HPV vaccine uptake in men who have sex with men in Scotland.

Human papillomavirus (HPV) vaccines are currently utilised globally in national immunisation programmes. In July 2017, a national HPV vaccine programme for men who have sex with men (MSM) was initiated across Scotland with vaccine being offered in the sexual health clinic setting. During the first year of this targeted vaccination programme, there were 5905 individuals who received at least one dose of HPV vaccine, representing 63.7% of eligible MSM attendees in this period. Vaccine uptake was relatively stable across all age groups (range 49.8-55.5%). The vaccination programme appears to have dovetailed well with pre-existing sexual health services and appears to be popular with MSM attending the service. The MSM HPV vaccine programme is a robust adjunct to the national girls programme but gender-neutral immunisation will reduce stigma and inequality in HPV-driven disease.

Measles in Scotland, 2013.

In 2013, Wales and England experienced large outbreaks of measles, a disease that has been targeted by the World Health Organisation for European elimination by 2015. Unfortunately, measles-mumps-rubella vaccine uptake declined to less than 80% in Wales and England after the Wakefield publicity and this resulted in increased population susceptibility to measles. In Scotland, measles-mumps-rubella vaccine uptake dropped to 87% in 2003. Scottish public health efforts in response to this decline aimed to maximise uptake of MMR1 by two years; ensure at least 95% uptake of one dose of measles-mumps-rubella before starting school at age five; and maximise uptake of the second dose of measles-mumps-rubella by age six. Although Scotland has not had any large outbreaks reported to date, transmission of measles from healthcare workers to patients has occurred and reiterates the importance of all healthcare workers accurately knowing their immune status and, when needed, to be fully immunised.

Use of Telephonetics RESULTS computer-facilitated telephone system with automatic results upload.

Our genitourinary medicine service implemented an automated telephone results system in 2010. This system is used in other services but few are able to upload negative results automatically from laboratory software. The use of this system reduced unanswered calls to a telephone results line and also the number of calls that had to be connected to clinical staff. Patients have better access to their results in a timely manner, as per the requirements of the recent Standards for the Management of Sexually Transmitted Infections document.

Acceptance of genitourinary medicine clinic appointments within 48 hours is influenced by patient perception of risk but not by symptoms.

The Department of Health has addressed access to genitourinary medicine services by setting targets that 100% of patients should be offered an appointment within 48 hours of contact and 95% should be seen within 48 hours. Such rapid access appointments are often declined by patients. We wished to ascertain whether patient perception of health risk or the presence of symptoms suggestive of a sexually transmitted infection (STI) might influence how quickly patients accept an appointment. We designed a two-armed study which demonstrated that up to 37% of patients offered an appointment within 48 hours declined it, with work commitments offered by 84% of these patients as the reason for deferring attendance. The presence of symptoms did not influence whether patients accepted an early appointment, however the patient's perception of health risk associated with an untreated STI was statistically significantly associated with earlier attendance (P < 0.0001). Increased public education regarding the consequences of untreated STI may therefore improve the acceptance by patients of appointments within 48 hours.

Treatment of asymptomatic rectal Chlamydia trachomatis: is single-dose azithromycin effective?

Rectal infection with Chlamydia trachomatis affects approximately 7% of men having sex with men (MSM), attending departments of Genito-Urinary (GU) Medicine [Manavi et al. Int J STD AIDS 2004;15:162-4], and the British Association for Sexual Health and HIV (BASHH) guidelines for the treatment of uncomplicated genital C. trachomatis infection include 1 g of single-dose oral azithromycin as a recommended regimen [BASHH 2006]. A retrospective analysis was performed on case-notes from all patients diagnosed with rectal C. trachomatis infection in the department of GU Medicine, Edinburgh for the one-year period from 1 June 2005. Of 101 new episodes of rectal chlamydial infection, only 9% were associated with anorectal symptoms. Excluding these, 85% of asymptomatic patients were treated with a single dose of azithromycin 1 g orally, with a calculated treatment failure rate of 13% (nine of 68). This suggests that single-dose azithromycin may be a less than effective treatment in asymptomatic rectal C. trachomatis infection. The potential treatment failure rate with this regimen emphasizes the need for a test of cure at the appropriate interval following treatment to ensure clearance of infection.

Hepatitis B testing and vaccination in patients recently diagnosed with HIV infection.

The British HIV Association currently recommends vaccination against hepatitis B virus (HBV) for all susceptible HIV-infected individuals, therefore a retrospective analysis was performed on case notes from all patients diagnosed with HIV infection in our department for a one-year period from 1st August 2005; in each case HBV serological testing and vaccination status were recorded. Fifty-one patients were diagnosed with HIV infection during the study period, however, serological testing for HBV infection had been undertaken in only 76% of susceptible patients by 12 months following their HIV diagnosis. At the time of analysis only 31% of patients were adequately vaccinated against HBV, with recorded HBV surface antibody titres of >100 IU/L. HBV remains a considerable cause of morbidity and mortality in HIV-infected individuals and this study suggests that prevention or detection of HBV infection requires increased vigilance on the part of physicians managing HIV-positive patients.

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.

Telephonetics RESULTS computer-facilitated telephone system: a novel method for patient results retrieval.

Patients who may have been at risk of sexually transmitted infections should receive information on the infections for which they are being tested, and how and when they can receive their results. In August 2005, we installed a novel 24-hour computer-facilitated telephone results system in our department and an audit was conducted for the month of September 2005 to evaluate the effectiveness of, and demand for, this service. During the initial audit period, 33.8% of male patients and 50.9% of female patients chose to access their results using the new telephone system, and there were no complaints regarding the system. From January 2006, we adopted this system as our principal method of conveying results, and we present data regarding the running of the system and uptake rates by patients to date. This novel method of results retrieval provides an efficient solution with a high level of patient satisfaction.