1,215 and 1,264 patients in each 4 week group respectively. Amongst HIV patients, DNA rates fell as the time increased between the appointment and sending the extra SMS reminder. For Sexual Health patients, DNA rates fell as the time was decreased between the appointment and the extra SMS reminder. For both patient groups the gradient of this fall was statistically significant. Discussion/conclusion This small project has demonstrated the optimum timing of SMS reminders appears different for HIV and Sexual Health patients. HIV patients had lower DNA rates when texted further from the appointment time, whereas Sexual Health patients DNA’d less often if texted nearer to their appointment. Further work is needed confirm the generalisability of our findings and reasons underpinning them.

Background Our ARV Network's 2009 audit highlighted the large proportion of patients with a CD4 count <350. A re-audit was designed to provide more information on patients with CD4 counts in this range. Methods We conducted a retrospective review of case notes for all patients in the network starting ARVs in 2010. For analysis of CD4 counts the cohort was divided into two groups; those diagnosed within 1 year of starting treatment and others. Results 114 patients started ARVs in 2010 from four centres in our network. 62 (54.4%) were male. Mean age was 38.4 years (range 17–62). Ethnicity data showed only 37.7% were white with the majority being Black (54.4%). 6 (7.0%) of 85 patients had a major NNRTI resistance mutation. Mean nadir CD4 count was 222 (range 5–610). 101 (88.6%) patients had a CD4 count under 350. 106 reasons for low CD4 count were recorded. 65 patients (64.3%) had low CD4 counts because of late diagnosis, 15 (14.8%) had declined ARV when initially offered while 10 (9.9%) had been lost to follow-up. The patients starting Rx within 1 year of diagnosis (no=67) had a lower mean nadir CD4 count compared to those diagnosed earlier (no=47) (162 cells vs 271 cells, p<0.5). There was no difference between the two groups in the number of patients having a pre-treatment resistance test, the mean CD4 rise 6 months after treatment initiation and the proportion of patients having an undetectable viral load 12 months after treatment initiation. At 6 months the mean CD4 count had risen from 222 at treatment initiation to 360, but 54 (47.4%) still had a CD4 count under 350. The main reasons for this were poor immune recovery in 80.7%, poor adherence 7%, poor attendance 5.3%. Discussion A proportion of our cohort started ARVs with a low CD4 count mainly due to late diagnosis. This is an important barrier to ARV initiation and needs to be addressed and our audit data would support the need for extra support and resources directed to earlier HIV diagnosis.

Background The national sexual health strategy recommends that services should meet the needs of local communities and identifies where service developments are needed most. The financial pressures of the health service and the operational pressures of trying to meet a 48-h target make it difficult to establish targeted outreach projects to reduce the burden of STIs and the uptake of STI/HIV screening and testing in hard to reach groups. Methods A needs assessment was carried out with relevant partner organisations and an outreach project with sexual health advisors was developed. The needs assessment identified three areas for targeted outreach: brothel services for heterosexual men, sauna for MSM and youth offender services. A health advisor outreach clinic was established and staffed 1–4 times a month. Outcome data from the clinics are presented. Results The youth offender service clinic was the most successful outreach with 32 patients seen over 17 sessions (23 males and nine females). There were 15 males tested in the sauna over 18 sessions and four female sex workers tested in two clinic sessions. STIs were identified in 20% of all patients seen (two cases of Gonorrhoea, six cases of Chlamydia, two cases of syphilis). The mean percentage of patients seen in the outreach clinics who had never been to the GUM clinic was 71% (75% in brothel, 84% in YOS, 34% from sauna). Discussion The targeted outreach has revealed a high level of STIs (20%) in the target group as assumed. The targeted outreach service should reduce the rate of STIs by appropriate treatment, partner notification and counselling. Recording of testing has missed out on the recording of educational activities and other health promotion carried out at sessions. Targeted outreach will help to improve access to those who don't normally attend, improve patient care and help reduce STIs in the community.

BackgroundAntenatal HIV testing in the UK has been a resounding success and is credited with reducing the rate of mother to child HIV transmission.AimsTo explore the characteristics of women who did not have the HIV test at booking, the reasons for declining and adherence to local policy on re-offering tests later in pregnancy. Between April 2010 and April 2011 a review of maternity case notes was carried out.Results6723 women were booked in early pregnancy in the relevant time period and 33 (0.5%) of these women did not have a documented HIV test. Notes were only available for 32 of these women.31/32 (96.8%) of the women were UK born, 27 (84.4%) partners were UK born. 11 (34.4%) women were pregnant for the first time. 13 (40.6%) women had no documentation of a HIV test within a year of booking. There was no documentation of intravenous drug use in any of the women or their partners. 7 (21.9%) women did not have any other blood borne virus testing done and none of these women had a recent documented HIV test either. Only in 8 (25%) women was there documentation of reasons for declining. 5 (12.5%) women were re-offered screening at about 28 weeks gestation in line with local policy with 4 (80%) accepting. 6 of 18 women were offered testing on admission to the labour ward and 2 (33.3%) were tested.DiscussionThe maternity unit has a policy for dealing with women declining HIV testing in pregnancy and achieved a 99.6% acceptance rate. This study shows that there are some problems with documentation of previous testing, risk assessment and consistently re-offering of the screening tests later on in pregnancy. When the test was re-offered later on in pregnancy there was a high acceptance rate emphasising the benefit of this approach. In view of these results further training of midwives with an emphasis on HIV risk assessment and re-offering testing later on in pregnancy will be implemented.

INTRODUCTION AND AIMS:This study was designed to determine whether providing an oral swab test in the community for blood borne virus testing leads to an increase in subsequent attendance for sexually transmitted infection (STI) screening at the STI clinic compared with making appointments for young people to attend the clinic for same day HIV testing and STI screening.DESIGN AND METHODS:Participants were randomised into either the oral swab test group or the blood test group of the trial if eligible.RESULTS:All the 27 participants in the oral swab test group were tested for HIV and hepatitis C compared with five for HIV and two for hepatitis C in the blood test group (P < 0.001). Only two of the 27 participants in the blood test group were tested for hepatitis B compared with 25 in the oral swab test group (P < 0.001). Nine participants in the oral swab test group attended the STI clinic for STI screening compared with three in the blood test group (P = 0.09).DISCUSSION AND CONCLUSIONS:An oral swab test in the community for blood borne virus testing leads to an increase in the number of young high-risk people tested for blood borne infections and is associated with a trend towards higher rates of subsequent attendance for STI screening.

Background Urethral swabs are uncomfortable due to the nature of the mucosa and may be a reason for non-attendance of men at sexually transmitted infection (STI) clinics. This randomised controlled trial describes the extent of discomfort associated with direct urethral sampling, and determines whether this varies by the type of swab used.Methods Male patients over the age of 16 years having swab tests were invited to participate and were randomly assigned to receive either a gonorrhoea dacron-tipped swab, a chlamydia rayon-tipped swab or a plastic 10 mu l urethral loop first for urethral sampling followed by the others sequentially. Discomfort was measured using a 0-100 mm visual analogue scale (VAS).Findings 129 men having urethral swabs carried out as part of their screening tests for STI were invited to participate in the study and 121 were recruited. The median pain scores (IQR) regardless of sampling method, before and after the urethral sampling were, first 0 mm (0-0) and 50 mm (22-71) (p<0.001), second 9 mm (0-28) and 59.5 mm (38.3-78) (p<0.001) and third 10 mm (0-31) and 58 mm (29.3-80) (p<0.001). Direct urethral sampling was associated with a median pain score of 60.5 mm using a rayon swab, 52 mm using a dacron swab and 25.5 mm using a plastic loop.Interpretation Direct urethral sampling is associated with discomfort and/or pain in men, which was significantly greater with a swab than a plastic loop. Urine should therefore be the specimen type of choice. When direct urethral sampling is indicated a loop is preferable to a urethral swab.

This study was designed to determine whether a better partner notification outcome could be achieved by giving female index patients with genital chlamydial infection a home sampling kit instead of contact slips only. Two hundred female patients attending a sexually transmitted infection clinic with a diagnosis of genital chlamydial infection were randomized to either the conventional partner notification arm using contact slips (swab testing arm) or the urine sampling kit for partner notification arm (urine testing arm). There were no differences in the number of partners treated per index case (0.67 in the swab testing group versus 0.62 in the urine testing group, P = 0.46), the median number of traceable partners and the number of index patients with at least one partner treated within 28 days. The addition of a urine testing kit to contact slips for male partners of women with genital chlamydial infection did not increase the partner notification rates for genital chlamydial infection.

The article of Garg et al. in this journal contributes to the literature on sexually transmitted infections in the Indian subcontinent by assessing the level of awareness about sexually transmitted infections in a community sample. The novel sampling method using a health camp recruited only males and had a relatively small number of participants who were mainly monogamous. This sampling bias may account for the relatively low awareness of symptoms attributable to sexually transmitted infections. An even more alarming finding was the fact that less than 40% of the participants were aware that condoms could prevent sexually transmitted infections. This should prompt the relevant health promotion campaigns focusing on the advantages of condom use for prevention of common sexually transmitted infections and HIV infection. Risk reduction interventions should remain a vital aspect of sexual health promotion; and in societies where womens power to maintain a monogamous relationship may be compromised a greater emphasis should be placed on targeting men in sexual health promotion campaigns. This study adds to the evidence base available on the level of knowledge of the general population in this area and highlights the need to focus health promotion campaigns on men as well as women. (full text)

Objective: To identify patient preferences for notification of sexual contacts when a sexually transmitted infection (STI) is diagnosed. Methods: A questionnaire survey of 2544 patients attending three large genitourinary clinics at Derby, Birmingham, and Coventry in the United Kingdom. Results: The median age of the respondents was 24 with 1474 (57.9%) women, 1835 (72.1%) white, 1826 (71.8%) single. The most favoured method of partner notification was patient referral, which was rated a “good” method by 65.8% when they had to be contacted because a sexual partner has an STI. Notifying contacts by letter as a method of provider partner notification is more acceptable than phoning, text messaging, or email. Respondents with access to mobile telephones, private emails, and private letters were more likely to rate a method of partner notification using that mode of communication as “good” compared to those without. With provider referral methods of partner notification respondents preferred to receive a letter, email, or text message asking them to contact the clinic rather than a letter, email or text message informing them that they may have an STI. Conclusion: Most respondents think that being informed directly by a partner is the best method of being notified of the risk of an STI. Some of the newer methods may not be acceptable to all but a significant minority of respondents prefer these methods of partner notification. The wording of letters, emails, or text messages when used for partner notification has an influence on the acceptability of the method and may influence success of the partner notification method. Services should be flexible enough to utilise the patients’ preferred method of partner notification.

The Obstetrician & GynaecologistVolume 8, Issue 4 p. 272-272 International Handbook of Chlamydia, 2nd edition Ade Apoola, Ade Apoola Consultant in Genitourinary Medicine Derbyshire Royal InfirmarySearch for more papers by this author Ade Apoola, Ade Apoola Consultant in Genitourinary Medicine Derbyshire Royal InfirmarySearch for more papers by this author First published: 24 January 2011 https://doi.org/10.1576/toag.8.4.272.27281AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume8, Issue4October 2006Pages 272-272 RelatedInformation

We assessed if gender and ethnicity were associated with differences in the number of patients satisfactorily treated and number of partners successfully treated for genital gonococcal infection by reviewing 400 cases. There were no differences in the rates of satisfactory treatment of gonorrhoea between men and women and the different ethnic groups. There was no difference in satisfactory partner treatment rates by ethnic origin; however, men were less likely to have their contacts satisfactorily treated within 28 days of diagnosis (odds ratio = 0.05, 95% confidence interval 0.3-0.7). This inequality may lead to difficulties in reducing the number of new gonorrhoea cases. More research is needed to find out why men behave differently from women regarding partner notification for genital gonorrhoea infection.