An update on STIs

Clare Doggett reports from The Society for Applied Microbiology meeting which this year covered “STIs in the 21^st century”

After a cup of coffee and a chance to peruse the trade show delegates, I settled in for the three morning lectures all presented by speakers from Public Health England (PHE), formerly the Health Protection Agency. The talks covered three fascinating and timely areas; ‘Epidemiology of STIs in the UK’, ‘Gonorrhoea – may be untreatable by 2015’ and ‘Changing trends in chlamydia infection’.

Gwenda Hughes kicked off the proceedings with her talk on the changing Epidemiology of STIs in the UK. Gwenda began by drawing delegate’s attention to the population groups with the highest incidence of disease; young adults, men-who-have-sex-with-men (MSM) and certain black, ethnic minority groups. She went on to give a fascinating overview of the current situation with STIs in the UK including the increasing prevalence of previously rare infections, for example; lymphogranuloma venereum and shigella, as well as a general increase in diagnoses of STIs. Gwenda suggested that the increase in these infections may be as a result of many factors including more screening, in programmes like the National Chlamydia Screening Programme, as well as the availability of better, more accurate diagnostic tests. Gwenda concluded her talk with a discussion about prevention methods.

Cathy Ison was the next speaker and her presentation ‘Gonorrhoea may be untreatable by 2015!’ certainly caught the attention of the delegates as well as the national press! Cathy started by explaining simply that we are running out of drugs to treat gonorrhoea, every time a new antibiotic is used to treat Neisseria gonorrhoea it develops resistance. Cathy went on to discuss the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) and some of the measures they are using to tackle this resistance. Some measures that are being considered are changing therapy before resistance reaches the 5% cut-off as well as the potential for combination therapies.

However Cathy reminded us that even if these control measures are used gonorrhoea still has the potential to become untreatable.

The final presentation before lunch was given by Sarah Woodall. Sarah began by discussing some of the associated problems with untreated chlamydia infection. Chlamydia trachomatis (CT) is the most commonly diagnosed bacterial STI in England and elsewhere. Sarah explained that rates of diagnosis of CT had increased dramatically over the past decade, however part of this rise may be due to increased testing through the National Chlamydia Screening Programme. Sarah continued by discussing trends in testing, diagnosis and complication rates. After these fascinating lectures which provided an excellent insight into the current situation in the UK, a delicious lunch and a further opportunity to visit the trade show was provided before delegates returned for the afternoon session. The three afternoon lectures covered; ‘The overlooked problem – Trichomonas vaginalis’, ‘HPV Vaccines, are they doing the job’ and ‘bacterial vaginosis (BV)’.

The first talk after lunch was given by John White, Guy’s and St Thomas’s NHS Foundation Trust, on the topic of Trichomonas vaginalis (TV). John began by discussing how prevalent TV is and its known synergy with HIV infection. As the majority of infection is asymptomatic John explained how essential screening is, especially as TV mostly affects populations in resource poor settings. John went on to discuss developments in diagnostic technologies as well as the potential for targeted screening programmes. John used data from his own clinical setting to demonstrate how these developments could work in practice. The second speaker of the afternoon was Heather Cubie who discussed the current situation with the HPV vaccine after five years of use. Heather highlighted some of the controversies and debates behind the two different vaccines available including gender issues and cultural barriers. Heather then explained the merits of the quadrivalent vaccine in reducing genital warts and that, whilst it was still too early to see whether the vaccine produced a reduction in cervical cancers, where the quadrivalent vaccine had been used, there was a clear decrease in diagnoses of genital warts within the vaccinated age group. Heather concluded by discussing likely changes within the health service delivery going forward.

The final speaker of the day Phillip Hay began by discussing the stigma still attached to bacterial vaginosis. He demonstrated this by asking the audience whether any of them had a friend or partner who had the condition. Only two people in the audience did. Philip went on to discuss some of the problems with BV and some of the novel treatment options for BV including the use of probiotics and prebiotics.

The day ended with a final opportunity to network over a cup of tea before heading home. The day was a great success with many varied and informative presentations. The meeting also made national news coverage including a discussion with one of the speakers, Cathy Ison, about resistant gonorrhoea on the Today programme.

Next year’s Spring Meeting will be held on 30 April 2014 at the Sheffield Hilton, Sheffield and is a one day meeting focusing on clinical microbiology topics. In 2014 the focus will be on 'Control of infection: current status and future prospects'. For more information visit: www.sfam.org.uk/en/events/index.cfm/springmeeting.

Author: Clare Doggett SfAM Communications Officer