The management of sexually transmitted infections: a scoping survey in primary care

Background National guidelines for sexually transmitted infections (STIs) in primary care exists but their management is uncertain. Aim To assess the management of STIs against national standards in primary care. Design & setting A questionnaire based study in London and Brighton. The survey was conducted in 2015 following reorganisation of sexual health services in England. Method Questionnaires were sent to GPs in London and Brighton about testing for STIs, treatment for gonorrhoea, specialist advice, and referral services. Results Of 119 GPs who responded, most expressed confidence in treating chlamydia (n = 105/119, 88%), trichomonas (n = 81/119, 68%), and herpes (n = 82/119, 69%) but not gonorrhoea (n = 32/119, 27%). Most referred cases of syphilis (n = 92/119, 77%) and genital warts (83/119, 70%) to genito-urinary medicine (GUM) as per guidance. Most GPs tested for gonorrhoea on patient request (n = 95/119, 80%), in tandem with chlamydia screening (n = 89/119, 75%), because of high risk status (n = 85/119, 71%) and genital symptoms (n = 108/119, 91%). Some GPs (n = 22/119, 18%) sampled urine for culture, 53/119 (45%) provided high vaginal swabs (HVS), and 28/119 (24%) provided self-taken vulvovaginal swabs (STVVS) for culture. These samples are not appropriate for gonococcal culture and not processed in the laboratory. Urethral swabs for men and endocervical swabs (ECS) are recommended for gonococcus culture. Over half (n = 60/102, 59%) of GPs did not treat gonorrhoea but some prescribed cefixime, ciprofloxacin, or azithromycin. Eighty-seven per cent (n = 104/119) sought advice from GUM, and 83/103 (81%) referred gonorrhoea nucleic acid amplification test (NAAT)-positive patients. Conclusion There is scope for improvement of STIs management in primary care to ensure that patients are optimally investigated, treated, and referred

Risk factors of occupation related back pain and neck pain among patients attending tertiary care hospital, Ahmedabad, India

Introduction: Neck/back pain is one of the common health problems associated with significant impact on health resulting in sickness absenteeism. Neck/back pain is one of important causes of disability adjusted life years worldwide. The Objectives of study were: To identify various occupations related risk factors and their possible role in occurrence of back pain/neck pain and Visual analogue scale(VAS) assessment of their perceived pain. Methods: The study was conducted at one of the tertiary care hospital at Ahmedabad city, India. All patients above age of 18 years attending physiotherapy department for treatment of back pain/neck pain and gave consent were taken as study participants. Information about certain body postures in their lifestyle or at workplace which can have effects on back pain/neck pain were asked. VAS for perceived pain was anchored by “no pain” (score 0) and “pain as bad as it could be” (score 100). Data were entered in MS Excel and analyzed by frequency, contingency coefficient and Goodman & Kruskal’s Gamma test. Result and Conclusion: Total of 512 participants were included in study, among which 53 & 392 participants had Neck pain and Back pain alone, respectively, while 67 participants had both Neck and Back pain. Age, Marital status, socioeconomic class, BMI and type of occupation revealed statistically significant association with severity of pain. Various body postures like prolonged sitting/ standing, frequent bending at waist/knee, Pulling/Pushing heavy objects, frequent weight lifting > 10 kg. and repetitive movement of back/neck revealed as statistically significant risk factors for back/neck pain

Ethnically diverse urban transmission networks of Neisseria gonorrhoeae without evidence of HIV serosorting

Objective We aimed to characterise gonorrhoea transmission patterns in a diverse urban population by linking genomic, epidemiological and antimicrobial susceptibility data. Methods Neisseria gonorrhoeae isolates from patients attending sexual health clinics at Barts Health NHS Trust, London, UK, during an eleven-month period underwent whole-genome sequencing and antimicrobial susceptibility testing. We combined laboratory and patient data to investigate the transmission network structure. Results One hundred and fifty-eight isolates from 158 patients were available with associated descriptive data. One hundred and twenty-nine (82%) patients identified as male and 25 (16%) as female; 4 (3%) records lacked gender information. Self-described ethnicities were: 51 (32%) English/Welsh/Scottish; 33 (21%) White, other; 23 (15%) Black British/Black African/Black, other; 12 (8%) Caribbean; 9 (6%) South Asian; 6 (4%) mixed ethnicity; 10 (6%) other; data were missing for 14 (9%). Self-reported sexual orientations were 82 (52%) men who have sex with men; 49 (31%) heterosexual; 2 (1%) bisexual; data missing for 25 individuals. Twenty-two (14%) patients were HIV-positive. Whole genome sequence data were generated for 151 isolates, which linked 75 (50%) patients to at least one other case. Using sequencing data, we found no evidence of transmission networks related to specific ethnic groups (p=0.64) or of HIV serosorting (p=0.35). Of 82 MSM/bisexual patients with sequencing data, 45 (55%) belonged to clusters of ≥2 cases, compared to 16/44 (36%) heterosexuals with sequencing data (p=0.06). Conclusion We demonstrate links between 50% of patients in transmission networks using a relatively small sample in a large cosmopolitan city. We found no evidence of HIV serosorting. Our results do not support assortative selectivity as an explanation for differences in gonorrhoea incidence between ethnic groups

ESBL-Producing and Macrolide-Resistant Shigella sonnei Infections among Men Who Have Sex with Men, England, 2015.

In England in 2015, Shigella sonnei isolates from men who have sex with men produced extended-spectrum β-lactamases and exhibited macrolide resistance. Whole-genome sequencing showed a close relationship among the isolates, which harbored a plasmid that was previously identified in a shigellosis outbreak among this population but has acquired a mobile element

East London Experience with Enteric Fever 2007-2012

The clinical presentation and epidemiology for patients with enteric fever at two hospitals in East London during 2007-2012 is described with the aim to identify preventive opportunities and to reduce the cost of treatment.A retrospective analysis of case notes from patients admitted with enteric fever during 2007 to 2012 with a microbiologically confirmed diagnosis was undertaken. Details on clinical presentation, travel history, demographic data, laboratory parameters, treatment, patient outcome and vaccination status were collected.Clinical case notes were available for 98/129 (76%) patients including 69 Salmonella enterica serovar Typhi (S. Typhi) and 29 Salmonella enterica serovar Paratyphi (S. Paratyphi). Thirty-four patients (35%) were discharged from emergency medicine without a diagnosis of enteric fever and then readmitted after positive blood cultures. Seventy-one of the 98 patients (72%) were UK residents who had travelled abroad, 23 (23%) were foreign visitors/new entrants to the UK and four (4%) had not travelled abroad. Enteric fever was not considered in the initial differential diagnosis for 48/98 (49%) cases. The median length of hospital stay was 7 days (range 0-57 days). The total cost of bed days for managing enteric fever was £454,000 in the two hospitals (mean £75,666/year). Median time to clinical resolution was five days (range 1-20). Seven of 98 (7%) patients were readmitted with relapsed or continued infection. Six of the 71 (8%) patients had received typhoid vaccination, 34 (48%) patients had not received vaccination, and for 31 cases (44%) vaccination status was unknown.Further interventions regarding education and vaccination of travellers and recognition of the condition by emergency medicine clinicians in travellers to South Asia is required

An extended genotyping framework for Salmonella enterica serovar Typhi, the cause of human typhoid.

The population of Salmonella enterica serovar Typhi (S. Typhi), the causative agent of typhoid fever, exhibits limited DNA sequence variation, which complicates efforts to rationally discriminate individual isolates. Here we utilize data from whole-genome sequences (WGS) of nearly 2,000 isolates sourced from over 60 countries to generate a robust genotyping scheme that is phylogenetically informative and compatible with a range of assays. These data show that, with the exception of the rapidly disseminating H58 subclade (now designated genotype 4.3.1), the global S. Typhi population is highly structured and includes dozens of subclades that display geographical restriction. The genotyping approach presented here can be used to interrogate local S. Typhi populations and help identify recent introductions of S. Typhi into new or previously endemic locations, providing information on their likely geographical source. This approach can be used to classify clinical isolates and provides a universal framework for further experimental investigations

Particulate Soiling and Soil Release Behaviour of Silk Fabric

29-36<span style="font-size:11.0pt;line-height:115%; font-family:" calibri","sans-serif";mso-ascii-theme-font:minor-latin;mso-fareast-font-family:="" "times="" new="" roman";mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:="" minor-latin;mso-bidi-font-family:"times="" roman";mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">The soiling and soil release behaviour of silk fabric has been investigated using a model particulate soil (ferric oxide). The result obtained has been compared with those for cotton and polyester fabrics of nearly the same construction. It is observed that the soiling of fabrics of the three different fiber types increase in the order < cotton< polyester, whereas soil release follows the opposite trend, i.e. silk > cotton > polyester. The location and distribution of soil particles on the fibre surface ha.ve been examined using the scanning electron microscope. The kinetics of particulate soil release from fabrics has been found to follow the first order rate process. The effect of washing period and washing temperature on the rate coefficient and the order of the soil release process has also been studied.</span

Application of X-ray micrography and imaging to study the effect of gentamicin on Pseudomonas aeruginosa

Aminoglycosides disrupt the outer membrane of Pseudomonas aeruginosa to facilitate access to their intracellular target. High-resolution X-ray micrography of live specimens is a relatively new technique. We used laser (nanosecond) plasma to image live cells of P. aeruginosa ATCC 27853. After exposure to 25 mg/L gentamicin for 15 min. we observed perturbation of the cell surface, membrane blebbings (370 nm and 273 nm diameter) away from the cell, formation of distinct channels (241 nm long) resulting from indentation and induction of cell elongation from 3-3.6 μm (control) to 4.6-5.26 μm (gentamicin-treated cells). These data illustrate the potential of high-resolution X-ray micrography for studying effects of drugs on live microbiological specimens