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Internet-based self-sampling at home for Chlamydia trachomatis improves testing rates, particularly for men
Improving uptake of testing is a key component of public health planning for reducing the burden of sexually transmitted infections. Since 2006, Sweden has rolled out a national, free at point of access, internet-based self-sampling service for chlamydia testing. An evaluation of this service between 2013 and 2017 has demonstrated an increase in self-sampling across the country, particularly for men, with 67% of tested men using the self-testing method only. With appropriate investment, a similar intervention could reduce the burden on sexual health services in the UK.
Sex Transm Infect 2020; http://dx.doi.org/10.1136/sextrans-2019-054256
Levonorgestrel-releasing intrauterine systems may affect breast cancer risk
Breast cancer risk in relation to hormone use continues to concern patients and clinicians. A systematic review and meta-analysis of the evidence has suggested a small increased risk of breast cancer in intrauterine system users. However, the authors acknowledge that there were methodological limitations for all included studies that could have introduced confounding factors. As with the use of hormone replacement therapy, we must discuss the risks and benefits of hormonal contraception with patients in the context of pregnancy risk and broader health concerns.
Acta Obstet Gynecol Scand 2020; https://doi.org/10.1111/aogs.13817
Misoprostol administration prior to IUC insertion may benefit specific groups of women
Debate has long raged about the benefits of misoprostol use prior to intrauterine contraception (IUC) insertion. This systematic review of randomised controlled trials (RCTs) and meta-analysis of misoprostol pretreatment has found some improvement in insertion rates for women with previous caesarean section and previous failed IUC insertion. However, misoprostol use increased the rate of side effects and made no difference to insertion rates for nulliparous women. It should not be used routinely for IUC insertion but could be considered in certain groups.
Eur J Contracept Reprod Health 2020; https://doi.org/10.1080/13625187.2019.1706079
Extending the gestational age for EMA at home is possible
In many parts of the world, early medical abortion (EMA) refers to treatment with mifepristone and misoprostol up to 63 days (9 weeks) of gestation. In the UK, this has recently increased to 70 days (10 weeks) with the advent of home-use misoprostol. In this open-label, non-randomised, multicentre, non-inferiority study oral mifepristone 200 mg followed by a single dose of buccal misoprostol 800 μg was given to participants seeking abortion at 71–77 days' gestation and those seeking abortion at 64–70 days' gestation. The study found a reduction in efficacy in the later gestational age group, although efficacy was greater than 85% in both groups. It may be that a second dose of misoprostol provided to patients at 71–77 days' gestation could raise the efficacy to a level comparable to earlier gestations.
Contraception 2020; https://doi.org/10.1016/j.contraception.2020.01.009
Tailored CHC regimes are safe, effective and valued by patients
Tailored regimes for combined hormonal contraception (CHC) have been emphasised in recent FSRH clinical guidance, but there is still uncertainty and confusion surrounding this in patients and clinicians alike. This best practice article summarises the different tailored regimes and explains their safety and side effect profiles, while rooting the practice in patient experience. This article may be helpful in convincing colleagues who are wary of tailored regimes to begin discussing them with their patients.
BMJ 2020; https://doi.org/10.1136/bmj.m200
Vaginal delivery changes physiological responses to sexual stimuli but not psychological responses
New mothers worry about the physical changes brought by pregnancy and vaginal delivery including continence and sexual function. A pilot study compared women following vaginal delivery and non-labouring caesarean section. Psychosexual investigations including vaginal laser Doppler imaging while watching neutral and erotic imagery, and other measures such as the Female Sexual Function Index were used. Investigators found that women who had vaginal births had lower genital blood flow during erotic stimuli compared with their counterparts with caesarean section only; however, there were no important differences across the other metrics. Postpartum sexuality is more complex than genital response alone and this study indicates that mode of delivery may be of limited importance compared with other biopsychosocial factors.
J Sex Med 2020; https://doi.org/10.1016/j.jsxm.2019.11.264
Positive results for HPV in cervical cytology associated with increased stress and anxiety
Many countries are moving to human papillomavirus (HPV) screening as the first screening test for cervical cytology. Australia was one of the first countries to do so and a cross-sectional survey of women tested has shown increased levels of anxiety and stress for those who received a positive result for HPV. The results of the survey should be taken in the context that a positive result for any kind of cervical cytology is likely to result in stress and anxiety. As community knowledge and understanding of HPV testing improves, receiving a positive result may not be as distressing in the future.
Sex Transm Infect 2020; http://dx.doi.org/10.1136/sextrans-2019-054290
Online discussion groups can improve perception of IUC use
The most reliable forms of contraception, including IUC and subdermal implants, are among the least used in Western countries. An RCT on an online forum allocated women to discussion groups where half the members were satisfied IUC users (intervention) or all women had never used IUC (control). The trial found that those in the intervention group had an increase in their knowledge of IUC but also more positive perceptions of the method. This intervention harnesses the natural inclination to value anecdotal evidence but needs further work to translate into a broader-reaching social media strategy and ultimately method uptake.
Contraception 2020; https://doi.org/10.1016/j.contraception.2020.01.014
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.