Lots of very interesting stuff at this 4 times a year single afternoon and evening meeting held at the sumptuous Royal Society of Medicine venue in central London. For me it is certainly worth the 2 hour train journey from the north of England.
The afternoon was hosted by the UK`s Medical Research Council and chaired by Professor Graham Hart. It followed a oral research presentation type format, all studies being funded by the MRC and the UK Department of Health. First up was Pippa Oakeshott with a presentation asking whether Mycoplasma Genitalium ( MG) was the “new chlamydia “. Her study used stored samples from college students collected for the POPI ( prevention of pelvic infection) study to seek to understand association between MG and Pelvic Inflammatory Disease ( PID) – a controversial area. What struck me was their incredible persistence in maintaining good rates of follow up and their highly creative use of other healthcare records, such as hospital notes and primary care records. MG prevalence was found to be 3.3% with black ethnicity, Bacterial Vaginosis and greater than 2 recorded sexual partners being independently associated. PID was more likely with MG but not in a statistically significantly fashion. Prevalence and Incidence were felt to be too low to justify screening so don`t expect that to start happening soon…..This study is due to appear soon in the journal “Clinical Infectious Diseases”.
The Health Protection Agency updated us on their UK surveillance for Antimicrobial resistance in Chlamydia. This was prompted by somewhat worrying reports from Sweden of a “new variant” demonstrating resistance to Azithromycin. Azithromycin is now the cornerstone of Chlamydia treatment in the UK, both within Sexually Transmitted Diseases clinics and in other settings such as England`s national Chlamydia Screening Programme. Thus far the HPA have not managed to directly assess the 18 suspicious samples they have received for direct evidence of resistance ( i.e. using MIC or “Minimum Inhibitory Concentration”, put simply growing the bug in the lab, known as culture, and then adding antibiotics to see if it stops growing). Instead, they have looked for genes in the Chlamydia Trachomatis genome believed to be associated with resistance. There is some evidence of genes associated with Azithromycin resistance and also with Tetracycline resistance ( the other main class of drugs used for Chlamydia in the UK). It is not clear exactly what the relationship is between these genes and treatment failure. They therefore appealed for UK STD clinicians to send them samples from patients where the usual antibiotics appear to have failed. In the meantime they hope to implement MIC assays. More to come on that issue, I think
Giving a public health trial the acronym MSTIC is certainly one way to keep clinicians interested ! Cath Mercer did an excellent ” Maths is fun” turn to demonstrate that a trial named ” how to Maximise STI control and Cost effectiveness” can keep an audience of sexual health doctors awake if in the right hands. Indeed her presentation turned into “tag team health mathematics ” with various mathematical modellers being dragged blinking out of the audience and into the spotlight. Put simply they have developed a web tool which clinicians, public health doctors and managers can use to decide which arrangement of STD care is most appropriate for their locality. For example, you could use it to show the most cost-effective way to divide STD management between specialist services and primary care. The English part of the UK has an financial arrangement for service procurement know as ” commissioning” and this kind of tool might well be very useful in better informing that process.
LGV-NET is a study of Lymphogranuloma Venereum in the UK, also MRC funded. This once mainly tropical Sexually Transmitted Infection has existed as an epidemic in the UK since 2003, with now over 1000 cases reported. Most cases occur in HIV positive Men who have Sex with Men ( MSM), but is the HIV association a biological or behavioural one ? This case control study compared MSM with confirmed LGV with symptomatic MSM with LGV-like symptoms and also MSM without symptoms attending clinics for screening. Computer assisted self-interviews and lab reports were linked and found that the symptoms of constipation, rectal discharge, rectal pain and tenesmus ( the urge to defaecate without the need to pass stool ) were strongly associated with LGV. HIV was found to be associated ( unsurprisingly, this is well known ) but there was evidence that there was confounding with behavioural risk factors such as unprotected anal sex, “fisting” and multiple partner situations ( sauna, backroom etc.) i.e. the practices which bring HIV also bring LGV. It also be that the phenomenon of “serosorting” ( HIV positive individuals choosing to have sex with other HIV positive individuals) or other HIV related sexual networking may be a factor. This study would seem to be a clear step away from a biological explanation for the strong HIV / LGV association and also help to focus LGV prevention messages towards those very specific risky situations.
The afternoon session finished with two studies looking at the sexual lives of Eastern Europeans in London. Political changes in the former “Eastern Bloc” countries and their entry into the European Union have led to massive social changes and significant migration to other countries within the EU, such as the UK. Fiona Burn presented the SALLEE study ( “Sexual attitudes and lifestyles of London`s Eastern Europeans”). Data collected from a sample of this population drawn by recruitment from a number of different settings were compared with London data from the NATSAL 2000 ( National survey of sexual attitudes and lifestyles, new version begins this year). Overall the Eastern Europeans had had more sexual partners,more experience of injecting drug use and men had more experience of paying for sex but lower rates of STIs reported and lower abortion rates. HIV prevalence was 1.1% , surprisingly higher than the UK average given the lower reported rates of other STIs.
Lucy Platt reported on the second “Eastern Europeans in London” study of the afternoon, looking specifically at females migrant sex workers. Participants were recruited from non clinic settings via social networks and also a variety of specialist commercial sex worker outreach projects. Research consent from this vulnerable group is by neccessity a complex process. Participants again completed computer assisted interviews and for this study screening samples for sexually transmitted infections were obtained. Compared to female sex workers of UK origin their Eastern European counterparts were more likely to be younger, have children, see more clients and have had an abortion ( and also less likely to use contraception). There was a suggestion that they might be at higher risk of violence, although this was not statistically significant but what was significant was the finding that women who had recently been in contact with an outreach service had a lower rate of infections. This to me would appear to validate the excellent work which these services do and inspire them to redouble their efforts to protect their clients from unwanted pregnancy and threats to their personal safety.
All in all an excellent afternoon, although somewhat disheartening to hear that this public funding stream for UK based sexually transmitted infection public health studies is threatened. It all seemed very relevant to me !
The evening had perhaps more of a private BASHH feel to it, touching as it did upon new educational initiatives. My feeling is that any STI blogreaders out there want barnstorming international public health ! So on that note I would like to mention only the final speaker of the evening, our esteemed editor, Jackie Cassell. She spoke about the new Public Health Curriculum for clinical trainees specialising in sexually transmitted infections. She evangelised about the need for clinical doctors to understand public health and hopes to catch us early in our careers. I am a convert !
Blog comments gratefully received. Thank you and goodbye !