By Dr Angela Bailey, Consultant HIV/GU medicine, Imperial College Healthcare NHS Trust
The Jefferiss Wing at St Mary’s hospital is one of the biggest sexual health clinics in the UK. As well as providing services for testing (walk in and bookable online), we have an active Clinical Trials Centre and many of our clinicians are involved in sexual health research which gives our patients a chance to participate in studies and access to the latest developments in STI care. Some key areas, which have been in the news over the last year, are discussed here.
Condoms are still important in protecting against STIs but other prevention strategies have been hitting the headlines. We participated in the PROUD study (1), which alongside the IPERGAY study (2) showed almost a 90% reduction in the risk of acquiring HIV for participants taking the PrEP medication. We hope to be able to offer access to PrEP again soon in a new study announced recently by Public Health England (3), as well as other PrEP trials; interested readers should contact the clinical trials unit to be kept up to date.
For those wanting more information about PrEP now or accessing PrEP already, we can offer information and monitoring through the Limit clinic, a project funded by Imperial College Healthcare charity which also offers specific help to patients involved in “chemsex”.
Syphilis resistance hit the press recently following a Nature Microbiology article (4) which identified a globally widespread azithromycin resistant strain. The high prevalence of azithromycin resistance in the population presenting with syphilis to the Jefferiss Wing was documented back in 2011 (5) and molecular techniques for the evaluation of syphilis infections remain an active research interest in the department. Current monitoring of syphilis relies on tests developed early in the last century, but work conducted at Imperial on quantitative PCR may provide a modern alternative. Tipple et al demonstrated a clinically plausible association between organism load and stage of infection i.e. higher numbers of organisms in ulcers in early disease vs secondary disease and higher organism load in blood in later disease (6). They have also shown a fall in organism numbers following treatment (7). This work is being forward taken currently and in future may improve follow up for patients in the clinic.
Young people are at higher risk of STIs and need tailored holistic services to help them maximise their sexual health and general wellbeing, particularly vulnerable groups at risk of sexual exploitation and gang involvement. New problems related to technology, such as “sexting” have been discussed at the highest level. Recent qualitative research with practitioners working with young people by Lisa Walton, a nurse practitioner, highlighted the need of young people for information about sexting, photo sharing and pornography alongside the need for practitioners to access training in these emerging issues. Alongside these newer concerns, practitioners reported that young people wanted information about basic sexual health facts, healthy relationships (including pleasure and desire) and consent. There were differences reported between young men and women in their understanding of consent and professionals felt this was a key issue which needed addressing. Future work should address the views of young people directly and of parents, who are seen as a barrier to timely, sex positive, consistent, robust and evidence based SRE programmes in schools.
Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. of Pre-Exposure prophylaxis (PrEP) against HIVMcCormack S et al. Lancet. 2016 Jan 2;387(10013):53-60)
ANRS IPERGAY Study Group. On-Demand Preexposure Prophylaxis in Men at High Risk forHIV-1 Infection. N Engl J Med. 2015 Dec 3;373(23):2237-46.)
Arora N et al. Origin of modern syphilis and emergence of a pandemic Treponema pallidum cluster. Nat Microbiol. 2016 Dec 5;2:16245.
Tipple C, McClure MO, Taylor GP. High prevalence of macrolide resistant Treponema pallidum strains in a London centre. Sex Transm Infect. 2011 Oct;87(6):486-8. doi: 10.1136/sextrans-2011-050082. PubMed PMID: 21917695.
Tipple C, Hanna MO, Hill S, Daniel J, Goldmeier D, McClure MO, Taylor GP. Getting the measure of syphilis: qPCR to better understand early infection. Sex Transm Infect. 2011 Oct;87(6):479-85. doi: 10.1136/sti.2011.049494. PubMed PMID: 21752804; PubMed Central PMCID: PMC3252622.
Tipple C, Jones R, McClure M, Taylor G. Rapid Treponema pallidum clearance from blood and ulcer samples following single dose benzathine penicillin treatment of early syphilis. PLoS Negl Trop Dis. 2015 Feb 20;9(2):e0003492. doi: 10.1371/journal.pntd.0003492. PubMed PMID: 25700164; PubMed Central PMCID:PMC4336135.