The objective of this study was to assess the length of time service users were prepared to wait for chlamydia and gonorrhoea (CT/GC) near-patient/point-of-care test (NP-POCT) results and to determine the possible effect on management. Individuals attending two UK clinics from November 2013 to February 2014 were surveyed asking the maximum length of time they would wait for CT/GC NP-POCT results after consultation. Linked CT/GC prevalence and treatment rates were analysed. A total of 1817 participants were surveyed, and 1356 provided CT/GC NAAT samples, in which it was found that 115 (8.5%) could wait over 90 minutes in clinic for their result. 115 received treatment at consultation, of which 50 were CT/GC negative and 12 were treated for urethritis or cervicitis; 38 attended as CT/GC contacts. Six of this population would have waited over 90 minutes were NP-POCTs available. A total of 129 tested CT/GC positive, of whom 65 were treated at their consultation, 61 at a later date, and three were untreated. Twelve of these 129 patients would also have waited over 90 minutes for a NP-POCT result. We conclude that 90-minute NP-POCTs are not acceptable to most clinic attendees and would not have impacted on treatment rates or inappropriate prescribing, and 20-minute NP-POCTs show a marginal benefit in treating CT/GC. While NP-POCTs for CT/GC are promising, they must meet client expectations and enhance disease management in order to be accepted by patients and clinicians.

The introduction of UK clinical guidelines in 2006 set clear standards for the provision of postexposure prophylaxis for HIV following sexual exposure (PEPSE) to patients who present to health-care settings. However, some patients have reported wide inequities in provision of PEPSE. We used a questionnaire to evaluate staff awareness and provision of PEPSE in various clinical situations in three major emergency departments (EDs) in the Wessex region of the UK. Thirty-three doctors and 50 nurses completed the questionnaire. There was a general lack of awareness regarding local protocols, availability of postexposure prophylaxis (PEP) packs and whom to contact for advice. Knowledge about PEP provision varied according to clinical scenario but was better among senior medical staff. The deficits in awareness and knowledge of PEPSE among ED staff highlighted in this study raises concerns about patients' access to this intervention. We plan to implement local training to address these issues and raise awareness of the local genitourinary medicine/HIV services as a source of advice.

Elite control of HIV infection has been defined as spontaneous and sustained maintenance of HIV RNA to <50 copies/mL in the absence of therapy. It is estimated to occur in approximately one in 300 HIV-infected individuals. We present the case of a Zimbabwean woman who tested positive for HIV-1 infection on routine antenatal bloods at 15 weeks gestation. Her CD4 count was 500 cells/mm(3); however, HIV-1 RNA viral load measured below the level of detection on several assays. A Cavidi ExaVir reverse transcriptase assay was below the level of detection. Pro-viral DNA was positive using long terminal repeat primers and sequencing demonstrated subtype C virus. Zidovudine monotherapy (250 mg twice daily) was commenced at 24 weeks for the prevention of mother to child transmission. She was keen for a standard vaginal delivery, having had one previously, and she delivered a healthy baby without complications at 39 weeks gestation. The neonate received four weeks of Zidovudine and tested negative for HIV infection. We discuss some challenges involved in the management of a pregnant 'elite controller'.