International journal of STD & AIDS
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Summary Comprehensive testing for asymptomatic sexually transmitted infections in Northern Ireland has traditionally been provided by genitourinary medicine clinics. As patient demand for services has increased while budgets have remained limited, there has been increasing difficulty in accommodating this demand. In May 2013, the newly commissioned specialist Sexual Health service in the South Eastern Trust sought to pilot a new model of care working alongside a GP partnership of 12 practices. ⋯ The aims of the pilot were achieved, namely to provide accessible, cost-effective sexual health care within a framework of robust clinical governance. Furthermore, it uncovered a high positivity rate for Chlamydia, especially in young men attending their general practice, and demonstrated a high level of patient satisfaction. Moreover the capacity of secondary care to deliver Levels 2 and 3 services was increased.
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Our aim was to describe the association between increasing access to antiretroviral therapy and all-cause mortality in South Africa from 2005 to 2009. We undertook a longitudinal, population-level study, using antiretroviral monitoring data reported by PEPFAR implementing partners and province-level and national all-cause mortality records from Statistics South Africa (provider of official South African government statistics) to analyse the association between antiretroviral therapy and mortality. Using mixed effects models with a random intercept for province, we estimated the contemporaneous and lagging association between antiretroviral therapy and all-cause mortality in South Africa. ⋯ The associated decrease in mortality the year after treatment reporting was seen in both adults and children, and men and women. Treatment provided from 2005 to 2008 was associated with 28,305 deaths averted from 2006 to 2009. The scale-up of antiretroviral therapy in South Africa was associated with a significant reduction in national all-cause mortality.
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Genitourinary case records of 42 pregnant women with syphilis were reviewed as part of a regional audit following the re-emergence of congenital syphilis in the north east of England. National standards, from the British Association of Sexual Health and HIV guidelines on managing syphilis in pregnancy, were met in the majority of cases with 69% being treated according to national guidance and all cases completing treatment. Locally developed standards on multidisciplinary working and communication were met less well, with particular issues regarding the documentation of pregnancy outcomes in GUM records and communication between specialities being highlighted. A regional good practice guide has been developed and implemented to address standards not met, reduce adverse outcomes and prevent future cases of congenital syphilis.
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Cryptococcosis, a significant opportunistic infection, has become a global concern since the advent of immunosuppressive chemotherapy or in immunodeficient patients. Host responses range from a harmless colonization to disseminated disease. ⋯ Due to the similar presentation of infection and IRIS, it is often confused with the relapse of cryptococcal meningitis. We report a case of paradoxical recurrent meningitis in response to the initiation of cART in a patient diagnosed with cryptococcal meningitis and propose that the recurrent symptoms resulted from a therapy-induced reconstitution of the immune response against residual Cryptococcus neoformans.
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We conducted a study to establish the prevalence of Mycoplasma genitalium amongst asymptomatic young people experiencing homelessness in the context of comprehensive health care delivery. All asymptomatic young people at risk of sexually transmitted infections were offered urinary polymerase chain reaction testing for M. genitalium whilst being tested for Chlamydia trachomatis and Neisseria gonorrhoeae over a four-month period in 2012. Those who tested positive were notified of the infection and offered treatment. ⋯ Of the eight cases of M. genitalium, seven were contactable and five were treated at our clinic with azithromycin 1 g stat. Two of the five returned after a month for a test of cure, identifying one resistant infection. Further data on the epidemiology of M. genitalium are required before testing recommendations can be made; however, consideration should be given to testing for M. genitalium in settings where other sexually transmitted infections are prevalent.