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DMPA use can have a negative impact upon cardiovascular disease biomarkers after 1 year of use
Depot medroxyprogesterone acetate (DMPA) is known to have metabolic side effects in relation to weight gain and bone density. A prospective, non-randomised comparison study in Sao Paulo recruited healthy young women, with normal body mass index (BMI) and glucose tolerance and insulin sensitivity, to commence DMPA or a copper intrauterine device (Cu-IUD) and evaluate cardiovascular disease (CVD) risk markers. At 1 year, the DMPA group had higher triglyceride levels and apolipoprotein B-100 compared to baseline. There were no other differences between the DMPA or Cu-IUD groups. The deterioration of these biomarkers, which are linked to atherogenesis, should give clinicians pause for thought when considering this method for women at higher risk of CVD.
Eur J Contracept Reprod Health Care 2018; https://doi.org/10.1080/13625187.2018.1455087
Dried blood spot sample collection kits are better than mini-tube blood sampling kits for postal HIV testing services
In England, sexual health services are experiencing unprecedented reductions in funding resulting in fewer staff and resources. Coupled with greater need and demand for sexually transmitted infection (STI) testing, this has sparked innovation in the form of postal testing services for HIV. This service evaluation found that by changing from using a mini-tube blood sample collection kit to a dried blood spot platform, the number of false-positives was reduced and the number of successfully analysed samples increased.
Sex Transm Infect 2018; https://doi.org/10.1136/sextrans-2018-053567
Last menstrual period is as reliable as bimanual examination for estimating gestational age in resource-limited abortion care settings
Ultrasound dating has become the standard method of assessing gestational age in abortion care settings. In resource-limited or remote settings this can delay access to abortion, resulting in greater gestational ages at treatment. A Nepalese audit comparing last menstrual period (LMP) with bimanual examination in rural community and pharmacy settings found that in women able to supply a date for LMP, this agreed with bimanual examination in 99.3% of cases. This approach could be used to provide earlier access to early medical abortion in remote and rural settings in the UK, reducing burden of visits and delays on patients.
Contraception 2018; https://doi.org/10.1016/j.contraception.2018.06.004
Asking patients about sex with a transgender or gender-diverse person is acceptable to individuals attending an Australian sexual health centre
Trans and gender-diverse (TGD) people are often excluded from research and service evaluation, but they represent a growing number of patients presenting to SRH clinics in the UK and internationally. This Australian retrospective cohort analysis sought to assess prevalence of self-reported sexual contact with TGD partners and related risk of chlamydial infection. Approximately 1.0% of male patients and 0.6% of female patients reported sex with a TGD person and there was no increased rate of chlamydial infection. This study represents a simple strategy for raising awareness of, and collecting data about, TGD people, their partners and prevalence of STI.
Sex Transm Infect 2018; https://doi.org/10.1136/sextrans-2018-053653
Continuing atypical antipsychotic medication during early pregnancy increases the risk of gestational diabetes
A large-scale retrospective cohort analysis of the Medicaid database has examined the relationship between use of atypical antipsychotics during pregnancy and risk of developing gestational diabetes. Data for more than 1.5 million pregnancies were analysed and approximately 10 000 expectant mothers had used at least one form of antipsychotic prior to or during their pregnancy. Women who continued their prescriptions of olanzapine or quetiapine during pregnancy were at significantly higher risk of gestational diabetes than those who discontinued or used other antipsychotics. There were many confounders in this study; however, these two antipsychotics are known to have metabolic side effects and so it may be sensible to provide targeted preconception counselling for women using these medicines.
Am J Psychiatr 2018; https://doi.org/10.1176/appi.ajp.2018.17040393
Raised BMI and significant dysmenorrhoea are factors most closely associated with low-lying IUD on ultrasound
Low-lying IUD and intrauterine system (IUS) can have a theoretical impact on their contraceptive efficacy. A cross-sectional sub-analysis of the Study of Environment, Life-style, and Fibroids (SELF) conducted in a cohort of African-Americans analysed 168 ultrasound scans with a 17% rate of low-lying IUD. Logistic regression found that high BMI, low level of education, and reporting the highest level of painful bleeding on the Likert scale were the factors most associated with low-lying IUD. While the numbers are small, this study does signal that for those women presenting with significant dysmenorrhoea and raised BMI with intrauterine contraception (IUC) in situ, an ultrasound to locate IUC may be warranted.
Contraception 2018; https://doi.org/10.1016/j.contraception.2018.02.018
Patients prefer brief behaviour change interventions that involve human contact to email or text messages
STI risk is largely dictated by sexual behaviour; however, there is a dearth of effective interventions to modify this behaviour. An exploratory study conducted in English sexual health clinics using a discrete choice experiment found that young people and men that have sex with men (MSM) preferred interventions involving face-to-face interaction to email and text-based interventions. Given the current strains on sexual health services in terms of resources, delivery of face-to-face interventions will prove difficult without adequate investment.
Int J STD AIDS 2018; https://doi.org/10.1177/0956462418760425
Better health for sex workers: decriminalisation arguably causes least harm
The current legal framework regarding sex work in the UK is widely regarded as having a negative impact on public health outcomes for sex workers. An analysis article reviewing the available evidence regarding outcomes of various legal frameworks states the case for decriminalisation of sex work as opposed to a semi-legalised or Nordic model. New Zealand decriminalised sex work in 2003 and since then has found that sex workers are more likely to report violent crime to police, less likely to select ‘risky’ clients, and more likely to successfully negotiate condom use.
BMJ 2018; https://doi.org/10.1136/bmj.k2609
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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