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- sexually transmitted infections
- intrauterine devices
- hormonal contraception
- human immunodeficiency virus
- ethnic minority and cultural issues
Women may choose flexible extended combined hormonal contraception regimes if offered information about them
Alternative combined hormonal contraceptive (CHC) regimes have received greater attention in recent times and feature in the forthcoming updated FSRH clinical guideline. A multicentre, cross-sectional epidemiological study of women in Spain attending for CHC assessed self-reported use of traditional versus flexible extended regimes following counselling using a standardised decision aid. Just under 50% of women opted to use the flexible extended regime, primarily to avoid menstruation and menstruation-related symptoms. Of those who favoured the traditional regime, 18.1% reported the desire to have monthly bleeds to reassure them they were not pregnant, demonstrating the need for further education that a monthly withdrawal bleed does not exclude pregnancy in a CHC user.
Eur J Contracept Reprod Health Care 2018; https://doi.org/10.1080/13625187.2018.1493099
Intrauterine contraception is safe for nulliparous women
Whether or not to initiate intrauterine contraception (IUC) for nulliparous women has long been a bone of contention for many clinicians. A systematic review has evaluated randomised and observational data regarding insertion of IUC in nulliparous women. Despite poor-quality data, the available evidence suggests that there is no difference in infection, expulsion or infertility rates in nulliparous women using IUC compared with parous women. Insertion may be technically more difficult, but is worth it when considering the potential of IUC to reduce unintended pregnancy in a younger, highly fertile population.
Eur J Contracept Reprod Health Care 2018; https://doi.org/10.1080/13625187.2018.1526898
A cloud-based mobile phone app combined with point-of-care testing by practitioners can aid STI diagnosis in resource-limited settings
Smartphone technology is now widely available globally, even in areas with limited resources. A cross-sectional study conducted in rural India found that antenatal screening for several infectious diseases, including HIV, syphilis and hepatitis B, as well as anaemia, could be increased by the use of a cloud-based app that linked pregnant women to community-based healthcare professionals (HCPs). These HCPs could then provide multiplex point of care testing near the patient’s home and link them to confirmatory testing and further care if positive. All outcomes were tracked on the app, which engaged patients in their care and results and kept a record for researchers and other HCPs. The technology is now being adapted for use in men who have sex with men (MSM) and hard to reach communities in Canada.
Sex Transm Infect 2018; https://sti.bmj.com/content/early/2018/10/15/sextrans-2017-053491
No one antibiotic regime is clearly superior in the treatment of PID
The treatment of pelvic inflammatory disease (PID) is a source of anxiety and confusion for patients and clinicians alike. A Cochrane systematic review has concluded that there is insufficient evidence to recommend the use of any one particular antibiotic regime for treatment of PID. There was no difference seen in clinical cure rates using tetracycline (doxycycline)- or macrolide (azithromycin)-based regimes. There was insufficient evidence to recommend use of a nitroimidazole (metronidazole) or not. Reassuringly, there was no evidence of greater harm caused by one regime over another.
Sex Transm Infect 2018; https://sti.bmj.com/content/early/2018/10/19/sextrans-2018-053693
Behavioural intervention messages improve return rates of postal HIV self-sampling kits
In order to broaden access to testing but simultaneously reduce costs, many clinics and health boards are turning to self-sampling and self-testing kits for HIV and other sexually transmitted infections (STIs). A randomised control trial of 9585 HIV self-sampling test users in England found that SMS text reminders, which included short behavioural intervention messages, significantly improved the return rate of kits, when compared with standard reminder messages. The behavioural intervention message emphasised that the return kit postage had already been paid, and set a deadline for return. These messages sought to minimise the burden of returning kits, and counteract ‘I’ll do it later’ thinking.
HIV Med 2018; https://doi.org/10.1111/hiv.12634
Rates of female genital mutilation and cutting are falling globally
An observational study has analysed trends in female genital mutilation or cutting (FGM/C) globally, with a particular focus on western Asia and Africa. Happily, there is evidence that rates of FGM/C are falling across all areas surveyed. The greatest reduction in FGM/C was seen in Eastern African countries. This reduction has been achieved by concerted coordinated efforts between governments, non-governmental organisations, charities and the health sector. It is essential that we do not become complacent, and build on this fantastic work to eradicate the practice of FGM/C.
BMJ Global Health 2018;3:e000549.
The effectiveness of ulipristal acetate to prevent follicular rupture is reduced by early administration of combined oral contraception
Ulipristal acetate (UPA) is a very helpful form of oral emergency contraception (EC); however, it has the downside that further contraception must be delayed to avoid interaction. An open-label biological study conducted in Oregon, USA has demonstrated that early administration of combined oral contraception (COC) at 48 hours following use of UPA results in significantly higher rates of follicular rupture within 5 days of administration of UPA compared with no use of COC. This study supports existing FSRH guidance for delaying initiation of hormonal contraception following use of UPA for EC. As always, it is important to remember the most effective method of EC is a copper intrauterine device.
Contraception 2018; https://doi.org/10.1016/j.contraception.2018.08.00398
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.