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Online HIV testing seems not to impair condom use and HIV-related knowledge

One of the concerns about online testing for sexually transmitted infections is that we lose the opportunity to provide targeted health advice to higher-risk groups. A serial questionnaire-based study administered to men who have sex with men (MSM) testing online at getcheckedonline.com and at a sexual health clinic in Vancouver has shown that baseline knowledge about HIV and condom use behaviours were the same in both groups and they are no different 3 months post-testing. The website was designed by healthcare professionals and incorporated targeted, evidence-based educational material. It is important when commissioning services to consider the value of this component of an online testing service, rather than simply offering tests alone.

Sex Transm Infect 2019; https://doi.org/10.1136/sextrans-2018-053652

Midwives discussing contraception with women with learning difficulties need clear and consistent guidance

Contraceptive counselling in many European countries is carried out by midwives and increasingly so in the UK. A qualitative study from Sweden used focus groups to explore midwives' attitudes towards contraceptive counselling for women with learning difficulties. The authors found that midwives are very motivated to supply contraception to this group of women. However, they have significant concerns about whom to approach for support in complex situations, and about their lack of experience in working with women who have learning difficulties. The authors believe that clear guidance about how to provide contraceptive counselling for those with learning difficulties are needed for nurses and midwives. Arguably this applies to doctors too.

Eur J Contracept Reprod Health 2019; https://doi.org/10.1080/13625187.2018.1555640

Women considering IUS should receive counselling on the bleeding patterns associated with varying progestogen dose

Intrauterine systems (IUS) are highly effective methods of contraception, which often result in lighter, less painful bleeding. In recent years, different dosage IUS have become available, with different effects on bleeding. This study synthethises data from several IUS marketing studies to evaluate rates of amenorrhoea and problematic bleeding for differing progestogen dosages. The 52 mg IUS remains the best choice for women desiring amenorrhoea or infrequent bleeding, although after 2 years of use, prolonged and frequent bleeding rates are low for all dosages.

Contraception 2019; https://doi.org/10.1016/j.contraception.2019.03.044

Pharyngeal swabs for chlamydia and gonorrhoea testing may be useful for women reporting performing oral sex

British Association for Sexual Health and HIV (BASHH) guidance currently states to 'consider’ pharyngeal testing for chlamydia and gonorrhoea in asymptomatic heterosexual cis-women. An observational cohort study in northern Italy added pharyngeal testing for all women and MSM when oral sex was reported. The study found no difference in the proportion testing positive for either chlamydia or gonorrhoea between men and women. More than 90% of those who tested positive were asymptomatic, although many had recent contact with a partner with chlamydia/gonorrhoea. As concern grows for antimicrobial resistance in gonorrhoea and the relatively low cost of testing, perhaps we should be ‘considering’ pharyngeal testing in more women, particularly those with recent positive contacts.

Int J STD AIDS 2019; https://doi.org/10.1177/0956462419838922

Ectopic pregnancy may predict future adverse pregnancy outcomes

Ectopic pregnancy occurs in approximately 2% of conceptions. A ‘big data’ study using electronic health records in the Canadian province of Quebec examined pregnancy outcome data for more than 1 million pregnancies between 1989 and 2013, and found that 10% of women whose first pregnancy was ectopic went on to have another. There were other significant but small increases in risk of placenta praevia, abruption, early delivery and low birth weight for women whose first pregnancy was ectopic compared with those who had never had an ectopic pregnancy. Big data must always be interpreted with caution as these associations do not prove causation, but greater surveillance in future pregnancies may be wise for these women.

Fertil Steril 2019; https://doi.org/10.1016/j.fertnstert.2019.03.019

Sexual functioning following prostate cancer treatment affects mental health outcomes in gay, bisexual and other MSM

Prostate cancer is the second most common cancer affecting gay, bisexual and other MSM. An online survey of MSM who had received cancer treatment in North America found that two-thirds reported poor-quality sexual function following treatment. This included poor erections, insufficient for insertive anal sex, and associated reduction in condom use. Those who reported poor sexual outcomes also reported significantly worse mental health outcomes to published standards. Sexual function rehabilitation following treatment of prostate cancer needs to be tailored appropriately for MSM.

Arch Sex Behav 2019; https://doi.org/10.1007/s10508-018-1360-y

Surgical termination of pregnancy for fetal anomaly is safe and valued by women

The majority of termination of pregnancy for fetal anomaly (TOPFA) in the UK are performed medically. This is related to access to the necessary surgical skills in National Health Service facilities, but also clinician belief that medical treatment is preferable for post-mortem diagnosis and that women would prefer medical care. This retrospective cohort study of an independent TOPFA service shows that a significant proportion of women will choose a surgical TOPFA over medical when offered a choice, and that these women felt the service was sensitive, helpful and supportive. Many conditions, including chromosomal abnormalities, can be diagnosed without an intact fetus, and so surgical TOPFA should be presented as an option alongside medical for women to make an informed choice.

J Obstet Gynaecol 2019; https://doi.org/10.1080/01443615.2019.1568973

Footnotes

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.