Why are HIV-positive mothers refusing to have their children screened for vertically transmitted HIV infection?

A previous audit showed that the HIV status of the majority (73%) of children of HIV-positive mothers attending a genitourinary clinic in the United Kingdom was unknown because mothers did not take up the offer of testing. The objectives of a re-audit were to establish the impact of the audit process on the uptake of testing and reasons for not taking up the offer of screening of offspring. One year after the previous audit, 13/92 (14%) of children not previously tested had their HIV status established. The reason for not testing was, in 43/52 (82%) mothers, the perception that a well child can not be infected with HIV. This was the only reason for not having their children tested in 16 mothers (31%). The next most common theme was fear of disclosure to others, in 29 (56%). The barriers for screening included fear of feeling guilty if the child was found to be positive.

Child sexual abuse and sexually transmitted infections: review of joint genitourinary medicine and paediatric examination practice.

Joint examination by doctors with complementary skills and screening for sexually transmitted infections (STIs) are recommended in children who may have been sexually abused or have been found to have an STI. Our study showed that criminal proceedings were more likely to be brought in cases with physical signs of sexual abuse. It could be difficult to prove whether sexual abuse had taken place or not with microbiological evidence alone, in the absence of other evidence. Significance of viral STIs in the context of sexual abuse should be evaluated carefully. The review of our practice re-enforced the importance of joint examination of children with suspected STIs.

Knowledge of their children's HIV status in HIV-positive mothers attending a genitourinary medicine clinic in the UK.

OBJECTIVES: To determine whether HIV-infected mothers knew the HIV status of their children, enabling the offer of targeted testing of children at risk. METHODS: All HIV-positive women attending the genitourinary medicine clinic at a district general hospital in the United Kingdom were asked whether they had children and the age, HIV status and residence of their children using a standardized proforma. RESULTS: A total of 297 HIV-positive women were included in a prospective audit. Two hundred and fifty-four women had 551 offspring; 143 had a total of 217 children aged <16 years. Of those children, 118 lived in the United Kingdom. Of the 99 children living abroad, 71% were living in Zimbabwe, 21% in other African countries (Zambia, Kenya, Burundi, Malawi and South Africa) and 5% in Jamaica and other Caribbean countries. Of the 118 children living in the UK, mothers knew the HIV status in 49 (42%), of whom nine (18%) were HIV positive. A further two older offspring were also HIV positive. Mothers were aware of the HIV status in significantly fewer children staying in the country of origin: nine (9%; P<0.05), of whom four were known to be HIV positive. All HIV-positive children living in the United Kingdom were under the care of paediatricians with special expertise in paediatric HIV infection. CONCLUSIONS: The HIV status of the majority of children of HIV-positive immigrant mothers is unknown, particularly those children who remain in their country of origin.

Impact of National Chlamydia Screening Programme on sexual health of children under the age of 16 years.

The objectives of the study were to investigate the rates of sexually transmitted infections (STIs), uptake of full STI screening and contraceptive use during pre- and post National Chlamydia Screening Programme (NCSP) periods and to determine the prevalence of sexual abuse/assault. The method used was a retrospective case notes audit of children aged <16 years. STIs were found in 20% (n = 264) of children; 10% had genital chlamydia. 157 (59%) of 264 children had an assessment for non-consensual sexual activity; of those, 34% had a history of past or continuing sexual abuse/assault. An uptake of 'full STI screening' and contraceptive use were similar in both pre- and post-NCSP periods. Overall STIs and chlamydia rates were higher during post-NCSP period. In conclusion, NCSP has not yet made any significant impact on sexual health of under-16-year-olds and the prevalence of past or ongoing sexual abuse/assault was high.

Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic.

OBJECTIVES: To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to a specialist genitourinary medicine (GUM) clinic. METHOD: Retrospective case notes review of 98 females aged 16 or less, who attended over a 5 year period (1996-2000). RESULTS: The overall prevalence of STIs was 26%. Among the girls who were aged 0-12 years (n = 16), one had gonorrhoea and another had Trichomonas vaginalis infection. Prevalence of STIs in those aged 13-16 years, who were not sexually active before the index assault, was 24% and in those who gave a history of previous consensual sexual activity it was 39% (p = 0.17). Chlamydial infection was more common among the girls who disclosed previous consensual sexual activity than in those did not disclose previous sexual activity (p = 0.012). The overall prevalence of vaginal candidiasis was 17% and bacterial vaginosis 13%. More than one third of the study population gave a history of previous sexual, physical, or other abuse. 81% reported having current psychological difficulties. Mood changes and sleep disturbances were reported more frequently than other psychological symptoms; 15% attempted self harm. All types of psychological difficulties, except mood changes, were not affected by the time interval between index assault and first presentation to the clinic and the type of assailant. 29% had no involvement with social and mental health services before their attendance at the clinic CONCLUSIONS: The prevalence of STIs among female child and adolescent survivors of rape and sexual assault attending a specialist clinic was high. The range of mental health and social difficulties was wide and multiple. The importance of an early assessment for the presence of STIs and mental health difficulties was demonstrated.

Hepatitis B virus infection among Chinese residents in the United Kingdom.

OBJECTIVE: To determine prevalence of hepatitis B virus (HBV) serological markers in Chinese residents in the United Kingdom. METHOD: Retrospective case-controlled study between January 1997 and June 2000 in two genitourinary medicine (GUM) clinics. RESULTS: 117 Chinese and 234 non-Chinese controls were studied. Baseline characteristics except marital status showed no difference. Overall prevalence of HBV serological markers was 35.8% in Chinese, controls 5.5% (p<0.001). Hepatitis B surface antigen (HBsAg) positive carrier rate was 12.8% in Chinese, controls 0.4% (p<0.001); 1.7% of Chinese patients were also hepatitis B e antigen (HBeAg) positive, none in controls. Natural immunity was acquired in 23.0% of Chinese, controls 5.1% (p<0.001). Prevalence of HBV serological markers in UK born Chinese was 6.7%, non-UK born Chinese 40.1% (p<0.011). Only 7.6% of Chinese had a history of previous HBV vaccination. CONCLUSIONS: Prevalence of HBV serological markers among Chinese patients attending two GUM clinics in London was high and only a minority of Chinese had immunisation against HBV. Although the prevalence of HBV markers in UK born Chinese was lower than non-UK born Chinese, they may be at continuous risk of HBV infection. Non-UK born Chinese patients attending GUM services in the United Kingdom should be targeted for screening and vaccination to reduce HBV transmission.

HIV post-exposure prophylaxis after sexual assault: the experience of a sexual assault service in London.

OBJECTIVES: To review the provision, uptake and outcome of HIV post-exposure prophylaxis (HIV-PEP) after sexual assault. METHODS: A retrospective case note review of patients attending a sexual assault service in London during 1999. RESULTS: Ten out of 150 patients were considered eligible for PEP after a careful risk assessment. Eight patients accepted HIV-PEP. Highly active antiretroviral therapy (HAART) consisted of Combivir/indinavir in six patients and Combivir/nelfinavir in two patients. Two patients changed their combination due to adverse events. Five patients completed the recommended 28 days of treatment. Three patients discontinued therapy due to adverse events. Two patients who completed HIV-PEP were noted to have raised cholesterol at follow-up. All patients who took PEP were HIV-1 and -2 antibody negative at six months. CONCLUSIONS: Compared with other published studies the completion rate of HIV-PEP in our study was high. The uptake and adverse events of HAART in this scenario were similar to previously published studies. A multidisciplinary approach to the management of this patient group will improve adherence to PEP.

Subcutaneous granulomatous lesions related to ritonavir therapy in a HIV infected patient.

We report a case of subcutaneous granulomatous lesions developed in a HIV seropositive man, related to ritonavir therapy. The importance of close monitoring and investigations of patients developing unusual side effects during highly active antiretroviral therapy (HAART) is demonstrated.

Graded challenge in an aciclovir allergic patient.

An immunocompetent woman presented with a hypersensitivity skin reaction following suppressive therapy with aciclovir for recurrent culture proved genital herpes simplex virus infection. She developed a similar reaction when treatment was changed to famciclovir. Without antiviral suppression her recurrences were frequent and distressing. Graded challenge was performed and she became tolerant to aciclovir. She successfully continued suppressive therapy for 1 year with no further hypersensitivity reactions or recurrences.