Switching from TDF/FTC/EFV to DRV/r in patients with suppressed HIV RNA resulted in significant improvements in 25(OH)D and bone biomarkers, and a 2-3% increase in BMD.

This audit assessed adherence to standards specified in the BASHH national guidance for management of infection with Neisseria gonorrhoeae (2018). All UK GUM/Integrated Sexual Health Services (Level 3 STI services) were invited to complete a brief survey of clinic service arrangements and case note review of the 40 individuals per clinic diagnosed with gonorrhoea via microscopy, nucleic acid amplification test (NAAT) and/or culture up to the end of 2019. Data collection was between 30/01/2020 and 27/03/2020 using an online survey. There was no case of possible treatment failure with ceftriaxone having been reported to PHE. The standard for receiving first line treatment was narrowly missed. The other five national audit standards were not met. Based on the results, the following recommendations were made: individual sexual health service to identify areas for improvement in performance or documentation for key outcomes; adhere carefully to treatment guidelines; encourage all individuals with gonorrhoea to accept testing for syphilis, HIV as well as chlamydia, and to engage in partner notification.

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BackgroundThere is a sustained high rate of lymphogranuloma venereum (LGV) amongst men who have sex with men (MSM) in the UK, with the highest annual number of diagnoses reported in 2015, yet prompt diagnosis of LGV, particularly from non-rectal sites, eludes clinicians.AimsWe present 4 cases highlighting the ongoing challenge of recognition of LGV lymphadenitis, particularly outside GUM settings, and challenges with diagnosis and management.Case reports4 MSM (3 with well-controlled HIV on antiretroviral therapy, 1 HIV negative) presented to their GPs with unilateral groin swellings, and were referred to haematology or surgical teams for investigation. Investigations included ultrasound, CT/MRI of the groin as well as fine needle aspiration, and in 2 cases surgical exploration followed by node excision. None of the patients had symptomatic proctitis, and triple-site NAAT swabs for Chlamydia trachomatis (CT) were negative, although 1 patient had previously diagnosed but untreated urethral CT one month prior. In 1 case, CT serology (WIF) showed a high L2 titre of >1:4000. In all cases, a 21-day course of doxycycline was commenced between 10–45 days from initial presentation. There was slow resolution of the lymphadenitis in 2 patients, necessitating a prolonged course of doxycycline (5 weeks), and addition of 7days of azithromycin 500mg once daily, respectively.ConclusionEarly recognition and management, including prompt aspiration/drainage of buboes and appropriate antibiotic treatment are key to management of LGV lymphadenitis. Poor penetration of antibiotics into abscesses and residual inflammation may delay clinical resolution compared to proctitis cases.