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There are currently no reliable epidemiological data for estimating the burden of sexually transmitted infections (STIs) in Oman. STIs such as gonorrhoea and chlamydia are often asymptomatic and associated with sexual and reproductive morbidity. An exploratory study was conducted in an antenatal clinic in Muscat, Oman, to assess the acceptability and feasibility of testing for gonorrhoea and chlamydia. Two hundred and twenty-one women were recruited over 14 weeks between July and October 2020. There were three cases of chlamydia (3/221, 1.36%); no cases of gonorrhoea were identified. Acceptability and feasibility for testing in this cohort of pregnant women were good despite anticipated cultural sensitivities surrounding sexually transmitted infections.

We conducted a cross-sectional analysis to determine HIV virologic failure and its associated factors among Omani people living with HIV who are on ART for > 6 months. Patients (n = 1427) were identified from a central national HIV surveillance dataset. Two-thirds (67%) of patients were male, and the median age was 39 years (IQR, 32-48 years). Out of 1427 patients, 14.4% had virologic failure (HIV viral load [VL] ≥ 200 copies/ml). The multivariate analysis showed that patients aged 25-49 years (adjusted odds ratio [aOR]: 1.76, 95% CI: 1.01-3.08) were significantly more likely to fail treatment, compared to those aged ≥ 50 years. Besides, having "Other" HIV risk factor (compared to heterosexuals, aOR: 1.82, 95% CI: 1.02-3.24) and receiving HIV care outside the capital Muscat (compared to those cared for in Muscat, aOR: 1.73, 95% CI: 1.11-2.7) were independently associated with virologic failure. HIV viral suppression (85.6%) in Oman is encouraging; however, further strategies, mainly targeting patients who are young (<50 years), those not disclosing their HIV risk factor and those attending HIV treatment centres outside Muscat, are required to enhance HIV treatment outcome in Oman.

Previous studies have highlighted disparities in care and outcomes in HIV-positive prisoners compared to HIV-positive individuals in the population. We audited clinical outcomes of HIV-positive prisoners accessing care in 2011. Public Health England were notified of 161 prisoners with HIV in the time period studied. Audit proformas were sent to clinics reporting prisoners to the genitourinary medicine clinic activity dataset in 2011. Thirty-two clinics responded. Data for 151 HIV-positive prisoners were reported by 12 clinics, with the other clinics not reporting any prisoners. Outcomes were compared to a previous audit, British HIV Association (BHIVA) and the National AIDS Trust guidelines. Initial CD4 counts were available for 101 patients, of which 42/101 had CD4 <350 cells/mm(3). At reception, viral load data were available for 95 patients, of which 74 were on antiretroviral therapy. Of these, 50/74 (68%) had VL <40 copies/ml. Fifty-one per cent of those on highly active antiretroviral therapy were seen in a specialist clinic less than four weeks after reception. Urgency of referral to a specialist HIV clinic was not related to CD4 or viral load. Twenty-two per cent had hepatitis C co-infection. Clinical outcomes have improved since the last audit but further opportunities exist to optimise care in prisons., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

In 2008, guidelines aimed at reducing undiagnosed HIV infection were published, recommending normalization of testing. Local initiatives were carried out in south-west London including an extensive primary care education programme. This study aimed to establish the impact of these initiatives on HIV diagnoses. Data on all new diagnoses referred to our centre were collected and analysed from patient records. A total of 394 patients were newly diagnosed with HIV from 2007 to 2011. Diagnosis in primary care and other non-sexual health (SH) settings increased by 184% during this period. There was an increase of 37% in the median CD4 count at diagnosis, taking the figure to 372 cells/mm³ in 2011. The proportion of patients presenting with a CD4 count of <200cells/mm³ decreased by 24%. The evidence suggests that these local initiatives were successful in increasing HIV diagnoses outside SH settings, particularly in very late presenters.

When counselling patients for postexposure prophylaxis after sexual exposure, we may need to inform them that the efficacy may be low, especially if the patient also had risks prior to the 72 hours between exposure and treatment. The use of a point-of-care test, as well as fourth generation HIV tests and HIV RNA in combination, can still miss seroconversion in the 'eclipse' phase of the infection as these tests are not designed to detect the earliest phase of infection.

A number of surveys highlight a shortage of dentists in the UK. There is also evidence of discrimination against those with HIV reported within the dental profession and service users. We decided to assess the extent of this problem in our HIV outpatients by conducting a cross-sectional survey, asking them to complete a questionnaire exploring issues related to dental care access, and using clients attending the routine genitourinary (GU) medicine outpatient clinic as controls. A total of 241 outpatients completed the survey, of whom 51 (21%) were HIV patients. Significantly, more HIV patients reported difficulty registering with a dentist than GU patients (58.8% versus 18.2%, chi(2) with Yates correction = 8.76, P = 0.0031). They also report significantly more dental health problems compared with controls (54.9% versus 32.1%, chi(2) with Yates correction = 8.02, P = 0.0046). In total, 34.6% of HIV patients who had declared their status to a dentist thought that it had negatively impacted on their care, with 6.2% being refused treatment. Our small survey confirms that discrimination in relation to access and level of dental care exists, with black African women being at most risk. Efforts are needed to raise professional standards and HIV awareness to prevent continuing inequalities in dental care provision.

Resistance of Neisseria gonorrhoeae (GC) to azithromycin is increasing. The dose of azithromycin used for treating uncomplicated genital chlamydia may be subtherapeutic for GC and contribute to gonococcal resistance. The National Chlamydia Screening Programme (NCSP) does not routinely screen for GC but advises further testing of clients with symptoms. This will miss asymptomatic cases. We conducted a case-note review of 100 women aged 16-24 years diagnosed with chlamydia and women aged 16-24 years co-infected with GC and chlamydia, who attended a London genitourinary clinic from 1 October 2004 to 30 September 2005. There were 559 chlamydia diagnoses; 38 (7%) were co-infected with GC. Those co-infected were younger: mean age 18.9 versus 20.3 (P = 0.005). They were also more likely to have symptoms: 28/38 (74%) versus 50/94 (53%) (P = 0.03). Two of 10 women with asymptomatic GC were contacts; meaning that eight cases of asymptomatic GC would have received subtherapeutic treatment. In conclusion, additional testing for GC should be considered in local NCSP protocols where there is a high prevalence of both infections.

There are many challenges in providing genitourinary medicine services in prison. A review of current service arrangements is overdue. Developing a national standard for sexual health in prison must be a priority. Clinical governance arrangements underpinned by better health informatics and reliable measures of outcomes are key in developing this strategy.

The commissioning of health services for all prisoners in publicly run prisons in England was transferred to local Primary Care Trusts in April 2006, pledging to provide an equivalent standard of health care as that in the community. We reviewed our experience of providing a specialist in-reach HIV service by performing a retrospective case notes review of all HIV-positive prisoners who accessed care from the prison genitourinary medicine service in three London prisons. A total of 112 HIV-positive prisoners were seen by the prison health-care service between April 2004 and 2006. This is the first study to look at how well HIV services are being provided during this transitional period of commissioning health services and provides insight into the challenges facing prison health-care providers. Good HIV outcomes are possible in prison but frequent transfers within the prison system and lack of effective HIV training among prison staff represent barriers to good care.

This is the first report of infection with HTLV-I associated with severe condylomatosis. Assessment of atypical or extensive genital warts should include testing for this retroviral infection.

Gynaecomastia arising in the context of antiretroviral therapy for HIV infection presents a number of challenges in diagnosis and management. We describe a thirty year old gay man with rapidly developing breast enlargement who was successfully treated with the anti-oestrogen tamoxifen.

Recent advances in information technology (IT) offer a wealth of new tools to enhance data collection and information processing. Used in conjunction with established statistical techniques, these advances could be applied to develop a better understanding of demographic and behavioural factors in the acquisition and spread of sexually transmitted infections (STIs). Successful implementation of these technologies will, however, require significant investment of resources, closer working between clinical specialties, and dealing with the fundamental concerns many clinicians as well as patients have over collection of personal data. An important first step towards realizing some of these benefits for data on STIs would be the disaggregation of data collected from genitourinary medicine (GUM) clinics.

A cohort of homosexual men at risk for human immunodeficiency virus (HIV) infection were studied prospectively over a 7-year period (1982/88) to assess trends in sexual behaviour and amyl nitrite intake. During the period, there were dramatic declines in the proportion of HIV seropositive and seronegative subjects reporting multiple casual partners for anal intercourse, unprotected anal intercourse and recreational use of amyl nitrite. Reported rates of orogenital intercourse remained the same during the period, whilst the total number of seroconversions fell from 17 for the period 1982-84 to 8 for 1985-88. High-risk sexual and related social behaviour among homosexual men, as assessed by patterns of anal intercourse behaviour and nitrite intake, changed over the 7-year period, with the greatest changes apparent before the widespread availability of HIV antibody testing and public education campaigns. This highlights the effectiveness of peer-group and community-based programmes in modifying the sexual behaviour of their members.

Three hundred and fourteen homosexual/bisexual men at risk for human immunodeficiency virus (HIV) infection (170 seroprevalent HIV-positive, 144 seronegative) were prospectively studied over 8 years to assess rates of HIV infection and disease progression, in conjunction with cellular and HIV serological markers. In HIV-positive subjects, CD4+ lymphocyte counts rose strikingly during the period surrounding seroconversion, then fell progressively over the intervening period to a mean level of 300 cells/mm3 when AIDS developed. Changes in CD8+ lymphocyte counts were less consistent. The trend for HIV serological markers over the study period was of progressive decline in the proportion of subjects with anti-p24 antibody, associated with an increase in the proportion of subjects with detectable HIV antigenaemia. However, only 45% of subjects tested had lost anti-p24 antibody by the time of AIDS diagnosis, and HIV antigen was detectable up to 4 years before this. Different HIV serological patterns were also observed in subjects presenting either with Kaposi's sarcoma or opportunist infections. Our data support the continued use of cellular and virological markers in the evaluation of HIV disease; however, the variability observed in this study highlights their limited ability in predicting specific clinical events. Care should therefore be taken to encompass both clinical and laboratory information in the medical assessment of the HIV-infected individual.

To assess the clinical and laboratory workload arising from human immunodeficiency virus (HIV)-related inpatient admissions in a London teaching hospital, a 10-month retrospective audit was performed of the casenotes of all HIV-infected inpatients admitted under the care of one consultant physician. During this period, 84 inpatients were identified who generated 371 admissions, of whom 71 (84.5%) had acquired immunodeficiency syndrome (AIDS). Over two-thirds of admissions were essentially day cases, attributed to blood transfusions, antimicrobial and tumour, chemotherapy, and minor surgery; with blood transfusions alone accounting for 43% of all admissions. Pulmonary infections (pyogenic and cell-mediated opportunist) accounted for 46 (12%) of admissions, with Pneumocystis carinii pneumonia second only to blood transfusions in caseload prevalence score (see below). Neurological complications of AIDS were associated with the longest admissions. Laboratory-based investigations were heavily utilized by AIDS inpatients, particularly bacteriological services. Choice of radiological investigation correlated with the anatomical site of disease presentation: plain radiology for chest symptoms, ultrasound for abdominal symptoms and computerized tomography (CT scanning) for neurological presentations. Drug-induced anaemia accounted for a substantial number of HIV-related admissions for red cell transfusions, which together with the disproportionate workload from daycase-type admissions, might be better handled in lower dependency day wards.