Identifying MSM-competent physicians in China: a national online cross-sectional survey among physicians who see male HIV/STI patients.

BACKGROUND: Men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) infection and sexually transmitted infection (STI) in China. Inadequate clinical services and poor clinical competency among physicians are major barriers to improving the sexual health of MSM. This study aims to understand physician clinical competency in providing MSM health services in China. METHODS: We conducted an online cross-sectional survey among Chinese physicians who have seen male patients for STI complaints in the past year. We obtained information on individual demographics, clinical practice, attitudes toward MSM, and interest in contributing to MSM clinical services. We defined an MSM-competent physician as one who asked male patients about sexual orientation, sexual practices, and recommended HIV/ STI testing during a clinic visit. We conducted multivariable logistic regression to identify factors associated with MSM competency. RESULTS: In total, 501 physicians completed the survey. The most common subspecialties were dermatovenereology (33.1%), urology (30.1%), and general medicine (14.4%). Roughly half (n = 267, 53.3%) reported seeing MSM in the past 12 months. Among physicians who saw MSM in the past 12 months, 60.3% (n = 161) met criteria as MSM-competent physicians, and most (n = 234, 87.6%) MSM-competent physicians reported positive or neutral attitudes towards MSM. Over 60% of all physicians were willing to participate in activities for improving MSM services, such as training and being on a list of physicians willing to serve MSM. MSM-competent physicians showed no sociodemographic differences compared with non MSM-competent physicians. MSM-competent physicians were more willing to have their medical institution named on a public clinic list capable of serving MSM (aOR: 1.70, 95%CI: 1.01-2.86) and being on a public physician list capable of serving MSM (aOR: 1.77, 95%CI: 1.03-3.03). CONCLUSIONS: MSM-competent physicians included a broad range of individuals that practiced in diverse clinical settings. Most physicians were interested in improving and expanding MSM clinical services, despite having neutral attitudes toward same-sex behavior. Future interventions should focus on developing MSM clinical competency and expanding services that meet the needs of MSM.

Survey of genitourinary medicine specialist registrars in the United Kingdom regarding genital dermatology training.

The British Association for Sexual Health and HIV Genital Dermatology Special Interest Group (SIG) conducted a survey of specialist registrar training in genital dermatology (GD) to inform future training provision provided by the group and other services. The survey shows that training in GD is variable with most trainees receiving GD training through formal lectures or ad hoc clinical teaching, with fewer trainees having access to specialist GD clinics. There is mixed confidence in diagnosis and use of topical steroids, and few trainees are independent in GD practical procedures. Many trainees feel training could be improved with requests for a formalised attachment, formal qualification and greater training in practical procedures. The GD SIG, in liaison with British Association for Sexual Health and HIV (BASHH), aims to optimise GD training for registrars. Plans for improved resources are in progress, including a practical skills course and e-learning. It is hoped this survey will also inform GD training at both local and national levels.

Building the bypass--implications of improved access to sexual healthcare: evidence from surveys of patients attending contrasting genitourinary medicine clinics across England in 2004/2005 and 2009.

OBJECTIVE: The objective of this study was to examine changes in patient routes into genitourinary medicine (GUM) clinics since policy changes in England sought to improve access to sexual healthcare. METHODS: Cross-sectional patient surveys at contrasting GUM clinics in England in 2004/2005 (seven clinics, 4600 patients) and 2009 (four clinics, 1504 patients). Patients completed a short pen-and-paper questionnaire that was then linked to an extract of their clinical data. RESULTS: Symptoms remained the most common reason patients cited for attending GUM (46% in both surveys), yet the proportion of patients having sexually transmitted infection (STI) diagnosis/es declined between 2004/2005 and 2009: 38%-29% of men and 28%-17% of women. Patients in 2009 waited less time before seeking care: median 7 days (2004/2005) versus 3 days (2009), in line with shorter GUM waiting times (median 7 vs 0 days, respectively). Fewer GUM patients in 2009 first sought care elsewhere (23% vs 39% in 2004/2005), largely from general practice, extending their time to attending GUM by a median of 2 days in 2009 (vs 5 days in 2004/2005). Patients with symptoms in 2009 were less likely than patients in 2004/2005 to report sex since recognising a need to seek care, but this was still reported by 25% of men and 38% of women (vs 44% and 58%, respectively, in 2004/2005). CONCLUSIONS: Patient routes to GUM shortened between 2004/2005 and 2009. While GUM patients in 2009 were less likely overall to have STIs diagnosed, perhaps reflecting lower risk behaviour, there remains a substantial proportion of high-risk individuals requiring comprehensive care. Behavioural surveillance across all STI services is therefore essential to monitor and maximise their public health impact.

The need for innovative sexually transmitted infection screening initiatives for young men: evidence from genitourinary medicine clinics across England.

The study objectives were to ascertain behavioural, access-related, health-seeking factors and sexually transmitted infection (STI) prevalence in young men (<25 years) attending genitourinary (GU) medicine clinics and compare them with older men (≥ 25 years) and young women (<25 years). Between October 2004 and March 2005, 4600 new attendees at seven sociodemographically and geographically contrasting GU medicine clinics across England completed questionnaires, which were linked to routine clinical data. Young men waited significantly less time to be seen in clinic compared with older men and young women. They were less likely to report symptoms than older men (P = 0.021) yet more likely to be diagnosed with chlamydia (P = 0.001) and gonorrhoea (P = 0.007). They were also more likely to be diagnosed with an acute STI relative to young women (P = 0.007). Our data confirm the need to make comprehensive STI screening readily available for young men and to develop effective and innovative screening strategies in different settings.

Genital warts and cost of care in England.

OBJECTIVES: To estimate the total number of cases of, and cost of care for, genital warts (GWs) in England, to inform economic evaluations of human papillomavirus vaccination. METHODS: The number of GW cases seen in general practices (GPs) and in genitourinary medicine (GUM) clinics was estimated using the General Practice Research Database and the GUM Clinic Activity Dataset. The overlap in care of cases in the two settings was estimated. The calculated costs of care in GP and hospitals were added to the costs of care in GUM clinics (estimated elsewhere) to estimate the cost of care for GWs in England. RESULTS: In England, in 2008, GP and GUM saw 80,531 new (157/100,000 population) and 68,259 recurrent (133/100,000 population) episodes, giving a total of 148,790 episodes of care of GWs (289/100,000 population). Seventy-three per cent of cases were seen only in GUM clinics, 22% were seen by a GP before being referred to GUM, and 5% by GPs only. Hospital care was given in 1.3% of cases and contributed 8% of the costs. The average cost of care per episode was £113, and the estimated annual cost of care in England was £16.8 million. CONCLUSIONS: This study provides a fairly comprehensive measure of GW frequency and care in England. GWs exert a considerable impact on health services, a large proportion of which could be prevented through immunisation using the quadrivalent human papillomavirus vaccine.

Variation in partner notification outcomes for chlamydia in UK genitourinary medicine clinics: multilevel study.

OBJECTIVES: To compare different ways of measuring partner notification (PN) outcomes with published audit standards, examine variability between clinics and examine factors contributing to variation in PN outcomes in genitourinary medicine (GUM) clinics in the UK. METHODS: Reanalysis of the 2007 BASHH national chlamydia audit. The primary outcome was the number of partners per index case tested for chlamydia, as verified by a healthcare worker or, if missing, reported by the patient. Control charts were used to examine variation between clinics considering missing values as zero or excluding missing values. Hierarchical logistic regression was used to investigate factors contributing to variation in outcomes. RESULTS: Data from 4616 individuals in 169 genitourinary medicine clinics were analysed. There was no information about the primary outcome in 41% of records. The mean number of partners tested for chlamydia ranged from 0 to 1.5 per index case per clinic. The median across all clinics was 0.47 when missing values were assumed to be zero and 0.92 per index case when missing values were excluded. Men who have sex with men were less likely than heterosexual men and patients with symptoms (4-week look-back period) were less likely than asymptomatic patients (6-month look-back) to report having one or more partners tested for chlamydia. There was no association between the primary outcome and the type of the health professional giving the PN advice. CONCLUSIONS: The completeness of PN outcomes recorded in clinical notes needs to improve. Further research is needed to identify auditable measures that are associated with successful PN that prevents repeated chlamydia in index cases.

Factors associated with genitourinary medicine clinic attendance and sexually transmitted infection diagnosis among central and east European migrants in London.

OBJECTIVES: There has been a large influx of central and east European (CEE) migrants to the U.K. following the expansion of the European Union. This paper examines factors associated with genitourinary medicine (GUM) clinic attendance and sexually transmitted infection (STI) diagnosis among CEE migrants in London. METHODS: A survey of sexual behaviour was conducted among CEE migrants attending two central London GUM clinics (n=299) and community venues in London (n=2276). Routinely collected clinic data were also analysed. RESULTS: CEE migrants made up 2.9% of male and 7.0% of female attendees at the clinics. Half the women attending sessions for female sex workers were from CEE countries, and paying for sex was widely reported by men. Women were more likely than men to have attended a GUM clinic in the U.K. (7.6% vs. 4.5%, p=0.002). GUM survey respondents were more likely than community survey respondents to report one or more new sexual partners in the past year (women 67.9% vs. 28.3%, p < 0.001; men 75.6% vs. 45.1%, p < 0.001) and homosexual partnership(s) in the past 5 years (men 54.3% vs. 1.8%, p < 0.001), but were less likely to report assortative heterosexual mixing (women 25.9% vs. 74.2%, p < 0.001; men 56.5% vs. 76.3%, p < 0.001). CONCLUSIONS: CEE patients make up a notable minority of patients attending two central London GUM clinics. Higher numbers of sexual partners, homosexual partnerships and sexual mixing with people from outside the country of origin are associated with GUM clinic attendance. Heterosexual CEE men report behaviours associated with HIV/STI acquisition but appear to be underutilising GUM services.

Central and east European migrant men who have sex with men: an exploration of sexual risk in the U.K.

BACKGROUND: Since May 2004, 10 central and east European (CEE) countries have joined the European Union. While HIV rates remain low among men who have sex with men (MSM) in CEE countries, there is no research on the sexual behaviour of CEE MSM in the U.K. METHODS: CEE MSM living in the U.K. (n=691) were recruited for an online questionnaire by two popular MSM websites. RESULTS: The majority of men had arrived in the U.K. since May 2004. A previous sexually transmitted infection (STI) diagnosis was reported by 30.7%, and 4.8% reported being HIV positive, the majority diagnosed in the U.K. Unprotected anal intercourse with a casual partner of unknown or discordant HIV status was reported by 22.8%. Men who had been in the U.K. for longer (>5 years vs. <1 year) reported more partners in the past 5 years (67.2% vs. 50.4% had >10 partners, p < 0.001) and were less likely to report their most recent partner was from their home country (14.9% vs. 33.6%, p < 0.001). Among migrant CEE MSM living in London, 15.4% had been paid for sex in the U.K. and 41.5% had taken recreational drugs in the past year. CONCLUSION: CEE MSM in the U.K. are at risk for the acquisition and transmission of STI and HIV through unprotected anal intercourse with non-concordant casual partners. Sexual mixing with men from other countries, commercial sex and increased partner numbers may introduce additional risk. This has important implications for the cross-border transmission of infections between the U.K. and CEE countries.

How and why do South Asians attend GUM clinics? Evidence from contrasting GUM clinics across England.

BACKGROUND: Improving access to sexual healthcare is a priority in the UK, especially for ethnic minorities. Though South Asians in the UK report low levels of sexual ill health, few data exist regarding their use of genitourinary medicine (GUM) services. OBJECTIVES: To describe reasons for attendance at GUM clinics among individuals of South Asian origin relative to patients of other ethnicities. METHODS: 4600 new attendees (5% South Asian; n=226) at seven sociodemographically and geographically contrasting GUM clinics across England completed a questionnaire between October 2004 and March 2005, which were linked to routine clinical data. RESULTS: South Asians were more likely than other groups to be signposted to the GUM clinic by another health service-for example, in women 14% versus 8% respectively (p=0.005) reported doing so from a family planning clinic. These women also reported that they would be less likely to go to the clinic if their symptoms resolved spontaneously compared with other women (51% vs 31%, p=0.024). However, relative to other clinic attendees, no differences in the proportions of South Asians who had acute STI(s) diagnosed at clinic were noted. Furthermore, South Asian men were more likely to report as their reason for attendance that they wanted an HIV test (23.4% vs 14.8%, p=0.005). CONCLUSION: Despite having similar STI care needs to attendees from other ethnic groups, South Asians, especially women, may be reluctant to seek care from GUM clinics, especially if their symptoms resolve. Sexual health services need to develop locally-delivered and culturally-appropriate initiatives to improve care pathways.

Referrals into a dedicated British penile cancer centre and sources of possible delay.

OBJECTIVE: To assess sources of delay in referral to a specialist Urology clinic for penile cancer. METHODS: Patients with penile cancer seen during the period December 2002 to December 2007 were identified from the unit's database. Information regarding presentation, diagnosis and pattern of referral was retrieved from records. Delay was defined as the time between the patient first noticing a penile lesion and date of first seeking medical advice, or additional time before being seen by a Urologist resulting from referral to another specialty. RESULTS: Of 100 patients, with a median age of 54 years (range 2-81 years), 19% were initially referred to other specialties (Genitourinary Medicine-13%, Dermatology-4%, Plastics 2%). Initial referrals to Genito-urinary Medicine and Dermatology resulted in mean delays of 6 and 3.5 months respectively, whereas the mean duration for patients to present to any medical practitioner from onset of symptoms was 5.8 months. Overall, 47% presented with locally advanced disease. CONCLUSION: Approximately one-fifth of patients with penile cancer are first referred to specialties other than Urology. This sometimes delays diagnosis, potentially affecting overall prognosis. The major source of delay, however, results from patient reluctance to seek medical advice. Thus, the greatest impact in this condition is likely to be achieved by increased public awareness and education.

[Assessment of the scientific impact of presentations at Spanish National Dermatology and Venereology Congresses from 2000 through 2003]. / Valoración del impacto científico de las comunicaciones presentadas en el Congreso Nacional de Dermatología y Venereología (años 2000-2003).

INTRODUCTION: The percentage of presentations at congresses that are later published is a measure of the scientific impact of these meetings. Our objective was to investigate how many studies presented in four Spanish national conferences (2000-2003) had been published in Spanish and international biomedical and dermatology journals, with or without an impact factor. MATERIAL AND METHODS: A search for publications in international indexed journals (using PubMed) or publications in unindexed Spanish journals (using Dermabase/Indice Médico Español) was undertaken by the name of first author, the first and last author, and the key words of the article. RESULTS: Of a total of 1,471 scientific presentations, only 200 (13.5 %) were published (118 in Spanish journals and 82 in international ones); that is, 1,271 studies (86.5 %) were not published either in a Spanish or an international journal. CONCLUSIONS: We found a low impact in terms of the publication rate for abstracts presented in 4 consecutive Spanish National Dermatology and Venereology Congresses compared to the rate of publication for other dermatology meetings such as the British Association of Dermatologists Annual Meeting.

Valoración del impacto científico de las comunicaciones presentadas en el Congreso Nacional de Dermatología y Venereología (años 2000-2003) / Assessment of the Scientific Impact of Presentations at Spanish National Dermatology and Venereology Congresses From 2000 Through 2003

Introducción: El porcentaje de publicación de las comunicaciones presentadas en los congresos es una medida del impacto científico de estas reuniones. Nuestro objetivo fue el conocer cuántos de los trabajos presentados en cuatro congresos nacionales (2000-2003) habían sido publicados en revistas científicas médicas y dermatológicas nacionales o internacionales, con o sin factor de impacto. Material y métodos: Se realizó una búsqueda como publicación internacional indexada (PubMed) o nacional no indexada (Dermabase/Índice Médico Español) incluyendo el nombre del primer autor, o del primero y el último, y las palabras clave del título. Resultados: De un total de 1.471 comunicaciones científicas presentadas, sólo fueron publicados un total de 200 trabajos (13,5 %) (118 nacionales y 82 internacionales), lo que significa que un total de 1.271 trabajos (86,5 %) no dieron lugar a ninguna repercusión escrita nacional o internacional. Conclusiones: Hallamos un factor de impacto bajo en cuanto al índice de publicación de los resúmenes presentados en cuatro Congresos Nacionales de Dermatología y Venereología consecutivos, en comparación con la proporción de publicación de otras reuniones dermatológicas, como la reunión anual de dermatólogos del Reino Unido (AU)

Introduction: The percentage of presentations at congresses that are later published is a measure of the scientific impact of these meetings. Our objective was to investigate how many studies presented in 4 Spanish national conferences (2000-2003) had been published in Spanish and international biomedical and dermatology journals, with or without an impact factor. Material and methods: A search for publications in international indexed journals (using PubMed) or publications in unindexed Spanish journals (using Dermabase/Índice Médico Español) was undertaken by the name of first author, the first and last author, and the key words of the article. Results: Of a total of 1471 scientific presentations, only 200 (13.5%) were published (118 in Spanish journals and 82 in international ones); that is, 1271 studies (86.5%) were not published either in a Spanish or an international journal. Conclusions: We found a low impact in terms of the publication rate for abstracts presented in 4 consecutive Spanish National Dermatology and Venereology Congresses compared to the rate of publication for other dermatology meetings such as the British Association of Dermatologists Annual Meeting (AU)

Increased attendances of people of eastern European origin at sexual health services in London.

OBJECTIVE: To describe the service use of migrants from eight central and eastern European (CEE) countries at two central London genitourinary medicine (GUM) clinics before and after accession to the European Union on 1 May 2004. METHODS: KC60 data collected between 1 June 2001 and 30 April 2007. Data refer to new attendances and exclude those attending for follow-up appointments. RESULTS: 102,604 people attended the clinics at least once over the study period. Between May 2006 and 30 April 2007 individuals born in the eight CEE countries accounted for 7.9% of attendances among women and 2.5% of attendances made by men; the proportion increasing significantly over the 6-year study period (p<0.001). Syphilis was more likely in CEE men (age-adjusted odds ratio (OR) 2.98, 95% CI 1.07 to 8.29) and family planning services were more likely to be required for CEE women (23.9% vs 12.4%, age-adjusted OR 2.33, 95% CI 2.02 to 2.68, p<0.001), than for those born elsewhere. A larger proportion of men from CEE countries were recorded as homosexual or bisexual than men from other countries (38.3% vs 31.9%, p = 0.003). CONCLUSIONS: CEE migrants already have a substantial impact on GUM services in London. If attendance rates continue at the current level CEE women will soon account for over 10% of new attendances. Although the majority of CEE migrants are men, proportionately fewer CEE men accessed GUM services than women. Sexual and reproductive health services need to adapt quickly to meet the needs of this growing population.

Patient-initiated delay at a genitourinary medicine clinic: are there public health consequences?

OBJECTIVES: To assess the public health consequence of patients electing not to be seen within 48 hours in a genitourinary medicine (GUM) clinic. METHODS: A 3-month retrospective case notes review was carried out for 310 new and re-book patients who chose to wait for more than 48 hours to be seen. RESULTS: Altogether, 10% (310/3110) of patients opted to be seen beyond 48 h. Their median wait was 6 days including weekends and 4 days excluding weekends. Demographic details did not vary except for the male to female ratio of 1:1.7 (1:1 in patients seen within 48 h). We found that no symptomatic patients or asymptomatic contacts of those with known sexually transmitted infections (STIs) reported sex with a new partner after booking their appointment. No patient reported sex with a recently treated partner who consequently required re-treatment and none suffered a complication of a STI. In addition, there were no cases of new HIV infection in this group and the rates of STIs were similar compared with patients seen within 48 hours of contacting the unit. CONCLUSIONS: Despite 10% of patients choosing to delay attendance beyond 48 h, no adverse public health outcomes were demonstrated.