The 374 clinic: an outreach sexual health clinic for young men

The need for innovative sexually transmitted infection screening initiatives for young men: evidence from genitourinary medicine clinics across England

The study objectives were to ascertain behavioural, access-related, health-seeking factors and sexually transmitted infection (STI) prevalence in young men (<25 years) attending genitourinary (GU) medicine clinics and compare them with older men (≥25 years) and young women (<25 years). Between October 2004 and March 2005, 4600 new attendees at seven sociodemographically and geographically contrasting GU medicine clinics across England completed questionnaires, which were linked to routine clinical data. Young men waited significantly less time to be seen in clinic compared with older men and young women. They were less likely to report symptoms than older men ( P = 0.021) yet more likely to be diagnosed with chlamydia ( P = 0.001) and gonorrhoea ( P = 0.007). They were also more likely to be diagnosed with an acute STI relative to young women ( P = 0.007). Our data confirm the need to make comprehensive STI screening readily available for young men and to develop effective and innovative screening strategies in different settings.

Self-directed sexually transmitted infection testing: providing noninvasive sexual health services

A literature review that addressed the possible reasons sexually transmitted infection (STI) rates are increasing indicated that self-directed STI testing for gonorrhea and chlamydia should be trialed. As such, a self-directed STI testing kit was developed and piloted for 6 months, during which 182 bathhouse patrons accessed services from both an on-site nurse and through the self-directed kits. In total, 127 of these individuals presented for testing from the nurse, with the remaining using the self-directed testing kits. Community/Participant feedback indicated that this testing method was a welcome adjunct to traditional services, thus suggesting that self-directed testing should be further explored.

Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting

This study aimed to systematically review and describe the evidence on chlamydia and gonorrhoea reinfection among men, and to evaluate the need for retesting recommendations in men. PubMed and STI conference abstract books from January 1995 to October 2006 were searched to identify studies on chlamydia and gonorrhoea reinfection among men using chlamydia and gonorrhoea nucleic acid amplification tests or gonorrhoea culture. Studies were categorised as using either active or passive follow-up methods. The proportions of chlamydial and gonococcal reinfection among men were calculated for each study and summary medians were reported. Repeat chlamydia infection among men had a median reinfection probability of 11.3%. Repeat gonorrhoea infection among men had a median reinfection probability of 7.0%. Studies with active follow-up had moderate rates of chlamydia and gonorrhoea reinfection among men, with respective medians of 10.9% and 7.0%. Studies with passive follow-up had higher proportions of both chlamydia and gonorrhoea reinfections among men, with respective medians of 17.4% and 8.5%. Proportions of chlamydia and gonorrhoea reinfection among men were comparable with those among women. Reinfection among men was strongly associated with previous history of sexually transmitted diseases and younger age, and inconsistently associated with risky sexual behaviour. Substantial repeat chlamydia and gonorrhoea infection rates were found in men comparable with those in women. Retesting recommendations in men are appropriate, given the high rate of reinfection. To optimise retesting guidelines, further research to determine effective retesting methods and establish factors associated with reinfection among men is suggested.

Success of a nurse led community based genitourinary medicine clinic for young people in Liverpool: review of the first year

OBJECTIVES

To assess the outcome and workload of a community based, nurse led comprehensive sexual health and contraceptive service for clients aged less than 25.

METHODS

Review of appointment diaries and clinic records of clients who attended the Brook genitourinary medicine (GUM) clinic. The workload, case mix, and achievement of national targets in the first year of the service were compared with those for the same age group of clients attending the nearby hospital based GUM clinic. A limited client satisfaction questionnaire was carried out 8 months after the clinic opened.

RESULTS

1061/1700 (62.4%) clients (185, 17.4% male) attended booked appointments. Chlamydia trachomatis was detected in 16.1% of women and 20.5% of men at Brook (p<0.05), where 22.6% of women and 50% of men had at least one sexually transmitted infection (p<0.001). HIV testing was offered to 98.5% of clients. 60.7% of all identified contacts attended a clinic for testing and/or treatment. Client responses to a questionnaire about the service were very favourable. Only 2.3% of Brook GUM clients needed referral to a physician.

CONCLUSIONS

Nurse led community based GUM services, such as the one provided at the Merseyside Brook Centre, appeal to young people and our success should encourage others to consider similar ventures.