Background. The World Health Organisation advice for post-partum women living with HIV (WLHs) in low- and middle-income countries is to breastfeed on suppressive antiretroviral treatment and use infant postnatal prophylaxis. In resource-rich settings, where formula feeding is safe, avoidance of breastfeed is advised. Methods. A questionnaire was created to survey attitudes to breastfeeding in WLHs in the United Kingdom. This was offered to all eligible pregnant women in the third trimester or within 3 months post-partum who attended HIV outpatient clinics from 2017 to 2018. Results. Ninety-four women completed the questionnaire, 69% were Black African and 92% had an undetectable HIV viral load. Thirty eight percent stated they would like to breastfeed and 89% said they would breastfeed if they were HIV negative. Sixty two percent had community members question why they did not breastfeed, and 66% felt forced to invent a reason why they were not breastfeeding. Conclusion. Current UK guidelines recommend formula feeding, proposing a harm reduction approach to support women with suppressed HIV who wish to breastfeed. Over a third of respondents said they would like to breastfeed because stigma and secrecy remain an issue for WLHs. This suggests that over time more women may choose this option.

This prototype test has excellent performance characteristics, comparable to currently used NAATs, and fulfils several World Health Organization ASSURED criteria. Its rapidity without loss of performance suggests that once further developed and commercialized, this test could positively affect clinical practice and public health.

Background We describe 11 cases of refractory vulvovaginal yeast infections (RVVYI) treated using oral voriconazole with or without concomitant topical agents. Methods Retrospective case-note review of all women prescribed oral voriconazole to treat RVVYI in five Sexual Health Clinics from Jan 2010-March 2020. Demographic details, clinical features, diagnostic results and treatment outcomes were collected. Results 11 women with vulvovaginal symptoms for a median of 1 year were treated with voriconazole. RVVYI was diagnosed clinically and confirmed on microscopy and culture with speciation. 10/11 isolates were fluconazole resistant, 1 intermediately sensitive, 10/11 were either fully or intermediately sensitive to voriconazole. All had received prior fluconazole and clotrimazole and 10/11 had used at least 2-weeks of one or more second-line antifungals with non-clearance of the yeast. Oral voriconazole 400 mg BD day-1, then 200 mg BD 13-days was prescribed and 10/11 women completed the course. Concomitant topical treatment was used by 6/11. Liver and renal function were monitored at 0, 7, 14 days. One woman stopped voriconazole after 5-days due to perioral tingling. Other transient side-effects were nausea ( n = 2), photosensitivity, muscle aches, hair thinning (all n = 1), peripheral visual disturbance ( n = 2). 8/11 experienced both symptom reduction and yeast clearance. Two women had an initial partial response but experienced resolution of symptoms following a second course of voriconazole. Conclusions Our observational data adds to the limited evidence to support voriconazole treatment for RVVYI. A 2-week course of voriconazole was tolerated and completed by 10/11 women. Eight women, five using concomitant topical agents, achieved mycological cure.

Background We have previously presented our review of routine enquiry (RE) for IPV in a genitourinary medicine (GUM) service. On-going integration with contraception services (CASH) combined with a new electronic patient record (EPR) in 2013 has prompted further review across the whole service (comprising 13 community clinics and the level 3 GUM service). Aim Have these service changes impacted on our recommendation that RE is undertaken for all new patients? In addition, how many cases of IPV are we identifying? 58% of those identified with current issues of IPV had attended the level 3 GUM service. In the majority, support was already in place. 567 had documentation of past issues of IPV, of which 58 had on-going needs identified. Experiences included child sexual abuse, stalking and social media harassment. Discussion Routine enquiry for IPV is feasible across an integrated service and identifies a range of issues. The proportion screened appears stable (71% in 2013 and 70% in 2014). The scale of the problem in our population is alarming and highlights the need for adequate staff training and clear referral pathways.

Background We have previously presented our review of routine enquiry (RE) for IPV in a genitourinary medicine (GUM) service. On-going integration with contraception services (CASH) combined with a new electronic patient record (EPR) in 2013 has prompted further review across the whole service (comprising 13 community clinics and the level 3 GUM service). Aim Have these service changes impacted on our recommendation that RE is undertaken for all new patients? In addition, how many cases of IPV are we identifying? 58% of those identified with current issues of IPV had attended the level 3 GUM service. In the majority, support was already in place. 567 had documentation of past issues of IPV, of which 58 had on-going needs identified. Experiences included child sexual abuse, stalking and social media harassment. Discussion Routine enquiry for IPV is feasible across an integrated service and identifies a range of issues. The proportion screened appears stable (71% in 2013 and 70% in 2014). The scale of the problem in our population is alarming and highlights the need for adequate staff training and clear referral pathways.