Search

BackgroundPartner concurrency, (having sexual partnerships overlapping in time), especially when condoms are not used, can facilitate sexually transmitted infections (STI) transmission. In Britain, STI diagnoses rates and the reporting of concurrency are higher among black Caribbeans than other ethnic groups. We explored attitudes towards, drivers, characteristics, and contexts of concurrent partnerships, and their implications for STI risk among black Caribbeans in England.MethodsPurposive sampling, by sex and age-groups, was used to recruit participants (overalln = 59) from five sexual health clinics and community settings in London and Birmingham, England. Audio-recorded four focus group discussions (n = 28 participants), and in-depth interviews (n = 31) were conducted (June 2014–December 2015). Transcribed data were thematically analysed using Framework Analysis.Results‘Main plus’ and ‘non-main’ concurrency were identified in this population. Main plus concurrency involves an individual having a main partner with whom s/he has a “relationship” with, and the individual and/or their partner secretly or explicitly have other non-main partners. In contrast, non-main concurrency entails having multiple, non-committed partners overlapping in time, where concurrency is usually taken as a given, making disclosure to partners irrelevant. While main partnerships were usually long-term, non-main partnerships ranged in duration from a single event through to encounters lasting several months/years. Condomless sex was common with ex/long-term/married/cohabiting partners; whereas condoms were typically used with non-main partners. However, condom use declined with partnership duration and familiarity with partners. Awareness of partners’ concurrency facilitated condom use, STI-testing, and partner notification. While unresolved feelings, or sharing children with ex-partners, usually facilitated main plus concurrency; non-main concurrency was common among young, and single people. Gender norms, notions of masculinity, and sexual desires influenced concurrency. Black Caribbean popular music, social media, peer pressure, and relationship norms among black Caribbeans were also perceived to encourage concurrency, especially among men and young people.ConclusionsConcurrency among black Caribbeans is shaped by a complex interaction between emotional/psychological, interpersonal, sociocultural, and structural factors. Concurrency type, its duration, and awareness influence sexual health choices, and thus STI risk in this population. Collecting these data during clinic consultations could facilitate offering partner notification methods tailored to concurrency type. Gender- and age-specific, culturally-sensitive interventions addressing STI risks associated with concurrency are needed.

Objectives To inform control strategies undertaken as part of an outbreak of Shigella flexneri 3a among men who have sex with men (MSM). Methods All men aged ≥18 years diagnosed with S flexneri 3a between October 2012 and May 2013 were invited to participate. Semistructured in-depth quantitative interviews were conducted to explore lifestyle and sexual behaviour factors. Results Of 53 men diagnosed, 42 were interviewed of whom 34 were sexually active MSM. High numbers of sexual partners were reported (median=22) within the previous year; most were casual encounters met through social media networking sites (21/34). 63% (20/32) were HIV-positive and actively sought positive partners for condomless sex. 62% (21/34) of men had used chemsex drugs (mephedrone, crystal methamphetamine and γ-butyrolactone/γ-hydroxybutrate), which facilitate sexually disinhibiting behaviour during sexual encounters. 38% (8/21) reported injecting chemsex drugs. Where reported almost half (12/23) had attended or hosted sex parties. All reported oral–anal contact and fisting was common (16/34). Many had had gonorrhoea (23/34) and chlamydia (17/34). HIV-positive serostatus was associated with both insertive anal intercourse with a casual partner and receptive fisting (adjusted OR=15.0, p=0.01; adjusted OR=18.3, p=0.03) as was the use of web applications that promote and facilitate unprotected sex (adjusted OR=19.8, p=0.02). Conclusions HIV-positive MSM infected with S flexneri 3a used social media to meet sexual partners for unprotected sex mainly at sex parties. The potential for the transmission of S flexneri , HIV and other infections is clear. MSM need to be aware of the effect that chemsex drugs have on their health.

Objectives In order to estimate HIV incidence among high-risk groups, in January 2009 the Health Protection Agency introduced the Recent Infection Testing Algorithm (RITA) in England and Northern Ireland (E&NI), currently the only regions to inform patients of RITA results. This survey of HIV specialists aimed to investigate the role of RITA in patient management and explore clinicians' views on its role in clinical practice and during partner notification. Methods An online questionnaire was distributed to HIV specialists via the British HIV Association membership email list in February 2011. Results Forty-two HIV specialists from 32 HIV centres responded to the survey among 90 centres enrolled in the programme (response rate 36%). Testing for recent infection was considered standard of care by 83% of respondents, 80% felt confident in interpreting results and 92% discussed results with patients, particularly in the context of a possible HIV seroconversion illness (96%) or when deciding when to start antiretroviral therapy (70%). A third (36%) of specialists were initially concerned that RITA results may cause additional anxiety among patients; however, no adverse events were reported. The majority (90%) felt that results could assist with contact tracing by prioritizing patients with likely recent infection. However, only a few centres have currently incorporated RITA into their HIV partner notification protocols. Conclusions RITA has been introduced into clinical practice with no reported patient adverse events. Access to results at centre level should be improved. National guidance regarding use of RITA as a tool for contact tracing is required.

Objectives Partner notification (PN) is important for sexually transmitted infection (STI) control. With developments in technology, such as text messaging, contacting partners is now easier. This study investigates the frequency and acceptability of text messaging in UK sexual health clinics for STI provider-led PN. Methods A questionnaire was distributed to health advisers (HAs), cascaded by the Society of Sexual Health Advisers and posted on their website. Results 65 questionnaires were returned. Most HAs use telephone for the first and second provider-led PN attempt (61, 94% and 51, 78%, respectively) with text messaging as preferred second choice (19, 29% and 32, 49%, respectively). Overall, 56 clinics (86%) used text messaging at some stage, even if not the preferred option. 29 (52%) clinics had text messaging guidelines and 31 (55%) used messaging templates. Messages varied; 33 (59%) request partner make contact, 11 (20%) mention risk of infection, 9 (16%) name the infection and 20 (36%) use a combination of messages. Six (10%) had contact with their Caldicott Guardian about text messaging. No confidentiality concerns were reported and no complaints were reported from partners about receiving unsolicited text messages. Conclusions Text messaging is widely used and is an important and acceptable tool for STI provider-led PN. It is the second preferred method for contacting partners after telephone for first and second provider-led PN attempts. A small number of clinics never use it. Message content varied; few named the infection. Concerns about confidentiality or negative impact for the partner were not reported. National guidance for the use of text messaging for provider-led PN is needed.

© 2015 Elsevier Ltd. Background: Shigellosis is an acute, severe bacterial colitis that, in high-income countries, is typically associated with travel to high-risk regions (Africa, Asia, and Latin America). Since the 1970s, shigellosis has also been reported as a sexually transmitted infection in men who have sex with men (MSM), in whom transmission is an important component of shigellosis epidemiology in high-income nations. We aimed to use sophisticated subtyping and international sampling to determine factors driving shigellosis emergence in MSM linked to an outbreak in the UK. Methods: We did a large-scale, cross-sectional genomic epidemiological study of shigellosis cases collected from 29 countries between December, 1995, and June 8, 2014. Focusing on an ongoing epidemic in the UK, we collected and whole-genome sequenced clinical isolates of Shigella flexneri serotype 3a from high-risk and low-risk regions, including cases associated with travel and sex between men. We examined relationships between geographical, demographic, and clinical patient data with the isolate antimicrobial susceptibility, genetic data, and inferred evolutionary relationships. Findings: We obtained 331 clinical isolates of S flexneri serotype 3a, including 275 from low-risk regions (44 from individuals who travelled to high-risk regions), 52 from high-risk regions, and four outgroup samples (ie, closely related, but genetically distinct isolates used to determine the root of the phylogenetic tree). We identified a recently emerged lineage of S flexneri 3a that has spread intercontinentally in less than 20 years throughout regions traditionally at low risk for shigellosis via sexual transmission in MSM. The lineage had acquired multiple antimicrobial resistance determinants, and prevailing sublineages were strongly associated with resistance to the macrolide azithromycin. Eight (4%) of 206 isolates from the MSM-associated lineage were obtained from patients who had previously provided an isolate; these serial isolations indicated atypical infection patterns (eg, reinfection). Interpretation: We identified transmission-facilitating behaviours and atypical course(s) of infection as precipitating factors in shigellosis-affected MSM. The intercontinental spread of antimicrobial-resistant shigella through established transmission routes emphasises the need for new approaches to tackle the public health challenge of sexually transmitted infections in MSM. Funding: Wellcome Trust (grant number 098051).

To inform control strategies undertaken as part of an outbreak of Shigella flexneri 3a among men who have sex with men (MSM).All men aged ≥18 years diagnosed with S flexneri 3a between October 2012 and May 2013 were invited to participate. Semistructured in-depth quantitative interviews were conducted to explore lifestyle and sexual behaviour factors.Of 53 men diagnosed, 42 were interviewed of whom 34 were sexually active MSM. High numbers of sexual partners were reported (median=22) within the previous year; most were casual encounters met through social media networking sites (21/34). 63% (20/32) were HIV-positive and actively sought positive partners for condomless sex. 62% (21/34) of men had used chemsex drugs (mephedrone, crystal methamphetamine and γ-butyrolactone/γ-hydroxybutrate), which facilitate sexually disinhibiting behaviour during sexual encounters. 38% (8/21) reported injecting chemsex drugs. Where reported almost half (12/23) had attended or hosted sex parties. All reported oral-anal contact and fisting was common (16/34). Many had had gonorrhoea (23/34) and chlamydia (17/34). HIV-positive serostatus was associated with both insertive anal intercourse with a casual partner and receptive fisting (adjusted OR=15.0, p=0.01; adjusted OR=18.3, p=0.03) as was the use of web applications that promote and facilitate unprotected sex (adjusted OR=19.8, p=0.02).HIV-positive MSM infected with S flexneri 3a used social media to meet sexual partners for unprotected sex mainly at sex parties. The potential for the transmission of S flexneri, HIV and other infections is clear. MSM need to be aware of the effect that chemsex drugs have on their health.

Objective: To compare the prevalence of HIV risk behaviours reported by heterosexuals without major risks for HIV acquisition diagnosed with HIV in England, Wales, and Northern Ireland, with those of the heterosexual general population. Methods: Demographic and sexual behaviour data for heterosexuals (without major risks for HIV) aged 16–44 from the British National Surveys of Sexual Attitudes and Lifestyles in 1990 and 2000 were compared to 139 HIV infected individuals without major risks for HIV aged 16+ at diagnosis, interviewed between December 1987 and March 2003. Comparisons were made overall and separately for the early and late 1990s. Results: HIV infected heterosexual men without major risks were significantly more likely to report first heterosexual intercourse before age 16 (adjusted odds ratio (AOR): 2.75; 95% confidence interval (CI),1.65 to 4.57), while both HIV infected heterosexual men and women reported greater partner numbers (AOR: men 2.44; CI, 1.4 to 4.05; AOR women 2.17; CI, 1.28 to 3.66) and never using condoms (AOR: men 7.97; CI,4.78 to 13.3; AOR women 3.95; CI, 2.30 to 6.80) than the heterosexual general population. There is evidence to suggest that the two groups were more similar in their reporting of partner numbers in the late 1990s relative to the early 1990s. Conclusion: Heterosexual HIV infected individuals without major risks for HIV acquisition in England, Wales, and Northern Ireland are significantly more likely to report high risk sexual behaviours relative to the British heterosexual general population. However, these differences may have decreased over time, at least for the number of partners. Effective sexual health promotion, including the continued promotion of condom use, would impact on the rising rates of STI diagnoses and also prevent HIV transmission among the heterosexual general population.

A small number of UK nationals who have a low, unrecognised or unacknowledged risk for HIV present late in the course of HIV infection; often after frequent attendances to primary care physicians. Information from in-depth interviews with individuals diagnosed with HIV in England, Wales and Northern Ireland (EW&NI) was analysed. Those diagnosed because of HIV-related symptoms (late diagnoses) were compared with those diagnosed for other reasons. Of the 286 individuals interviewed, 157 (55%) had HIV-related symptoms at the time of diagnosis, and 129 were tested for other reasons. A greater proportion of those diagnosed late were male and older. Of the 157 late diagnoses, 77 were considered to have acquired HIV heterosexually in the UK, 19 heterosexually abroad, 16 through 'high-risk' behaviours, 15 heterosexually by a 'high-risk' partner, four through blood transfusion and the remainder through an unusual or unknown route. A significantly higher proportion of those diagnosed late had had a long-standing relationship. None had been informed by a current or ex-partner of their HIV status. Primary care physicians should consider HIV as a possibility when patients without an apparent risk for HIV-infection present with symptoms indicative of possible immune suppression. Sensitive partner notification practices that enable a greater number of individuals to inform their partners should be explored.

Between November 2013 and August 2014, nine cases of verocytotoxin-producing Escherichia coli O117:H7 VT1 were confirmed in adult men. Further investigation using semi-structured interviews revealed that eight cases were United Kingdom (UK)-born men who have sex with men (MSM) who had sexually acquired infection in the UK. Most were HIV-positive with high numbers of sexual partners. This behavioural profile resembles that associated with the recent rapid increase in other sexually acquired infections in MSM.

An unmatched retrospective case control study was conducted to test the feasibility of investigating social and behavioural factors which may have contributed to recent HIV seroconversion in a group of homosexual men. Participants, recruited from a London sexually transmitted disease (STD) clinic, were sexually active and had had a negative HIV test with a subsequent test (positive (cases) or negative (controls)) within three to 15 months. Twenty cases and 22 controls were recruited between February and October 1995. There was no difference between cases and controls in: the number of regular or casual sexual partners, the proportion who were unaware of their regular partners' serostatus (cases 60%, controls 59%), or the proportion who had known HIV-positive regular partners (cases 20%, controls 23%). A significant difference in sexual behaviour was found only when the HIV status of partners, if known, was taken into account: cases were more likely than controls to have had unprotected receptive anal intercourse with a partner not known to be HIV-negative (OR = 5.5, CI = 1.15-29.50). Fifty per cent of the cases and 27% of the controls acquired acute STDs between the two HIV tests. All participants achieved high self-efficacy scores, but the controls believed their peers placed a greater value on safer sex. Cases cited emotional issues and the use of drugs and alcohol as contributing to their seroconversion, whereas controls cited a commitment to safer sex and the avoidance of high-risk situations as contributing to their remaining HIV-negative. The results illustrate the importance of acknowledging the concept of 'negotiated safety' in studies of sexual behaviour; seroconversion was only associated with unprotected sex with a partner not known to be HIV-negative. Despite high self-efficacy scores, indicating the skills to negotiate safer sex, high levels of unsafe anal intercourse were reported. Differences between cases and controls included the importance of safer sex, periods of emotional vulnerability, influence of peers and the appropriate use of condoms. There is a need for these results to be confirmed in a larger and more powerful study.

The aim of the study was to identify and describe the characteristics of persons born in the UK who acquire HIV infection abroad.Analyses using case reports and follow-up data from the national HIV database held at the Health Protection Agency were performed.Fifteen per cent (2066 of 13 891) of UK-born adults diagnosed in England, Wales and Northern Ireland between 2002 and 2010 acquired HIV infection abroad. Thailand (534), the USA (117) and South Africa (108) were the countries most commonly reported. As compared with UK-born adults acquiring HIV infection in the UK, those acquiring HIV infection abroad were significantly (P 0.01) more likely to have acquired it heterosexually (70% vs. 22%, respectively), to be of older age at diagnosis (median 42 years vs. 36 years, respectively), and to have reported sex with a commercial sex worker (5.6% vs. 1%, respectively). Among men infected in Thailand, 11% reported sex with a commercial sex worker.A substantial number of UK-born adults are acquiring HIV infection in countries with generalized HIV epidemics, and in common holiday destinations. Of particular concern is the high proportion of men infected reporting sex with a commercial sex worker. We recommend HIV prevention and testing efforts be extended to include travellers abroad, and that sexual health advice be provided routinely in travel health consultations and in occupational health travel advice packs, particularly to those travelling to high HIV prevalence areas and destinations for sex tourism. Safer sex messages should include an awareness of the potential detrimental health and social impacts of the sex industry.

Introduction Although Shigellosis is often associated with travel to high incidence regions, outbreaks of Shigella flexneri and S. sonnei associated with sexual transmission between men have been reported in the UK, Australia and elsewhere. We examined national trends in Shigella spp. diagnoses to explore the evidence for on-going sexual transmission of S. flexneri 3a and transmission of other Shigella serotypes or species between men in England. Methods Local hospital laboratories submit presumptive strains of Shigella spp. to the Public Health England national reference laboratory for confirmation and typing. We report trends in diagnoses in men and women aged 16 to 60 years old, excluding cases with recent travel outside the UK. Results Between January 2004 and February 2015, 53% (5,051/9,534) of Shigella spp. diagnoses made in England were not travel-associated, and diagnoses of S. flexneri 3a, S. flexneri 2a, and S. sonnei accounted for 78% of these cases. S. flexneri 3a diagnoses in men increased steadily from 2004 (3 cases) and peaked in 2013 (154 cases). Diagnoses of S. flexneri 2a in men followed a similar pattern, although increases emerged later, rising from 9 cases in 2004 to 220 cases in 2014. In 2010, diagnoses of S. sonnei in men began to exceed those in women (147 compared to 133 cases), and have since risen steadily in men (267 cases in 2014). Diagnoses in women remained low/stable throughout the study period, and the male to female gender ratios increased substantially, peaking in 2014 at 59:1, 17:1 and 3:1 for S. flexneri 3a, S. flexneri 2a, and S. sonnei . Conclusion Surveillance data suggest an intensification of the shigellosis epidemic associated with sex between men in England. The timing and heterogeneity in species and serotypes implies separate introductions into the population. These data raise the possibility of new shigellosis outbreaks occurring elsewhere. Disclosure of interest statement No pharmaceutical grants were received in the development of this study.

The trends underlying the rapid and substantial increases in HIV diagnoses among heterosexual people in the United Kingdom are complex and sometimes misunderstood. Although the number of people becoming infected with HIV through heterosexual intercourse in the United Kingdom is rising steadily, most of the overall rise in HIV diagnoses among heterosexuals is among people who originate from and were infected abroad, mainly in Africa.1 We describe HIV diagnoses where infection was probably acquired through heterosexual intercourse in the United Kingdom. The Health Protection Agency Centre for Infections receives voluntary and confidential reports of HIV diagnoses in England, Wales, and Northern Ireland.2 For all reports, the centre collects the probable route of infection and the probable country of infection for patients who were infected through heterosexual intercourse. A research nurse/counsellor follows up where data are incomplete. Where more than one possible country of infection is given, the country with the highest prevalence of HIV is allocated by an epidemiologist or a research nurse/counsellor. If an individual was probably infected in the United Kingdom, further information concerning the partner's probable route and country of infection are recorded. If it is uncertain but possible that the partner was infected in the United Kingdom, …

It is important to establish the likely route of infection for all reported HIV infected individuals if the HIV epidemic is to be understood. Investigating routes of infection may bring unusual infection routes to light. Steps have been taken in the United Kingdom (UK) to establish the likely mode of HIV acquisition for everyone reported as infected. If an initial report is incomplete the clinician caring for the patient is asked for relevant information. If further information is needed, and an interview is feasible and acceptable to both the clinician and the patient, information is collected from the patient through face-to-face semistructured interview. Such follow up has identified 19 cases (among 34,000 records of individuals with HIV and/or AIDS for which probable routes of infection have established) who seem to have acquired HIV infection in unusual circumstances. Seven of the 19 cases described in this paper are thought to have acquired HIV infection in the UK, two in Spain, and ten in countries with a high prevalence of HIV infection. This paper describes the circumstances in which HIV transmission is believed to have occurred.

Background Sexual transmission of Shigella flexneri serotype 3a infection amongst MSM has emerged as a health concern. Control has been challenging as risk factors associated with transmission have not been determined. Interviews were undertaken to explore and understand the lifestyle and sexual behaviour of MSM diagnosed with S. flexneri between October 2012 and February 2013 and inform intervention strategies. Methods All males ≥ 18 years diagnosed with S. flexneri 3a were asked to participate in enhanced surveillance. Those who consented were invited to take part in semi-structured face-to-face interviews. Results Of 35 men diagnosed with S. flexneri , 27 were interviewed, of whom 21 were sexually active MSM (4 heterosexuals and 2 MSM without recent sexual activity were excluded from the analysis). High numbers of sexual partners were reported (median = 40) in the previous year; most were casual encounters met through internet sites (13/21) or saunas (7/21). Mephedrone, ketamine, crystal methamphetamine and GBL had been used by 62% (13/21) during sexual encounters and appeared linked to disinhibiting behaviour. A third (9/21) had attended sex parties and 3 reported ‘slamming’ (injecting recreational drugs) at these events. All reported oral-anal contact, fisting was common (10/21), scat play less so (4/21). Over half (11/21) were HIV-positive and actively sought positive partners. Condom use was rare. Many had had gonorrhoea (13/21) and chlamydia (10/21). Syphilis, lymphogranuloma venereum and hepatitis C infections were also reported. Conclusions Recreational drug use appears strongly associated with sexual risk taking and transmission of S. flexneri . The potential for further infectious disease outbreaks and HIV transmission is clear. MSM whether HIV positive or negative need to be aware of the adverse impact of certain recreational drugs on their sexual health. HIV and sexual health clinicians should discuss recreational drug use with their patients and refer them to appropriate treatment services where indicated.

Background In the UK the primary objective of RITA has been to measure HIV incidence. The UK is the first country to routinely return results to patients and with over 7000 tests returned to clinicians so far, RITA is now seen as part of baseline HIV clinical care in participating centres. Objectives To evaluate patients9 experience of receiving a RITA result, including effects on identifying likely timing of infection, partner notification and relationships. Methods Five HIV centres in England asked their patients to complete a questionnaire on their experience of receiving a “recently infected” RITA result soon after their HIV diagnosis. Results Forty patients with newly diagnosed HIV and a “recent” RITA result completed the questionnaire (93% MSM). The majority (30/40, 75%) said that receiving the recent RITA result was helpful; 10 were unsure how helpful it was, and no participants found it unhelpful. 24 patients (60%) reported RITA helped identify partners who may be at risk of HIV and 24 (62%) felt it helped them to better understand how they may have been infected. Most (35, 88%) either felt neutral or “not more upset” when they learnt that they were likely recently infected. Of those in a relationship 33/37 (89%) reported RITA testing had not caused any relationship problems. Conclusion The majority of patients receiving recent RITA results found this information helpful and no-one found it unhelpful. The result was felt to be useful in increasing an understanding of the likely timing of infection and for identifying “at risk” partners.

Background A test for recent infection (avidity test) is offered for all patients newly diagnosed with HIV in England and Wales as part of an HIV incidence surveillance programme. The UK is currently the only country to return these results to individual patients. Objectives To determine the acceptability and patient experience of receiving a RITA test result soon after HIV diagnosis. Methods This was a qualitative study using semi-structured interviews. 14 people recently diagnosed with HIV who had a RITA result consented to participate. Analyses were based on the framework method using N-Vivo software. Interviews were transcribed, coded and emergent themes identified. Results All participants agreed that the more information available to them about the possible duration of infection the better. Unsurprisingly the HIV diagnosis and the emotions and practical issues associated with it had far more impact than the RITA result. None of the participants experienced any problems with former partners as a consequence of their RITA result although some could see the theoretical potential for such problems. “Recently infected” RITA results were felt to be potentially useful for identifying “at risk” partners. However partner notification was not altered in the study group because the individuals concerned had other reasons to suspect recent infection. Other major themes identified were the perceived stigma; the difficulty of sharing the diagnosis of HIV with family and friends; and the many conflicting emotions that people had to deal with at diagnosis including anger, grief, self-blame, fear and depression. Conclusion RITA testing is a potentially useful epidemiological tool. These interviews demonstrated that receiving a RITA result, while useful to some people, is a minor issue compared with dealing with the HIV result itself. Reassuringly none of the participants reported negative outcomes from receiving the RITA result.

Background Partner notification is important for STI control. With developments in technology notifying partners is now easier. The HPA was keen to understand the acceptability and use of SMS texting for PRPN for STIs. Methods A questionnaire distributed to GUM colleagues, cascaded by the Society of Sexual Health Advisers and posted on their website. Results 65 sites responded. Most (61, 93%) use telephone for 1st attempt for PRPN with texting as preferred second choice (19, 29%). For 2nd attempt, telephone remained preferred method (51, 79%) but texting increased with 32 (49.2%) choosing this method; letter use also increased. Majority of sites used texting for PRPN (56, (86%); frequency varied—over half using it up to 50% of the time. 29 (45%) had texting guidelines and 31 (55%) used texting templates. Messages varied; 33 (59%) requesting partner make contact, 9 (16%) naming the infection. Six (11%) had contact with Information Governance Board about texting; no negative outcomes reported. Two partners complained, not about receiving a text but about being denied the identity of the index patient. 9 (14%) sites never used texting. Conclusion Telephone contact was the preferred option for 1st and 2nd attempt for PRPN. Texting was the 2nd most used method and was seen as acceptable within the clinic and also with Information Governance Board. Frequency varied considerably and message content differed but even if used infrequently, was seen as important if other methods failed. Reassuringly no complaints about texting were received from partners. A small number of sites never use texting.

In the period 1985-1992, 176 significant occupational exposures to HIV were reported to the PHLS Communicable Disease Surveillance Centre. The outcome at three months post exposure was reported for 134 (76%) incidents. Ninety-nine of these involved percutaneous exposure to HIV-infected blood or serum; two resulted in seroconversion, one following the use of zidovudine post exposure. Under-reporting of significant exposures may have been considerable. However, the observed transmission rate, of 2%, is not inconsistent with other estimates. Two other documented seroconversions after occupational exposure have been reported, making a total of four health care workers known to have acquired HIV infection after occupational exposure in the UK. Another six UK health care workers have possible occupationally acquired HIV infections. Five of these probably became infected while working in adverse conditions in Africa; the other while working with HIV-infected patients in the United States and Europe. A summary of current good practice of post exposure management is provided. Practitioners providing post exposure care are asked to contribute to the national surveillance scheme. Initial reporting of significant occupational exposures, and of serological outcome at a minimum of six months post exposure, should be regarded as integral to satisfactory post exposure management.

By the end of 1991, there had been 417 reports of AIDS and 1620 reports of HIV-1 infection in persons in England, Wales and Northern Ireland who probably acquired their infection through sexual intercourse between men and women. Between 1986 and 1991, the proportion of AIDS cases attributable to heterosexual transmission increased from 2% to 14% and of diagnosed HIV-1 infections from 4% to 23%. Reported HIV-1 infections inadequately reflect the extent of infection as only individuals choosing to be tested can be reported. HIV-1 infection acquired during heterosexual intercourse may be the result of transmission from partners who were infected by routes other than heterosexual transmission (first generation transmission) or of transmission from infected partners who were themselves infected through heterosexual intercourse (second generation transmission). Of the 417 cases in which AIDS was acquired through heterosexual intercourse, 42 (10%) were categorised as due to first generation transmission, 328 (79%) as second generation transmission--abroad, and 47 (11%) as second generation transmission--UK. Transmission categories could be allocated to 1438 of the 1620 reports of HIV infection: 17% were categorised as first generation, 74% as second generation--abroad, and 9% as second generation--UK. Heterosexual transmission of HIV infection is increasing, both in individuals acquiring their infection abroad as well as those who become infected in the United Kingdom.

Reports of 217 HIV-1 infected persons have been investigated. Initially, 122 were described as having no identified risk of HIV infection and 95 were described as probably infected through heterosexual intercourse. The sexual partners of 34 of these 95 cases were reported as having acquired their infection heterosexually in the UK but information on the risk status of the sexual partners of the remaining 61 cases was lacking. Telephone follow-up through microbiologists and clinicians resulted in the recategorisation of 132 cases. Interviews were conducted with 22 HIV infected heterosexuals without a major risk for HIV infection, either in themselves or their sexual partners, and who had no evidence of heterosexual exposure outside the UK. Interviews confirmed the categorisation of 15 cases (9 male, 6 female) as due to second generation HIV-1 infection ie, infection acquired through heterosexual intercourse in the UK with a partner who also became infected through heterosexual intercourse. A possible chain of transmission is described involving three of these 15 cases.

While the risk of transmission through oral sex for men who have sex with men (MSM) is low, discrepancies remain between study findings and there is uncertainty about the exact degree of risk.1 Between July 2001 and September 2003, a total of 4150 MSM were newly diagnosed with HIV infection in England, Wales, and Northern Ireland and reported to the Communicable Disease Surveillance Centre in London. Reports for 1359 cases received during this time included the question “Does the patient believe himself to have been …

Surveillance data suggest an intensification of the shigellosis epidemic associated with sexual transmission in men who have sex with men (MSM) in England with separate introductions into the population. In 2014, sexual transmission between MSM might have accounted for 97%, 89%, and 43% of non-travel associated Shigella flexneri 3a and S. flexneri 2a, and S. sonnei diagnoses. Clinicians should sensitively ascertain sexual history for men with enteric infections to facilitate prompt diagnosis and appropriate management.