Genital herpes - diagnosis, treatments, attitudes and response to disclosure amongst members of the UK Herpes Viruses Association.

A diagnosis of genital herpes may result in psychological as well as physical morbidity. Many patients require on-going help and contact the Herpes Viruses Association (HVA), a UK patient support organisation. The HVA conducts occasional questionnaires relating to various issues surrounding herpes and this study reports on a survey conducted amongst members in 2015. The survey was done using SurveyMonkey and covered diagnosis/treatment, both allopathic and self-help, physical and psychological impact and disclosure to partners. Three hundred and fifty-eight women and 103 men completed the questionnaire. Male respondents were older than women (48.6 versus 42.9 years). The majority were first diagnosed in sexual health clinics. A high proportion had informed partners about the diagnosis and in 83% disclosure did not result in rejection. 57% were taking prophylaxis with more taking treatment episodically rather than continually; 11.3% sourced medications on-line. Alternative treatments were used commonly with Lomaherpan cream (Melissa officinalis), lidocaine ointment and a diet with reduced arginine and increased lysine the most frequent choices. Other alternative treatments included olive leaf extract, Eleuthercoccus senticosus and vitamin supplements. Women reported being troubled psychologically more than men. Neuropathic pain was reported by 80.4% of the women and 64.1% of the men. Although antiviral treatment is cheap and well-tolerated it is still being refused by some healthcare providers. There still appears to be a considerable degree of stigma experienced by patients which can be mitigated by support from patients' support groups such as the HVA.

2018 UK national guideline for the management of donovanosis.

The objective of this guideline is to provide guidance for the diagnosis and management of donovanosis, a now rare sexually transmitted infection. This guidance is primarily for professionals working in UK Sexual Health services (although others may find it useful) and refers to the management of individuals presenting with possible symptoms of donovanosis who are over the age of 16. An updated literature review since the last Clinical Effectiveness Group (CEG) guideline produced for this condition in 2011 has shown few new developments. Most reports in the literature relate to cases of unusual presentations of the condition.

2016 European guideline on donovanosis.

Donovanosis is a rare sexually transmitted infection now mainly seen in sporadic cases in Papua New Guinea, South Africa, India, Brazil and Australia. The causative organism is Calymmatobacterium granulomatis, though a proposal has been put forward that the organism be reclassified as Klebsiella granulomatis comb nov The incubation period is approximately 50 days with genital papules developing into ulcers that increase in size. Four types of lesions are described - ulcerogranulomatous, hypertrophic, necrotic and sclerotic. The diagnosis is usually confirmed by microscopic identification of characteristic Donovan bodies on stained tissue smears. More recently, polymerase chain reaction methods have been developed. The recommended treatment is azithromycin 1 g weekly until complete healing is achieved.

2014 UK national guideline for the management of anogenital herpes.

These guidelines concern the management of anogenital herpes simplex virus infections in adults and give advice on diagnosis, management, and counselling of patients. This guideline replaces the 2007 BASHH herpes guidelines and includes new sections on herpes proctitis, key points to cover with patients regarding transmission and removal of advice on the management of HSV in pregnancy which now has a separate joint BASHH/RCOG guideline.

Black stone - a natural remedy for premature ejaculation and performance enhancement, or maybe not?

We describe the use of a non-prescribed aid (Black stone) for premature ejaculation that resulted in a chemical burn on the penis with an appearance similar to severe balanitis.

Effect of Chlamydia diagnosis on heterosexual relationships.

This study investigated whether a Chlamydia diagnosis was associated with relationship breakup or physical violence from partners when compared to other attenders at a sexually transmitted infections (STIs) clinic. Patients diagnosed with Chlamydia and who had a regular partner at the time of diagnosis, were contacted 3-12 months later and completed a questionnaire on relationship history. A comparison group of gender-matched non-STI patients were also interviewed. About half of Chlamydia cases (exposed) and non-cases (unexposed) had broken up with their partner since diagnosis (52% vs. 47%; p=0.42), but cases were more likely to have split up within one week of diagnosis (48% vs. 24%; p=0.003), and somewhat more likely to resume the relationship (24% vs. 15%; p=0.24). The prevalence of reported physical violence in the past year was slightly higher in cases than the unexposed group (9% vs. 4%; p=0.09). Cases that saw a health adviser were less likely to report experiencing physical violence than those who had not seen a health adviser (7% vs. 12%: p=0.31). Patients with Chlamydia are more likely to suffer relationship breakup soon after diagnosis than STI clinic attenders without an STI. Health advice should include reassurance about sexual relationships as well as safer sex.

Neurocognitive function in HIV infected patients on antiretroviral therapy.

OBJECTIVE: To describe factors associated with neurocognitive (NC) function in HIV-positive patients on stable combination antiretroviral therapy. DESIGN: We undertook a cross-sectional analysis assessing NC data obtained at baseline in patients entering the Protease-Inhibitor-Monotherapy-Versus-Ongoing-Triple therapy (PIVOT) trial. MAIN OUTCOME MEASURE: NC testing comprised of 5 domains. Raw results were z-transformed using standard and demographically adjusted normative datasets (ND). Global z-scores (NPZ-5) were derived from averaging the 5 domains and percentage of subjects with test scores >1 standard deviation (SD) below population means in at least two domains (abnormal Frascati score) calculated. Patient characteristics associated with NC results were assessed using multivariable linear regression. RESULTS: Of the 587 patients in PIVOT, 557 had full NC results and were included. 77% were male, 68% Caucasian and 28% of Black ethnicity. Mean (SD) baseline and nadir CD4+ lymphocyte counts were 553(217) and 177(117) cells/µL, respectively, and HIV RNA was <50 copies/mL in all. Median (IQR) NPZ-5 score was -0.5 (-1.2/-0) overall, and -0.3 (-0.7/0.1) and -1.4 (-2/-0.8) in subjects of Caucasian and Black ethnicity, respectively. Abnormal Frascati scores using the standard-ND were observed in 51%, 38%, and 81%, respectively, of subjects overall, Caucasian and Black ethnicity (p<0.001), but in 62% and 69% of Caucasian and Black subjects using demographically adjusted-ND (p = 0.20). In the multivariate analysis, only Black ethnicity was associated with poorer NPZ-5 scores (P<0.001). CONCLUSIONS: In this large group of HIV-infected subjects with viral load suppression, ethnicity but not HIV-disease factors is closely associated with NC results. The prevalence of abnormal results is highly dependent on control datasets utilised. TRIAL REGISTRY: ClinicalTrials.gov, NCT01230580.

Using mathematical modelling to estimate the impact of periodic presumptive treatment on the transmission of sexually transmitted infections and HIV among female sex workers.

BACKGROUND: In settings with poor sexually transmitted infection (STI) control in high-risk groups, periodic presumptive treatment (PPT) can quickly reduce the prevalence of genital ulcers, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). However, few studies have assessed the impact on HIV. Mathematical modelling is used to quantify the likely HIV impact of different PPT interventions. METHODS: A mathematical model was developed to project the impact of PPT on STI/HIV transmission amongst a homogeneous population of female sex workers (FSWs) and their clients. Using data from Johannesburg, the impact of PPT interventions with different coverages and PPT frequencies was estimated. A sensitivity analysis explored how the projections were affected by different model parameters or if the intervention was undertaken elsewhere. RESULTS: Substantial decreases in NG/CT prevalence are achieved among FSWs receiving PPT. Although less impact is achieved among all FSWs, large decreases in NG/CT prevalence (>50%) are possible with >30% coverage and supplying PPT every month. Higher PPT frequencies achieve little additional impact, whereas improving coverage increases impact until NG/CT becomes negligible. The impact on HIV incidence is smaller, longer to achieve, and depends heavily on the assumed NG/CT cofactors, whether they are additive, the assumed STI/HIV transmission probabilities and STI durations. Greater HIV impact can be achieved in settings with lower sexual activity (except at high coverage), less STI treatment or high prevalences of Haemophilus ducreyi. CONCLUSIONS: Despite the model's assumption of homogeneous risk behaviour probably resulting in optimistic projections, and uncertainty in STI cofactors and transmission probabilities, projections suggest PPT interventions with sufficient coverage (> or = 40%) and follow-up (> or = 2 years) could noticeably decrease the HIV incidence (>20%) among FSW populations with inadequate STI treatment.

Changes in STI services following a community based STI-intervention project in Cambodia.

The aim of this study was to assess changes in sexually transmitted infections (STI) related care following a STI project with a particular focus on registered brothel-based (direct) female sex workers (DFSWs) in four border provinces of Cambodia. A survey of health care facilities providing STI care was undertaken and the results compared with a baseline survey done two years previously. The main components of the project were: renovation of the STI clinics, STI training, formation of mobile teams, provision of STI drugs, and the introduction of basic laboratory tests at STI clinics. Interviews were held with health care providers and STI patients and a manual check was made of the STI register and special forms for DFSWs. Clinical management of STI cases was assessed for DFSWs, women with vaginal discharge and men with urethral discharge. Advice given to clients about condom use, partner notification and STI education was assessed and availability of STI drugs was reviewed. STI clinic attendance by DFSWs each month increased from 72% (296/412) to 93% (459/496). The proportion of DFSWs diagnosed with presumed STIs decreased from 86.5% (256/296) to 25.5% (117/459) and cervicitis from 32.8% (135/412) to 12.6% (58/459). The percentage of men attending STI clinics decreased from 26.9% (251/933) to 9.4% (102/1,080). The proportion of presumed STI cases/all cases attending health centers decreased from 7.0% (934/13,177) to 4.3% (739/17,224). The introduction of laboratory tests coincided with a marked reduction in DFSWs diagnosed with cervicitis. Further validation studies are required to determine whether this reduction was accompanied by a real decrease in gonorrhea and chlamydia.

Genital ulcers and concomitant complaints in men attending a sexually transmitted infections clinic: implications for sexually transmitted infections management.

BACKGROUND: Although genital herpes has emerged as the most common cause of genital ulcers in Southern Africa, treatment for herpes is not available routinely in the region. This study was performed to determine the etiology of genital ulcers in men in Durban and assess other sexually transmitted infections-related symptoms, presentation, and treatment patterns in this group. METHODS: Polymerase chain reaction (PCR) tests were performed on specimens from consecutive male patients with genital ulcers to detect sexually transmitted pathogens. PCR was also performed for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis on urethral specimens from consecutive subjects with dysuria or urethral discharge. Antibody tests for syphilis and herpes simplex virus type-2 (HSV-2) and human immunodeficiency virus antibodies were performed. RESULTS: Of 162 patients enrolled with genital ulcers, 77.7% were human immunodeficiency virus-positive and 84.6% had antibodies to HSV-2. PCR results showed the following prevalences: HSV-2 53.7%, lymphogranuloma venereum 13.6%, Treponema pallidum 3.7%, Hemophilus ducreyi 1.2%, mixed infections 6.2%, and no pathogens identified 33.3%. One case of donovanosis was diagnosed clinically. In men with HSV-2 ulcers, delay before attendance recorded for 68 men was 1 to 3 days (24%), 4 to 7 days (47%), 8 to 14 days (12%), 15 to 30 days (12%), and >30 days (6%). History-taking using prompting increased the sensitivity but decreased the specificity and positive predictive value of reported genital ulceration when assessed against ulcers seen on examination. CONCLUSIONS: Men at risk of genital ulcers should be asked about relevant symptoms with and without prompting and examined clinically to maximize the likelihood of correct diagnosis and treatment. The finding of a high prevalence of HSV-2 and associated dysuria cautions against providing empirical treatment for gonorrhoea and chlamydia in ulcer patients with dysuria but without urethral discharge. Innovative strategies to limit the burden of HSV-2 infection in this population are required.

Rapid HIV testing in a clinic setting.

The aim of this audit was to review the use of a rapid HIV test in a genitourinary (GU) clinic setting. The rapid test was used selectively on patients mainly deemed to be from high-risk groups with risk behaviours. In total, 120 tests were carried out on 90 patients of whom 18 (20%) were HIV positive, including six who had tested positive previously. Eleven (61.1%) of the positive tests were direct referrals from the GU clinic. The vast majority of those tested resided in the local area. Rapid HIV testing can be undertaken on selected patients in a GU clinic setting provided appropriate support is available for those patients who test positive.