Posts in ‘Bacteria’ category

Cuts to sexual health services are putting patients at risk

Posted on 20th March 2017 by · No comments

Cuts to sexual health services in parts of England are placing the care of patients at risk, a new report has warned according to a report published in the BMJ.

The research by the healthcare think tank the King’s Fund concluded that budget cuts of more than 20% to genitourinary medicine (GUM) services in some parts of the country had led to service closures and staffing cuts that have harmed patient care. Experts said that the findings were particularly worrying given that numbers of diagnoses of sexually transmitted infections such as syphilis and gonorrhoea were rising.

Current pressures on services were also having a negative effect on staff morale and leading some staff to consider alternative careers, the report warned.

The researchers analysed data and interviewed frontline staff to examine the effect of funding pressure on patient care across four service areas: GUM, district nursing, elective hip replacements, and neonatal care.

Their findings indicated that sexual health and district nursing had been hardest hit which undermined the vision set out in NHS England’s Five Year Forward View to strengthen prevention and community based services.

The authors said that sexual health services such as GUM had become more prone to budgetary cuts since moving from the NHS to local government, because of local authorities’ legal obligation to balance their books.

Centenary of nationwide free access to sexual health clinics in England and Wales

Posted on 3rd February 2017 by · No comments

STI began in 1925 as the British Journal of Venereal Disease, and you can read early editions on the sti.bmj.com website. The very first issue covers skin complaints often mistaken for syphilis, the use of bismuth and malaria inoculation to treat syphilis, and the establishment of a network of clinics following a Royal Commission.1 It also discusses diathermy in the treatment of gonorrhoea!

A hundred years ago, we had no effective treatment for gonorrhoea, and it is sobering to realise we may soon be in the same position. The GRASP surveillance system which tracks antimicrobial resistance in England and Wales shows indications that we are not far from ceftriaxone treatment failures in a report by Town et al.2 In an age of nucleic acid based diagnostics, we need alternatives to culture for detecting resistance. A fascinating report by Graham et al reports that whole genome sequencing can be achieved with urine specimens, including the detection of markers associated with resistance.3 On a related note, this month’s editorial by Nigel Garrett reflects on the perhaps brief life of syndromic management.4
Read full article

 

Project on chlamydia wins prize

Posted on 18th July 2016 by · No comments

Infection by Chlamydia trachomatis the commonest bacterial sexually transmitted infection in the UK and can result in long term complications such as pelvic inflammatory disease and infertility in women.gabriel schembri prize

Once treatment is given to the patient and their partner(s) a test of cure is recommended. However when this should be done is unclear. A similar question hangs over another common sexually transmitted bacterial infection, gonorrhoea.

Dr Gabriel Schembri and his colleagues in Manchester in collaboration with researchers in London have completed a study, part co-funded by STIRF (in conjunction with BASHH)  in an effort to answer these questions:

STIRF-015: Testing for chlamydia and gonorrhoea: persistence of a positive test result after successful treatment.

The study has now finished and was presented at the British Association for sexual Health and HIV (BASHH) meeting in Oxford (July 2016) and won the prize for the best oral presentation.TOC-BASHH presentation

The investigators showed that the site of infection may have an effect on time to clearance of infection, with pharyngeal gonorrhoea infections and vaginal chlamydia infections taking longer to clear than other sites.

 

The results of this study will help guide clinicians to the timing for tests of cure.

Risks for pelvic inflammatory disease in students

Posted on 17th February 2016 by · No comments

In the latest issue of the Sexually Transmitted Infections, Phillip Hay and colleagues in the UK report on a prospective study of female students attending 11 universities and 9 further education colleges in London.

At the start, the students were asked to fill a questionnaire and provide a self taken vaginal sample for infection screening. After 12 months, they were assessed for pelvic inflammatory disease (PID), a condition that can lead to infertility and other complications.

PID was found in 1.6% of the particpants. Unsurprisingly the strongest predictor of PID was the presence of Chlamydia trachomatis at the first visit (relative risk (RR) 5.7).

However, adjusting for this, the authors reported that significant predictors of PID were ≥2 sexual partners (RR 4.0) or a new sexual partner during follow-up (RR 2.8), and age <20 years (RR 3.3). Somewhat surprisingly recruitment from a further education college rather than a university also increased the relative risk of PID 2.6 fold, perhaps reflecting different health protection behaviors (eg condom use) between the two groups.

The study concluded that in addition to known risk factors such as multiple or new partners in the last 12 months and younger age, attending a further education college rather than a university were risk factors for PID.

They recommended that sexual health education and screening programs could be targeted at these high-risk groups.

Report of gonorrhoea resistant to all antibiotics in UK

Posted on 31st December 2015 by · No comments

A highly drug-resistant gonorrhoea outbreak in the north of England has been identified.

Fifteen cases of “super-gonorrhoea” have been detected by Public Health England since March, the British Association for Sexual Health and HIV reported.

For an entertaining understanding of how microbes develop resistance see this short video

 

The perils of chemsex

Posted on 3rd December 2015 by · No comments

The term “Chemsex” is used in the United Kingdom to describe intentional sex under the influence of psychoactive drugs, mostly among men who have sex with men. The main drugs are mephedrone, γ-hydroxybutyrate (GHB), γ-butyrolactone (GBL), and crystallised methamphetamine. These drugs are often used in combination to facilitate sexual sessions lasting several hours or days with multiple sexual partners.

Mephedrone and crystal meth are physiological stimulants, increasing heart rate and blood pressure, as well as triggering euphoria and sexual arousal. GHB (and its precursor GBL) is a powerful psychological disinhibitor and also a mild anaesthetic.

Anecdotal reports and some small qualitative studies in the UK find that people engaging in chemsex report better sex, with these drugs reducing inhibitions and increasing pleasure.

Unfortunately use of chemsex can lead to mental health problems which can be permanent. Moreover Casual sex, particularly if under the influence of alcohol or drugs can lead to the acquisition of sexually transmitted infections and even such bugs as shigella, an infection causing severe bacillary dysentery and diarrhoea usually associated with travel to regions such as Indian subcontinent, North and East Africa and South America.

See trailer for Chemsex, a film ChemsexOfficial directed by William Fairman and Max Gogarty (a Peccadillo Pictures)  in the medical journal Lancet.

Lesbian and bisexual health facts

Posted on 17th August 2015 by · No comments

The US based Centre for disease control (CDC) has recently updated its factsheet on lesbian and bisexual health. The CDC emphasises the potential risks of acquiring sexually transmitted infections and HIV from certain sexual practices. The article provides advise on how lesbian and bisexual women can protect themselves.

Transmitting an STI and the law

Posted on 31st July 2014 by · No comments

On May 8 2014 the UK Court of Appeal dismissed the appeal of David Golding against a 14 month prison sentence for transmitting herpes to his partner.

An Editorial in the BMJ by Emily Clarke an colleagues highlights the numerous and  complicated issues that arise from this verdict including:

what constitutes grievous bodily harm,

how you determine that sexual transmission has occurred,

how serious is herpes infection, and

what this judgement means both for health care workers who advise and inform patients on the risks of transmission and on the infected individual and their duty of informing all partners of potential risk of transmitting an infection even during asymptomatic shedding.

The Editorial correctly highlights the dangers of criminalizing sexually transmitted infections and the various problems that arise from this judgement which was based on a law passed 170 years ago addressing totally unrelated issues and at a time when STI’s were not understood as they are today.

Bacteria living in men’s penises could be promoting sexually transmitted infections

Posted on 9th July 2014 by · No comments

The debate about whether to circumcise or not continues to raise passions. The fact that male circumcision reduces acquisition of HIV from an infected partner has been proven by three randomised clinical trials. And male circumcision may also protect against other sexually transmitted infections.

One of the most powerful arguments against male circumcision is that it only addresses acquired infections in the male. A recent report in the Scientist that bacteria living under the foreskin can promote STI’s would help answer this critique.

Just as the vaginal microbiome differs among women and changes over time, the penis is home to a variety of bacteria that vary with age, sexual activities, and whether the man is circumcised, among other things. And it’s not just the skin that envelops the male sexual organ that’s inhabited by microbes: researchers continue to identify bacteria that dwell within the urogenital tract, a site once considered sterile in the absence of infection.

David Nelson and colleagues at Indiana University in Bloomington found evidence to suggest that the sexually transmitted pathogens in the urogenital tract were obtaining metabolites from other microbes. “There was a signature in the chlamydial genome that suggested this organism might be interacting with other microorganisms,” said Nelson. “That’s what initially piqued our interest. And when we went in and started to look, we found that there were a lot more [microbes] than we would have anticipated being there.”

The researchers found that some men pass urine containing a variety of lactobacilli and streptococci species, whereas others have more anaerobes, like Prevotella and Fusobacterium. In terms of overall composition, “we see a lot of parallels to the gut,” said Nelson, noting that there doesn’t seem to be a standout formula for a “healthy” urogenital tract. Commensal microbes within the urethra could make a man more susceptible to infection by supporting colonization by pathogens like Chlamydia, whereas bacteria that consume the environment’s nutrients could help prevent it. “We just don’t know at this point,” said Nelson.

To date, circumcision is the known largest influence on the composition of the penis microbiome. In a 2010 PLOS ONE paper, Lance Price of the Translational Genomics Research Institute in Phoenix, Arizona, and his colleagues showed that the bacteria that colonized the base of the penis’s tip, or glans, varied before and after circumcision. More specifically, the researchers found fewer anaerobic bacteria within six months after the men in a study were circumcised. Those findings have since been confirmed.

Definitely further studies in this field should be encouraged.

Sexual health of female sex worker in the UK

Posted on 3rd June 2014 by · No comments

Female sex workers (FSWs) are assumed to be at increased risk of sexually transmitted infections (STIs). Using routine STI surveillance data, McGrath-Lone et al  in an article published in the latest issue of Sexually Transmitted Infections investigated differences in sexual health between FSWs and other female attendees at sexual health (genitourinary medicine – GUM) clinics in England.

They reported on 2704 FSWs visiting to 131/208 GUM clinics, (primarily large, FSW-specialist centres in London) in 2011. By comparison with other female attendees, FSWs travelled further for their care and had increased risk of certain STIs (eg, gonorrhoea Odds Ratio: 2.76, p<0.001). Significantly migrant FSWs had better sexual health outcomes than UK-born FSWs (eg, period prevalence of chlamydia among those tested: 8.5% vs 13.5%, p<0.001) but were more likely to experience non-STI outcomes (eg, pelvic inflammatory disease OR: 2.92, p<0.001).

They concluded that although FSWs in England have access to high-quality care through the GUM clinic network, there was evidence of geographical inequality in access to these services.

A minority do not appear to access STI/HIV testing through clinics, and some STIs are more prevalent among FSWs than other female attendees.

Targeted interventions aimed at improving uptake of testing in FSWs should be developed, and need to be culturally sensitive to the needs of this predominantly migrant population.