P210 The prevalence of chlamydia in pregnant women compared with non-pregnant women in a busy sexual health clinic in the UK: Making the case for systematic chlamydia screening in pregnancy?: Abstract P210 Table 1

Background Medical problems during pregnancy are the leading cause of maternal mortality in the UK. Pregnant women often present through acute services to the medical team, requiring timely access to appropriate services, physicians trained to manage medical problems in pregnancy, with locally agreed guidance available. Methods Data were collected through the Society for Acute Medicine Benchmarking Audit, a national audit of service delivery and patient care in acute medicine over a 24 hour period. Results One hundred and thirty hospitals participated: 5.5% had an acute medicine consultant trained in obstetric medicine, and 38% of hospitals had a named lead for maternal medicine. This was not related to hospital size (p = 0.313). Sixty-four units had local guidelines for medical problems in pregnancy; 43% had a local guideline for venous thromboembolism in pregnancy. Centres with a named lead had more guidelines (p = 0.019). Conclusion Current provision of services within acute medicine for pregnant women does not meet national recommendations.

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Introduction of screening guidelines for men who have sex with men at an STD clinic, the Melbourne Sexual Health Centre, Australia

Sexual Health ◽

10.1071/sh05006 ◽

2005 ◽

Vol 2 (4) ◽

pp. 241 ◽

Cited By ~ 12

Author(s):

Nichole A. Lister ◽

Anthony Smith ◽

Christopher K. Fairley

Keyword(s):

Sexual Health ◽

Health Centre ◽

Health Clinic ◽

Chlamydia Screening ◽

Screening Guidelines ◽

Computer Reminder ◽

Sex With Men ◽

New Guidelines ◽

One Year ◽

The Impact

Background: A recent audit indicated that a substantial proportion of men who have sex with men (MSM) were not screened for rectal gonorrhoea and chlamydia at the Melbourne Sexual Health Clinic, Melbourne, Australia. In response, screening guidelines for MSM were introduced at the clinic using a computer reminder. The aim of this study was to evaluate the impact of the guidelines and alert on screening MSM for gonorrhoea and chlamydia. Methods: The medical records of MSM were reviewed for gonorrhoea and chlamydia screening by site (pharyngeal, urethral and rectal), four months before the implementation of the guidelines and alert (July to October 2002), and one year thereafter (beginning November 2002). Results: After the introduction of the guidelines there was a significant increase in rectal chlamydia testing (55% to 67%, P < 0.001), and significant reduction in pharyngeal chlamydia and gonorrhoea testing (65% to 28%, P < 0.001, and 83% to 76%, P = 0.015 respectively). The proportion of tests that were positive by any site did not change (7% to 7%). Conclusions: The introduction of a computer reminder for new guidelines was temporally associated with screening that conformed more closely to clinical guidelines.

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Improving the antenatal and post-partum management of women presenting to Sexual Health Services with positive syphilis serology through audit

International Journal of STD & AIDS ◽

10.1177/0956462417691443 ◽

2017 ◽

Vol 28 (9) ◽

pp. 929-931 ◽

Cited By ~ 2

Author(s):

Christina H Munro ◽

Ruth Henniker-Major ◽

Virginia Homfray ◽

Rita Browne

Keyword(s):

Sexual Health ◽

Congenital Syphilis ◽

Post Partum ◽

Partner Notification ◽

Cost Effective ◽

Contact Tracing ◽

Health Clinic ◽

Middlesex Hospital ◽

Electronic Referral ◽

The Uk

The incidence of congenital syphilis remains low in the UK, but the morbidity and mortality to babies born to women who are untreated for the condition make testing for the disease antenatally one of the most cost-effective screening programmes. Women attending North Middlesex Hospital, UK with a positive syphilis test at their antenatal booking visit are referred to St Ann’s Sexual Health Clinic, London, for management and contact tracing. We were concerned that our initial audit revealed that a large proportion of women referred to our service never attended and recorded partner notification was poor. Following the implementation of recommendations, specifically the introduction of an electronic referral system, re-audit showed an improvement in attendance, contact tracing, documentation and communication.

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Highlighting the clinical need for diagnosing Mycoplasma genitalium infection

International Journal of STD & AIDS ◽

10.1177/0956462417753527 ◽

2018 ◽

Vol 29 (7) ◽

pp. 680-686 ◽

Cited By ~ 3

Author(s):

Catherine A Ison ◽

Helen Fifer ◽

Simon Gwynn ◽

Paddy Horner ◽

Peter Muir ◽

...

Keyword(s):

Sexual Health ◽

Mycoplasma Genitalium ◽

Health Clinic ◽

Specific Patient ◽

Laboratory Staff ◽

Modified Delphi ◽

Delphi Approach ◽

Consensus Statements ◽

Sexual Contacts ◽

The Uk

Despite Mycoplasma genitalium (MG) being increasingly recognised as a genital pathogen in men and women, awareness and utility of commercially available MG-testing has been low. The opinion of UK sexual health clinicians and allied professionals was sought on how MG-testing should be used. Thirty-two consensus statements were developed by an expert group and circulated to clinicians and laboratory staff, who were asked to evaluate their level of agreement with each statement; 75% agreement was set as the threshold for defining consensus for each statement. A modified Delphi approach was used and high levels of agreement obviated the need to test the original statement set further. Of 201 individuals who received questionnaires, 60 responded, most (48) being sexual health consultants, more than 10% of the total in the UK. Twenty-seven (84.4%) of the statements exceeded the 75% threshold. Respondents strongly supported MG-testing of patients with urethritis, pelvic inflammatory disease or unexplained persistent vaginal discharge, or post-coital bleeding. Fewer favoured testing patients with proctitis and support was divided for routinely testing Chlamydia-positive patients. Testing of current sexual contacts of MG-positive patients was supported, as was a test of cure for MG-positive patients, although agreement fell below the 75% threshold. Respondents agreed that all consultant- or specialist-led services should have access to testing for MG (98.3%). There was strong agreement for having MG-testing available for specific patient groups, which may reflect concern over antibiotic resistance and the desire to comply with clinical guidelines that recommend MG-testing in sexual health clinic settings.

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Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis

BMJ Open ◽

10.1136/bmjopen-2020-038505 ◽

2020 ◽

Vol 10 (11) ◽

pp. e038505

Author(s):

Susie Huntington ◽

Georgie Weston ◽

Farah Seedat ◽

John Marshall ◽

Heather Bailey ◽

...

Keyword(s):

Cost Effectiveness ◽

Pregnant Women ◽

Neonatal Death ◽

Cost Effective ◽

Screening Strategy ◽

Base Case ◽

Scenario Analyses ◽

The Uk ◽

The Cost ◽

In Pregnancy

ObjectivesTo assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women.DesignA decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results.SettingUK antenatal screening programme.PopulationHypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year.Primary and secondary outcome measuresThe primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses.ResultsBase case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494.ConclusionsUniversal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.

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Managing HIV in pregnancy in a community-based sexual health clinic: a decade in review

International Journal of STD & AIDS ◽

10.1258/ijsa.2012.011466 ◽

2012 ◽

Vol 23 (11) ◽

pp. 806-809 ◽

Cited By ~ 2

Author(s):

S Duncan ◽

R Jones ◽

M McIntyre ◽

A Pilsniak ◽

J Trott ◽

...

Keyword(s):

Sexual Health ◽

Health Clinic ◽

Community Based ◽

In Pregnancy

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The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

10.1101/2021.01.04.21249195 ◽

2021 ◽

Author(s):

◽

Nicola Vousden ◽

Kathryn Bunch ◽

Edward Morris ◽

Nigel Simpson ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Surveillance System ◽

Absolute Risk ◽

Preterm Births ◽

Incidence Rates ◽

Minority Ethnic Group ◽

Symptom Status ◽

The Uk ◽

In Pregnancy

ABSTRACTBackgroundEvidence on risk factors, incidence and impact of SARS-CoV-2 infection in pregnant mothers and their babies has rapidly expanded but there is a lack of population level data to inform accurate incidence rates and unbiased descriptions of characteristics and outcomes. The primary aim of this study was to describe the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK compared to pregnant women without SARS-CoV-2 in order to inform future clinical guidance and management.Methods and FindingsWe conducted a national, prospective cohort study of all hospitalized pregnant women with confirmed SARS-CoV-2 from 1st March 2020 to 31st August 2020 using the UK Obstetric Surveillance System (UKOSS) across all 194 hospitals in the UK with a consultant-led maternity unit. Incidence was estimated using the latest national maternity data. Overall, 1148 hospitalized women had confirmed SARS-CoV-2 in pregnancy, 63% of which were symptomatic. Therefore, the estimated incidence of hospitalization with symptomatic SARS-CoV-2 was 2.0 per 1000 maternities (95% CI 1.9-2.2) and for asymptomatic SARS-CoV-2 was 1.2 per 1000 maternities (95% CI 1.1-1.4). Compared to pregnant women without SARS-CoV-2, women hospitalized with symptomatic SARS-CoV-2 were more likely to be overweight or obese (adjusted OR 1.86, 95% CI 1.39-2.48 and aOR 2.07, 95% CI 1.53-2.29 respectively), to be of Black, Asian or Other minority ethnic group (aOR 6.24, 95% CI 3.93-9.90, aOR 4.36, 95% CI 3.19-5.95 and aOR 12.95, 95% CI 4.93-34.01 respectively), and to have a relevant medical comorbidity (aOR 1.83, 95% CI 1.32-2.54). Compared to pregnant women without SARS-CoV-2, hospitalized pregnant women with symptomatic SARS-CoV-2 were more likely to be admitted to intensive care (aOR 57.67, 95% CI 7.80-426.70) but the absolute risk of poor outcomes was low. Cesarean births and neonatal unit admission were increased regardless of symptom status (symptomatic aOR 2.60, 95% CI 1.97-3.42 and aOR 3.08, 95% CI 1.99-4.77 respectively; asymptomatic aOR 2.02, 95% CI 1.52-2.70 and aOR 1.84, 95% 1.12-3.03 respectively). Iatrogenic preterm births were more common in women with symptomatic SARS-CoV-2 (aOR 11.43, 95% CI 5.07-25.75). The risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status but numbers were small. The limitations of this study include the restriction to women hospitalized with SARS-CoV-2, who may by nature of their admission have been at greater risk of adverse outcome.ConclusionsWe have identified factors that increase the risk of symptomatic and asymptomatic SARS-CoV-2 in pregnancy. The increased risks of cesarean and iatrogenic preterm birth provide clear evidence of the indirect impact of SARS-CoV-2 on mothers and maternity care in high income settings. Clinicians can be reassured that the majority of women do not experience severe complications of SARS-CoV-2 in pregnancy and women with mild disease can be discharged to continue their pregnancy safely.

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Hepatitis A susceptibility in newly attending men who have sex with men to an urban sexual health centre

International Journal of STD & AIDS ◽

10.1177/0956462420961960 ◽

2020 ◽

pp. 095646242096196

Author(s):

Colin Fitzpatrick ◽

Fionnuala Finnerty ◽

Deborah Williams ◽

Daniel Richardson

Keyword(s):

Sexual Health ◽

Hepatitis A ◽

Health Centre ◽

Herd Immunity ◽

Risk Groups ◽

Health Clinic ◽

Record System ◽

Young Msm ◽

Sex With Men ◽

The Uk

Within the UK, the majority of hepatitis A occurs in high risk groups such as men who have sex with men (MSM). It has been estimated that 70% of MSM need immunity to provide adequate herd immunity. We aimed to estimate the proportion of hepatitis A susceptibility in MSM throughout a 10-year period (2010–2019), and explore associated demographic factors. Using our Electronic Patient Record system, we extracted anonymous clinical data between for MSM at their first attendance; including hepatitis A IgG result, age, country of birth and diagnosis of an STI. Overall, 1401/6884(20%) were tested for hepatitis A IgG at their first attendance, with 626/1401 (45%, 95% CI = 42%–47%) showing susceptibility. Testing rates increased between 2010–2019 (OR = 67.79, 95%CI = 39.09–117.60, p = <0.0001); however, susceptibility remained similar (OR = 0.98, 95%CI = 0.33–2.89, p = 0.98). MSM aged 35 and under had significantly higher susceptibility vs MSM aged over 35 (OR 3.4176, 95%CI = 2.71–4.31, p = <0.0001). UK-born had significantly higher susceptibility vs non-UK born (OR 1.5, 95%CI = 1.2147–1.8618, p = 0.0002). Susceptibility of hepatitis A in MSM may be higher than necessary to control future outbreaks. It is important that effective targeting of MSM, particularly young MSM, occur at all levels of healthcare and not solely rely on opportunistic presentation at a sexual health clinic.

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A protocol for the economic evaluation of the smoking Cessation in Pregnancy Incentives Trial III (CPIT III)

BMJ Open ◽

10.1136/bmjopen-2020-038827 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038827

Author(s):

Nicola McMeekin ◽

Lesley Sinclair ◽

Linda Bauld ◽

David Michael Tappin ◽

Alex Mitchell ◽

...

Keyword(s):

Economic Evaluation ◽

Usual Care ◽

Pregnant Women ◽

Financial Incentives ◽

Cost Effective ◽

Good Opportunity ◽

Link Type ◽

The Uk ◽

In Pregnancy

IntroductionSmoking results in an average 10-year loss of life, but smokers who permanently quit before age 40 can expect a near normal lifespan. Pregnancy poses a good opportunity to help women to stop; around 80% of women in the UK have a baby, most of whom are less than 40 years of age. Smoking prevalence during pregnancy is high: 17%–23% in the UK. Smoking during pregnancy causes low birth weight and increases the risk of premature birth. After birth, passive smoking is linked to sudden infant death syndrome, respiratory diseases and increased likelihood of taking up smoking. These risks impact the long-term health of the child with associated increase in health costs. Emerging evidence suggests that offering financial incentives to pregnant women to quit is highly cost effective.This protocol describes the economic evaluation of a multi-centre randomised controlled trial (Cessation in Pregnancy Incentives Trial III, CPIT III) designed to establish whether offering financial incentives, in addition to usual care, is effective and cost effective in helping pregnant women to quit.Methods and analysisThe economic evaluation will identify, measure and value resource use and outcomes from CPIT III, comparing participants randomised to either usual care or usual care plus up to £400 financial incentives. Within-trial and long-term analyses will be conducted from a National Health Service and Personal Social Services perspective; the outcome for both analyses will be quality adjusted life-years measured using EQ-5D-5L. Patient level data collected during the trial will be used for the within-trial analysis, with an additional outcome of cotinine validated quit rates at 34–38 weeks gestation and 6 months postpartum. The long-term model will be informed by data from the trial and published literature.Ethics and disseminationTrial registration numberISRCTN15236311; Pre-results (https://doi.org/10.1186/ISRCTN15236311).

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