Goals Assess outcomes in patients with an index presentation of spontaneous bacterial peritonitis (SBP) over a 13-year period. Background SBP, a bacterial infection of ascites, has a poor prognosis. Study Retrospective cohort study assessing mortality (standardised to 32 months) and prognostic factors in patients with SBP during two periods: period 1 (June 2006–November 2012) and period 2 (December 2012–May 2019). Results The study included 178 patients who were followed up for 11.6 (29.2) months. Mortality was high, with 12-, 24- and 32-month survival being 32%, 26% and 24%, respectively. Inpatient mortality was 36% with mortality in those surviving hospitalisation being 62%. Serum creatinine at the time of SBP diagnosis was an independent predictor of mortality at 32 months [hazard ratio (HR) 1.002, P = 0.023] and inpatient mortality (HR 1.003, P = 0.035). Positive ascitic fluid culture and ascitic fluid neutrophil count were independent predictors of 32-month (HR 1.679, P = 0.008) and inpatient mortality (HR 1.0001, P = 0.005), respectively. Patients in period 2 had lower ascitic fluid albumin (5.9 ± 3.3 g/L vs. 10.8 ± 5.4 g/L, P < 0.001), higher ascitic fluid neutrophil count (815.0 cells/mm3 vs. 345.0 cells/mm3, P < 0.001) and higher rates of hepatorenal syndrome-acute kidney injury (58 vs. 35%, P = 0.002). Mortality at 32 months and mortality in those surviving hospitalisation were similar at 78 vs. 73%, P = 0.392 and 66 vs. 58%, P = 0.355, for periods 1 and 2, respectively. Conclusions Despite more advanced initial presentations, mortality rates have remained similar over the last 13 years. Serum creatinine at the time of SBP diagnosis is an independent predictor of mortality.

Objective Hepatitis B is sexually transmitted among men who have sex with men (MSM) and has previously been endemic in some populations of MSM. Presence of anti-hepatitis B core (anti-HBc) determines previous or ongoing infection. We aimed to establish the prevalence and associations of anti-HBc in our clinic population of MSM. Method A cross-sectional study of newly attending MSM to determine the prevalence and associations of testing positive for anti-HBc using our clinic database from 2012 to 2019. We used crude odds ratios to identify any associations. Results There were 3342/5842 (58%) newly attending MSM who were tested for anti-HBc between 2012 and 2019. Of the 3342 MSM tested for anti-HBc, the median age was 30 years (interquartile range 23–43), 442 (13%) were living with HIV, 10 (0.3%) were HBsAg positive, 62 (1.9%) had past/current hepatitis C, 401 (12%) had a positive syphilis enzyme immunoassay (EIA), 455 (14%) were diagnosed with either gonorrhoea or chlamydia and 1080 (32%) were non-UK born. A total of 331 (10%, 95% confidence interval (CI) = 8.9–11.0) tested positive for anti-HBc and the proportion testing positive reduced significantly throughout the study period (P < 0.004). Testing positive for anti-HBc was associated with age >30 years (OR = 8.2, 95% CI = 5.9–11.4, P < 0.0001), having past/current hepatitis C (odds ratio (OR) = 5.0, 95% CI = 3.0–8.6, P < 0.0001), having a positive syphilis EIA (OR = 5.9, 95% CI = 4.4–7.3, P < 0.0001) and being non-UK born (OR = 1.4, 95% CI = 1.1–1.8, P < 0.006). There were no associations with HIV status or having a diagnosis of gonorrhoea or chlamydia. Conclusion Although reducing, the prevalence of anti-HBc remains endemic in MSM locally and further efforts are needed to enhance hepatitis B prevention strategies.

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Hepatitis A is a sexually transmitted enteric infection in men who have sex with men (MSM). HIV pre-exposure prophylaxis (PrEP) has increased opportunities for sexual health interventions in MSM. 588 (372 in 2019, 216 in 2021) MSM attended for the first time in the study periods. MSM were significantly more likely to be screened for Hepatitis A susceptibility in 2021 than 2019 (93% vs 56%, P = 0.0001). Susceptibility (Hepatitis A IgG negative) to Hepatitis A did not change between in 2021 and 2019 (48% vs 47%, P = 0.921). De-medicalising PrEP is important as it will increase overall uptake. However, coupling PrEP with other sexual health interventions must not be lost.

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