Whistlestop tour

Having just returned from the Centers for Disease Control and American Sexually Transmitted Diseases Association (ASTDA) conference in Atlanta, I’m struck by the speed of technological change in how we collect, handle and use data. Many presentations addressed novel means of surveillance, and indeed addressed a wider variety of potential influences on sexual health than we usually consider— for example, housing, and local crime rates. Secret diaries are no longer in the form of a the handwritten scrawl of Adrian Mole aged 13—we now ask research subjects and to entrust us with online records of their sexual life. In this issue Stalgaitis and Glick report a systematic review of the use of web-based diaries in sexual risk behaviour research, reflecting on their use, methodological issues and best practice. Such diaries appear to be a useful tool but there many complexities, which are discussed in an accompanying editorial by Hensel. These are a fascinating read, as we all grapple with the growing challenges of digital healthcare. Traditionally, sexual health care in England has had specific legal provision for confidentiality, over and above that normally afforded to patients. With the recent re-organisation of the NHS, these regulations are in flux and likely to lapse. The British Association for Sexual Health and HIV (BASHH) undertook a survey of patient attitudes to confidentiality provision, which is reported in this month’s expanded BASHH column. Sexual health clinics in the UK nowadays take a broader interest in their health of their patients, seeking to address and refer on for issues such as smoking, and alcohol or drug misuse. Lonsdale-Eccles et al report this month a case of fixed drug reaction related to consumption of impressive quantities of gin and tonic. We like our clinical articles to go beyond the guidelines, and address issues where there is real uncertainty and difficulty in our practice. This month, Horner and colleagues present an educational article on the management of chronic pelvic pain syndrome in men reporting to sexual health services, alongside a letter describing how they evaluated their provision for this group of patients. Also of clinical interest is a letter by Davies et al reporting audit and re-audit of the management of syphilis in pregnancy. There is no room at all for complacency—what are you doing locally to ensure prompt and effective care? A perennial preoccupation in our speciality is prompt and accurate diagnosis. We know that very early HIV is highly infectious, and it is thought that early treatment may reduce viral reservoirs. Sane et al show that a high proportion of newly diagnosed HIV infections in MSM attending Dutch STI clinics are recent, demonstrating—as elsewhere—the important role of STI clinics in early case finding and linkage into care, with a view to reducing transmission as well as improving outcomes. In a second study from the Netherlands, Bartelsman et al the performance of that well known Point of Care Test, the Gram stain, is reviewed. Used in high risk symptomatic males, it reduced the cost of a correctly managed consultation. It is always good to see successful studies of vulnerable populations, so important in advocacy and planning of services. Wong et al compare the sexual risk behaviours of Singaporean men seeking sex online with those who frequent brothels, finding higher levels in the former group who need to be addressed with educational interventions. Transgender women are a vulnerable group across the globe, as highlighted in a recent editorial. Santos et al report high HIV prevalence, along with modest antiretroviral therapy (ART) use and viral suppression in San Francisco transgender women, in whom housing instability was associated with poor outcomes. Last but by no means least, we report STI outcomes of a randomised trial of microbicides, a review of HIV prevalence in military populations, the use of condoms for contraception in HIV infected clients, HIVoutcomes in drug using sex workers, and a model of the dual impact of HIV therapy and sexual behaviour changes in Uganda, chlamydial seroprevalence in the Netherlands and peer led HIV testing in China. I hope you will find this month’s issue as fascinating as I did!