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- early detection of cancer
- gonorrhea
- infertility
- long-acting reversible contraception
- reproductive health
- sexually transmitted diseases
Pain at vulvar biopsy is not reduced by addition of buffer to lidocaine
Vulvar skin is very sensitive and so an anaesthetic is recommended to minimise pain during biopsy of vulvar lesions. However, local anaesthetic injections themselves can be painful. Clinical guidelines often suggest considering adding a ‘buffer’ to a local anaesthetic to minimise pain on injection, yet the evidence base for this is minimal. This randomised controlled trial (RCT) compared plain lidocaine 1% with lidocaine 1% plus sodium bicarbonate. The trial was powered to show a difference in 15 mm on a 100 mm visual analogue scale; however, no difference between study groups was detected. Topical lidocaine cream or gel may prove more effective as this would remove any injection pain and anxiety related to the use of a needle.
Obstet Gynecol 2020;135(3):609-614.
Fresh embryo transfer at IVF is associated with greater incidence of VTE than frozen-thawed transfers
Typically, during in vitro fertilisation (IVF) an embryo is transferred following ovarian stimulation and egg collection (a ‘fresh’ embryo transfer). Any remaining embryos are frozen, to be thawed and transferred at a later date if desired. IVF is known to increase the risk of venous thromboembolism (VTE) during pregnancy; however, this Swedish registry study has demonstrated that fresh embryo transfers are more likely to lead to VTE compared with frozen-thawed transfers and indeed natural conceptions. These results must be taken in the context of the timeframe during which they were collected – 1992 until 2012 – when VTE prevention strategies were not so commonplace as today, and it is important to acknowledge that the absolute number of VTE remained small in all groups. These findings are important for the counselling of women and targeted prevention of VTE for those choosing IVF.
J Thromb Haemost 2020; https://doi.org/10.1111/jth.14840
Uptake of HPV vaccination can be improved by a multilevel intervention with providers
Human papillomavirus (HPV) vaccination uptake is important in the prevention of cervical cancer for future generations; however, as with all vaccines, acceptance can be inconsistent. This stepped-wedge RCT of a multilevel intervention found a significant improvement in vaccine initiation rates and completion rates at five centres in the USA. The intervention involved training of staff in motivational interviewing techniques, raising staff awareness of vaccination data and locally tailored quality improvement strategies to improve uptake. HPV vaccination takes place predominantly in schools in the UK; however, the principles of this intervention may be applicable in the UK health context and elsewhere.
Pediatrics 2020; https://doi.org/10.1542/peds.2019-2737
COVID-19 led to reduced online male sex work
COVID-19 had a profound effect on all kinds of business, including sex work. This study analysed the creation and activity of male sex worker profiles on a large, popular online sex work website. During the period of COVID-19, researchers found a significant reduction in the number of new profiles being created, a decrease in profile views by clients and an increasing move to non-face-to-face forms of sex work. This decrease in activity is likely to represent economic hardship for these sex workers, whose work is not considered in typical ‘furlough’ schemes. As clinicians, we should discuss finances and signpost to relevant sources of support when caring for sex workers.
Sex Transm Infect 2020; http://dx.doi.org/10.1136/sextrans-2020-054550
A proportion of patients will spontaneously clear Neisseria gonorrhoeae
Antimicrobial resistance remains a growing concern and threat to treatment options for those infected with Neisseria gonorrhoeae. This substudy of the GToG trial follows a group of recruited patients (approximately 20% of those recruited) who spontaneously cleared the infection at genital and extragenital sites between their initial test and pretreatment test. Their demographic characteristics were not different from those who did not spontaneously clear; however, they were less likely to be coinfected with Chlamydia trachomatis and less likely to experience dysuria. Point-of-care testing prior to treatment may be useful in the future to avoid unnecessary antimicrobial treatment in these patients.
Sex Transm Infect 2020; http://dx.doi.org/10.1136/sextrans-2020-054500
A new method of removing single-rod contraceptive implants
Subdermal contraceptive implant insertion is an uncomplicated procedure. Removal of implants, however, is more difficult and so limits the types of healthcare professionals who can perform this procedure. A new medical device has been developed and trialled at a single centre in Sweden with the intention that it could be used to remove implants with minimal training. The device still requires refinement (41% of attempted removals failed in this trial) but these early data are promising. The device may have a role in resource-limited settings to improve access to insertion and removal of subdermal implants using less skilled cadres of health professionals or perhaps enable patients to remove their own implants.
Contraception 2020; https://doi.org/10.1016/j.contraception.2020.07.005
Virtual reality may reduce pain during hysteroscopy
Distraction is a recognised technique for the management of pain during gynaecological procedures, most typically in the form of ‘vocal local’, for example, a support worker engaging the patient in conversation to take their mind off the procedure. A small, single-centre RCT has shown reduction in pain during hysteroscopy for women using virtual reality (VR) headsets showing a calming scene compared with standard care. As VR technology improves and becomes less expensive, it may be a viable option for pain management in National Health Service (NHS) settings – indeed patients may bring along their own VR equipment. Further study is needed, however, as the intervention worked very well for some participants but poorly for others and so targeted application of VR may be the best approach.
BJOG 2020; https://doi.org/10.1111/1471-0528.16377
Footnotes
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.