Proceedings of the New Zealand Society for the Study of Diabetes Annual Scientific Meeting

The proceedings contain 17 papers. The topics discussed include: HIV patient preferences for care: resetting for a new normal;who accesses emergency hormonal contraception through an online sexual health service?;menstrual, sexual, and reproductive health interventions in out-of-school girls: a systematic review;three cycle QIP: improving testing and management of mycoplasma genitalium in a tertiary sexual health center 2019 - 2021;the weekend effect in GUM: a preliminary audit into genital herpes management across the week;comparing trichomonas vaginalis clinical care before and after the COVID-19 pandemic;time to start testing for latent tb infection(LTBI) - a quality improvement project;who, what, when, where, how and why? addressing the challenges of patient and public involvement and engagement (PPIE) within STI research and co-producing and applying a PPIE strategy within the SEQUENCE digital research program;an analysis of service users accessing a routine contraception service via an online platform during the COVID-19 pandemic;and effect of the COVID-19 pandemic on chlamydia testing and diagnosis within Scotland's largest sexual health service.

MYCOPLASMA GENITALIUM TESTING: A VICTIM OF TENDERING AND COVID?

Introduction Mycoplasma Genitalium is a relative newcomer to sexual health clinics;but is testing now routinely embedded in practice? In a clinic victim to a traumatic tendering process and then to the pandemic, a full audit cycle revealed the truth and some unexpected findings. Methods 1. Patient list based on GUMCAD codes for: Mycoplasma Genitalium, Pelvic inflammatory disease, Non-specific urethritis, epididymo-orchitis. Cycle 1 looked retrospectively at March-August 2021 (6 months) comparing findings to BASHH standards. 2. Intervention: Presentation of audit findings and a teaching session on Mycoplasma Genitalium 3. Retrospective second cycle audit looking at October 2021- January 2022 (3 months). Results Cycle 1: • 53 patients tested. Of the 11 women tested, 9 were mycoplasma contacts. • 41% NSU and 10% PID presentations were tested • 14 cases positive (26%), 25% had test of cures Cycle 2: • 68 patients tested. • 64% NSU and 46% PID presentations tested • 12 cases positive (18%), 100% contacted for test of cure. Other findings • Testing is dependent on clinician: Nurses met guidelines in 100% of patients, GUM doctors 64% and GP Trainees 50%. Health advisors contacted 100% of patients for test of cures. • No routine resistance testing provided, but 17% had documented resistance, 33% clinical resistance Discussion Mycoplasma was overlooked with tendering and covid no doubt playing a part. This audit highlighted the deficiencies, but interventions improved testing;nurses effectively adopting it into routine practice whilst uptake from doctors was limited. Resistance levels are concerning and support the need for routine resistance testing.

A REVIEW OF THE MANAGEMENT OF PELVIC INFLAMMATORY DISEASE AT A COMMUNITY CLINIC COMPARING PRACTICES BEFORE AND DURING THE COVID-19 PANDEMIC

Background Pelvic inflammatory disease (PID) usually results from infection ascending from the endocervix. The British Association for Sexual Health and HIV guidelines state that the diagnosis of PID should be considered in women under 25 with recent onset, bilateral lower abdominal pain and local tenderness on bimanual examination where pregnancy has been excluded. They recommend testing for chlamydia, gonorrhoea and mycoplasma genitalium. Method Electronic patient records were reviewed to identify episodes coded C5A during the last six months of 2019 and 2020. 46 patients were identified in 2019 and 43 in 2020. The following were recorded: demographics, symptoms, sexual history, examination findings, investigations, treatment, partner notification, follow-up. Results The age range of the 89 patients was 18-62, 51% were aged 25-34. Patients came from a range of ethnicities reflecting the diverse population. All patients were tested for chlamydia and gonorrhoea, none for mycoplasma genitalium. A pregnancy test was not performed in 19/89 (21%) patients. Documentation of examination findings was sometimes absent. Follow-up was recorded in 8/89 (9%) cases. Results were similar in 2019 and 2020, although ceftriaxone administration was more common pre-pandemic. Key results are summarised in the accompanying table 1. Conclusions PID management in 2019 and 2020 was similar. Increased testing for mycoplasma could guide antibiotic therapy. The importance of pregnancy testing in women presenting with lower abdominal pain should be highlighted to clinicians. Telephone calls could be used to facilitate follow-up appointments. (Figure Presented).

LOVE IN A COVID CLIMATE-DOES GOING MASKLESS IN CLINIC INDICATE GOING CONDOMLESS IN THE BEDROOM?

Introduction Although Covid-19 mask wearing is no longer a legal requirement in England it is advised in healthcare settings and it is trust policy for patients and staff to wear one. The aim was to identify an association between choosing not to wear a facemask and the acquisition of an STI. Methods We carried out a retrospective analysis of 50 patients who attended Axess Sexual Health clinic at the Royal Liverpool University Hospital in March 2022. We specifically recorded whether they wore a facemask or not during the consultation. We then reviewed diagnosis of an STI in the last 3 months and recording of episodes of unprotected sexual intercourse (UPSI). Results Overall 48% (24) of patients did not wear a facemask during their consultation. 85% (22/26) of those presenting with a facemask had UPSI in the last 3 months compared with 83% (19/23, 1 unrecorded) of those with no mask. However, 56% (14/26) of those who wore a mask were diagnosed with an STI in the last 3 months compared with 67% (16/24) in those that chose not to wear a mask in clinic. Of the remaining 8 patients, 2 patients were treated empirically for M.Genitalium and 2 were treated for NSU. Discussion People who wear face masks may have a higher degree of health anxiety and may engage in testing more regularly. Those without facemasks may be more likely to engage in risk-taking behaviour or not disclose the full extent of their risk-taking.

TOC THREE WAYS: AN EVALUATION OF METHODS OF TEST OF CURE FOR GC AND MG

The covid-19 pandemic restricted face-to-face contact with patients and encouraged new ways of working. Patients needing test-of-cure (TOC) for gonorrhoea (GC) and mycoplasma genitalium (MG) could no longer attend clinics. Staff offered alternatives, advising patients to order tests from our on-line service (usually if they were already registered) or providing patient with a 'blue bag': test kit and prepaid envelope to send to the laboratory from home. Methods Reviewed all patients diagnosed with GC or MG August 2020-January 2021 and compared TOC rates depending on method used Results 164 patients diagnosed with MG or GC, attending iCasH Cambs for treatment TOC achieved for 77% of all patients, GC 80% (106/136), MG 75% (21/28), it was 88% for patients with a documented follow-up plan in the records. Discussion Return rates were similar to the previous year and well above national average. Home sampling for TOC is an effective and acceptable method for patients. TOC kits provided by the clinic allowed testing for infections such as MG and avoided the need for a new patient to register on the on-line testing platform. Return rates were slightly higher using the 'blue bag' system than the on-line platform (87% vs 82%). While the difference was not statistically significant, providing samples for TOC in clinic might be preferable for some patients. (Table Presented).

BASHH 2022 Abstracts

The proceedings contain 159 papers. The topics discussed include: HIV patient preferences for care: resetting for a new normal;who accesses emergency hormonal contraception through an online sexual health service?;menstrual, sexual, and reproductive health interventions in out-of-school girls: a systematic review;three cycle QIP: improving testing and management of mycoplasma genitalium in a tertiary sexual health center 2019 - 2021;the weekend effect in gum: a preliminary audit into genital herpes management across the week;comparing trichomonas vaginalis clinical care before and after the COVID-19 pandemic;and time to start testing for latent tb infection(LTBI)- a quality improvement project.

HIGH LEVEL of HIV VIRAL SUPPRESSION in UGANDAN MEN with URETHRITIS and BACTERIAL STI

Background: Historically, control of HIV infection in young men living with HIV (LWH) has been problematic. We examined the STI/HIV burden in young men with urethral discharge syndrome (UDS) in Kampala, Uganda. Methods: Between Oct 2019-Nov 2020, 250 men with UDS were enrolled at 6 urban sites. All HIV positive men (20%, 50/250) had plasma viral load testing (Abbott m2000 RealTime HIV-1);when VL>1000 copies/mL, resistance and recency testing (Asanté HIV-1 Rapid Recency Assay, Sedia Biosciences) were performed. Penile meatal swabs were retrospectively tested for gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium (Hologic Aptima CT/NG, TV, MG). Descriptive statistical analysis, logistic, and bivariable and multivariable regression were undertaken. Results: Among the men LWH, 92% (46/50) had VL<1000;4 were not suppressed, 1 of whom was previously undiagnosed. Among the viremic individuals, no major resistance mutations were found and none appeared recently infected. Men (median age 24[22;32]) reported sex partners/previous 2 months (median 2[1;2]), 61.6% engaged in transactional sex in the previous 6 months, and 48.4% reported alcohol use. 44.4% reported alcohol use before sex in the previous 6 months. Overall, 0.4% reported 'always' condom use, 21.8% continued condomless sex since onset of UDS symptoms. There was a high burden of active, undiagnosed STIs found in these men (see Table);of the 10% who had syphilis, 80% were previously undiagnosed. Agreement between HIV-and syphilis-POC and lab-based testing was 100% and 95% (19/20), respectively. By multivariable logistic regression, alcohol use (OR, 3.32 (95% CI:1.61, 7.11)), and condomless sexual activity since symptom onset (OR, 2.86 (95% CI:1.20, 6.84)) were significantly associated with HIV;92% had at least one other STI. Conclusion: Among men presenting with UDS, bacterial STIs were very common. 20% had HIV with a surprisingly high level of viral suppression and no evidence of resistance in those with detectable VL. Recency testing results were non-discriminatory;none appeared recently infected. Risk of future HIV acquisition is high in those not LWH. Given the high frequency of bacterial STI, alcohol use and unprotected high-risk sexual behavior in this population, men with UDS who test negative for HIV should be prioritized for PrEP. Future research, evaluating the effect of SARS-CoV-2 on the burden of STI and level of viral suppression in this population, is required.

Testing and diagnosis of HIV, hepatitis B and C, and bacterial STI in French STI clinics (CeGIDD) in 2020: individual data from SurCeGIDD surveillance. (S..ropositivit.. au VIH: diagnostic, pr..vention et v..cu au temps de la Covid-19.) [French]

Introduction - The CeGIDDs are centres of information, screening and diagnosis for HIV, viral hepatitis and bacterial sexually transmitted infections (STIs), a network of French free-to-use clinics created in 2016. This article describes the characteristics of CeGIDD visitors as well as the screening and diagnostic activities carried out by the structures for the year 2020, comparing them with 2018. Method - We present a repeated cross-sectional study, based on continuous monitoring data from the SurCeGIDD system, which relies on the secure transmission of individual visitor data according to a predefined format. The socio-demographic and behavioural data of the visitors, and their reasons for consultation, are described. The proportions of visitors tested and the positivity rates for HIV, hepatitis B (HBV) and C (HCV), syphilis, gonococcus (NG), Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are described according to sexual practices. Results - In 2020, 336,333 consultations were reported by 50.3% of the 336 CeGIDDs identified in 2020. Attendance at CeGIDDs fell sharply in the second quarter of 2020 (-58% compared to the first quarter). In 2020, the visitors were mostly men (62.1%) and young people under 30 (64.5%). About a quarter (23.5%) of the visitors were born abroad. The proportion of men having sex with men (14.8%) and trans people (0.38%) had increased compared to 2018. The most frequent reasons for consultation remained risk exposure (60.4%) and systematic screening (43.3%). Some reasons for consultation increased between 2018 and 2020, such as initiating or monitoring a post-exposure prophylaxis. An increase in positivity rate between 2018 and 2020 is observed for HIV (from 0.37% to 0.41%), but especially for NG (from 2.8% to 4.0%), undoubtedly related to changes in visitor characteristics. At the same time, positivity rates decreased for HBV (from 1.3% to 0.93%) and HCV (from 0.94% to 0.60%). They are relatively stable for CT (7.0% in 2020), MG (6.8%) and syphilis (1.0%). Conclusion - Despite a drop in consultations in 2020 related to the COVID-19 pandemic, the CeGIDDs continued to carry out their screening/diagnostic missions in a comprehensive sexual health approach. SurCeGIDD surveillance provides elements for monitoring the national sexual health strategy, hence the need to improve the comprehensiveness and completeness of the data collected.