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Objective: We aimed to characterise gonorrhoea transmission patterns in a diverse urban population by linking genomic, epidemiological and antimicrobial susceptibility data., Methods: Neisseria gonorrhoeae isolates from patients attending sexual health clinics at Barts Health NHS Trust, London, UK, during an 11-month period underwent whole-genome sequencing and antimicrobial susceptibility testing. We combined laboratory and patient data to investigate the transmission network structure., Results: One hundred and fifty-eight isolates from 158 patients were available with associated descriptive data. One hundred and twenty-nine (82%) patients identified as male and 25 (16%) as female; four (3%) records lacked gender information. Self-described ethnicities were: 51 (32%) English/Welsh/Scottish; 33 (21%) white, other; 23 (15%) black British/black African/black, other; 12 (8%) Caribbean; 9 (6%) South Asian; 6 (4%) mixed ethnicity; and 10 (6%) other; data were missing for 14 (9%). Self-reported sexual orientations were 82 (52%) men who have sex with men (MSM); 49 (31%) heterosexual; 2 (1%) bisexual; data were missing for 25 individuals. Twenty-two (14%) patients were HIV positive. Whole-genome sequence data were generated for 151 isolates, which linked 75 (50%) patients to at least one other case. Using sequencing data, we found no evidence of transmission networks related to specific ethnic groups (p=0.64) or of HIV serosorting (p=0.35). Of 82 MSM/bisexual patients with sequencing data, 45 (55%) belonged to clusters of ≥2 cases, compared with 16/44 (36%) heterosexuals with sequencing data (p=0.06)., Conclusion: We demonstrate links between 50% of patients in transmission networks using a relatively small sample in a large cosmopolitan city. We found no evidence of HIV serosorting. Our results do not support assortative selectivity as an explanation for differences in gonorrhoea incidence between ethnic groups., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objectives: The levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena®) is one of the most reliable and cost-effective methods of contraception. In the UK, uptake of this method among nulligravid women under 25 years of age is very low. This study surveyed the knowledge and attitudes of general practitioners (GPs) towards the use of the LNG-IUS by young nulligravidae., Method: A questionnaire containing 15 multiple choice questions was sent to GPs in City and Hackney Primary Care Trust, in London, in 2008., Results: Seventy-one GPs responded (38%). None would opt for the LNG-IUS as their first choice contraceptive method for nulligravid women under 25 years of age. Ninety-two percent stated that an oral contraceptive was their first choice, whilst only 8% chose a long-acting reversible contraceptive (LARC). Seventeen percent considered that the LNG-IUS was associated with an increased risk of pelvic inflammatory disease (PID), and 23% stated it was associated with an increased risk of ectopic pregnancy., Conclusions: The LNG-IUS was not widely promoted or provided to young nulligravid women by GPs participating in this survey. Misconceptions relating to PID and risk of ectopic pregnancy and perceived difficulty of insertion in nulligravidae may contribute to the low use of this contraceptive.

Introduction: Research within the European Union has shown international visitors to have a higher injury mortality than residents. Traffic accidents are the leading cause of injury-related death among overseas visitors and evidence suggests overseas visitors are at a greater risk of being involved in road traffic accidents than the resident population. Little information looks specifically at pedestrian injuries to overseas visitors. Pedestrian deaths account for 21% of all UK road deaths., Methods: A retrospective database review of London helicopter emergency medical service (HEMS) missions was undertaken to examine the number and type of missions to overseas visitors, specifically examining pedestrian incidents., Results: Of 121 missions to overseas visitors, 74 (61%) involved the visitor as a pedestrian struck by a vehicle. Thirty-five pedestrians (47%) were struck by a bus and 20 by a car (27%). Fourteen patients (19%) had an initial Glasgow coma scale score of 3-8, suggesting severe head injury and half of all patients required prehospital intubation (38/74, 51%). Mortality was 16% (12/74%) and 62 patients (84%) survived to hospital discharge. Of 39 patients admitted to the Royal London Hospital, the average injury severity score (ISS%) was 23.0 (ISS >15 denotes severe trauma) with a mean inpatient stay of 17.9 days., Conclusion: During the 7-year period studied, 61% of HEMS missions to overseas visitors involved a pedestrian being struck by a vehicle, compared with 16% of missions to UK residents. For HEMS missions, serious trauma to pedestrians is disproportionally more common among the visitor population to London.

Objective: To determine the seroprevalence of hepatitis A antibodies in homosexual and heterosexual males attending a genitourinary medicine (GUM) clinic., Design: Prospective study of male patients recruited from a GUM clinic during a 10 week period in 1993., Setting: Central London outpatient GUM department at Chelsea and Westminster Hospital., Subjects: 255 patients were recruited, comprising 185 homosexual and 70 heterosexual males. Ninety two men were known to be HIV-positive, of whom 89 were homosexual., Main Outcome Measures: Serum samples were screened for both IgM and IgG antibodies to hepatitis A by enzyme linked immunoassay. Results were matched to an anonymously completed questionnaire., Results: 81 of the 255 subjects (31.8%) had been exposed to hepatitis A, two of whom were IgM positive. There were similar hepatitis A seroprevalence rates in homosexual (32.4%) and heterosexual men (30.0%). Although 48.1% of the homosexual men were known to be HIV-positive, compared with 4.3% of the heterosexuals. Hepatitis A seroprevalence remained comparable in both groups after patients with known HIV infection were excluded from the analysis. 11.4% of the heterosexual men admitted to oral-anal sexual contact compared with 62.2% of the homosexual men. This sexual practice was not associated with antibodies or a past history of hepatitis A exposure., Conclusions: There was no detectable difference in hepatitis A seroprevalence between male homosexual and heterosexual GUM clinic attenders, despite a much higher level of oral-anal sexual activity among the homosexual population.