Rationalization of microscopy in the detection of Neisseria gonorrhoeae in women

This study looks at the sensitivity of microscopy in the diagnosis of Neisseria gonorrhoeae (NG), the effect of microscopy on time to treatment of NG and the added value of microscopy in the management of gonorrhoea. Women diagnosed with NG at an inner city genitourinary (GU) medicine clinic between August 2005 and July 2006 were identified and the notes reviewed. There were 103 women who were culture positive for NG. The sensitivity of microscopy was 38%. Microscopy is a point of care test (POCT) and in this group, it facilitated the treatment of 19% ( n=20) of cases of NG infection at the first visit to a GU medicine service. If a POCT is not available, this would result in delayed treatment (32% of patients waited longer than 14 days and 3% did not return for treatment). In total, 29% of women did not return for test of cure, therefore confirming that effective first-line therapy is essential in the treatment of N. gonorrhoeae.

Introduction of a nurse-led sexual health service for HIV-positive men

A nurse-led clinic offering screening for sexual infections to men within an existing HIV outpatient service was created. A retrospective case-note review was undertaken of those having a sexual health (SH) screen between May and December 2007. A total of 125 men had an SH screen, 117 identified as men who have sex with men and 84 were asymptomatic. Six (7%) asymptomatic men had chlamydial and two (2%) had gonococcal infection. Six new diagnoses of syphilis and two of hepatitis C virus infection were made. We suggest that introducing a nurse-led clinic offering SH screening within HIV services has helped to achieve national standards and improved the SH of our patients.

Partner notification in pregnant women with HIV: findings from three inner-city clinics

British HIV Association guidelines recommend that all HIV-positive pregnant women should be encouraged to disclose their HIV infection to their partner and that this should be viewed as a process rather than an event. The aim of this study was to describe local practice of partner notification (PN) and patterns of disclosure in a group of HIV-positive women in an antenatal setting. A retrospective case note and local pregnancy database review was undertaken. Women who had accessed specialist HIV antenatal care at one of three east London hospitals with an expected delivery date between 1 March 2004 and 30 June 2006 were identified. In total, 145 women were identified. HIV status had not been disclosed to a partner in 19% (n=27) of case notes reviewed. There was no documented discussion about PN in 18% (n=26) of case notes. Forty-three per cent (n=62) of case notes documented that the male partner had accessed HIV testing after PN was discussed. All HIV-positive pregnant women should have a documented discussion about PN. Concurrent HIV testing offered to both partners may improve HIV testing uptake in male partners and should be explored further. Care plans should include screening for intimate partner violence and housing problems; referral pathways should be established clearly when involving other agencies.

Integrated community-based sexual health services for young people in urban areas: are we meeting the needs of the local community?

Community-based sexual health services (SHS) are intended to improve access for people who may have difficulty attending traditional genitourinary medicine clinics. The objective of this study was to review uptake of sexually transmitted infection (STI) testing in an outreach clinic for those under 25 in an area where Black and minority ethnic groups comprise the majority of the local population. A retrospective case-notes review was undertaken of those attending. Standards were that Fraser guidelines should be completed in all under 16-year-old and all clients should be offered STI testing, HIV testing and contraception (if applicable) in accordance with local standards. One hundred and seventeen clients attended. Ten percent self-reported ethnicity was Asian. Thirty-six (31%) clients tested for chlamydia. Thirty (26%) had an HIV test. Five (14% of those tested) had a positive nucleic acid amplification test for chlamydia. Five (13%) of those requesting long term contraception had STI testing. This service has successfully improved access to STI screening. However, there may have been missed opportunities to offer tests in those requesting contraception. Under-representation of those of non-white ethnicity suggests access to SHS may be a particular problem and further work is required to improve the sexual health of the local community.

Management of survivors of sexual assault within genitourinary medicine

Summary

Survivors of sexual assault can access treatment and care within genitourinary (GU) medicine services by attending walk-in, booked or a dedicated clinic. Haven Whitechapel the local Sexual Assault Referral Centre (SARC) provides a forensic and aftercare service. A team was set up to ensure efficient communication and clear referral pathways between the centres. This service was audited after eight months of joint working. A retrospective case note review of women attending between August and March 2007 was undertaken. Sixty-nine women were referred to the dedicated clinic. Vaginal rape was reported by 80% of the women. Offer of forensic medical examination documented in 71% presenting within the forensic timeframe. Emergency contraception was offered to 75% of the women. HIV-acquisition risk was documented in 70%. Seventy-eight percent had a sexually transmitted infection screen at their first visit. An HIV test was done to 41% of the women; all were found to be negative. Sixty-two percent women attended follow-up. GU medicine staff should receive specific training in sexual assault. We recommend that GU medicine services and SARC work in partnership to improve the care of victims of sexual assault who access general GU medicine services.

Antiretroviral therapy in pregnancy: local practice in East London, UK

A review of antiretroviral prescribing, mode of delivery and pregnancy outcome was performed to assess local practice against the new British HIV Association guidelines. HIV status prior to pregnancy, antiretroviral medication, viral load, mode of delivery and pregnancy outcome were determined in 95 pregnancies recorded between 2004 and 2006 via retrospective case-note review. In total, 75% (n=71) of pregnancies resulted in live births; 56% (n=53) of pregnancies occurred in women who knew they were HIV positive prior to the current pregnancy; 49% (n=26) of them conceived on antiretroviral therapy (ART). Use of protease-inhibitor-based ART and number of normalvaginal delivery increased and the use of zidovudine (AZT) monotherapy and emergency caesarean section (CS) fell during the study period. In conclusion, there was an increase in vaginal deliveries and a reduction in the number of emergency CSs between 2004 and 2006.