HIV-associated sensory neuropathy is the most frequent manifestation of HIV disease, afflicting 40-50% of patients whose HIV disease is otherwise controlled by antiretroviral therapy. It often presents with significant neuropathic pain and is consistently associated with previous exposure to nucleoside reverse transcriptase inhibitors including stavudine (d4T), which is widely used in resource-limited settings. Here we investigated complex pain-related behaviours associated with d4T treatment using ethologically relevant thigmotaxis and burrowing behaviours in adult rats. Detailed neuropathological response was also examined using neurochemistry, electron microscopy, and proteomics. After 2 intravenous injections of d4T (50 mg/kg, 4 days apart), rats developed hind paw mechanical hypersensitivity, which plateaued at 21 days after initial d4T injection, a time that these animals also had significant changes in thigmotaxis and burrowing behaviours when compared to the controls; reductions in hind paw intraepidermal nerve fibre density and CGRP/IB4 immunoreactivity in L5 spinal dorsal horn, suggesting injury to both the peripheral and central terminals of L5 dorsal root ganglion neurons; and increases in myelinated and unmyelinated axon diameters in the sural nerve, suggesting axonal swelling. However, no significant glial and inflammatory cell response to d4T treatment was observed. Sural nerve proteomics at 7 days after initial d4T injection revealed down-regulated proteins associated with mitochondrial function, highlighting distal axons vulnerability to d4T neurotoxicity. In summary, we have reported complex behavioural changes and a distinctive neuropathology in a clinically relevant rat model of d4T-induced sensory neuropathy that is suitable for further pathophysiological investigation and preclinical evaluation of novel analgesics.

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This report describes an unusual cause for halitosis and an unusual treatment for the underlying problem. Halitosis is a symptom which can result from a diverse range of underlying pathologies, most frequently those affecting the oral cavity or respiratory tract. Uncommonly, it arises due to pathology within the upper gastrointestinal tract. The case of a patient presenting with severe persistent halitosis attributable to mesh erosion occurring 8 years after redo laparoscopic hiatus hernia repair is described. Full external healing of the erosion tract was observed such that no symptomatic oesophageal perforation resulted. Mesh erosion is typically managed with surgical intervention. In this case, the infected mesh was successfully removed endoscopically.

VVS and rectal positive NAATs, the AC2 Reactive Light Units levels were equivalent, suggesting active infection at both sites. Discussion/conclusion In this sample of women with no rectal symptoms, the rectum was the most prevalent site for chlamydia infection, and rectal swabs found significantly more infections than VVS. There was no association with reported anal sex indicating sexual risk history is unreliable for targeted screening in women. Background/introduction Few data are available to guide the best time to perform a test of cure using nucleic acid amplification tests (NAATs) following treatment for chlamydia (CT) and gonorrhoea (NG). Aim(s)/objectives The association between the type of infection, organism load, site of infection and treatment were compared to the time for the NAAT to become negative after treatment. Methods Individuals who had a positive NAAT test for CT and/ or NG were eligible. Self-taken specimens from the site of infection were collected at 8 time points.The time to first negative test following treatment was examined using survival analysis techniques. Results 102 men (87 MSM) and 52 women were recruited to the study (84 NG, 71 CT infections). 28 participants with NG and 16 with CT were lost to follow up. On day 0, 20 participants diagnosed with NG and 8 diagnosed with CT had negative tests. Median time to negativity for NG infection was 2 days (IQR 1-5) and for CT infection was 4 days (IQR 2-5). At day 14 after treatment 92% of participants were CT negative, and 84% NG negative.All tests were negative by day 35 for both infections. Discussion/conclusion This study provides valuable data in determining the time to test of cure for CT and NG infections. Site of infection may have an effect on time to clearance of infection, with pharyngeal NG infections and vaginal CT infections taking longer to clear than other sites.The results of this study will help guide clinicians to the timing for test of cure. O023

The Goldilocks principle, ie not too much or too little, but just right, is important when prescribing thyroid hormone replacement, especially in the elderly or women of reproductive age. The authors present the results of their multi‐practice audit evaluating the monitoring of patients on thyroid hormone replacement in primary care.