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Sexually Transmitted Infections current issue



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Highlights from this issue

2018-02-20T06:25:35-08:00

Domestic violence and abuse (DVA) is a growing concern in a range of health settings, and it is increasingly recognised that enquiry by healthcare practitioners can enable pathways to earlier intervention and support. We have published a growing range of research and guidance on domestic and intimate partner violence in recent years, as practitioners have grappled with the best way to broach a sensitive issue in a busy clinical setting. This month Lyus and Masters provide a thoughtful overview1 in relation to two studies published in this issue. Sohal et al report a feasibility study of a training, support and referral intervention for DVA in two sexual health clinics2, while Horwood et al describe the staff experience of participating in a pilot of routine enquiry.3 

Starting from a different standpoint, Mathews et al explore the relationship between intimate partner violence (IPV) and partner...




T-CARQ: a BASHH trainee collaborative for audit, research and quality improvement

2018-02-20T06:25:36-08:00

Genitourinary medicine (GUM) is a relatively small and rapidly evolving specialty. The specialty is currently facing several challenges including tendering of services and changes to the GUM specialty training programme to encompass internal medicine. Due to the nature of the specialty, sexual health clinics are often run quite differently. They serve different patient groups with different clinical needs. Therefore, trainees can have variable training with inconsistent opportunities in clinical exposure, teaching and research. For example, trainees in London are exposed to a much larger HIV cohort than trainees in smaller cities, allowing them more easily to gain both clinical and research experience in this area.

The BASHH Trainees Collaborative for Audit,  Research and Quality Improvement Projects (T-CARQ) is a relatively new subgroup of ‘BASHH Doctors in Training.’ It was set up in 2015 by GUM trainees for trainees to encourage multicentre, national collaborative work. It aims to enable trainees who work...




Routine enquiry for domestic violence and abuse in sexual health settings

2018-02-20T06:25:36-08:00

Domestic violence and abuse (DVA) destroys lives. It can take many forms, including physical, sexual and psychological abuse, but at its heart is the use of power and control to deprive survivors of the right to their own bodies and futures. DVA exacts a heavy toll on the mental and physical health of survivors and their families, and for an average of two women a week, it is fatal.1

DVA is highly prevalent, particularly among women.2 It accounts for 11% of all crimes reported to police in England and Wales, and more than one in four women and around one in six men have experienced DVA since the age of 16.2 However, official figures are likely to be an underestimate, because much DVA remains hidden.2 Survivors may not disclose or report DVA out of fear for their own or their family’s safety,...




Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention

2018-02-20T06:25:36-08:00

Objectives

Sexual health and gynaecological problems are the most consistent and largest physical health differences between abused and non-abused female populations. Sexual health services are well placed to identify and support patients experiencing domestic violence and abuse (DVA). Most sexual health professionals have had minimal DVA training despite English National Institute for Health and Care Excellence recommendations. We sought to determine the feasibility of an evidence-based complex DVA training intervention in female sexual health walk-in services (IRIS ADViSE: Identification and Referral to Improve Safety whilst Assessing Domestic Violence in Sexual Health Environments).

Methods

An adaptive mixed method pilot study in the female walk-in service of two sexual health clinics. Following implementation and evaluation at site 1, the intervention was refined before implementation at site 2. The intervention comprised electronic prompts, multidisciplinary training sessions, clinic materials and simple referral pathways to IRIS ADViSE advocate-educators (AEs). The pilot lasted 7 weeks at site 1 and 12 weeks at site 2. Feasibility outcomes were to assign a supportive DVA clinical lead, an IRIS ADViSE AE employed by a local DVA service provider, adapt electronic records, develop local referral pathways, assess whether enquiry, identification and referral rates were measurable.

Results

Both sites achieved all feasibility outcomes: appointing a supportive DVA clinical lead and IRIS ADViSE AE, establishing links with a local DVA provider, adapting electronic records, developing local referral pathways and rates of enquiry, identification and referral were found to be measurable. Site 1: 10% enquiry rate (n=267), 4% identification rate (n=16) and eight AE referrals. Site 2: 61% enquiry rate (n=1090), a 7% identification rate (n=79) and eight AE referrals.

Conclusions

IRIS ADViSE can be successfully developed and implemented in sexual health clinics. It fulfils the unmet need for DVA training. Longer-term evaluation is recommended.




Assessing for domestic violence in sexual health environments: a qualitative study

2018-02-20T06:25:36-08:00

Objectives

Domestic violence and abuse (DVA) is a major clinical challenge and public health issue. Sexual health services are an important potential site of DVA intervention. The Assessing for Domestic Violence in Sexual Health Environments (ADViSE) intervention aimed to improve identification and management of DVA in sexual healthcare settings and is a modified version of the Identification and Referral to Improve Safety (IRIS) general practice programme. Our qualitative evaluation aimed to explore the experiences of staff participating in an IRIS ADViSE pilot.

Methods

Interviews were conducted with 17 sexual health clinic staff and DVA advocate workers. Interviews were audio recorded, transcribed, anonymised and analysed thematically.

Results

Staff prioritised enquiring about DVA and tailored their style of enquiry to the perceived characteristics of patients, current workload and individual clinical judgements. Responding to disclosures of abuse was divided between perceived low-risk cases (with quick onwards referral) and high-risk cases (requiring deployment of institution safeguarding procedures), which were viewed as time consuming and could create tensions with patients. Ongoing training and feedback, commissioner recognition, adequate service-level agreements and reimbursements are required to ensure sustainability and wider implementation of IRIS ADViSE.

Conclusions

Challenges of delivering and sustaining IRIS ADViSE included the varied styles of enquiry, as well as tensions and additional time pressure arising from disclosure of abuse. These can be overcome by modifying initial training, providing regular updates and stronger recognition (and resources) at policy and commissioning levels.




Cross-sectional study to evaluate Trichomonas vaginalis positivity in women tested for Neisseria gonorrhoeae and Chlamydia trachomatis, attending genitourinary medicine and primary care clinics in Bristol, South West England

2018-02-20T06:25:36-08:00

Background

Highly sensitive, commercial nucleic acid amplification tests (NAAT) for Trichomonas vaginalis have only recently been recommended for use in the UK. While testing for T. vaginalis is routine in symptomatic women attending genitourinary medicine (GUM) clinics, it is rare in asymptomatic women or those attending primary care. The aim of this study was to evaluate the positivity of T. vaginalis using a commercial NAAT, in symptomatic and asymptomatic women undergoing testing for chlamydia and gonorrhoea in GUM and primary care settings.

Methods

Samples from 9186 women undergoing chlamydia and gonorrhoea testing in South West England between May 2013 and Jan 2015 were also tested for T. vaginalis by NAAT alongside existing tests.

Results

T. vaginalis positivity using NAAT was as follows: in GUM 4.5% (24/530, symptomatic) and 1.7% (27/1584, asymptomatic); in primary care 2.7% (94/3499, symptomatic) and 1.2% (41/3573, asymptomatic). Multivariable regression found that in GUM older age, black ethnicity and deprivation were independent risk factors for T. vaginalis infection. Older age and deprivation were also risk factors in primary care. Testing women presenting with symptoms in GUM and primary care using TV NAATs is estimated to cost £260 per positive case diagnosed compared with £716 using current microbiological tests.

Conclusions

Aptima TV outperforms existing testing methods used to identify T. vaginalis infection in this population. An NAAT should be used when testing for T. vaginalis in women who present for testing with symptoms in primary care and GUM, based on test performance and cost.




Ten years transmission of the new variant of Chlamydia trachomatis in Sweden: prevalence of infections and associated complications

2018-02-20T06:25:36-08:00

Objectives

In 2006, a new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden. It has a deletion in the plasmid resulting in failed detection by the single target systems from Abbott and Roche used at that time, whereas the third system used, from Becton Dickinson (BD), detects nvCT. The proportion of nvCT was initially up to 65% in counties using Abbott/Roche systems. This study analysed the proportion of nvCT from 2007 to 2015 in four selected counties and its impact on chlamydia-associated complications.

Methods

C. trachomatis-positive specimens collected from 2007 to 2015 were analysed by a specific PCR to identify nvCT cases. Genotyping was performed by multilocus sequence typing (MLST) and ompA sequencing. Ectopic pregnancy and pelvic inflammatory disease records were extracted from the national registers.

Results

In total, 5101 C. trachomatis-positive samples were analysed. The nvCT proportion significantly decreased in the two counties using Roche systems, from 56% in 2007 to 6.5% in 2015 (p<0.001). In the two counties using BD systems, a decrease was also seen, from 19% in 2007 to 5.2% in 2015 (p<0.001). Fifteen nvCT cases from 2015 and 102 cases from 2006 to 2009 had identical MLST profiles. Counties using Roche/Abbott systems showed higher mean rates of ectopic pregnancy and pelvic inflammatory disease compared with counties using BD systems.

Conclusions

The nvCT proportion has decreased in all counties and converged to a low prevalence irrespective of previous rates. Genotyping showed that nvCT is clonal and genetically stable. Failing detection only marginally affected complication rates.




Can enhanced screening of men with a history of prior syphilis infection stem the epidemic in men who have sex with men? A mathematical modelling study

2018-02-20T06:25:36-08:00

Objectives

The aim of this study is to determine the transmission impact of using prior syphilis infection to guide a focused syphilis screening intervention among men who have sex with men (MSM).

Methods

We parameterised a deterministic model of syphilis transmission in MSM to reflect the 2011–2015 syphilis outbreak in Winnipeg, Canada. Enhanced screening of 75% of men with prior syphilis every 3 months (A) was compared with distributing equivalent number tests to all MSM (B) or those with the highest partner number (C). We compared early syphilis incidence, diagnoses and prevalence after 10 years, relative to a base case of 30% of MSM screened annually.

Results

Strategy A was expected to avert 52% of incident infections, 44% of diagnosed cases and reduce early syphilis prevalence by 89%. Strategy B had the least impact. Strategy C was most effective, averting 59% of incident cases. When screening frequency was semiannual or annual, strategy A was the most effective.

Conclusions

Enhanced screening of MSM with prior syphilis may efficiently reduce transmission, especially when identification of high-risk men via self-reported partner numbers or high-frequency screening is difficult to achieve.




Genetic transmission networks reveal the transmission patterns of HIV-1 CRF01_AE in China

2018-02-20T06:25:36-08:00

Objectives

The epidemic of HIV-1 CRF01_AE has become a major public health issue in China. This study aimed to characterise the transmission patterns of genetic networks for CRF01_AE nationwide and elucidate possible opportunities for prevention.

Methods

We isolated and conducted genetic transmission network analysis of all available CRF01_AE pol sequences (n=4704) from China in the Los Alamos HIV sequence database.

Results

A total of 1391 (29.6%) sequences were identified as belonging to 400 separate networks. Of men who have sex with men (MSM) in the networks, 93.8% were linked to other MSM and only 2.4% were linked to heterosexual women. However, 11.8% heterosexual women in the networks were linked to MSM. Lineages composed mainly of MSM had higher transmission than those that were mostly heterosexuals. Of the 1391 individuals in networks, 513 (36.9%) were linked to cases diagnosed in different provinces. The proportion of individuals involved in inter-province links was interrelated with the number of migrant people (Spearman’s r=0.738, p=0.001).

Conclusions

The outcome of this study could help improve our ability to understand HIV transmission among various regions and risk groups in China, and highlighted the importance of targeting MSM and migrants by prevention and intervention efforts.




Lactobacillus iners-dominated vaginal microbiota is associated with increased susceptibility to Chlamydia trachomatis infection in Dutch women: a case-control study

2018-02-20T06:25:36-08:00

Introduction

This prospective study aimed to study the composition and structure of the vaginal microbiota prior to Chlamydia trachomatis infection.

Methods

A nested case–control study was performed in 122 women, half of which acquired C. trachomatis within a year after their first visit. At the first visit, the composition and structure of vaginal microbial communities were analysed using 16S rRNA sequencing in the context of the sociodemographic and sexual risk behaviour information using logistic regression.

Results

Five vaginal community state types (CSTs) were identified. Four CSTs were dominated by Lactobacillus spp., of which L. crispatus (37%) and L. iners (33%) were the most common. One CST was characterised by the absence of Lactobacillus spp. (25%) and the presence of an array of strict and facultative anaerobes. Multivariate logistic regression analysis revealed that women with a L. iners-dominated CST had an increased risk of C. trachomatis infection (p=0.04; OR: 2.6, 95% CI 1.0 to 6.6).

Conclusions

The distribution of CSTs dominated by Lactobacillus spp. agreed with previous studies. However, the frequency of dysbiosis among Caucasian women was relatively high (24%). Having vaginal microbiota dominated by L. iners was associated with an increased risk for C. trachomatis infection. Therefore, we hypothesise that specific signatures of vaginal microbiota are indicative of increased host predisposition to acquiring STIs.




Population-based Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis prevalence using discarded, deidentified urine specimens previously collected for drug testing

2018-02-20T06:25:36-08:00

We used a novel method to test for STIs among a non–healthcare-seeking military population in the San Diego region of California. Active-duty US Navy and Marine Corps personnel were randomly selected to provide urine specimens to Navy Drug Screening Laboratory, San Diego in October and November 2013 for the Department of Defense drug testing programme. If specimens screened negative for drugs (>99% of samples), urine specimens were discarded, deidentified and subsequently tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and Trichomonas vaginalis (TV) using the Aptima Combo 2 and TV assay as specified by the manufacturer (Hologic, San Diego, CA, USA). The Tigris direct tube sampling system was used for high-throughput nucleic acid amplification testing (NAAT). Urine specimens older than 6 days were not tested due to sample degradation concerns.

The overall prevalence of CT was 2.1% (95% CI 1.79 to 2.36, n=205/9953), GC 0.01% (95% CI 0.00 to...




A phase II clinical study to assess the feasibility of self and partner anal examinations to detect anal canal abnormalities including anal cancer

2018-02-20T06:25:36-08:00

Objective

Anal cancer is a common cancer among men who have sex with men (MSM); however, there is no standard screening protocol for anal cancer. We conducted a phase II clinical trial to assess the feasibility of teaching MSM to recognise palpable masses in the anal canal which is a common sign of anal cancer in men.

Methods

A clinician skilled in performing digital anorectal examinations (DARE) used a pelvic manikin to train 200 MSM, aged 27–78 years, how to do a self-anal examination (SAE) for singles or a partner anal examination (PAE) for couples. The clinician then performed a DARE without immediately disclosing results, after which the man or couple performed an SAE or PAE, respectively. Percentage agreement with the clinician DARE in addition to sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the SAE, PAE and overall.

Results

Men had a median age of 52 years, 42.5% were African American and 60.5% were HIV positive. DARE detected abnormalities in 12 men while the men’s SAE/PAEs detected 9 of these. A total of 93.0% of men classified the health of their anal canal correctly (95% CI 89.5 to 96.5). Overall percentage agreement, sensitivity and specificity were 93.0%, 75.0% and 94.2%, respectively, while PPV and NPV were 45.0% and 98.3%, respectively. The six men who detected the abnormality had nodules/masses ≥3 mm in size. More than half of men (60.5%) reported never checking their anus for an abnormality; however, after performing an SAE/PAE, 93.0% said they would repeat it in the future.

Conclusion

These results suggest that tumours of ≥3 mm may be detectable by self or partner palpation among MSM and encourage further investigation given literature suggesting a high cure rate for anal cancer tumours ≤10 mm.




Use of condoms: pitfalls of retrospective case-note analysis

2018-02-20T06:25:36-08:00

In the early 1970s an American researcher suggested that condoms were ineffective in preventing STD transmission.1 Uncertain about the argument, I studied condom use in men attending our GUM department at St Thomas’ Hospital.

I addressed two potentially confounding factors: had condoms been used at every act of intercourse, ‘invariably’; and had the condom been used ‘properly’, that is, used throughout intercourse, with no unprotected genital contact before or after. The questions were asked, and the facts gathered, prospectively.

The condom and gonorrhoea2 was published in 1977 and found significantly fewer gonococcal infections among the ‘invariable’ and ‘proper’ users (but, interestingly, little difference in non-specific urethritis diagnoses). Since then there has been a profusion of papers on condoms and STI/HIV transmission but many rely on retrospective data and assume that questions about condom usage need little or no qualification.

In the 1990s, as part of...




Acceptability and ease of use of mailed HPV self-collection among infrequently screened women in North Carolina

2018-02-20T06:25:36-08:00

Objectives

Self-collection of cervico-vaginal samples for human papillomavirus (HPV) testing has the potential to make cervical cancer screening more accessible to underscreened women. We evaluated the acceptability and ease of use of home-based HPV self-collection within a diverse population of low-income, infrequently screened women.

Methods

Participants were low-income women from North Carolina who had not received Pap testing in 4 or more years. Eligible women received a self-collection kit containing instructions and a brush for home-based sample collection. A total of 227 women returned a self-collected sample by mail and completed a questionnaire to assess their experiences with HPV self-collection. We described acceptability measures and used logistic regression to identify predictors of overall positive thoughts about the self-collection experience.

Results

Nearly all women were willing to perform HPV self-collection again (98%) and were comfortable receiving the self-collection kit in the mail (99%). Overall, 81% of participants reported positive thoughts about home-based self-collection. Women with at least some college education and those who were divorced, separated or widowed were more likely to report overall positive thoughts. Aspects of self-collection that participants most commonly reported liking included convenience (53%), ease of use (32%) and privacy (23%). The most frequently reported difficulties included uncertainty that the self-collection was done correctly (16%) and difficulty inserting the self-collection brush (16%).

Conclusions

Home-based self-collection for HPV was a highly acceptable screening method among low-income, underscreened women and holds the promise to increase access to cervical cancer screening in this high-risk population.




Whole genome sequencing of Neisseria gonorrhoeae reveals transmission clusters involving patients of mixed HIV serostatus

2018-02-20T06:25:36-08:00

Objectives

Prevention and control of gonorrhoea depends on understanding the nature of sexual networks and risk factors for infection. We aimed to use high-resolution typing (whole genome sequencing (WGS)) of Neisseria gonorrhoeae isolates plus patient questionnaire data to gain insights into transmission patterns in a high prevalence setting.

Methods

During a 9-month period (July 2014–March 2015), patients diagnosed with gonorrhoea attending sexual health service in Brighton, UK, were invited to provide anonymised detailed information by questionnaire about risk factors for infection. Questionnaire data plus WGS data from cultured isolates were analysed to yield information about sexual networks and risk factors for infection.

Results

104/149 individuals who consented to participate in the study were culture positive. 97/104 (93%) were male. 80 self-reported to be men who have sex with men (MSM). 35/104 (34%) of patients were HIV positive. 51/104 (49%) individuals reported using geosocial networking applications to facilitate contact. Sex under the influence of drugs was reported by 16/34 (46%) of HIV-positive MSM, 17/41 (41%) of HIV-negative MSM and 5/15 (31%) of heterosexuals. WGS data were available for 100 isolates from 83 patients. 55 isolates (66%) belonged to genetically related subtypes involving one or more patients, who could be plausibly linked through recent direct or indirect transmission. Four transmission clusters containing 3–12 individuals were composed of MSM of mixed HIV serostatus.

Conclusions

We show that data obtained from WGS of N. gonorrhoeae and enhanced epidemiological data obtained from patient questionnaires are mutually supportive and reveal insights into sexual networks. Our findings suggest that serosorting may have declined as a practice and indicate the importance of designing public health interventions that target infection risks associated with recreational drug use and contact made using geosocial networking applications.




Kissing while high on ecstasy: lessons from a gay dance party attendee

2018-02-20T06:25:36-08:00

It has been hypothesised that the oropharynx plays a major role in overall gonorrhoea transmission among gay, bisexual and other men who have sex with men (MSM) and this has been recently proven by a mathematical model suggesting that 75% of incident gonorrhoea cases would have to be acquired via the oropharynx-to-oropharynx pathway, that is, kissing.1 However, there have been very limited studies examining kissing among MSM.

The author remembers going out to a gay dance party with a friend, where this friend consumed the party drug ecstasy (3,4-methylenedioxymethamphetamine, also known as MDMA). The author subsequently watched his friend kiss more than 15 different partners over the course of just a few hours at that gay dance party, without having sex with any of them. This friend explained that ecstasy is an empathogen, and as such it made him feel closer and more emotionally connected to those around...




Sexual relationships, intimate partner violence and STI partner notification in Cape Town, South Africa: an observational study

2018-02-20T06:25:36-08:00

Objectives

We aimed to identify individual and sexual partnership characteristics associated with partner notification (PN) among people with STI. We hypothesised that PN would be less likely in more casual sexual partnerships and in partnerships with intimate partner violence (IPV).

Methods

We conducted an observational study among the first 330 patients with STI enrolled in a trial of a behavioural intervention to reduce STI incidence, at a clinic in a poor, Cape Town community. We included 195 index patients (those reporting STI symptoms), and conducted longitudinal analyses using participant-completed questionnaires on the day of diagnosis and 2 weeks later. Using partnership data for five recent sexual partners, we assessed factors associated with reported PN with logistic regressions, adjusting for repeated measurements on the same participant for each partner.

Results

The sample included 99 males with 303 partners and 96 females with 158 partners. Males reported perpetrating IPV in 46.2% of partnerships. Females reported being IPV victims in 53.2% of partnerships. Males notified 58.1%, females 75.4% of partners during the 2 weeks following diagnosis. Type of partner was an independent correlate of PN for males and females, with the odds of PN lower in more casual partnerships. For males, reporting physical IPV perpetration in the partnership was an independent correlate of PN. For females, there was no association between IPV victimisation in a partnership and PN.

Conclusions

Efforts to decrease the pool of infectious partners need to have a strong focus on the promotion of PN in casual relationships and one-night stands. IPV was not identified as a barrier to PN. In future, we need to investigate the association between IPV with an objective measure of PN success such as partner testing or treatment, or index patient reinfection.

Clinical trial registration

PACTR201606001682364; Pre-results.




Whole-genome sequencing reveals transmission of gonococcal antibiotic resistance among men who have sex with men: an observational study

2018-02-20T06:25:36-08:00

Objectives

Drug-resistant Neisseria gonorrhoeae are now a global public health threat. Direct transmission of antibiotic-resistant gonococci between individuals has been proposed as a driver for the increased transmission of resistance, but direct evidence of such transmission is limited. Whole-genome sequencing (WGS) has superior resolution to investigate outbreaks and disease transmission compared with traditional molecular typing methods such as multilocus sequence typing (MLST) and N. gonorrhoeae multiantigen sequence (NG-MAST). We therefore aimed to systematically investigate the transmission of N. gonorrhoeae between men in sexual partnerships using WGS to compare isolates and their resistance to antibiotics at a genome level.

Methods

458 couples from a large prospective cohort of men who have sex with men (MSM) tested for gonorrhoea together between 2005 and 2014 were included, and WGS was conducted on all isolates from couples where both men were culture-positive for N. gonorrhoeae. Resistance-determining sequences were identified from genome assemblies, and comparison of isolates between and within individuals was performed by pairwise single nucleotide polymorphism and pangenome comparisons, and in silico predictions of NG-MAST and MLST.

Results

For 33 of 34 (97%; 95% CI 85% to 100%) couples where both partners were positive for gonorrhoea, the resistance-determining genes and mutations were identical in isolates from each partner (94 isolates in total). Resistance determinants in isolates from 23 of 23 (100%; 95% CI 86% to 100%) men with multisite infections were also identical within an individual. These partner and within-host isolates were indistinguishable by NG-MAST, MLST and whole genomic comparisons.

Conclusions

These data support the transmission of antibiotic-resistant strains between sexual partners as a key driver of resistance rates in gonorrhoea among MSM. This improved understanding of the transmission dynamics of N. gonorrhoeae between sexual partners will inform treatment and prevention guidelines.




HPV vaccination among men who have sex with men in Ireland: GPs awareness and vaccination rates

2018-02-20T06:25:36-08:00

Human papillomavirus (HPV) is implicated in the development of cervical, vulval, anal, penile and oropharyngeal cancers.1 Men who have sex with men (MSM) have higher rates of these cancers,1 particularly anal cancer, where the rates are 15 times higher than the general population.2

In Ireland, girls have been vaccinated against HPV since 2010. As of January 2017, MSM up to the age of 26 can access the HPV vaccine through public sexual health clinics free of charge. There is no funding available for primary care.

We developed an online survey to assess knowledge of HPV vaccination guidelines for MSM among general practitioners (GPs) in Ireland and to assess vaccination rates in primary care.  We then emailed it to GPs and GP trainees in Ireland.

Four hundred and ninety-seven GPs and 88 GP trainees completed the survey giving an overall response rate of 15%.

Fifty-eight...




Clinical round-up

2018-02-20T06:25:36-08:00

Dark chocolate is good for you

Chocolate supplementation has been shown to be of benefit to endothelial function and vasodilation in HIV-negative individuals. Teixeira et al1 aimed to evaluate the impact of chocolate consumption on arterial elasticity in HIV-positive patients. They conducted a double-blinded crossover trial of 110 HIV-positive patients with stable infection (viral load <500 copies/mL and on antiretroviral (ARV) therapy for at least 6 months). The mean duration of ARVs was 12.9 years. Participants were randomised to receive 15 days of a dark chocolate containing dietary supplement, followed by a 15-day washout period and a further 15 days of placebo, or the reverse. Arterial elasticity, body composition, lipids, CRP and thiobarbituric acid reactive substances were measured. Significant alterations were seen in arterial elasticity (as measured by the large artery elasticity index) (p=0.049), and the mean HDL-c concentration after dark chocolate was higher (p=0.045).

Predicting previous ARV exposure

Genotypic and...