Category: men’s health

COVID-19 restrictions and changing sexual behaviours in MSM in London, UK

A recent article in the journal Sexually Transmitted Infections has looked at changes in behaviour in MSM in London during the Covid 19 pandemic. The study was web-based and only among HIV-negative MSM in a large urban setting.

Objectives: The COVID-19 pandemic and its related restrictions have affected attendance to and delivery of UK sexual healthcare services.

Methods: This was a cross-sectional, anonymous, web-based survey among HIV-negative MSM at high risk of HIV infection who attended  a sexual health and HIV clinic in London in August 2020. They collected data on sociodemographic characteristics, sexual behaviour and related mental well-being experienced during lockdown.

Results: 814 MSM completed the questionnaire: 75% were PrEP users; three quarters reported they have been sexually active, about half  had sex outside their household. The majority reported fewer partners than prior to lockdown. Interestingly 73% had discussed COVID-19 transmission risks with their sexual partners.

One out of five reported guilt for breaching COVID-19 restrictions and three out of four implemented one or more changes to their sexual behaviour. PrEP users reported higher partner number, engagement in ‘chemsex’ and use of sexual health services than non-PrEP users.

Conclusions: COVID-19 restrictions had a considerable impact on sexual behaviour and mental well-being in respondents. High rates of sexual activity and STI diagnoses were reported during lockdown. Changes to sexual health services provision for MSM must respond to high rates of psychological and STI-related morbidity and the challenges faced by this population in accessing services.

Mycoplasma genitalium: the next sexually transmitted superbug?

Antimicrobial resistance and treatment failures are the biggest challenges

The publication of national treatment guidelines does not usually generate headlines in national newspapers. However, the recent release of draft management guidelines for Mycoplasma genitalium infection was accompanied by high profile media coverage suggesting that it is the next sexually transmitted “superbug.” So what are the facts behind these headlines, and how concerned should we be?

First isolated in 1981, M genitalium is the smallest known self replicating bacterium. Most infections are probably asymptomatic and have no adverse health outcomes. Nonetheless, evidence that M genitalium is associated with serious genitourinary and reproductive health morbidity is accumulating.

In men, there is an unequivocal association with non-gonococcal urethritis, and it is detected in up to 40% of men with persistent and recurrent urethritis. In women, a recent meta-analysis found significant associations with a range of clinical syndromes and adverse reproductive health outcomes, including cervicitis, postcoital bleeding, pelvic inflammatory disease, preterm birth, and spontaneous abortion, and a weak association with infertility.

The population prevalence of M genitalium infection ranged from 1.3% to 3.9% and was higher in countries with a low development index. In Britain, a probability sample survey estimated a prevalence of around 1.3% in the sexually active British population aged 16-44 years.4 In common with many other sexually transmitted infections (STIs), M genitalium infection rates can be considerably higher in men who have sex with men, sex workers, and people attending STI clinics.

Antimicrobial resistance

The main concern is M genitalium’s increasing resistance to azithromycin and moxifloxacin, the recommended first and second line treatments in Europe, North America, and Australia, especially in the Asia-Pacific region. For example, single nucleotide polymorphisms in region V of the 23S rRNA gene, which confer macrolide resistance, were found in over 60% of M genitalium specimens from people attending STI clinics in Australia in 2015. Furthermore, selective pressure can lead to the emergence of macrolide resistance after exposure to suboptimal levels of drug.

Importantly, resistance markers are highly correlated with treatment failure, especially when the organism load is high.

New project approved for 2018: Provision and Accessibility of Pre-exposure Prophylaxis (PrEP) in North England and the West Midlands.

Project title: Exploring perspectives on provision and accessibility of Pre-exposure prophylaxis (PrEP) in North England and the West Midlands.

Principal Investigator Professor Marie Claire Van Hout

Team: Professor Vivian Hope; Mr Jim McVeigh: Mrs Jennifer Germain

Site: Public Health Institute, Liverpool John Moores University, Liverpool

The United Kingdom (UK) has a concentrated HIV epidemic, with an estimated 101,200 people living with HIV in 2015. A decrease in diagnoses among men who have sex with men (MSM), the group most affected by HIV transmission, has recently been observed, and is probably due to increased frequency of testing (3 monthly) among those at greatest risk and rapid treatment for those testing positive.

Pre-exposure prophylaxis (PrEP) is an evidence based biomedical HIV prevention strategy which involves HIV negative individuals taking antiretroviral drugs to reduce probability of infection if exposed. The UK PROUD study found PrEP reduced HIV infection risk by 86% among MSM. PrEP is available on the NHS in Wales and Scotland. In October 2017, the IMPACT trial commenced in England, with PrEP being rolled out to 10,000 eligible people.

The project will explore and describe MSM and health professional perspectives on PrEP using qualitative interviews in three Northern cities (Liverpool, Manchester, Sheffield) and one city in the West Midlands (Birmingham) where PrEP is available through the IMPACT trial. Interviews with a purposive sample of participants (8-12 MSM and 4-8 health professionals per city) will focus on: PrEP awareness and sources of information including eligibility, compliance, drug interaction and online sourcing; impact of PrEP on HIV testing patterns, hepatitis C, sexual risk and other sexually transmitted infections; and on issues related to accessing PrEP and optimal service provision

The project is timely given the current IMPACT trial in England, with results informing policy, practice and professional training.

Is antiretroviral treatment for HIV increasing the susceptibility to syphilis

Recently, the world has experienced a rapidly escalating outbreak of infectious syphilis primarily affecting men who have sex with men (MSM); many are taking highly active antiretroviral therapy (ARV) for HIV-1 infection.

Treatment with ARV reduces risk of infection (because of greatly reduced viral load) and near-normal life expectancy for those on treatment. The currently accepted hypothesis is that these factors result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 sexually transmitted infections, including gonorrhoea, chlamydia and syphilis.

However, syphilis incidence has increased more rapidly than other STDs. In a recent open access article in the journal Sexually Transmitted Infections, Reckart and colleagues hypothesise that ART itself  may alter the innate and acquired immune responses to Treponema pallidum, the bacterium causing infectious syphilis, and that this biological explanation plays an important role in the current syphilis epidemic.

In a leading article in the same journal, Susan Tuddenham and colleagues (only available to subscribers), find the hypothesis intriguing despite some flaws. They go on to suggest that further work is necessary to look at the mechanisms underlying the current syphilis epidemic.

In the same issue David Glidden et al point out that in the early double blind trials with pre-exposure prophylaxis (PrEP) no increase in syphilis was found between those taking PrEP and those taking placebo. These findings would suggest that short term exposure to ART has no effect on the acquired immune responses to Treponema pallidum.

Sexually transmitted infections: challenges ahead

A commissioned article in Lancet Infectious Diseases on July 9, 2017 highlights some of the major issues and challenges facing us in the growing global epidemic of sexually transmitted infections (STI). Authors Prof Mabhus Unemo et al summarise the key issues as follows:

WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research.

In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control.

Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease.

The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials.

Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches.

STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control.

Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation.

Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.

Read full article on Lancet Infectious Diseases

Cuts to sexual health services are putting patients at risk

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

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

 

Invitation to apply for research Funds – 2016 Round

Applications are invited from researchers in various fields related to sexual health, HIV and other sexually transmitted viruses.

Sexually Transmitted Infections Research Foundation (STIRF) was set up to pump prime research projects relating to the epidemiology, pathophysiology, management, and health care delivery of sexually transmitted infections and HIV in the East and West Midland, the North East and North West Regions.

The primary aim is to provide initial funding to allow promising projects from young researchers to obtain preliminary results as a prelude to acquire further funds from larger funding bodies.

We invite applications from researchers in the above regions on projects relating to sexually transmitted diseases and HIV. All projects will be initially screened by the Scientific Committee of STIRF and those considered suitable will be sent for peer review by experts in the field.

The following fields of research will be considered in relation to STIs and HIV

  • Epidemiology of HIV and other sexually transmitted diseases
  • Research on HPV and other sexually transmissible malignancies
  • Health care delivery including views of clients
  • Issues relating to deprived or marginalised communities.
  • Pathophysiology of diseases and syndromes
  • Inter-relationship between diseases
  • Treatment modalities
  • Complications of treatment and co-morbidities

Applications should not exceed £50,000 in the first year. Depending on satisfactory reports a further £25,000 may be available for the second year. Joint funding with other grant giving bodies will be considered.

For further information and guidance on how to apply visit

How to apply for grants

Deadline for applications is 30th June 2016

Applications using the appropriate form downloaded from the STIRF web site should be sent by email to:

Dr Mohsen Shahmanesh,(Hon Secretary STIRF)

Stirfweb@gmail.com

Access to Sexual Health Services for the Somali Community in Birmingham UK

The UK, hosts a large number of refugees from Somalia.

Somalis are absent from much of the official statistics largely because ‘Somali’ is rarely recognised as a distinct ethnic category. Therefore, when decisions are being made in relation to addressing the needs of recently arrived refugees the needs of those who originate from Somalia may be neglected.

Somalis are known to have a high level of need but low uptake of health care services. This included sexual health.

Earlier STIRF funded a project which looked at issues and problems relating to access for sexual health services. The project is now completed and is presented in a meeting held on:

Date: April 27
Venue: Birmingham City University
Time: 16.00 – 18.00

Meeting on Sexual Health needs of Somali Community

The perils of chemsex

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.