These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.

IntroductionWithin the chemsex population reports of sexual assault, non-consensual sex and coercion are rising. We looked at consent among our chemsex clinic users.MethodsRetrospective data review of patients from April 2015 to March 2017. Data was collected on sexual assault, coercion, exploitation, risk taking, sexually transmitted infections and drug use.Results72 men were seen with a median age of 32. 41 (56.9%) were HIV positive, and 11 (15.3%) had Hepatitis C. 53 (73.6%) patients used Mephedrone, 40 (55.6%) GHB and 22 (30.6%) Crystal Meth. 13 (18.1%) patients reported self-harm. In total 23 (31.9%) patients reported non-consensual sex. A minority 5/30 (16.7%) were identified from April 2015 to Jan 2016 when using the terminology ‘forced into sex’. After realising that addressing consent is more complex in this cohort, we prioritised consent discussions around unwanted sexual attention and from Jan 2016 to March 2017 18/42 (42.9%) reported non-consensual sex (Table 1).Abstract O14 Table 1ChemsexAssault/coercionN/42 (%)Non-consensual sex18 (42.9%)Reported as sexual assault6 (14.3%)Coercive sex4 (9.5%)Sex while unconscious3 (7.1%)Assaulted > once2 (4.8%)Allegations of organised assault2 (4.8%)Injected/filmed while unconscious1 (2.4%)DiscussionOur data shows rates of non-consensual sex among chemsex users of up to 42.9%. There is a lack of patient understanding around what sexual assault and consent are and exploring this in a sensitive manner is paramount. Sexual assault discussions must be reviewed in both standard sexual health and chemsex clinics.

BackgroundEffectiveness of HIV postexposure prophylaxis (PEPSE) correlates with speed of uptake following HIV exposure. Time to first dose has not improved in the UK for over 10 years. On-demand pre-exposure prophylaxis (PrEP) has shown that people can self-start medication for HIV prevention.We hypothesised that advanced provision of PEPSE (HOME PEPSE) for men who have sex with men (MSM) to self- initiate would reduce time to first dose following HIV exposure.MethodsPhase IV, randomised, prospective, 48-week, open-label study was carried out. MSM at medium risk of acquiring HIV were randomised (1:1) to immediate or deferred standard of care (SOC) HOME PEPSE. Every 12 weeks, participants self-completed mental health/risk behaviour surveys and had HIV/sexually transmitted infection (STI) testing.HOME PEPSE comprised a 5-day pack of emtricitabine/tenofovir disoproxil fumarate/maraviroc 600 mg once daily initiated following potential exposure to HIV. If taken, participants completed a risk survey; PEPSE continuation was physician directed. Primary outcome was time from potential exposure to HIV to first PEPSE dose.Findings139 participants randomised 1:1; 69 to immediate HOME PEPSE and 70 to deferred HOME PEPSE. Median age 30 years (IQR 26–39), 75% white, 55% UK born and 72% university educated. 31 in HOME PEPSE and 15 in SOC arm initiated PEPSE. Uptake of HOME PEPSE was appropriate in 27/31 cases (87%, 95% CI: 71% to 95%). Median time from exposure to first dose was 7.3 hours (3.0, 20.9) for HOME PEPSE and 28.5 hours (17.3, 34.0) for SOC (p<0.01). HOME PEPSE was well tolerated with no discontinuations.No significant differences in missed opportunities for PEPSE uptake, sexual behaviour or bacterial STI infections between treatment arms.InterpretationHOME PEPSE reduced the time from exposure to first-dose PEPSE by 21+ hours, with no impact on safety. This significantly improves the efficacy of PEPSE and provides an option for people declining PrEP.

Successful interventions to prevent congenital HIV require adherence to highly active antiretroviral therapy (HAART) in pregnancy from mothers and agreement with other interventions including mode of delivery and infant testing. We sought to audit adherence support offered antenatally, adherence with HAART, recommendations for delivery and infant testing in women receiving HIV care at our unit and delivering a child in 2004 and 2005. Of the 32 women identified, an adherence discussion was conducted when commencing therapy in 87% and subsequent visits in 77%. Five women were non-adherent with HAART, one disagreed with recommendations for delivery, and attendance at initial post-natal tests was documented in 61%. In general, the British HIV Association guidelines with regard to adherence are followed. Although numbers in this cohort are small, age, ethnicity and pre-pregnancy HIV diagnosis did not seem to affect adherence, but being therapy naïve and poor adherence may predict non-attendance at infant follow-up.

Background/introductionRecreational drug use (RDU), particularly the chemsex drugs mephedrone, crystal methamphetamine and gamma-hydroxybutyric acid (GHB) are associated with significant harms. Occasionally this has led to hospital admission with significant morbidity and mortality.Aim(s)/objectivesTo review inpatient admissions from a large HIV service and look at RDU associations.MethodsA prospective analysis of admissions to an HIV inpatient service between April 2015 and March 2016 was conducted. Information was collected on demographics, admission details, complications and drug use.ResultsFrom 194 admissions there were 19 (9.8%) related to RDU. Median age was 33.5 (range 23–65). All were male and 18 (94.7%) were men who have sex with men (MSM). 4 (21.1%) were Hepatitis C co-infected. 5 (26.3%) patients took GHB, 5 (26.3%) mephedrone and 4 (21.1%) crystal meth. Cause of admission can be seen in Table 1. There were 3 deaths due to drug overdoses during the study period.Abstract O017 Table 1Chemsex-related admissionsDiagnosisN (%)Overdose9 (47.4%), 4 ITU admissionsPsychosis3 (15.8%)Abscess2 (10.5%)Arrhythmias2 (10.5%)DVTs1 (5.3%)Withdrawal1 (5.3%)Rhabdomyalysis1 (5.3%)Discussion/conclusionRDU was responsible for 9.8% of admissions, with GHB, mephedrone and crystal meth responsible for 21–26%. This may underestimate the true effect of drug admissions as it only involves HIV positive MSM. We’ve developed a chemsex clinic and city-wide task and finish group, in liaison with Public Health to address the growing effect of chemsex. Clinicians need to ensure RDU is regularly reviewed and timely interventions are offered to limit harms.