Sexual transmission of infections across Europe: appraising the present, scoping the future.

Objectives: Our journal partnered with the Europe section of the International Union against STI (IUSTI) at a workshop held at the 18th European AIDS Conference in London on 30 October 2021. The workshop reviewed epidemiological trends and discussed STI care provision within HIV services across Europe. Methods and Results: We started by highlighting trends in bacterial STIs reported to the European Centre for Disease Prevention and Control from countries in the European Union/European Economic Area. This showed that notifications of bacterial STIs reached an all-time high in 2019, but are expected to be impacted by the COVID-19 pandemic in 2020-2021. We then reviewed the evolving relationship between STIs and HIV and pointed out how antiretroviral treatment and pre-exposure prophylaxis remain highly effective against HIV transmission despite the rising incidence of STIs. Within emerging concepts in STIs, we appraised the benefits and risks of asymptomatic screening for chlamydia, and also considered the potential perils of routinely testing for agents that lack a defined role in disease. Finally, we discussed standards of STI care for people living with HIV, informed by a brief survey of IUSTI Europe country representatives and members of the Euroguidelines in Central and Eastern Europe network. Conclusions: The survey indicated substantial variability and identified key improvement targets: fighting barriers to effective service provision and access, increasing diagnostic capability and taking leadership in driving up the quality of care. We must not forget the STI-related needs of the many people who will be living with HIV for decades into the future.

Multiple drug allergy syndrome in pregnancy: Lessons for sexual health physicians.

Co-existence of multiple drug allergies and pregnancy often results in vexing dilemmas for physicians. A 21-year-old pregnant woman presented with asymptomatic cervicitis with dual infection with Chlamydia trachomatis and Neisseria gonorrhoeae during her third trimester. She reported a history of generalised rash with mucous membrane involvement following use of both macrolides and penicillins. Her gonococcal infection was successfully treated with a single dose of intramuscular gentamicin and chlamydial infection with oral clindamycin and rifampicin.

'It's all in the message': the utility of personalised short message service (SMS) texts to remind patients at higher risk of STIs and HIV to reattend for testing-a repeat before and after study.

BACKGROUND: Patients at increased risk of sexually transmitted infections (STIs)/HIV acquisition are advised to reattend for retesting. A previous study showed that 'generic' text reminders did not improve reattendance. AIM: To assess if a personalised text message with increased contact information would increase reattendance rates of at-risk patients. METHODS: Patients who are at risk of future STIs, defined by having a current acute STI, attending for emergency contraception, commercial sex workers (CSWs) or men who have sex with men (MSM), were sent a text reminder to reattend for retesting 6 weeks after initial visit. Reattendance rates were measured for September to December 2012 (control group who received a generic text message) and February to May 2014 (intervention 'personalised message' group who received a text message containing their first name and ways to contact the clinic). Reattendance was counted within 4 months of the end of the initial episode of care. RESULTS: The reattendance rate was significantly higher for the intervention group: 149/266 (56%) than the control group: 90/273 (33%) (p=0.0001) and was also significantly higher in the intervention group than the control group in patients with the following risks: recent chlamydia (64/123 (52%) vs 43/121 (36%)) (p=0.03), recent gonorrhoea (41/64 (64%) vs 4/21 (19%)) (p=0.0003) and MSM (26/45 (58%) vs 3/18 (16%)) (p=0.006). New STI rates in the reattending intervention group and controls were 26/ 149 (17%) and 13/90 (14%) (n.s), respectively. CONCLUSIONS: Sending a personalised text message with increased contact information as a reminder for retesting increased reattendance rates by 23% in patients who are at higher risk of STIs.

The effect of electronic patient records on hepatitis B vaccination completion rates at a genitourinary medicine clinic.

The study was conducted to assess whether the introduction of an electronic patient records-based system affected hepatitis B vaccination completion rates and post-vaccination return rates, when compared to a paper-based system. Data were gathered for three groups of patients: those commencing vaccination (a) when paper records were in use (paper records group), (b) after electronic patient records were introduced (basic electronic patient records group) and (c) after electronic patient records were enhanced with recall (enhanced electronic patient records group). Compared to the paper records group, the third dose completion rates for patients managed using electronic patient records did not differ significantly: 74/119 (62.2%) paper vs. 58/98 (59.2%) basic electronic patient records, p = 0.652 and 89/130 (68.5%) enhanced electronic patient records, p = 0.298. On sub-group analysis, completion rates in patients of black ethnicity in the enhanced electronic patient records group were significantly higher than those in the paper records group: 16/19 (84.2%) enhanced electronic patient records vs. 11/23 (47.8%) paper, p = 0.014. Patients in the enhanced electronic patient records group were more likely than those in the paper records group to attend for measurement of hepatitis B surface antibody levels: 61/130 (46.9%) vs. 39/119 (32.8%), p = 0.023.

Using short message service text reminders to reduce 'did not attend' rates in sexual health and HIV appointment clinics.

'Did not attend' and cancellation rates were compared for two 12-month periods before (2009) and after (2012/2013) the introduction of routine short message service text reminders being sent to patients who have pre-booked appointments. After the introduction of short message service text appointment reminders, the overall 'did not attend' rates fell by 4% from 28% to 24% (p < 0.005) and by 10% from 28% to 18% (p < 0.05) for male sexual health appointments. There was no significant change in the HIV clinic 'did not attend' rates. In the same periods, the cancellation rates increased 4% overall (from 62% to 66%) and by 17% (from 55% to 72%) for female sexual health clinics (p < 0.005). These results suggest that routine text reminders increase clinic attendance rates by reminding patients to attend and prompting them to cancel if they cannot come.

The utility of short message service (SMS) texts to remind patients at higher risk of STIs and HIV to reattend for testing: a controlled before and after study.

BACKGROUND: Patients attending for sexually transmitted infection (STI)/HIV testing may be at continuing risk of infection and advised to return for retesting at a later date. OBJECTIVES: To measure the impact of short message service (SMS) text reminders on the reattendance rates of patients who require repeat STI testing. METHODS: Reattendance rates were measured for two groups of higher risk patients: those listed for routine SMS text reminders in 2012 and a control group of patients from 2011 with the same risk profile who had not received any active recall. Reattendance was counted if it was within 4 months of the end of the episode of care. RESULTS: Reattendance rates were not statistically different between the text group 32% (89/274) and the control group 35% (92/266). Reattendance also was not statistically different between the text and control groups respectively in patients with the following risks: recent chlamydia 43/121 (36%) versus 41/123 (33%), recent gonorrhoea 4/21 (19%) versus 7/21 (33%), recent emergency contraception 27/60 (45%) versus 25/56 (45%) and other risks 7/27 (26%) versus 9/26 (35%). High rates of STIs were found in patients who reattended in both the text group (13/90, 14%) and control group (15/91, 17%) and at even higher rates at reattendance if the reason for recall was chlamydia infection at the initial visit: 9/43 (21%) in the text group and 10/41 (24%) in the control group. CONCLUSIONS: SMS texts sent as reminders to patients at higher risk of STIs and HIV did not increase the reattendance rate, when compared with standard advice, in this service which already has a high reattendance rate. STI rates were high in those patients who reattended.

Pancreatic panniculitis secondary to acinar cell carcinoma of the pancreas.

We report the case of a 68-year-old white woman who presented with painful, 1- to 4-cm, erythematous nodules located bilaterally on the anterior and medial shins that had progressively developed and worsened over the last month. Workup revealed pancreatic panniculitis (PP) secondary to acinar cell carcinoma of the pancreas (ACCP). The unique clinicopathologic features, differential diagnosis, underlying causes, associated laboratory and clinical findings, pathophysiology, treatments, and appropriate workup for PP also are reviewed.

A prospective study of the effectiveness of electronic patient records in rapid-cycle assessment of treatment and partner notification outcomes for patients with genital chlamydia and gonorrhoea infection.

OBJECTIVE: To assess the effectiveness of electronic patient records (EPRs) in facilitating multiple, rapid measurements of treatment and partner notification (PN) outcomes for chlamydia and gonorrhoea. METHODS: In two sexual health clinics, the proportion of patients with chlamydia and gonorrhoea who had been treated within 4 weeks of diagnosis was measured, and also the proportion where at least one of their partners had been treated. These outcomes were measured monthly for 6 months, and changes in recording practice were instituted when necessary. RESULTS: It took 8 h to capture and analyse the data for 89 patients in month 1. The health advisers subsequently entered data into searchable fields to facilitate better data capture. As a result, by month 6 it took only 1.5 h to measure these outcomes using an electronic search. It had previously taken 2 days to perform the same analysis using paper records. In month 1, successful treatment was recorded in 26/27 (96%) patients with gonorrhoea and 57/61 (93%) with chlamydia, and there was successful PN for gonorrhoea and chlamydia patients in 19/27 (70%) and 39/61 (64%). By month 6, the recorded outcomes were 30/31 (97%) and 81/86 (94%), respectively, for successful treatment and 28/31 (90%) and 74/86 (86%) for successful PN, respectively. CONCLUSIONS: Frequent rapid clinical outcome monitoring is easily attained using EPRs as long as the data are entered into searchable fields. Treatment and PN success for chlamydia and gonorrhoea with this method are well above national targets, which may be attributable to both the use of EPRs and better data capture.

Atypical presentations of herpesvirus infections in patients with chronic lymphocytic leukemia.

The characteristic presentation of herpesvirus infections is a vesicular rash. The initial lesions appear as erythematous papules that turn into grouped vesicles and pustules eventuating into crusts. In most cases, the features are so characteristic that a diagnosis can be made by history and physical examination without further diagnostic testing. However, patients who are immunosuppressed (including those with hematologic malignancies) often have atypical presentations of herpesvirus infections. These cases require a high index of suspicion and appropriate diagnostic testing for proper management. In this report, we describe two patients with chronic lymphocytic leukemia who developed atypical presentations of herpes zoster and herpes simplex infections. Herpetic infections should always be in the differential diagnosis of cutaneous ulcerations with necrosis in patients who are immunocompromised. Because of the atypical appearance of the lesions, the diagnosis may be confused or mistaken for several other conditions.