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The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.

The World Health Organisation advice for post-partum women living with HIV (WLHs) in low- and middle-income countries is to breastfeed on suppressive antiretroviral treatment and use infant postnatal prophylaxis. In resource-rich settings, where formula feeding is safe, avoidance of breastfeed is advised. A questionnaire was created to survey attitudes to breastfeeding in WLHs in the United Kingdom. This was offered to all eligible pregnant women in the third trimester or within 3 months post-partum who attended HIV outpatient clinics from 2017 to 2018. Ninety-four women completed the questionnaire, 69% were Black African and 92% had an undetectable HIV viral load. Thirty eight percent stated they would like to breastfeed and 89% said they would breastfeed if they were HIV negative. Sixty two percent had community members question why they did not breastfeed, and 66% felt forced to invent a reason why they were not breastfeeding. Current UK guidelines recommend formula feeding, proposing a harm reduction approach to support women with suppressed HIV who wish to breastfeed. Over a third of respondents said they would like to breastfeed because stigma and secrecy remain an issue for WLHs. This suggests that over time more women may choose this option.

Supplemental Material, sj-pdf-1-std-10.1177_09564624211003761 for United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020 by Mimie Chirwa, Olubanke Davies, Sheena Castelino, Mbiye Mpenge, Farai Nyatsanza, Gulshan Sethi, Majid Shabbir and Michael Rayment in International Journal of STD & AIDS

Supplemental Material, sj-pdf-1-std-10.1177_0956462421999951 for Over a third of childbearing women with HIV would like to breastfeed: A UK survey of women living with HIV by Farai Nyatsanza, Jessica Gubbin, Thomas Gubbin, Paula Seery, Pippa Farrugia, Adam Croucher, Yvonne Gilleece, Melanie Rosenvinge, Sherie Roedling, Liat Sarner, Dayawathie Nayagam, Clare Stradling, Angelina Namiba, Nicola Fearnley, and Hermione Lyall in International Journal of STD & AIDS

Persistent genital arousal disorder (PGAD) is a condition characterized by spontaneous and often unrelenting sensations of genital arousal in the absence of sexual desire or stimulation. These sensations typically do not fully remit with orgasm and are by definition intrusive, unwanted, and distressing. Sufferers tend to complain of genital throbbing and often pain. It is thought to be a rare condition; however, it is likely many sufferers remain undiagnosed. Initial triggers include stress, anxiety, medication withdrawal, or initiation and sexual intercourse. Exacerbating factors include sitting and/or tight clothing, and relieving factors include relaxation and distraction. Possible etiologies of PGAD include pudendal/dorsal clitoral nerve neuropathy and a cognitive disorder related to anxiety, depression, and nonconsensual sex. Management of PGAD requires a multidisciplinary team approach and has to be of a holistic nature. This can include medication, mindfulness cognitive based therapy, and pelvic floor physiotherapy.

Syphilis is caused by the spirochete bacterium Treponema pallidum and can be transmitted both sexually and from mother to child. T pallidum can infect any organ and produces a clinical disease with a relapsing and remitting course. It is not hard to see, therefore, why it is often described as the great mimic. In this review, we provide an update of modern syphilis epidemiology, clinical presentations, and testing and treatment strategies.

Background Patients at increased risk of sexually transmitted infections (STIs)/HIV acquisition are advised to reattend for retesting. A previous study showed that ‘generic’ text reminders did not improve reattendance. Aim To assess if a personalised text message with increased contact information would increase reattendance rates of at-risk patients. Methods Patients who are at risk of future STIs, defined by having a current acute STI, attending for emergency contraception, commercial sex workers (CSWs) or men who have sex with men (MSM), were sent a text reminder to reattend for retesting 6 weeks after initial visit. Reattendance rates were measured for September to December 2012 (control group who received a generic text message) and February to May 2014 (intervention ‘personalised message’ group who received a text message containing their first name and ways to contact the clinic). Reattendance was counted within 4 months of the end of the initial episode of care. Results The reattendance rate was significantly higher for the intervention group: 149/266 (56%) than the control group: 90/273 (33%) (p=0.0001) and was also significantly higher in the intervention group than the control group in patients with the following risks: recent chlamydia (64/123 (52%) vs 43/121 (36%)) (p=0.03), recent gonorrhoea (41/64 (64%) vs 4/21 (19%)) (p=0.0003) and MSM (26/45 (58%) vs 3/18 (16%)) (p=0.006). New STI rates in the reattending intervention group and controls were 26/ 149 (17%) and 13/90 (14%) (n.s), respectively. Conclusions Sending a personalised text message with increased contact information as a reminder for retesting increased reattendance rates by 23% in patients who are at higher risk of STIs.

Starting July 2013, all patients attending a sexual health clinic who reported risk of extra-genital infection were offered self-taken extra-genital swabs. The study aim was to assess the detection rate of extra-genital infection since self-taken swabs were introduced. We compared patients diagnosed with chlamydia and gonorrhoea in six-month periods before (February–July 2012) and after (February–July 2014) the introduction of self-taken extra-genital swabs. There were 408 (98 gonorrhoea, 310 chlamydia) detected infections in the 2012 period and 404 (121 gonorrhoea, 283 chlamydia) in 2014. The rate of extra-genital chlamydia/gonorrhoea increased fourfold from 18/408, 4.4% to 77/404 19% ( P

Objectives The 2008 UK National Guidelines for HIV testing recommended HIV testing should be offered to all general medical admissions aged 16–60 years in high prevalence areas, and that this should be evaluated to ensure this was effective in diagnosing previously undiagnosed HIV. Methods HIV testing was introduced as a routine test for all patients admitted to the acute medical admissions unit, comparisons were made between the testing rates before, during and after this intervention. Results The pilot was initiated in August 2009. Prior to the pilot the unit was carrying out 15 tests per month. However, when the pilot was introduced 82 tests were being carried out per month with a total of 10 new diagnoses since the start of the pilot. The proportion of patients tested versus those eligible for testing remained low varying between 6% and 22% month by month. 10 patients we found to be HIV positive with a prevalence of approximately 1%, 10 fold higher than the cut off for cost effectiveness used in the guidelines. Conclusions Overall the pilot showed that HIV testing could be delivered without the use of extra resources and is acceptable to patients.

Lichen Sclerosus is a chronic inflammatory skin disorder. In men it presents mainly on the prepuce, coronal sulcus and glans penis. The cause of lichen sclerosus is not fully understood, but genetic and autoimmune factors are thought to be important. Infections have been investigated as a cause, but with no clear evidence of a potential causative agent. In men the association with autoimmune diseases is weaker; however studies have shown a family history of diabetes mellitus, and thyroid disease are possible risk factors. Other suggested potential causes are chronic intermittent damage by urine, as early circumcision seems to be preventative in those who do not have congenital anomalies such as hypospadias. Recommended treatments include circumcision and potent topical steroid ointments. Taking this into consideration we reviewed notes of patients that presented to the monthly Joint Dermatology clinic with a diagnosis of lichen sclerosus to ascertain the number of recurrences post circumcision. We found four cases of recurrence of lichen sclerosus in patients attending the clinic over a four month period. Ages varied between 39–81 years old. One patient had diabetes mellitus, and another had been circumcised twice. All patients needed treatment with potent topical steroid ointment. Lipscombe et al . stated that 50% of patients who had a circumcision had a recurrence. It is important when discussing management with patients to remember that lichen sclerosus can recur after circumcision. From our observations, the presence of folds of skin still covering the glans penis best predicts recurrence.

Background Patients at increased risk of STI/HIV acquisition are advised to re-attend for re-testing. A previous study showed that ‘generic’ text reminders did not improve re-attendance. Aim To assess if a personalised text message would increase re- attendance rates of at risk patients who require repeat STI testing. Methods At-risk patients were sent a text reminder to re-attend for re-testing 6 weeks after their initial visit. They were considered to be ‘at risk’ if they had an acute STI or had attended for emergency contraception at the initial visit, or were MSM. Re-attendance rates were measured for September to December 2012 (control group who received a generic text message advising re-attendance) and February to May 2014 (personalised message group who received a text message containing their first name and several different ways to contact the clinic). Re-attendance was counted within four months of the end of the initial episode of care. Results The re-attendance rate was significantly higher for the personalised message group (144/266(54%) than the control group: (90/273 (33%) (P = 0.0001) and was also significantly higher in the personalised message group than the control group in patients with the following risks: recent chlamydia (61/123(50%) vs (43/121(36%) (P = 0.03), recent gonorrhoea (42/64(66%) vs (4/21(19%) (P = 0.0003) and MSM (25/45(56%) vs (3/18(16%) (P = 0.006). New STI rates in the re-attending ‘personalised message’ group and controls were 26/144(18%) and 13/90 (14%) (n.s) respectively. Conclusion Sending a personalised text message as a reminder for re-testing increases re-attendance rates in patients who are at higher risk of STIs.