British Association for Sexual Health and HIV Scottish investigation 2010-2011: reasons for non-attendance in individuals lost to follow-up for HIV care for more than 12 months in Scotland.

As of 31 March 2011, 6696 HIV diagnoses had ever been reported in Scotland; of these, 1791 individuals had died, 3339 were attending specialist services, but the remainder had defaulted from specialist care; an investigation into their reasons for non-attendance, and the efforts of services to re-engage, was undertaken by British Association for Sexual Health and HIV Scottish branch using a web-based survey questionnaire. Twelve of the 13 Scottish HIV services returned information for 424 of 579 eligible cases; 112 of these 424 individuals were identified as genuine non-attendees. Findings indicate that the epidemiology of these non-attendees is similar to that of the whole Scottish HIV cohort. Three-quarters of individuals failed to attend a booked appointment following their last known attendance and very few attempts to contact non-attending individuals were successful. This survey has refocused attention on those lost to follow-up, while quality of the national data-set has improved, providing a clearer epidemiological picture of people living with HIV in Scotland.

An audit of the contraception service offered to teenagers attending Scottish genitourinary medicine clinics in 2007.

An audit of contraception service offered to teenagers attending Scottish genitourinary (GU) medicine clinics in 2007 was carried out by collecting data from each main clinic of 11 Scottish health boards. The case notes of 579 women aged under 18 years were reviewed. In 553 (95.5%) cases, sufficient data were available to make an assessment regarding whether the women needed any advice on having a reliable method of contraception. Of these 553 women, 280 (50.6%) were assessed as requiring contraceptive advice. Of the 280 women who needed advice, 156 (56%) received it. Currently, there are some gaps in the provision of contraception services offered to teenagers attending GU medicine clinics, which could be improved by increasing awareness among staff and providing adequate resources.

Completion of a British Association for Sexual Health and HIV regional audit loop: HIV testing in genitourinary medicine clinics in Scotland in 2004 and 2008.

In 2004, the British Association for Sexual Health and HIV Scottish Branch audited HIV testing in new attendees diagnosed with a sexually transmitted infection at genitourinary medicine clinics in Scotland. In 2008 the audit loop was completed. Large increases were seen in rates of test offer and uptake, particularly in health boards with low baseline levels of testing. Overall rates of testing remain below those recommended and wide variability between boards persists.

Audit of hepatitis B vaccination of men who have sex with men attending Scottish genitourinary medicine clinics.

Practice related to hepatitis B vaccination of men who have sex with men (MSM) in Scottish genitourinary medicine clinics was audited against targets based on the offer and completion of vaccination set by the British Association of Sexual Health and HIV. Of 521 cases audited from 11 clinics, 215 (41%) were eligible for vaccination and 175 (81%) of eligible MSM were offered vaccination. Of those, 144 (82%) accepted vaccination. The super-accelerated schedule was most commonly prescribed but only 29% of those starting this schedule completed it, compared with 57% of those receiving the standard course. The overall vaccination completion rate was 31% and 82% of those completing vaccination had antisurface antibodies measured. A more robust recall system and uniformity in vaccination policies addressing the balance of patient compliance and immunogenicity of vaccine schedule are needed to improve completion rates.

An audit of the interval to treatment of anogenital Chlamydia trachomatis at Scottish genitourinary medicine clinics.

Timely treatment of sexually transmitted infections can reduce complications and prevent onward transmission. Several audit standards exist in this area. We audited the timeliness of treatment of 538 episodes of chlamydia at 12 Scottish genitourinary medicine clinics against a national standard and against a local best practice target. Three clinics treated 95% of patients within two weeks and 10 clinics treated 95% of patients within four weeks. All clinics treated 60% of patients within four weeks. Overall, all clinics performed well against published standards, but less well against the best practice target.

Factors affecting time to treatment following diagnosis of genital Chlamydia trachomatis infection in Scottish genitourinary medicine clinics.

Early treatment of genital Chlamydia trachomatis can reduce complications and transmission. Guidelines have proposed standards for how soon people should be treated following a test. Data from an audit of Scottish genitourinary (GU) medicine clinics was analysed to identify factors associated with a short interval to treatment of chlamydia. A sample of 538 cases of chlamydia diagnosed at 12 Scottish GU medicine clinics between 1 April 2005 and 30 June 2005 was studied. Variables assessed included: age, sex, sexuality, whether a contact, symptoms, whether microscopy was performed, time to lab result and how the result was given. Earlier treatment was associated with: being a contact, having symptoms, being male, performing microscopy (male patients only) and giving the result at a follow-up appointment. Most of these variables (sex, symptoms, etc.) are without the influence of clinic policies and the ones which can be influenced (microscopy and follow-up appointments) are becoming less common. Time to treatment of genital chlamydia might therefore increase in the future.

HIV testing in Scotland. Are we meeting the standard? BASHH Scotland national audit 2004.

Most sexually transmitted infections (STIs) are associated with increased risk of HIV transmission. The draft Scottish Sexual Health Strategy (2003) proposed that 'HIV testing [should be] offered to all GUM clinic attendees not known to be HIV infected who present with a new STI. ... Reasons for non-uptake should be recorded.' We performed a national audit comparing practice in Scottish genitourinary (GU) medicine services against these standards. The results show that practice is highly variable but overall in 2004 Scottish GU medicine clinics were failing to meet the strategy standard.

An oral fluid test for syphilis.

We have developed a time-resolved fluorescence immunoassay to detect antibodies to Treponema pallidum recombinant antigens in oral fluid specimens. Using an 'Oracol' swab, oral fluid was collected from 34 subjects with a serological diagnosis of syphilis and 97 seronegative controls. Using a cut-off of three standard deviations over control mean, the sensitivity and specificity of the assay in all subjects with positive syphilis serology was 76.5% and 97.9%, respectively. In those with early syphilis, the sensitivity and specificity of the assay was 100% and 97.9%. In a non-outbreak situation, screening clinic attendees for syphilis using oral fluid specimens is potentially useful when collection of blood is not practicable. In addition, it may have much to offer in outreach projects and epidemiological investigations.

Vaginal algometer: development and application of a device to monitor vaginal wall pressure pain threshold.

We describe a device (which we have named a vaginal algometer) which can measure the pressure pain threshold (PPT) on the lateral walls of the vagina. The device was assessed in 63 healthy women and a normal range for this measurement was established. Each woman had her vaginal wall PPT measured and was asked about the acceptability of the procedure. We demonstrate that the vaginal algometer can provide a quantitative assessment of vaginal PPT and that the procedure is acceptable to most women.