Relationship structure and sexual health

21 Dec 2020Registered users

Consensually nonmonogamous partnerships, including open relationships, comprise a substantial proportion of sexual relationships in the USA, a national population-based survey has concluded. It is important to be non-judgemental when eliciting sexual histories, to discuss risks and offer the right tests to the right people to minimise STI/HIV transmission.

LARC uptake increases in young women

24 Mar 2020Paid-up subscribers

There has been a significant increase in the use of long-acting reversible contraception in women under 25 over the past decade, a national survey has found. However, condoms and the oral contraceptive pill are still the most commonly used methods.

Where do patients seek help for genitourinary symptoms?

25 Nov 2019Paid-up subscribers

The majority of patients with genitourinary (GU) symptoms do not attend sexual health clinic (SHCs), although many would consult their GP, an analysis of Natsal-3 survey data has shown. Natsal-3 is a probability sample survey of sexual behaviour involving 15,162 women and men in Britain aged 16-74 years.

Gonorrhoea may be transmitted by kissing in men who have sex with men

24 Oct 2019Paid-up subscribers

Men who have sex with men (MSM) may transmit oropharyngeal gonorrhoea to partners by kissing, a cross-sectional study from Australia has found.

Antiretroviral treatment in gay men minimises risk of HIV transmission

24 Jun 2019Registered users

There is effectively zero risk of HIV transmission in gay men through condomless sex when HIV viral load is adequately suppressed, the findings of the PARTNER2 study, published in the Lancet, suggest.

Adolescents face barriers to accessing sexual health information online

22 May 2019Paid-up subscribers

Teenagers are reticent to search for sexual health information online, a small qualitative study has found.

Orgasm induced by non sexual behaviour

20 Dec 2018Registered users

Orgasm may be a neuropsychological process associated with diverse forms of stimulation, according to the findings of a study published in the International Journal of Sexual Health. The investigators analysed comments from 919 individuals who responded to an anonymous post in 2013 on the website PostSecret.com. The individual, unknown to the research team, described having an orgasm during exercise. The respondents posted comments about their own experiences of non genital/non sexual orgasms.

GP training programme improves HIV testing rates

22 Nov 2018Registered users

Sexual Health in Practice (SHIP), an educational programme tailored to general practice, increased GPs’ rates of HIV testing.

Intrauterine device use associated with reduced risk of cervical cancer

22 Oct 2018Registered users

Women who had used an intrauterine contraceptive device (IUD) were found to have a lower risk of cancer of the cervix in a systematic review and meta-analysis.

Patients at risk of STIs not attending sexual health services

25 Jul 2018Registered users

More than 80% of women and nearly 90% of men who reported having unsafe sex in the past year did not consult sexual health services, findings from the third National Sexual Attitudes and Lifestyles (Natsal 3) study have shown.

Exploring the barriers to fitting IUCDs in primary care

25 Jun 2018Registered users

A general practice study has revealed a reluctance among GPs and practice nurses to fit intrauterine contraceptive devices (IUCDs). An online survey was sent to 69 practices in the south east of England and 208 individuals responded. More than two-thirds of the respondents were GPs and nearly a third were nurses. When asked about statements relating to potential barriers to providing or recommending IUCDs, respondents who were not trained to fit IUCDs were more likely to identify with more barriers than those who had been trained.

Composition of vaginal microbiota may increase risk of chlamydia infection

22 May 2018Paid-up subscribers

 Lactobacillus iners-dominated vaginal microbiota was associated with increased susceptibility to Chlamydia trachomatis infection in women, in a Dutch nested case-control study.

Self-taken swabs can detect bacterial vaginosis and candidiasis

23 Jan 2018Registered users

Lower vaginal swabs taken by patients are as reliable as high vaginal swabs taken by clinicians for the detection of vulvovaginal candidiasis or bacterial vaginosis, a UK study has shown.

Dyspareunia in women associated with physical and mental health conditions

23 Nov 2017Paid-up subscribers

The third National Survey of Sexual Attitudes and Lifestyles in Britain (Natsal-3) has found a strong association between women reporting painful sex and poor physical health and depressive symptoms.

Chlamydia and HIV testing for young people in primary care

22 Jun 2017Registered users

Young men and women would be happy to be offered chlamydia screening, contraception and HIV tests from GPs, a UK study has shown.

GP vs clinic care for people living with HIV

22 Mar 2017Registered users

Around 60% of people living with HIV would choose GP care in preference to an HIV clinic, a UK study has found.

Exploring risk-taking behaviour for STIs in middle age

22 Feb 2017Paid-up subscribers

Sexually transmitted infection (STI) rates are increasing in the over 45 age group. However, feelings of guilt, embarrassment about age and stigma attached to STIs may deter middle-aged people from consulting sexual health services, a UK study has found.

Saliva may be a vehicle for gonorrhoea transmission.

15 Dec 2016Registered users

Almost half of men who have sex with men (MSM) with positive cultures for gonorrhoea from the pharnyx also had positive saliva samples, in a study from Australia, suggesting that saliva may act as a vehicle for transmission of the infection.

Lidocaine spray reduces pain during IUD insertion

23 May 2016Registered users

Women treated with a 10% lidocaine spray during IUD insertion suffered significantly less pain than those treated with a placebo spray in a randomised, double-blind, placebo-controlled trial of 200 women.

Does vasectomy affect sexual function?

28 Apr 2016Registered users

Vasectomy does not appear to be associated with reduced sexual activity, a large study from the United States has found. The study authors used the National Survey of Family Growth (NSFG) dataset comprising 7,643 women and 4,928 men.

Recreational use of drugs to enhance sexual performance

21 Mar 2016Registered users

Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) have revealed that a substantial minority of people in Britain have used medication recreationally to enhance sexual performance.

Is mine a normal size doctor?

22 Dec 2015Paid-up subscribers

Healthcare professionals may be asked by men nervous about their penis size whether they are normal. However, we are not able to offer much in terms of reassurance because there is very little information about the normal distribution of penis length based on objective measurements on a large enough number of men to make it representative. This systematic review aimed to produce a nomogram which shows the normal distribution of penis measurements.

Shortfalls in primary care management of HIV

25 Nov 2015Paid-up subscribers

A case notes review from general practices in inner London has shown that there is still room for improvement in the management of patients with HIV, particularly in the coding of ART, prescribing of drugs with potential interactions and timely diagnosis. A total of 31 out of 44 (70.5%) GP surgeries in Hackney took part in the study. Representatives from each practice performed a retrospective case notes review.

How well do GPs manage STIs?

21 Oct 2015Paid-up subscribers

General practice makes an important contribution to the diagnosis and management of chlamydia and gonorrhoea infections in England, a population-based study has found. However, although most patients diagnosed with chlamydia were managed appropriately, many patients with gonorrhoea were treated with antimicrobials that are no longer recommended.

Is rapid HIV testing effective in primary care?

05 Aug 2015Paid-up subscribers

An educational outreach programme promoting opt-out rapid HIV testing of new practice registrants led to increased rates of HIV diagnosis but there was no significant difference in the proportion having low CD4 counts at diagnosis. The study was based in Hackney, an area of London with a diagnosed HIV prevalence of 8 per 1,000. Practices were randomised into two groups. The intervention group received a practice-based outreach educational programme with follow-up training, integrated rapid HIV testing into the registration health check, provided free rapid HIV tests and were paid £10 per test completed.

Identifying factors associated with unplanned pregnancy

22 Jun 2015Paid-up subscribers

More than six out of ten unplanned pregnancies in Britain occur in women aged 20-34 years, a national study has found. Age under 16 at first intercourse, smoking and low educational attainment were all associated with unplanned pregnancy. This study was part of the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) which uses a stratified probability sample of 15,162 men and women aged 16-74 years in Britain.

Domestic violence and termination of pregnancy

21 May 2015Paid-up subscribers

One in six women requesting a termination has suffered domestic violence during their lifetime and 4% during the current pregnancy, a study from a London clinic has found.

How do patients with STIs inform their partners?

23 Mar 2015Paid-up subscribers

Most patients with STIs prefer to inform their partners by telephone or face to face, a study from Australia has found. Patients diagnosed with a bacterial STI at the Sydney Sexual Health Centre, over a three-month period in 2010, were studied. Data were extracted on: age, gender, bacterial STI diagnosed, number of sexual partners identified at the treatment visit, number of partners the index case was able to notify, methods used for partner notification and the known outcomes of notification. There were 224 patients diagnosed with one or more of gonorrhoea, chlamydia and infectious syphilis.

Hormonal contraception use and acquisition of HIV

23 Feb 2015Paid-up subscribers

There is a small increased risk of HIV infection in women using depot hormonal contraception, a meta-analysis of studies from Sub-Saharan countries has found. No increased risk was seen for users of oral contraception in the general population.

Gay men who use GSN apps to find partners at greater risk of STIs

22 Jan 2015Paid-up subscribers

Men who have sex with men (MSM) who use geosocial networking applications (GSN apps) to find partners may have a higher risk of chlamydia and gonorrhoea infection, findings from a US study suggest.  The MSM, who identified themselves as HIV negative, were recruited from two STI testing and treatment sites in Los Angeles from August 2011 to January 2013.

Hormonal contraceptive prescribing in teenagers rises

22 Jan 2015Paid-up subscribers

Use of hormonal contraceptives by adolescents has increased over the past decade, a  UK national retrospective cohort study has found. Data were obtained from the IMS Disease Analyzer (IMS DA) database, on girls aged 12-18 years who had had at least one prescription for a contraceptive drug between 1 January 2002 and 31 December 2011.

Could HPV infection be transmitted by the use of vibrators?

15 Dec 2014Paid-up subscribers

Human papilloma virus (HPV) was detected on vibrators 24 hours after cleaning, in a small study in the United States. This finding suggests that shared use of sex toys could lead to transmission of HPV. Women aged 18 to 29 were recruited as part of a larger study looking into the sexual behaviour of women who have sex with women and men. A total of 28 women were recruited and 20 consented to participate.

Exploring women’s reasons for requesting termination

24 Nov 2014Paid-up subscribers

Financial concerns followed by contraceptive failure were the reasons most frequently cited by women requesting a termination in a study from the NE of England. A total of 274 women attending a termination of pregnancy (TOP) pre-assessment clinic at Hull Royal Infirmary answered a confidential, anonymous, self-administered questionnaire between January 2011 and November 2012.

Could urine testing be used to detect cervical HPV infection?

23 Oct 2014Paid-up subscribers

Urine sampling could potentially become an acceptable alternative to conventional cervical cytology for detecting cervical human papilloma virus (HPV), a systematic review and meta-analysis suggests. A total of 16 articles reporting on 14 studies, covering 1,443 women, were included in the meta-analysis.

Catheters may affect patients’ sexual function

25 Jul 2014Paid-up subscribers

Urinary catheters can have adverse effects on body image and sexual function, a qualitative study has revealed. A total of 36 individuals, aged 22 to 96, who had used an indwelling urinary catheter for three months or longer were interviewed. Two thirds of the participants were men. Most (22) of the patients had catheters because of a neurological condition; the second most common reason was cancer (prostate, bowel and uterus).

Improving chlamydia screening in primary care

23 Jun 2014Registered users

Use of a structured intervention can double the rate of chlamydia screening in practices, a UK study has found. A prospective, cluster randomised controlled trial tested whether using the components of the theory of planned behaviour (TPB) improved chlamydia screening rates in general practices. Practices were recruited from 11 primary care trusts (PCTs) in SW England from 2009 to 2011.

Has the QOF influenced GP prescribing of LARC?

22 May 2014Registered users

Prescribing of long-acting reversible contraception (LARC) in primary care rose after introduction of the new QOF contraception indicators in 2009, a study has shown. Quarterly prescribing (PACT) data were used from a random sample of 581 general practices in England from April 2007 to March 2012. [With external links to current evidence]

Patients endorse opt-out testing for HIV in primary care

20 Mar 2014Registered users

Patients like the idea of opt-out HIV testing at GP surgeries but some have concerns about confidentiality, a qualitative UK study has found. The study used focus groups drawn from Brighton, which has a diagnosed HIV prevalence of 7.59 per 1,000 patients, to elicit attitudes and concerns regarding HIV opt-out testing. [With external links to current evidence]

Exploring women’s misconceptions about IUDs

24 Feb 2014Registered users

Myths and misconceptions about intrauterine contraception abound, a study in women seeking termination of pregnancy has shown. This study took place at the Royal Infirmary of Edinburgh which provides up to 80% of abortion services in Lothian, Scotland. Women undergoing abortion were recruited to complete a short questionnaire regarding their beliefs about intrauterine contraception. [With external links to the current evidence base]

Comparing venous thrombosis risk in COCPs

22 Jan 2014Registered users

Both the progestogen used and the dose of ethinylestradiol affect the venous thrombosis risk associated with combined oral contraceptive pills (COCPs), a systematic review and network meta-analysis has found. A total of 3,110 publications were retrieved of which only 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two cohorts was 1.9 and 3.7 per 10,000 woman-years which is consistent with previously reported rates of 1-6 per 10,000 woman-years. COCP use increased the venous thrombosis risk compared with non-use, relative risk (RR) 3.5, (95% CI:2.9 to 4.3). All preparations were associated with more than a two-fold increased risk of venous thrombosis compared with non-use. [With external links to the current evidence base]

Do rapid HIV tests improve frequency of testing?

23 Oct 2013Registered users

Rapid HIV tests did not result in a sustained increase in testing, although the rate of initial HIV testing increased by a third in a study of men who have sex with men (MSM).This non-blinded randomised control study was based in the Melbourne Sexual Health Centre. The men were aged >18, reported having sex with a man within the previous year, had had a negative HIV test within the previous two years, and were attending for clinical care. [With external links to current evidence]

Exploring young women’s reasons for choosing an IUS

23 Sep 2013Registered users

More than a third of young women who decided to have an IUS inserted did so because they felt it was a ‘fit and forget’ method of contraception, a study from a university-based practice in the UK has found. Almost a quarter chose the method because they had had problems with oral contraception and one in ten cited the non-contraceptive benefits. [With external links to the current evidence base]

Which indicator conditions predict HIV?

25 Jul 2013Registered users

A UK study using The Health Improvement Network (THIN) database to identify symptoms and clinical diagnoses associated with HIV infection has assessed their predictive value in diagnosing HIV in primary care. The THIN database contains anonymised patient records from 386 UK general practices; these include sociodemographic data, diagnoses, treatments, clinical measurements, laboratory results, secondary care referrals and hospital diagnoses. [With external links to current evidence]

Genital warts decline in wake of HPV vaccination

24 Jun 2013Paid-up subscribers

A large study from Australia has demonstrated a significant reduction in genital warts following introduction of the quadrivalent HPV vaccination programme in mid-2007. Eight sexual health services provided retrospective data from 2004 to 2011. Data were collected on demographics, sexual behaviour and diagnosis of genital warts; two large clinics also collected self-reported HPV vaccination status of new patients from 2009. The number of patients diagnosed with new genital warts was presented as a proportion of new patients seen. The proportion of Australian born patients who tested positive for chlamydia was used as a comparison.

What do patients look for in STI testing services?

25 Apr 2013Registered users

Perceived level of expertise is a key factor influencing patients’ decision to attend GUM clinics rather than general practice for STI testing, a qualitative study has found. Waiting arrangements and method of receiving results were also important factors in selecting a service. [With external links to current evidence]

Improving screening for chlamydia in primary care

21 Mar 2013Paid-up subscribers

Financial incentives combined with practice-based support, audit and feedback helped improve GP screening rates for chlamydia in practices in South London.

Educational intervention increases HIV testing in primary care

28 Jan 2013Paid-up subscribers

Training GPs and practice nurses using a multifaceted educational intervention can improve HIV testing rates in general practice, a longitudinal study has found. Sexual Health in Practice (SHIP) addresses the barriers to HIV testing and teaches a systematic clinical approach to testing. It covers four situations where HIV tests may be offered: patient request; opportunistic testing for those found to be high risk through history taking; diagnostic testing for those with relevant symptoms; and screening. SHIP training, which aims to attract GPs and practice nurses irrespective of whether they have an interest in sexual health, was commissioned by Haringey PCT in North London. [With external links to current evidence]

Exploring staff attitudes to providing HIV testing outside specialist areas

30 Oct 2012Registered users

Staff perceptions about the time needed to carry out HIV testing and to manage the results appear to be the main barriers to expanding testing to non-traditional settings, the qualitative arm of the HINTS study has found. Many healthcare staff also had preconceptions about patients’ attitudes to testing which were not borne out when patients were asked their views. Focus groups were conducted in the pre- and post-testing phases. Four themes emerged from the focus group discussions: stigma of HIV; targeted versus routine testing; special skills and operational issues. [With external links to current evidence]

Patients willing to accept HIV tests in different clinical settings

30 Oct 2012Registered users

The majority of patients across all sociodemographic groups are happy to be offered HIV tests irrespective of the clinical setting, the HINTS study has found. The study was set in four locations in London where diagnosed HIV prevalence exceeds 2 per 1,000: an emergency department (ED), an acute care unit (ACU), a dermatology outpatient clinic (OPD), and a large primary care centre (PC). In the first three settings, tests were offered by seconded local sexual health and permanent staff and a small number of non-clinical staff; only GPs were involved in the PC arm. [With external links to current evidence]

Diagnosing HIV in patients with glandular fever like symptoms

20 Sep 2012Paid-up subscribers

Offering HIV tests to patients who present with glandular fever-like illness would improve the detection rate of HIV, a primary care study has shown. The prevalence of HIV infection in patients presenting with glandular fever-like illness in practices in Lambeth and Southwark was studied. Samples submitted to the local laboratory for a glandular fever screen between April 2009 and June 2010, with and without a concomitant HIV request, were anonymised and retrospectively tested for HIV. [With external links to current evidence]

High HPV prevalence found in young women

20 Jun 2012Paid-up subscribers

Sexually transmissible HPV infection is highly prevalent in the British population, particularly among young women, the second National Survey of Sexual Attitudes and Lifestyles (Natsal-2) has revealed. HPV DNA was detected in 29% of urine samples from women and 17% of samples from men. Natsal-2 used a probability sample of the population aged 16-44 years, resident in Britain. A total of 11,161 people were interviewed for the study.

GPs could play a key role in shared HIV care

25 Apr 2012Registered users

Primary care teams can make a valuable contribution to counselling, testing and treatment for HIV, a systematic review has shown. The authors looked at various shared-care models of HIV involving primary and secondary care. [With external links to current evidence]

Genital warts fall following quadrivalent HPV programme

24 Jan 2012Registered users

The number of new cases of genital warts in women and heterosexual men under 21 has fallen dramatically in Melbourne in the wake of the Australian HPV vaccination programme using a quadrivalent vaccine.

Female genitalia images may affect women’s perception of normality

16 Dec 2011Registered users

NHS-funded cosmetic surgery on female genitalia increased from 400 to 1,100 procedures between 2002 and 2008. Most operations were to reduce protuberance of labia minora from between the labia majora. Morphology of female genitalia may vary. A woman may be aware of such variability from seeing other people’s bodies or looking at pictures and films. These may contribute to a concept of what is normal and in part to women’s anxieties about their own bodies. The authors looked at differences in female genitalia from three genres of imagery: online pornography, textbooks and feminist publications. Dr Richard Ma comments: 'GPs may be used to dealing with men who present with anxieties about erectile difficulties and penis size; however, we may be less able to deal with women with anxieties about genital morphology as they tend not to present as often. This paper helps us to understand some of the causes of these anxieties and aids our own understanding of the norm.'

GUM clinics show wide regional variation in distribution

22 Nov 2011Registered users

The vast majority of the population in England live within 30 minutes of their nearest GUM clinic, only 3% have to travel further. However, there is a wide variation in geographical distribution with more difficult access in the South West and eastern regions.  Writes Richard Ma: 'Despite apparently good access to sexual health services for the majority of the population, levels of STIs, unplanned pregnancies and HIV remain high. According to this paper, no one in London has to travel more than 30 minutes to a GUM clinic and yet it has high rates of unplanned pregnancies, STIs and HIV. One explanation is that even if a clinic is within 30 minutes’ travelling time, those who need the service most may not access it; also, someone who may benefit from a sexual health screen may not travel to a GUM clinic. It remains inequitable that some GPs offer a full range of sexual health services whereas others do not. Although timely access and close proximity may address sexual health needs, commissioners may need to work on improving the coverage of sexual health services in non-GUM settings such as general practice, community contraceptive clinics, youth services and pharmacies, where people are more likely to be offered a check-up opportunistically when they attend for another reason.'

Testing for gonorrhoea in the community

19 Oct 2011Registered users

The prevalence of Neisseria gonorrhoeae (GC) in young people, aged 15-24, was found to be 0.47% in a study carried out in the community.

Although not part of the National Chlamydia Screening Programme (NCSP), some areas under the programme provide screening for gonorrhoea as well. The number of tests for Chlamydia trachomatis (CT) and GC were obtained from five NCSP areas providing dual testing. Four areas introduced testing in 2007 and the fifth in 2008. Two of these areas were outside London and the rest within Greater London. The period of data collection was not stated. A total of 219,412 samples were tested from the five programme areas. The percentage of CT-positive samples ranged from 2.7% to 9.2%, GC positivity ranged from 0.2% to 2.1% which is consistent with other prevalence studies. CT positivity was higher outside London but that of GC varied; one London programme area consistently had the highest CT and GC positivities.

Which GP and patient characteristics influence HIV testing?

19 Sep 2011Paid-up subscribers

GPs who are under 35 and working in metropolitan areas are more likely to offer HIV tests, a study from Australia has found. Patients deemed to be at risk by their GP or who present for screening are most likely to be tested. The study used data from a cross-sectional, national survey of GP activity called BEACH (Bettering the Evaluation and Care of Health). This database has been running since 2000; each year, approximately 1,000 GPs from a national, rolling sample are recruited. [With external links to current evidence]

Which patients are being screened for chlamydia?

08 Aug 2011Registered users

The National Chlamydia Screening Programme (NCSP) appears to be reaching young people at increased risk of chlamydia, according to a recent study. Says Dr Richard Ma, commenting on the study, 'While it might be difficult to imagine GPs and nurses offering chlamydia screening to any 18-24 year old they see, they might be more likely to offer the test if they perceive that the young person is at higher risk of sexually transmitted infection. This may explain the differences in positivities between the NCSP and the general population.'

Patients' expectations of sexual health services in primary care often go unmet

25 May 2011Registered users

Patients who present to general practice with a suspected STI expect to be offered tests, given information and a formal referral to a GUM clinic if care is not offered on site. However, a qualitative study found that these expectations were often not met and many would prefer to be treated at a GUM clinic in future. 'It is refreshing to see that the public chose to see their GP in the first instance for sexual health matters. They expected their sexual histories to be explored, genital examinations to be done, and tests for STI and HIV to be offered. It is unfortunate, however, that some of the patients did not get what they wanted from general practice. It feels to me that we as GPs sometimes create barriers so that people do not get the care they need and it doesn't just apply to sexual health. It is the old chestnut: PUNs and DENs - patients' unmet needs might be doctors' educational needs. Let's try to do something about it.'

Tailoring contraceptive services to young people

25 May 2011Registered users

Anonymity and confidentiality are the key priorities for young people using contraceptive health services, a systematic review has found. Non-judgemental staff and accessibility are also deemed important. [With external links to current evidence]

Risk factors for chlamydia infection in contacts

23 Mar 2011Registered users

 Young age, having sex more than once with the infected partner, and a greater number of partners are all risk factors for chlamydia in contacts, a study from a GUM clinic has shown. A questionnaire-based, cross-sectional study was carried out using contacts of chlamydia cases attending a GUM clinic in Leicester. Only those who were verified as a contact case and willing to have a chlamydia test were included. 'This study is too small to trigger any changes to current practice. Larger studies are needed to weigh up the risks and benefits of switching to a policy of offering epidemiological treatment just to high-risk contacts, the researchers conclude. However, this study helps to reinforce the importance of partner notification as an important tool to reduce onward infection of STIs such as chlamydia. Not only do we need to convey the importance to the index case that their partners need testing and treatment, but we also need to remember to test and treat the partners if they present to us in general practice.'

Epididymo-orchitis managed syndromically in primary care

21 Feb 2011Registered users

Many men presenting with epididymo-orchitis in general practice are being prescribed antibiotics but not undergoing investigation, a large UK study has found. Information from the General Practice Research Database (GPRD), which contains anonymised longitudinal patient records from 460 general practices, was used to estimate the incidence of epididymo-orchitis in primary care between 2003 and 2008 and examine the management of patients with this condition. Men aged 15-60 years presenting with a first episode of epididymo-orchitis between 30th June 2003 and 30th June 2008 were included. Aspects of management assessed included: testing for STIs or UTIs, treatment using specific antibiotics for epididymo-orchitis, evidence of referral for further care or management only within the practice. A total of 12,615 patients, median age 37 years, with a first episode of epididymo-orchitis were identified. The incidence was highest in 2004-2005 and declined in the later years of the study. The fall in incidence coincided with the roll out of the National Chlamydia Screening Programme but a causal link cannot be substantiated by this study. 'The incidence of acute epididymitis, with or without testicular involvement, is estimated to be around 40/10,000 person years in the UK. In men under 35, the likely pathogen is an STI such as chlamydia or gonorrhoea; in older men, this is likely to be due to non-sexually transmitted infections. Just under half of cases may have no identifiable cause. Effective treatment is important to avoid complications such as infertility, prostatitis and urethral strictures. Cases related to STIs present opportunities for partner notification.'

Risk of HIV transmission from MSM undergoing treatment

21 Feb 2011Registered users

There is a one in five risk of  men who have sex with men (MSM) being treated for HIV passing on the infection to their male partners if they do not use condoms. Using data from a cohort of MSM in the Netherlands, researchers used mathematical modelling to predict the probability that a man will infect his uninfected male partner over the course of first-line antiretroviral treatment. [With external links to current evidence]

PID guidelines not followed in primary care

24 Jan 2011Registered users

Although the management of pelvic inflammatory disease (PID) is improving in general practice, most patients are still failing to be treated according to national guidelines, a UK study has shown. The British Association of Sexual Health and HIV (BASHH) has published guidelines for the management of PID which includes tests that are routinely available in primary care and antibiotics that are easily obtained from community pharmacists. The investigators used information from the General Practice Research Database (GPRD), a database of anonymised longitudinal patient records from 460 general practices. 'A total of 3,797 women were coded as having a first episode of PID during the study period; the incidence appeared to decrease from 19.3 to 8.9/10,000 person-years. The National Chlamydia Screening Programme had just been rolled out at the beginning of the study period; in theory, screening and treating for chlamydia may prevent cases of PID but this relationship cannot be substantiated from this study alone.'

Healthcare professionals' views a barrier to HIV testing

20 Dec 2010Registered users

The attitude of doctors and healthcare administrative staff is a greater obstacle to extending HIV testing than that of patients, a study has found.This paper set out to explore the attitudes of patients to being offered HIV testing in Cornwall where the prevalence is reported as 32 per 100,000 population. [With external links to current evidence]

Point of care chlamydia tests are not reliable

24 Nov 2010Registered users

Point of care (POC) diagnostic tests for chlamydia have low sensitivity and positive predictive value, a study from the Netherlands has found. The researchers evaluated the diagnostic performance of three POC tests: Handilab-C, Biorapid CHLAMYDIA Ag test and QuickVue Chlamydia test comparing them with the nucleic acid amplification test (NAAT), the gold standard for diagnosing chlamydia. All the POC tests were commercially available and had a CE mark (Conformitée Européene). 'The authors described these tests as having ‘alarmingly poor performance' particularly in terms of sensitivity and positive predictive value; they also state that these tests are not ready for widespread use. Clearly in practice, this would result in infections being missed and unnecessary treatment for those with false-positive results.'

Can computers take sexual histories?

20 Oct 2010Registered users

Computer-assisted interviewing can encourage the disclosure of sexual risk-taking behaviour, a study has found. However, this approach was not accompanied by an increase in STI diagnoses. A total of 2,351 patients over the age of 16 with a new clinical episode attending two large sexual health clinics in central and SW London were enrolled in the trial. Patients were randomised into three arms: computer-assisted self-interview (CASI) with a touch-screen computer in private, after which a clinician assessed a computer printout of the history; computer-assisted personal interview (CAPI) where patient and clinician view the screen together but the data is input by the clinician, using the same interview schedule as in CASI; pen and paper interview (PAPI) with a clinician as per usual care completing a proforma. In the third group, data from clinic notes were transferred into same electronic format as CASI and CAPI.  'Embarrassment is a huge barrier for both doctors and patients in general practice which gets in the way of good sexual healthcare. It appears the use of computers to take sexual histories can yield more sensitive sexual behaviours, but whether patients are willing to disclose these to their GP and have them recorded in their notes might be a different matter.'

Antiretroviral therapy reduces rates of HIV-1 transmission

20 Oct 2010Registered users

Giving antiretroviral therapy (ART) to patients with HIV-1 could reduce transmission rates in the population. The Partners in Prevention HSV/HIV Transmission Study enrolled heterosexual adults from seven African countries (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia) co-infected with HIV-1 and herpes simplex virus type 2 (HSV-2), along with their HIV-1 seronegative partners. [With external links to current evidence]

Chlamydia screening needs to improve targeting of young men

20 Jul 2010Registered users

The UK's National Chlamydia Screening Programme (NCSP) is an opportunistic screening programme for chlamydia in under-25s that has been rolled out in England since 2003. All anonymised data from the NCSP from April 2006 to March 2007 were analysed in the South East region. Only 1% of men under 25 and 3% of women in this age group in the South East underwent chlamydia screening in the fourth year of the national programme. Community contraception services, youth services and general practice detected the majority of positive results in both sexes, nearly half of positive men and almost two-thirds of positive women. 'The authors suggest that a strategy that can give access to both high numbers of the target population and a wide variety of individuals needs to be developed. They call for greater engagement with general practice, contraceptive services and youth clinics - all of which can generate large volumes with relatively high positivity compared with other settings. '

Non-albicans vaginal candidiasis rates remain stable

22 Jun 2010

The widespread availability of OTC azole antifungals does not appear to have increased the incidence of resistant candida species, according to a study from the North of England. A total of 18 patients with non-albicans vaginal candidiasis were prescribed amphotericin and flucytosine vaginal cream; all were clear of their initial yeast isolate but two had persistent symptoms and had positive cultures for C. albicans which cleared with azoles.'In practice, we may see women with recurrent thrush or thrush resistant to treatment. We may treat syndromically (without any investigations) for simple cases. However, with recurrent or resistant cases, getting at least one swab that demonstrates candida and possibly another swab requesting testing specifically for Candida glabrata may help to support treatment with non-azole antifungals.'

Pharmacists selective when offering chlamydia screening with emergency contraception

22 Jun 2010Registered users

Pharmacists participating in a scheme to offer chlamydia screening to young women requesting emergency contraception (EC), did not offer it comprehensively. They were less likely to offer testing to women who were married, in a long-term relationship or who had recently been tested. 'The pharmacists surveyed here undertook specific training in sexual health and chlamydia screening in their own time and offered the service free of charge to their customers and for this they are to be commended.However, that screening was offered preferentially implies that at times they were acting expediently and at others were making value judgements. The tendency to decline to offer screening to girls under 16 is an opportunity missed. It could be argued that some screening is better than none but it does highlight the need for proper training and adequate resources if inroads into chlamydia infection are to be realised.'

Internet STI tests are unreliable

22 Jun 2010Registered users

A study of internet STI testing sites from the United States has found that the quality is variable and often poor.The authors state their concern that the quality of STI testing services was often poor and called for national regulatory control of quality to protect customers from receiving inaccurate results. However, they do not dismiss entirely the advantage of properly regulated internet-based STI testing services in a broader strategy to encourage more testing for thoseat risk. 'it is of course desirable that the public are using the internet not just to source information regarding STIs but also that they are choosing to test for STIs, especially those who are too embarrassed or unwilling to attend their GP or sexual health clinic.  Internet sites that offer STI testing services and advice may be available but they are not free and are not regulated. In UK practice, it is entirely possible for patients to use internet-based services for DIY testing at home. We should advise caution if patients choose to use these services and also if they have received test results that are negative.'

Chlamydia screening can reduce rates of pelvic inflammatory disease

18 May 2010

'While the POPI study does not prove beyond doubt the effectiveness of a chlamydia screening programme, it does prove there is some evidence that it can reduce incidence of PID. Also of interest is that it helps clinicians not to dismiss taking a sexual history in a woman who has had a chlamydia test as she might have been exposed to risks since the last test.'

HIV-positive patients consult GPs at same rate as general population

15 Jan 2010Registered users

 Patients with HIV consult their GP on a similar scale to the wider population, a large retrospective cohort study has found. The study used data from the UK General Practice Research Database (GPRD), which involved 348 practices, yielding 5,504 person-years of follow up for known HIV-positive individuals. Using the data that were available for a total of 1,438 men and 751 women recorded as HIV positive, the following were estimated: GP and nurse consultation rates for HIV patients compared with rates for the GP-registered population; the cost of GP and nurse consultations; consultation rates for selected morbidities and the proportion of prescriptions in 2005 that included a medication considered to present potential for serious adverse interactions with HIV medications. [With external links to current evidence]

HIV testing has increased in primary care

15 Jan 2010Registered users

HIV testing of men and women increased 11- and 19-fold respectively in general practice between 1995 and 2005. However, testing rates still remained relatively low. [With external links to current evidence]

Rapid HIV tests in primary care are acceptable to patients

01 Oct 2009Registered users

Current UK national guidelines recommend an increase in HIV testing in primary and secondary care settings to improve early diagnosis. However, I think for this to be successfully rolled out in primary care, there need to be adequate incentive structures in place to encourage uptake, and effort should be concentrated in areas of high HIV prevalence such as London, Brighton and other urban areas. [With external links to current evidence]

What factors influence young women's choice of contraception?

27 Aug 2009Registered users

The oral contraceptive pill (OCP) is still the contraceptive method of choice for most young women, a small study shows. Their use of, and views on, hormonal contraceptives: the OCP, progestogen-only pill and progestogen injection were explored in a qualitative study. The 20 participants were selected from a sample of a randomised trial of a school-based sex education intervention. [With external links to current evidence]

Does the type of intrauterine contraception influence vaginal flora?

01 Jun 2009Registered users

No significant difference could be shown in the development of abnormal vaginal flora in women fitted with an IUCD compared with IUS users, in a study from the UK. A total of 172 women requesting IUCD or IUS contraception were recruited to the study from contraceptive clinics between August 2000 and April 2003. In all, 78 women had a copper IUCD inserted and 94 had a progesterone-incorporated IUS. The women were assessed before and twice after fitting, using high vaginal swabs and Ison-Hay criteria for grading vaginal flora.

Risk taking behaviour linked to STIs in students

01 Jun 2009Paid-up subscribers

Having multiple partners and using recreational drugs are associated with an increased risk of STIs in students.

STI course improves GPs' practice

29 Mar 2009Paid-up subscribers

Sexual health

Women prefer primary care for contraceptive services

01 Feb 2009Paid-up subscribers

Nearly two-thirds of women use contraceptive services provided by their practice, according to a Natsal survey. Natsal is probably the most comprehensive survey of sexual health carried out on the adult British public using a sample that best represents the population (a "probability sample"). [With external links to current evidence]

HPV prevalence underestimated

01 Jul 2007Paid-up subscribers

A study from the USA reinforces the recent recommendation of the US Advisory Committee on Immunization Practices that the new human papillomavirus (HPV) vaccine should be offered to all girls aged 11 and 12.