Lidegaard O, Nielson LH, Skovlund CW, Lokkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10 BMJ 2012;344:e2990 doi: 10.1136/bmj.e2990 (Published 10 May 2012)

This is basically a companion paper to the one published last year in the BMJ, which concentrated on the Pill and was comprehensively criticised in the January issue of the Journal (Dinger & Shapiro 2012), to which readers are referred, as well as to the Rapid Responses posted on the BMJ website. This analysis, also from the Danish registry looks at the EVRA patch NuvaRing, Implanon and the levonorgestrel-releasing intra-uterine system (Mirena IUS). All the previous issues of confounding, lack of information regarding smoking, BMI, and family history, and not comparing like with like apply here.

It is important to compare new users with new users, as a well-established fact is that the risk of VTE is highest in the first 6 months of use of oestrogen-containing contraceptives. It is therefore important to look at the launch dates of contraceptive products. NuvaRing was launched in Denmark in late 2001 / early 2002, while the EVRA patch was launched there in September 2003. Meanwhile combined pills containing levonorgestrel have been in use since the 1970s, and those containing norgestimate since the mid 1980s. Thus, since the study period began in 2001, all users of NuvaRing and EVRA must have been new users, and so also more likely to be first time users / women with risk factors. Meanwhile, the users of the comparator COCs were more likely to be long term users and therefore at lower risk, since the high risk women in those groups will have been weeded out within the first 6 months of use – before the study began (ie attrition of susceptibles). The effect of duration of use is most clearly seen with NuvaRing in Table 4, where compared with non-users of hormonal contraceptives,  the relative risk becomes appreciably lower with increasing duration of use, declining from 8.36 for <1 year of use to 3.83 for use of 1 to 4 years. In addition, the numbers in each duration category are small, leading to random variability.  For the patch (6 exposed women) and the implant (5 women) not even the overall numbers are adequate.

With regard to the two progestogen only methods under study, not surprisingly neither was associated with a significantly increased risk of VTE – progestogen only methods have not been implicated in VTE risk, since this is related to oestrogen (Reid et al, 2010). Indeed, progestogen only methods are advised for women with risk factors for VTE (Blanco-Molina et al 2012). However, in the abstract, the authors misleadingly state that ‘the relative risk was increased in women who used subcutaneous implants’ and yet their relative risk of 1.4 had confidence intervals of 0.6 – 3.4, ie not even approaching statistical significance.  For the IUS, not only was the relative risk not increased, it was significantly decreased at 0.6 (95% CI 0.4 – 0.8). This has no biological plausibility and simply highlights the lack of credibility of the analysis.

Anne Szarewski, Editor-in-Chief, J Fam Plann Reprod Health Care

Diana Mansour, Consultant in Community Gynaecology and Reproductive Health Care, Head of Sexual Health Services, Newcastle Upon Tyne,

References

Dinger JC, Shapiro S. Combined oral contraceptives, venous thromboembolism, and the problem of interpreting large but incomplete datasets  J Fam Plann Reprod Health Care 2012;38:2–6. doi:10.1136/jfprhc-2011-100260

Reid RL, Westhoff C, Mansour D, de Vries C, Verhaeghe J, Boschitsch E,et al.   Oral Contraceptives and Venous Thromboembolism: Consensus Opinion from an International Workshop held in Berlin, Germany in December 2009  J Fam Plann Reprod Health Care 2010; 36(3): 117–122

Blanco-Molina MA, Lozano M, Cano A, Cristobal I, Pallardo LP, Lete I. Progestin-only contraception and venous thromboembolism Thrombosis Research 129 (2012) e257–e262

Melinda Gates’ New Crusade: Investing Billions in Women’s Health

Melinda Gates this week pledged billions of dollars to be spent on improving access to contraception. In her many travels she repeatedly met women who were unable to gain access to something which most of the rest of the world take for granted. In an interview with Newsweek she recounted stories from the women many of whom were unable, for example, to get repeat injections of Depo Provera. In July she is teaming up with the British government to cosponsor a summit of world leaders in London, to start raising the $4 billion the Foundation says it will cost to get 120 million more women access to contraceptives by 2020. And in a move that could be hugely significant for American women, the Foundation is pouring money into the long-neglected field of contraceptive research, seeking entirely new methods of birth control. Ultimately Gates hopes to galvanize a global movement. “When I started to realize that that needed to get done in family planning, I finally said, OK, I’m the person that’s going to do that,” she says. More from the Gates Foundation website.

Paper confirms EC IUD failure rate less than 1 per 1000

Authors of the first ever systematic review of all available data from the last 35 years argue that IUDs should be routinely offered and available to those requesting emergency contraception. They found that the failure rate was less than 1 per 1000 when they analysed data from 42 studies involving 7034 women using 8 different IUDs. They also found that 85% clinicians in one study never offered this as an option. In a press release this week one of the authors, Professor James Trussell, said:

“This is an extremely difficult problem to deal with, especially as in many countries women can just go to their local pharmacy to obtain the ‘morning after pill’, but virtually no women know to ask for an IUD and many family planning clinics and surgeries do not offer same-day insertion. Offering same-day insertion would remove a huge barrier to the greater use of IUDs.”

Online First – Postnatal contraceptive choices in HIV-positive women [Duncan et al.]

Gillian Robinson (Associate Editor) writes:

“This paper describes an exciting example of how an integrated contraception and sexual health service can work to provide holistic care for women. This clinic provides women living with HIV with prenatal, antenatal and postnatal care in a community setting. The paper is a retrospective case note review. Uptake of postnatal contraception was high yet more than 20% of women were not seen postnatally. The authors suggest that the reasons for this are explored to ensure all women with HIV receive contraception in the early postnatal period to prevent unwanted pregnancy.”

NAT calls for new health bodies to tackle late diagnosis of HIV

“Halve It”, a broad coalition of leading experts and advocates in HIV and AIDS, welcomes the renewed call by the National AIDs Trust (NAT) for the urgent prioritisation of HIV testing in its new ‘HIV testing action plan’ which provides vital strategic guidance to health bodies on tackling the serious issue of late HIV diagnosis in the UK.

FDA Approves first pill for Heavy Menstrual Bleeding (HMB)

Natazia is a combination oral contraceptive (COC) consisting of estradiol valerate and estradiol valerate/dienogest. The US Food and Drug Administration (FDA) first approved Natazia in May 2010 to prevent pregnancy. On March 14, 2012, the FDA also approved Natazia to treat heavy menstrual bleeding (HMB), making it the first and only OC indicated for this purpose. One interesting thing is that until now we have known Natazia, in the UK, as Qlaira and until now it has not been widely used. More details at Medscape.

UK women misdiagnosing genital infections

To mark National BV Day on 18th April a study found that one in four British women has misdiagnosed themselves on the internet. Researchers found Dr Google is now the first port of call for women with genuine health concerns who are almost twice as likely to check online before consulting a doctor or even talking to Mum. But searching their symptoms online and self-medicating has led a tenth of the country’s women to endure unpleasant side effects as a result of their misdiagnosis.

Morning after pill courier service launched

A new service allows women (living in London) to order emergency contraception on the internet, so it arrives within two hours, rather than having to see their GP to obtain the drugs. For £20, women can order the drug by filling out an online form through the internet medical practice DrEd.com. The forms, which ask users to confirm they are aged over 18, will be assessed by doctors before pills are dispatched by courier. Currently they only offer Levonelle®, which can also be purchased in advance and by buying 2 packets for £24.00 at a saving of 37%.

Pharmacists should provide oral contraceptive services, says NHS report

As reported by Jacqui Wise in the BMJ:
“A report from NHS South East London has recommended that trained community pharmacists provide oral contraceptive consultation services after a successful pilot scheme to widen access to contraception.  The part of the report that has received the most media coverage is a recommendation to “consider providing the service to women under 16 years where appropriate.” The report said that this may help reduce numbers of teenage pregnancies.”

Brook and fpa respond to proposal to introduce contraceptive pill in pharmacies

Responding to the proposal that the contraceptive pill should be available from pharmacies without a prescription to young people, including those under 16, the chief executives of Brook and FPA, Simon Blake and Julie Bentley said: “The majority of young people under 16 are not having sex, however we must ensure that those who are can access support and services when they need to. “Although Brook and FPA welcome proposals which could increase young people’s access to sexual health services and information, all the necessary safeguards must be in place to ensure young people can get the information and support they need. “This includes pharmacists having the appropriate clinical knowledge about contraception, being able to communicate effectively with young people, having the right type of environment including a confidential space, as well as the appropriate support and referral networks.”

Egg-Sharing in Fertility Treatment

Evaluating egg-sharing: new findings on old debates – as reported in BioNews
Egg-sharing refers to a scheme where a woman undergoing fertility treatment donates a portion of her eggs to an anonymously matched recipient in exchange for a reduction in treatment costs. As a very specific form of egg donation, egg-sharing has generated heated debate since its introduction in the UK in 1998. While proponents argue it provides a win-win solution, allowing two women to help each other conceive, critics talk of the potential ethical and psychological consequences. Until recently, there has been very little empirical data to inform these discussions. However, new research conducted by Gurtin and Golombok at the University of Cambridge Centre for Family Research, in collaboration with the London Women’s Clinic, hopes to redress this balance.

Men’s health expert presents to Members of European Parliament

A leading men’s health expert presented a report detailing the health challenges facing men across Europe MEPs and key European decision-makers at the European Parliament in Brussels.

Professor Alan White, Director of the Centre for Men’s Health at Leeds Metropolitan University was commissioned by the European Commission to produce a report which gives the first complete picture of the breadth of issues affecting men’s health across Europe.  Professor White brought together 36 leading researchers from 34 countries across Europe to undertake the research which highlights the state of men’s health in Europe as a serious public health concern. more info

Faculty Consultations

The CEU Guideline on “Barrier Methods-Contraception and STI prevention” is for consultation until 21st May. see FSRH website:

BASHH Mentoring Group is currently seeking new members:

BASHH would like new representatives to support coordination of mentors and mentees within North West regions and Wales. The successful candidates would also be involved in the activities that the Mentoring Group is currently taking forward nationally. Closing date for applications: 16^th May 2012.  see BASHH website for more details

And finally – we hear reports that Virgin Care have obtained ‘preferred bidder’ status in the tender to run West Sussex sexual health services .

new audit reveals shocking truth as 3.2m women face restrictions in access to contraceptives or services

A new audit of the commissioning of contraceptive and abortion services in England has revealed a stark picture of inequality in women’s healthcare, with a third of women of reproductive age unable to choose from the full range of contraceptives or services in their local area.

The audit was carried out by the Advisory Group on Contraception – a coalition of leading experts and advocacy groups interested in sexual and reproductive health – through Freedom of Information requests made to Primary Care Trusts (PCTs). The report of the audit findings, Sex, lives, and commissioning: An audit of the commissioning of contraceptive and abortion services in England demonstrates that:

As many as 3.2 million women of reproductive age (15-44) are living in areas where fully comprehensive contraceptive services, through community and/or primary care services, are not provided

• Those PCTs restricting access to contraceptives or contraceptive services had a higher abortion rate than the national average
• Over a quarter (28%) of PCTs responding to the audit did not have a strategy in place or under development to address unintended pregnancy and the need for abortion or repeat abortion

The audit also uncovered evidence of PCTs introducing access restrictions based on cost rather than choice or quality:

• NHS North Lancashire confirmed one method of contraception was not prescribed “due to lack of funding/training for staff”
• NHS Brighton and Hove confirmed that its “GP-led health centre will only prescribe Long Acting Reversible Contraceptive (LARC) methods to residents of Brighton and Hove.  Non-residents attending with a filled prescription for LARC will be provided with a fitting”
• NHS Haringey Teaching said that from the 1 October 2011 “women aged over 25 do not receive contraception pills from the local CaSH [Contraception and Sexual Health] Service; they receive this service from their GP”
• NHS Barnet stated that “In 2010 the PCT introduced a restriction on over 25’s accessing integrated services for generic contraceptive advice… Only patients within this age group who have complex needs can be seen by an integrated service”

Dr Connie Smith, Consultant in Sexual and Reproductive Healthcare, said:

“Contraception is a very personal issue.  What is right for one woman may not be right for another.  That is why the national NICE guidelines on contraception are built around the importance of choice. 

 “PCTs that are restricting choice are getting worse outcomes.  As a result of flouting national guidance, women are paying a big personal cost and the NHS is bearing a huge financial cost.  Unintended pregnancy costs the NHS more than £755 million every year.  For every £1 spent on contraception the NHS saves £12.50, so restricting access and choice is a complete false economy, harming women and the NHS.  Those PCTs with restrictions in place need to have an urgent rethink.”

Dr Anne Connolly, a GP with a special interest in sexual health, added:

“As a GP I know how important it is to get contraception right.  We must take a personal approach to meeting women’s needs and operating a blanket ban on some services or contraceptives goes completely against this. 

 “It is very concerning that so many PCTs have no strategy in place to address unintended pregnancy and that some are introducing restrictions on contraceptives or services.  The Department of Health should urgently publish a sexual health strategy showing how the needs of women of all ages can be met, alongside clear standards about the quality of service women have a right to expect.”

The AGC has made a series of recommendations for how sexual health and contraceptive services could be more effectively planned, commissioned and delivered.  These include:

• The Department of Health should publish its planned sexual health policy document without further delay and ensure that it sets out clearly the expectation for commissioners to commission comprehensive, open access services that reflect a life-course approach for people of all ages
• NICE should prioritise the development of the quality standard on contraceptive services
• Contraceptive services must be commissioned based on the principles of the NHS Constitution. Commissioners should remove any policies or contracts in place which limit an individual’s access to contraceptive services based on reasons of age or place of residence
• Commissioners should ensure that up-to-date strategies are in place to reduce unintended pregnancy, and the need for abortion and repeat abortions, and these strategies should focus on addressing the needs of women of all ages

The All-Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPGSRH) has launched an inquiry and call for evidence into restrictions in access to contraceptive services.

Examples have already been seen of commissioners cutting prescribing budgets for contraceptive methods to meet targets for savings, with consequences for choice and public health outcomes. In addition the Public Health Minister, Anne Milton MP, in a response to a parliamentary question tabled on contraceptive services, has recently confirmed that the Department of Health has received “representations from clinicians and voluntary sector organisations on the current commissioning of contraception by primary care trusts (PCTs) and access to certain types of contraception by certain age groups”.

On Monday 6 February, the APPGSRH held a meeting to discuss possible restrictions in access to sexual health services to residents-only and to people under 25 years old.  During the meeting members of the Advisory Group on Contraception (AGC) presented the initial findings from a Freedom of Information audit which had found variations in access to contraceptive services and methods.

The APPGSRH expressed concerns at the findings from the audit, in particular:

• Evidence of commissioners restricting access to contraceptive services on the basis of age or place of residence
• The impact that the drive for efficiency savings is having on women’s choice of the full range of contraceptive methods
• Some methods of contraception only being made available with a GP referral
• The impact of changes to the commissioning structures on the continuity and quality of contraceptive care

The APPGSRH is launching this inquiry in the belief that its work can contribute to the debate about how high quality contraceptive services can be delivered in the context of the healthcare reforms; and how access to the full range of contraceptive services and methods can be improved for women of all ages.

The inquiry will bring together further evidence and understanding to the current provision of contraceptive services across the country. It will also look at uncovering examples of good practice in relation to the availability of contraceptive services which can be shared amongst new and emerging commissioners of services.  We are therefore encouraging stakeholders – including commissioners, healthcare professionals and service user representatives – to submit written evidence which will help feed into the inquiry’s discussions.

Call for written evidence

The deadline for written evidence is 5pm on Friday 18 May and submissions should be sent to appg@fpa.org.uk. Submissions should be no more than 2,500 words. For more information click here.

The Course of 5 (C5) is the 2nd stage of the new DFSRH blended learning training package – it provides a link between the theory element (e-SRH) and the practical, clinical assessments (ACP).

What is involved in C5? 5 one-hour, assessed workshops in groups of no more than 4 per facilitator. These are usually offered as a one-day or 2 half day package organised locally by Faculty Registered Trainers. They can also be done as 5 individual sessions.

When can I do this?  C5 cannot be undertaken until you have registered for the diploma and e-portfolio and have completed the e-SRH sessions. It must be passed before moving on to clinical practice.

What is covered? The content is fixed by the Faculty and covers:
Session 1 – Taking a Sexual History and HIV pre test discussion and testing
Session 2 – STI Screening and Testing and Teaching the use of Condoms
Session 3 – Practical Aspects of Contraception – including diaphragm and implant fitting
Session 4 – Young people; Consent, Confidentiality, Fraser Guidelines and Safeguarding children
Session 5 – Managing Sensitive Scenarios – dealing with unwanted pregnancy, psycho sexual problems and referral for sterilisation.

How is it assessed? There are 9 assessment criteria in which you must demonstrate active and appropriate participation in all the sessions.

How do I access a C5? A list of local contact details is available from the Faculty website.

How much does it cost? The courses are costed locally and will vary according to set up.

Where can I get more information? For full details visit the Faculty website training section

I am a nurse – can I do the Course? The simple answer is yes, but it may depend where you live and who is organising C5 in your area. Nurses cannot gain the Faculty diploma but can do the e-SRH sessions and C5. In some areas nurses are using this to access training in SRH and some clinics may then be happy to offer clinical assessment too.

This quarter’s Journal includes the following:

Redefinition of women’s health care

Last year the Royal College of Obstetricians and Gynaecologists published ‘High Quality Women’s Health Care: a Proposal for Change’ that proposed a radical change to the structure of UK women’s health services. Andrew Horne and Johannes Bitzer discuss this exciting document from both a UK and a European perspective, commenting on its implications for sexual health provision. See page 68

Multidrug-resistant gonorrhoea

Gonorrhoea infection is increasing in the UK with a 3% increase in cases between 2009 and 2010. Last year there was a report of a ceftriaxone-resistant isolate; there is a growing concern that gonorrhoea may become incurable. The commentary by Taylor and Bignell is timely. It reviews the current position and provides clear guidelines on screening and treatment, which may prove challenging for some community services that rely exclusively on the use of nucleic acid amplification tests. See page 70

At last, a COC licensed for use in a flexible extended regimen

Data are presented from Phase III studies of a 20 µg ethinylestradiol/3 mg drospirenone combined pill, designed to be used in a flexible regimen. The studies evaluated the efficacy of the regimen, bleeding patterns, safety (ie, metabolic and endometrial parameters) and effect on dysmenorrhoea. Comparisons were with a fixed extended regimen and the conventional 24-day regimen. Results show good efficacy, tolerability and safety with the flexible regimen, and a significant reduction in both bleeding and dysmenorrhoea. See pages 73, 84, 94

Does hormone replacement therapy cause breast cancer? Part 4. The Million Women Study

Shapiro et al. continue their review of breast cancer and hormone replacement therapy papers, this time focusing on the Million Women Study. They conclude that despite its massive size, this study did not satisfy causal criteria. The online version of this paper has already been the focus of a great deal of media publicity and both a news piece and an editorial in the BMJ. Readers should also look at the Letters section for related correspondence that the Journal has received as a result. See page 102

A new aid to diagnosis

Ultrasound imaging has been of value to our specialty for over two decades and skills and equipment have steadily become more available within sexual and reproductive health clinics. In their article on hysterosonography using a local anaesthetic gel, Pillai and Shefras present their experience with a simple and effective new technique that takes imaging a step further, allowing clear diagnosis of intrauterine abnormalities, particularly causes of abnormal bleeding or failed intrauterine device/system (IUD/IUS) insertion, as well as aiding location and easier retrieval of IUDs with missing threads. Many readers will be familiar with the use of lidocaine gel to aid IUD insertion: not surprisingly, uterine instrumentation in conjunction with scanning was reported to be less painful with this technique. This is a promising approach to simplifying and improving the cost-effectiveness of care for women presenting with some complex contraception problems. See page 110

Abortion legislation in a changed world

In his latest Legal Opinion article, Sam Rowlands reviews legislation governing early medical abortion (EMA) and the licensing of EMA drugs in the UK and in other jurisdictions. He then looks at the ways in which such legislation has been used – or in some cases circumvented. EMA has helped to fulfil the crucial need for safe abortion worldwide, but in the author’s view the laws governing abortion in most countries are out of step with scientific advances. Readers may find the author’s conclusions and suggestions for future changes to our own abortion laws thought-provoking. See page 117

Role of doulas in abortion care

Doulas, or lay support persons, have had a longstanding role in supporting women in labour. Chor et al. argue that their role should be extended to caring for women having abortions, where they can help women relax and provide information. They suggest that engagement of the medical community will be instrumental in successfully expanding the role of abortion doula programmes within abortion provision. See page 123

Abortion in the classical world

Lesley Smith continues her series on the history of contraception and reproductive health with a look at attitudes to and practices of abortion in ancient times. It appears that even then, abortion was at the heart of much medical ethical debate. See page 125

Status of health professionals in the 21st century

Has the status of health professionals in society today fallen? If so, why? And is it a good or a bad thing? The Journal’s Consumer Correspondent, Susan Quilliam, explores the issue in her latest article. See page 127

Twenty-five years on: HIV remains a concern

In his latest ‘Then and Now’ article, Lindsay Edouard looks at topics covered by this Journal in 1987. New approaches to contraception were emerging. But was there a threat to community family planning services and would litigation faced by USA manufacturers restrict contraceptive choice? However, the major concern was the emergence of HIV/AIDS, with reinforcement of the advice that barriers should be used in addition to hormonal methods. In 2012, in the light of controversial research suggesting a possible association between hormonal contraception and increased HIV risk in some settings, Edouard draws our attention to the WHO very recent guidance regarding dual protection: 25 years on, advice has not changed. See page 131

Plus – Online Poll

Will the recent article on hormone replacement therapy and breast cancer alter your prescribing practice with regard to HRT?

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Faculty News

The latest edition of FSRH News is available on the website.

This report from Jennie Bristow (editor, Abortion Review)

23 March 2012

UK: Health Secretary launches shock wave of inspections on abortion clinics

The Health Secretary, Andrew Lansley, yesterday announced to the UK media that the Care Quality Commission (CQC) would be carrying out a series of ‘unannounced inspections’ on abortion clinics throughout the UK to ensure that doctors are complying with the ‘spirit and the letter’ of the 1967 Abortion Act. Jennie Bristow reports.

This action, which Lansley confirmed in a statement to Parliament today, 23 March, is allegedly a response to concerns that doctors are ‘pre-signing’ the HSA1 abortion forms. ‘The process of pre-signing certificates where the doctor does not know who the woman is for whom that certificate may be used in relation to that abortion is in itself illegal. I am not prepared to tolerate a failure to respect the law,’ Lansley said in a press statement yesterday.

He further stated: ‘The CQC has agreed to undertake unannounced inspections to identify the scale of this problem and we will set up a special team comprising of all the necessary regulators… to look at how we stamp out bad practice in abortion clinics.’

The BBC gives a more measured explanation of the law regarding the HSA1 form. ‘Except in emergencies, the law says two doctors must certify an abortion. However, there is no requirement for them to have actually seen the woman – only that they should have seen and assessed the necessary clinical information about her case, which could have been taken by another doctor or nurse.’

Lansley’s concern is that this ‘second signature’ is being provided before the doctor has reviewed the relevant notes. This is not the practice of most abortion providers, including British Pregnancy Advisory Service (BPAS). However, launching a wave of CQC inspections on the basis of forms potentially being pre-signed in some other clinics is a strange and heavy-handed action, for three reasons.

First, the second doctor’s signature has been long understood to be a legal, rather than a clinical, safeguard; arising from attempts in the 1960s to pass a controversial new law in the form of the Abortion Act. As such, many politicians – including Lansley himself – have questioned whether it is necessary to retain this cumbersome and clinically irrelevant requirement in the 21st century.

As the BBC explains, ‘The requirement for two doctors’ signatures was criticised as long ago as 2007, when a report by MPs on the Commons science and technology committee recommended it be removed because of the potential for abortions to be unnecessarily delayed.’ And Andrew Lansley himself, during the debate about the abortion law that took place in 2008, said:

‘If a woman needs an abortion in terms sanctioned by the Abortion Act 1967, it must surely be better for it to be an early, medical abortion than a later, surgical one. I therefore hope that the House will consider whether the requirement for two doctors to consent to an abortion being performed, and the restrictions on nurses providing medical abortions, need to be maintained.’

So it is strange indeed that the Health Secretary, busily engaged as he is in controversial reforms of the entire health service, should now view strict adherence to the ‘two doctors’ requirement as a sudden issue of major clinical concern. His quote in yesterday’s press statement could not be more different from the temperate approach that he took four years ago. On 22 March 2012, Lansley argued:

‘I am shocked and appalled to learn that some clinics – which look after women in what are often difficult circumstances – may be allowing doctors to pre-sign abortion certificates. This is contrary to the spirit of the Abortion Act. The rules in the Abortion Act are there for a reason – to ensure there are safeguards for women before an abortion can be carried out.’

The second peculiarity of this shock wave of inspections is that the ‘evidence’ upon which they have been launched seems remarkably thin. It seems to have come out of police investigations launched on the back on the Daily Telegraph’s investigation into ‘sex selection’ abortions last month, which itself found little evidence that such abortions were carried out.

There may be more basis Lansley’s concerns than a flimsy newspaper investigation – but we do not know. And this is the third and most striking peculiarity of today’s Parliamentary statement: that the media were briefed about it before any of the clinics whose work it might concern.

Ann Furedi, chief executive of BPAS, said: ‘Abortion doctors provide an important service to women who are often in difficult circumstances. Their work is already intensely scrutinised, with clinics regularly inspected by the CQC.

‘Mr Lansley says he is shocked and appalled by the practices he has uncovered. BPAS is shocked and appalled that Mr Lansley has found it necessary to inform journalists of alleged breaches of the abortion law before he has informed those responsible for providing the services that have been investigated, and before the investigation is concluded.’

The celebration, hosted by Nitin Ganatra (Eastenders), to mark the hard work and dedication of people involved in sexual health across the UK took place at Troxy, London. Celebrities, including Janet Ellis, Zoe Margolis, Sharon Marshall, Johnny Partridge and our own Susan Quilliam and Alison Hadley were in attendance to show support and present awards to:

Sexual health professional of the year: Kay Elmy, Peterborough Contraceptive and Sexual Health Service.
JLS young person of the year: Azizi Kosoko, Terrence Higgins Trust.
Rosemary Goodchild Award for excellence in sexual health journalism: Sophie Goodchild for her article ‘Free love: what happened to AIDS?’  Men’s Health magazine.
Adult sexual health service/project of the year: ‘Morning-after-pill in the post’ campaign, bpas.
Young people’s sexual health service/project of the year: Sheffield Open Doors, Sheffield Contraception and Sexual Health Service, School Nursing Service and the Young People’s Drug and Alcohol Service.
Pamela Sheridan Award for Innovation in SRE: Shropshire Respect Yourself Relationship and Sex Education Programme.
Lifetime Achievement in sexual health award presented to Professor Michael Adler CBE.

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Research highlights risks with current tests for Chlamydia trachomatis

“Researchers, from the University of Southampton and the Wellcome Trust Sanger Institute, have discovered that Chlamydia is much more diverse than was previously thought. Using whole genome sequencing, the researchers show that the exchange of DNA between different strains of Chlamydia to form new strains is much more common than expected.”  Current clinical tests only give a positive or negative result and can not identify different strains.  In clinical practice those found to be chlamydia positive after treatment were assumed to have been re-infected but this may not be the case.  Up until now antibiotic resistance has not been seen in humans only in the laboratory but current tests would be unable to demonstrate this if it did occur.

New BASSH Patient Information Leaflets

The BASSH Clinical Effectiveness Group (CEG) has produced new patient leaflets on Safer Sex, Epididymo-orchitis and Gonorrhoea. These are available from their website along with details about up-coming events as well as news and other guidelines.

GMC seeks views on proposed changes to the way doctors are assessed for GP or specialist registration through the ‘equivalence’ or CESR/CEGPR route to registration

Information and access to consultations are via the GMC e-consultation website.

“This International Women’s Day, the world’s women have much to celebrate: maternal mortality rates are declining after years of stagnation; the importance of maternal health is receiving unprecedented attention; and one solution in our efforts to save women’s lives during childbirth, misoprostol, is gaining significant traction globally. But we have further to go for the world’s women.”  IWD website has links to a number of events happening around the globe and asks supporters to publish and share their initiatives

fpa and Brook join forces with Durex

Two of the country’s leading sexual health charities and the biggest condom brand in the UK have announced a major collaboration with a three year programme to deliver a number of sexual health initiatives; information events, public awareness campaigns and learning materials.

Media Reaction to Abortion – gender selection and legal issues

in the ongoing debate around gender-selection abortion an Open letter of support for doctors who provide abortion services was published by Reproductive Health Matters, the international journal for sexual and reproductive health and rights, signed by members of Voice for Choice, leaders in womens’ health and abortion care. The letter clarifies many of the misinterpretations of legal issues that have been voiced in much of the ‘popular’ press.

Sexual Health Trainers – new PGA Med Ed (SRH)

The FSRH website has details of the planned changes to ‘training the trainers’.  The current letter of competence (Loc MEd) will be replaced by the new Post Graduate Award in Medical Education (Sexual and Reproductive Health).  In collaboration with Keele University the course is aimed at doctors working in CASH, GP’s, those in GUM and nurses who wish to gain a recognised teachers qualification in sexual health. This PGA will, for doctors, be accepted as appropriate for Primary Trainers for DFSRH purposes.

The GMC Education Update (Feb 2012) includes notification of a consultation on the recognition and approval of trainers.

New Clinical Guidance – Management of Vaginal Discharge in Non-Genitourinary Medicine Settings

The FSRH Clinical Effectiveness Unit (CEU) have published their latest clinical guidance document which updates previous guidance from 2006. Changes include: new tests for gonorrhoea and chlamydia; changes to treatments available for vulvovaginal candidiasis (VVC) & bacterial vaginosis (BV); and new advice on combined hormonal contraception (CHC) and antibiotics.

BPAS website hacked

The British Pregnancy Advisory Service website has been the subject of attempted hacking.  A 27 yr old man has been arrested on suspicion of offences under the Computer Misuse Act.  In a statement issued today BPAS say that:

“Around 26,000 attempts to break into our website were made over a six hour period, but the hacker was unable to access any medical or personal information relating to women who had received treatment at bpas.”