British association for sexual health and HIV national guideline for the management of anogenital warts in adults (2024).

This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of human papillomavirus (HPV)-related warts at anogenital sites including the external genitals, vagina, cervix, urethra, perianus and anal canal. The guideline is aimed primarily at patients aged 16 years or older presenting to healthcare professionals working in level 3 sexual health services in the United Kingdom. However, the principles of the recommendations may be applied in other care settings, including in primary care, using locally adapted care pathways where appropriate. The management of HPV-related anogenital dysplasia or warts at other extragenital sites is outside the scope of this guideline.

A randomised controlled study of mouth swab testing versus same day blood tests for HIV infection in young people attending a community drug service.

INTRODUCTION AND AIMS: This study was designed to determine whether providing an oral swab test in the community for blood borne virus testing leads to an increase in subsequent attendance for sexually transmitted infection (STI) screening at the STI clinic compared with making appointments for young people to attend the clinic for same day HIV testing and STI screening. DESIGN AND METHODS: Participants were randomised into either the oral swab test group or the blood test group of the trial if eligible. RESULTS: All the 27 participants in the oral swab test group were tested for HIV and hepatitis C compared with five for HIV and two for hepatitis C in the blood test group (P < 0.001). Only two of the 27 participants in the blood test group were tested for hepatitis B compared with 25 in the oral swab test group (P < 0.001). Nine participants in the oral swab test group attended the STI clinic for STI screening compared with three in the blood test group (P = 0.09). DISCUSSION AND CONCLUSIONS: An oral swab test in the community for blood borne virus testing leads to an increase in the number of young high-risk people tested for blood borne infections and is associated with a trend towards higher rates of subsequent attendance for STI screening.

A randomised controlled trial to assess pain with urethral swabs.

BACKGROUND: Urethral swabs are uncomfortable due to the nature of the mucosa and may be a reason for non-attendance of men at sexually transmitted infection (STI) clinics. This randomised controlled trial describes the extent of discomfort associated with direct urethral sampling, and determines whether this varies by the type of swab used. METHODS: Male patients over the age of 16 years having swab tests were invited to participate and were randomly assigned to receive either a gonorrhoea dacron-tipped swab, a chlamydia rayon-tipped swab or a plastic 10 µl urethral loop first for urethral sampling followed by the others sequentially. Discomfort was measured using a 0-100 mm visual analogue scale (VAS). FINDINGS: 129 men having urethral swabs carried out as part of their screening tests for STI were invited to participate in the study and 121 were recruited. The median pain scores (IQR) regardless of sampling method, before and after the urethral sampling were, first 0 mm (0-0) and 50 mm (22-71) (p<0.001), second 9 mm (0-28) and 59.5 mm (38.3-78) (p<0.001) and third 10 mm (0-31) and 58 mm (29.3-80) (p<0.001). Direct urethral sampling was associated with a median pain score of 60.5 mm using a rayon swab, 52 mm using a dacron swab and 25.5 mm using a plastic loop. INTERPRETATION: Direct urethral sampling is associated with discomfort and/or pain in men, which was significantly greater with a swab than a plastic loop. Urine should therefore be the specimen type of choice. When direct urethral sampling is indicated a loop is preferable to a urethral swab.

Treatment and partner notification outcomes for gonorrhoea: effect of ethnicity and gender.

We assessed if gender and ethnicity were associated with differences in the number of patients satisfactorily treated and number of partners successfully treated for genital gonococcal infection by reviewing 400 cases. There were no differences in the rates of satisfactory treatment of gonorrhoea between men and women and the different ethnic groups. There was no difference in satisfactory partner treatment rates by ethnic origin; however, men were less likely to have their contacts satisfactorily treated within 28 days of diagnosis (odds ratio = 0.05, 95% confidence interval 0.3-0.7). This inequality may lead to difficulties in reducing the number of new gonorrhoea cases. More research is needed to find out why men behave differently from women regarding partner notification for genital gonorrhoea infection.

Managing genital chlamydial infection: the effects of ethnic origin and method of follow-up.

We assessed if ethnicity and method of follow-up were associated with differences in the number of patients and the number of partners successfully treated for genital chlamydial infection. This was done by retrospectively reviewing the first 400 cases of genital chlamydia diagnosed between February and June 2001 who had a traditional clinic follow-up and the first 400 cases from the same period in 2002 when the telephone follow-up was used. The telephone follow-up appointment system, when compared to a traditional clinic follow-up appointment system, eliminated differences between Black and White ethnic groups in the numbers of patients and partners satisfactorily treated.

Primary HIV infection.

Primary HIV can be asymptomatic or result in a severe symptomatic illness. Common symptoms are pyrexia, pharyngitis, malaise, lethargy, maculopapular rash, mucous membrane ulceration, lymphadenopathy and headache. It can be reliably diagnosed by a positive virologic test in the absence of HIV-specific antibodies. Progression to late-stage disease is influenced by the severity of the symptoms in primary HIV infection, the duration of the illness, the presence of neurological symptoms and the presence of oral candidiasis. This stage is characterized by a very high viral load and infectiousness. Currently the experimental data are insufficient to recommend whether or not those diagnosed with primary HIV infection should routinely receive antiretroviral therapy.