Bacterial vaginosis is the commonest cause of abnormal vaginal discharge in women of childbearing... more Bacterial vaginosis is the commonest cause of abnormal vaginal discharge in women of childbearing age, with a prevalence as high as 50% in some communities. The symptoms of discharge and offensive smell can cause considerable distress, although 50% of women are asymptomatic when diagnosed. Microbiologically the usually dominant lactobacillus flora is overwhelmed by an overgrowth of predominantly anaerobic organisms, accompanied by a rise in pH. A biofilm containing predominantly Gardnerella vaginalis and Atopobium vaginae has been described recently. Metronidazole is the antibiotic of choice for treatment, but relapse within 1 or 2 months is common. Bacterial vaginosis is a risk factor for acquisition of sexually transmitted infections including HIV, and for post-abortion endometritis and adverse pregnancy outcomes such as late miscarriage and preterm birth. Studies of antibiotics in pregnancy have not consistently shown reduced adverse outcomes so better strategies need to be studied to improve pregnancy outcome.
Background Abdominal adiposity in HIV-1 patients initiating antiretroviral therapy may be part of... more Background Abdominal adiposity in HIV-1 patients initiating antiretroviral therapy may be part of a restoration-to-health phenomenon. Lipoatrophy is associated with long-term thymidine analogue therapy. Individual protease inhibitors (PIs) differ in their effects on lipids and insulin resistance. Methods A randomized open-label multicentre 96-week trial compared changes in fat distribution in patients with suppressed HIV-1 RNA and abdominal adiposity, who either continued on their current twice-daily ritonavir-boosted PI (PI/r) or switched to once-daily boosted atazanavir (ATV/r). Treatment with two nucleoside reverse transcriptase inhibitors was unchanged. Body composition was assessed by dual-energy x-ray absorptiometry (DEXA) and abdominal computerized tomography (CT) scanning. Results In total, 201 patients were randomized; 131 switched to ATV/r. Viral suppression (<50 copies/ml) was similarly maintained (93% ATV/r versus 89% PI/r). Mean changes from baseline in trunk-to-limb...
ObjectivesOropharyngeal squamous cell carcinoma is the most common human papillomavirus (HPV)-ass... more ObjectivesOropharyngeal squamous cell carcinoma is the most common human papillomavirus (HPV)-associated cancer in the UK, but little is known about the prevalence of oropharyngeal HPV in sexually active teenagers. We investigated reported HPV vaccination coverage (in females) and prevalence of oropharyngeal HPV in sexually active students attending six technical colleges in London, UK.MethodsIn 2017, we obtained mouthwash samples and questionnaires from male and female students taking part in the ‘Test n Treat’ chlamydia screening trial. Samples were subjected to HPV genotyping.ResultsOf 232 participants approached, 202 (87%) provided a mouthwash sample and questionnaire. Participants’ median age was 17 years and 47% were male. Most (73%) were from black and minority ethnic groups, 64% gave a history of oral sex, 52% reported having a new sexual partner in the past 6 months, 33% smoked cigarettes, 5.9% had concurrent genitourinary Chlamydia trachomatis infection and 1.5% Neisseria ...
Objective: Neisseria gonorrhoeae infection is a global, major public health problem. It is the se... more Objective: Neisseria gonorrhoeae infection is a global, major public health problem. It is the second leading bacterial sexually transmitted infection (STI) in sub-Saharan Africa and worldwide. As study findings on the topic are inconsistent, we conducted a systematic review and meta-analysis to determine the pooled prevalence of N. gonorrhoeae infection in sub-Saharan Africa among reproductive-aged women. Methods: Published studies were systematically retrieved from PubMed, Embase, CINHAL and Science Direct. Their quality was measured using the Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data, and the score of each included study had to meet at least 4.5 out of 9 indicators of quality. Results: The meta-analysis of 35 studies showed that the pooled prevalence of N. gonorrhoeae infection among reproductive-aged women in sub-Saharan Africa was 3.28% (95% confidence interval 2.61%, 3.94%). Conclusion: The prevalence of N. gonorrhoeae infection was higher than that found in other studies carried out in the region. The results suggest that greater attention should be paid to the primary prevention of N. gonorrhoeae. We recommend the implementation of STI education for reproductive-aged women and the use of specific and rapid diagnostic testing for N. gonorrhoeae infection in STI clinics. N. gonorrhoeae screening and treatment should be integrated into in-and outpatient clinics to reduce infection among reproductive-aged women.
We sought to describe the natural history of abnormal vaginal flora in pregnancy and estimate the... more We sought to describe the natural history of abnormal vaginal flora in pregnancy and estimate the efficacy of oral clindamycin in eradicating it and preventing relapse. METHODS: This was a subanalysis of a randomized trial of oral clindamycin for abnormal vaginal flora in pregnancy. All 494 enrolled women were asked to provide a vaginal smear 2 weeks after treatment and every second participant to provide further smears at 20, 24, 28, 32, and 36 weeks of gestation. We used Nugent score of Gram-stained smears to assess the cure rate among the clindamycin group and the rate of spontaneous resolution among the placebo group.
There are few data in the literature regarding the ability of surgical trainees and surgeons to c... more There are few data in the literature regarding the ability of surgical trainees and surgeons to correctly interpret intraoperative cholangiograms (IOCs) during laparoscopic cholecystectomy (LC). The aim of this study was to determine the accuracy of surgeons' interpretations of IOCs. Methods: Fifteen IOCs, depicting normal, variants of normal and abnormal anatomy, were sent electronically in random sequence to 20 surgical trainees and 20 consultant general surgeons. Information was also sought on the routine or selective use of IOC by respondents. Results: The accuracy of IOC interpretation was poor. Only nine surgeons and nine trainees correctly interpreted the cholangiograms showing normal anatomy. Six consultant surgeons and five trainees correctly identified variants of normal anatomy on cholangiograms. Abnormal anatomy on cholangiograms was identified correctly by 18 consultant surgeons and 19 trainees. Routine IOC was practised by seven consultants and six trainees. There was no significant difference between those who performed routine and selective IOC with respect to correct identification of normal, variant and abnormal anatomy. Conclusions: The present study shows that the accuracy of detection of both normal and variants of normal anatomy was poor in all grades of surgeon irrespective of a policy of routine or selective IOC. Improving operators' understanding of biliary anatomy may help to increase the diagnostic accuracy of IOC interpretation.
A polymerase chain reaction (PCR) was developed for Chlamydia trachomatis in which a 380 base pai... more A polymerase chain reaction (PCR) was developed for Chlamydia trachomatis in which a 380 base pair DNA fragment was amplified. Amplification occurred with the DNA from the 15 serovars but not with that from other Chlamydia spp or with DNA from a variety of other organisms. Chlamydial DNA (10"g) could be detected and the PCR seemed to be able to detect single organisms. Urethral swabs were obtained from 37 men with acute non-gonococcal urethritis (NGU), 18 (49%) of whom were positive for C trachomatis by MicroTrak. As a result of clinical re-examinations 65 urethral swabs were available for analysis by the PCR. In comparison with MicroTrak, PCR had a sensitivity of 95%, a specificity of 94%, a positive predictive value of 86% and a negative predictive value of 98%. The PCR was apparently less sensitive (82%) in tests on urine samples. Overall, however, values of sensitivity and specificity of the PCR compared favourably with those of MicroTrak. The PCR for C trachomatis is likely to be a valuable technique for research, but problems of DNA contamination suggest that it should not be recommended for routine diagnosis.
The prevalence and complications of bacterial vaginosis are population dependent. In pregnancy, b... more The prevalence and complications of bacterial vaginosis are population dependent. In pregnancy, bacterial vaginosis is associated with late miscarriages and infection driven pre-term delivery. Regardless of the aetiology of pre-term delivery, surviving infants are at increased risk of subsequent neurodevelopmental handicap. Intervention studies in bacterial vaginosis positive pregnant women at high risk of pre-term delivery demonstrate the benefits of antibiotic treatment. Current evidence suggests that bacterial vaginosis may increase the efficiency of heterosexual HIV transmission. Metronidazole remains the mainstay of treatment of bacterial vaginosis. No treatment prevents relapse, which occurs in 20-30% of cases within 1 month. New approaches that are based on a better understanding of the pathophysiology of bacterial vaginosis are required to improve the clinical management of recurrent bacterial vaginosis.
BJOG: An International Journal of Obstetrics and Gynaecology, 2006
To determine whether metronidazole reduces early preterm labour in asymptomatic women with positi... more To determine whether metronidazole reduces early preterm labour in asymptomatic women with positive vaginal fetal fibronectin (fFN) in the second trimester of pregnancy. Randomised placebo-controlled trial. Fourteen UK hospitals (three teaching). Pregnancies with at least one previous risk factor, including mid-trimester loss or preterm delivery, uterine abnormality, cervical surgery or cerclage. Nine hundred pregnancies were screened for fFN at 24 and 27 weeks of gestation. Positive cases were randomised to a week&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s course of oral metronidazole or placebo. Primary outcome was delivery before 30 weeks of gestation. Secondary outcomes included delivery before 37 weeks. The Trial Steering Committee (TSC) recommended the study be stopped early; 21% of women receiving metronidazole (11/53) delivered before 30 weeks compared with 11% (5/46) taking placebo [risk ratio 1.9, 95% confidence interval (CI) 0.72-5.09, P = 0.18]. There were significantly more preterm deliveries (before 37 weeks) in women treated with metronidazole 33/53 (62%) versus placebo 18/46 (39%), risk ratio 1.6, 95% CI 1.05-2.4. fFN was a good predictor of early preterm birth in these asymptomatic women; positive and negative predictive values (24 weeks of gestation) for delivery by 30 weeks were 26% and 99%, respectively (positive and negative likelihood ratios 15, 0.35). Metronidazole does not reduce early preterm birth in high risk pregnant women selected by history and a positive vaginal fFN test. Preterm delivery may be increased by metronidazole therapy.
BJOG: An International Journal of Obstetrics and Gynaecology, 1996
We do not believe that the technique for measurement of SmcO, which we have previously described ... more We do not believe that the technique for measurement of SmcO, which we have previously described is invalidated by these observations. We have previously shown that changes in fetal cerebral oxygenation as measured by NIRS correlate well with expected physiological changes in various clinical situationse. This degree of consistency makes it unlikely that the observed changes are due to movement artefact or compartment shifts. In summary, this paper raised some interesting questions on the use of NIRS in the case of a nonviable fetus, but we question its relevance to intrapartum studies of live fetuses.
F1000 - Post-publication peer review of the biomedical literature, 2017
OBJECTIVES-Prior studies suggest that the composition of the vaginal microbiome may positively or... more OBJECTIVES-Prior studies suggest that the composition of the vaginal microbiome may positively or negatively affect susceptibility to sexually transmitted infections (STI) and bacterial vaginosis (BV). Some female hormonal contraceptive methods also appear to positively or negatively influence STI transmission and BV. Therefore changes in the vaginal microbiome that are associated with different contraceptive methods may explain, in part, effects on STI transmission and BV. STUDY DESIGN-We performed a retrospective study of 16S rRNA gene survey data of vaginal samples from a subset of participants from the Human Vaginal Microbiome Project at Virginia Commonwealth University. The subset included 682 women who reported using a single form of birth control that was condoms, combined oral contraceptives (COCs), depot medroxyprogesterone acetate (DMPA), or the levonorgestrel-releasing intrauterine system (LNG-IUS).
Bacterial vaginosis is the commonest cause of abnormal vaginal discharge in women of childbearing... more Bacterial vaginosis is the commonest cause of abnormal vaginal discharge in women of childbearing age, with a prevalence as high as 50% in some communities. The symptoms of discharge and offensive smell can cause considerable distress, although 50% of women are asymptomatic when diagnosed. Microbiologically the usually dominant lactobacillus flora is overwhelmed by an overgrowth of predominantly anaerobic organisms, accompanied by a rise in pH. A biofilm containing predominantly Gardnerella vaginalis and Atopobium vaginae has been described recently. Metronidazole is the antibiotic of choice for treatment, but relapse within 1 or 2 months is common. Bacterial vaginosis is a risk factor for acquisition of sexually transmitted infections including HIV, and for post-abortion endometritis and adverse pregnancy outcomes such as late miscarriage and preterm birth. Studies of antibiotics in pregnancy have not consistently shown reduced adverse outcomes so better strategies need to be studied to improve pregnancy outcome.
Background Abdominal adiposity in HIV-1 patients initiating antiretroviral therapy may be part of... more Background Abdominal adiposity in HIV-1 patients initiating antiretroviral therapy may be part of a restoration-to-health phenomenon. Lipoatrophy is associated with long-term thymidine analogue therapy. Individual protease inhibitors (PIs) differ in their effects on lipids and insulin resistance. Methods A randomized open-label multicentre 96-week trial compared changes in fat distribution in patients with suppressed HIV-1 RNA and abdominal adiposity, who either continued on their current twice-daily ritonavir-boosted PI (PI/r) or switched to once-daily boosted atazanavir (ATV/r). Treatment with two nucleoside reverse transcriptase inhibitors was unchanged. Body composition was assessed by dual-energy x-ray absorptiometry (DEXA) and abdominal computerized tomography (CT) scanning. Results In total, 201 patients were randomized; 131 switched to ATV/r. Viral suppression (<50 copies/ml) was similarly maintained (93% ATV/r versus 89% PI/r). Mean changes from baseline in trunk-to-limb...
ObjectivesOropharyngeal squamous cell carcinoma is the most common human papillomavirus (HPV)-ass... more ObjectivesOropharyngeal squamous cell carcinoma is the most common human papillomavirus (HPV)-associated cancer in the UK, but little is known about the prevalence of oropharyngeal HPV in sexually active teenagers. We investigated reported HPV vaccination coverage (in females) and prevalence of oropharyngeal HPV in sexually active students attending six technical colleges in London, UK.MethodsIn 2017, we obtained mouthwash samples and questionnaires from male and female students taking part in the ‘Test n Treat’ chlamydia screening trial. Samples were subjected to HPV genotyping.ResultsOf 232 participants approached, 202 (87%) provided a mouthwash sample and questionnaire. Participants’ median age was 17 years and 47% were male. Most (73%) were from black and minority ethnic groups, 64% gave a history of oral sex, 52% reported having a new sexual partner in the past 6 months, 33% smoked cigarettes, 5.9% had concurrent genitourinary Chlamydia trachomatis infection and 1.5% Neisseria ...
Objective: Neisseria gonorrhoeae infection is a global, major public health problem. It is the se... more Objective: Neisseria gonorrhoeae infection is a global, major public health problem. It is the second leading bacterial sexually transmitted infection (STI) in sub-Saharan Africa and worldwide. As study findings on the topic are inconsistent, we conducted a systematic review and meta-analysis to determine the pooled prevalence of N. gonorrhoeae infection in sub-Saharan Africa among reproductive-aged women. Methods: Published studies were systematically retrieved from PubMed, Embase, CINHAL and Science Direct. Their quality was measured using the Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data, and the score of each included study had to meet at least 4.5 out of 9 indicators of quality. Results: The meta-analysis of 35 studies showed that the pooled prevalence of N. gonorrhoeae infection among reproductive-aged women in sub-Saharan Africa was 3.28% (95% confidence interval 2.61%, 3.94%). Conclusion: The prevalence of N. gonorrhoeae infection was higher than that found in other studies carried out in the region. The results suggest that greater attention should be paid to the primary prevention of N. gonorrhoeae. We recommend the implementation of STI education for reproductive-aged women and the use of specific and rapid diagnostic testing for N. gonorrhoeae infection in STI clinics. N. gonorrhoeae screening and treatment should be integrated into in-and outpatient clinics to reduce infection among reproductive-aged women.
We sought to describe the natural history of abnormal vaginal flora in pregnancy and estimate the... more We sought to describe the natural history of abnormal vaginal flora in pregnancy and estimate the efficacy of oral clindamycin in eradicating it and preventing relapse. METHODS: This was a subanalysis of a randomized trial of oral clindamycin for abnormal vaginal flora in pregnancy. All 494 enrolled women were asked to provide a vaginal smear 2 weeks after treatment and every second participant to provide further smears at 20, 24, 28, 32, and 36 weeks of gestation. We used Nugent score of Gram-stained smears to assess the cure rate among the clindamycin group and the rate of spontaneous resolution among the placebo group.
There are few data in the literature regarding the ability of surgical trainees and surgeons to c... more There are few data in the literature regarding the ability of surgical trainees and surgeons to correctly interpret intraoperative cholangiograms (IOCs) during laparoscopic cholecystectomy (LC). The aim of this study was to determine the accuracy of surgeons' interpretations of IOCs. Methods: Fifteen IOCs, depicting normal, variants of normal and abnormal anatomy, were sent electronically in random sequence to 20 surgical trainees and 20 consultant general surgeons. Information was also sought on the routine or selective use of IOC by respondents. Results: The accuracy of IOC interpretation was poor. Only nine surgeons and nine trainees correctly interpreted the cholangiograms showing normal anatomy. Six consultant surgeons and five trainees correctly identified variants of normal anatomy on cholangiograms. Abnormal anatomy on cholangiograms was identified correctly by 18 consultant surgeons and 19 trainees. Routine IOC was practised by seven consultants and six trainees. There was no significant difference between those who performed routine and selective IOC with respect to correct identification of normal, variant and abnormal anatomy. Conclusions: The present study shows that the accuracy of detection of both normal and variants of normal anatomy was poor in all grades of surgeon irrespective of a policy of routine or selective IOC. Improving operators' understanding of biliary anatomy may help to increase the diagnostic accuracy of IOC interpretation.
A polymerase chain reaction (PCR) was developed for Chlamydia trachomatis in which a 380 base pai... more A polymerase chain reaction (PCR) was developed for Chlamydia trachomatis in which a 380 base pair DNA fragment was amplified. Amplification occurred with the DNA from the 15 serovars but not with that from other Chlamydia spp or with DNA from a variety of other organisms. Chlamydial DNA (10"g) could be detected and the PCR seemed to be able to detect single organisms. Urethral swabs were obtained from 37 men with acute non-gonococcal urethritis (NGU), 18 (49%) of whom were positive for C trachomatis by MicroTrak. As a result of clinical re-examinations 65 urethral swabs were available for analysis by the PCR. In comparison with MicroTrak, PCR had a sensitivity of 95%, a specificity of 94%, a positive predictive value of 86% and a negative predictive value of 98%. The PCR was apparently less sensitive (82%) in tests on urine samples. Overall, however, values of sensitivity and specificity of the PCR compared favourably with those of MicroTrak. The PCR for C trachomatis is likely to be a valuable technique for research, but problems of DNA contamination suggest that it should not be recommended for routine diagnosis.
The prevalence and complications of bacterial vaginosis are population dependent. In pregnancy, b... more The prevalence and complications of bacterial vaginosis are population dependent. In pregnancy, bacterial vaginosis is associated with late miscarriages and infection driven pre-term delivery. Regardless of the aetiology of pre-term delivery, surviving infants are at increased risk of subsequent neurodevelopmental handicap. Intervention studies in bacterial vaginosis positive pregnant women at high risk of pre-term delivery demonstrate the benefits of antibiotic treatment. Current evidence suggests that bacterial vaginosis may increase the efficiency of heterosexual HIV transmission. Metronidazole remains the mainstay of treatment of bacterial vaginosis. No treatment prevents relapse, which occurs in 20-30% of cases within 1 month. New approaches that are based on a better understanding of the pathophysiology of bacterial vaginosis are required to improve the clinical management of recurrent bacterial vaginosis.
BJOG: An International Journal of Obstetrics and Gynaecology, 2006
To determine whether metronidazole reduces early preterm labour in asymptomatic women with positi... more To determine whether metronidazole reduces early preterm labour in asymptomatic women with positive vaginal fetal fibronectin (fFN) in the second trimester of pregnancy. Randomised placebo-controlled trial. Fourteen UK hospitals (three teaching). Pregnancies with at least one previous risk factor, including mid-trimester loss or preterm delivery, uterine abnormality, cervical surgery or cerclage. Nine hundred pregnancies were screened for fFN at 24 and 27 weeks of gestation. Positive cases were randomised to a week&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s course of oral metronidazole or placebo. Primary outcome was delivery before 30 weeks of gestation. Secondary outcomes included delivery before 37 weeks. The Trial Steering Committee (TSC) recommended the study be stopped early; 21% of women receiving metronidazole (11/53) delivered before 30 weeks compared with 11% (5/46) taking placebo [risk ratio 1.9, 95% confidence interval (CI) 0.72-5.09, P = 0.18]. There were significantly more preterm deliveries (before 37 weeks) in women treated with metronidazole 33/53 (62%) versus placebo 18/46 (39%), risk ratio 1.6, 95% CI 1.05-2.4. fFN was a good predictor of early preterm birth in these asymptomatic women; positive and negative predictive values (24 weeks of gestation) for delivery by 30 weeks were 26% and 99%, respectively (positive and negative likelihood ratios 15, 0.35). Metronidazole does not reduce early preterm birth in high risk pregnant women selected by history and a positive vaginal fFN test. Preterm delivery may be increased by metronidazole therapy.
BJOG: An International Journal of Obstetrics and Gynaecology, 1996
We do not believe that the technique for measurement of SmcO, which we have previously described ... more We do not believe that the technique for measurement of SmcO, which we have previously described is invalidated by these observations. We have previously shown that changes in fetal cerebral oxygenation as measured by NIRS correlate well with expected physiological changes in various clinical situationse. This degree of consistency makes it unlikely that the observed changes are due to movement artefact or compartment shifts. In summary, this paper raised some interesting questions on the use of NIRS in the case of a nonviable fetus, but we question its relevance to intrapartum studies of live fetuses.
F1000 - Post-publication peer review of the biomedical literature, 2017
OBJECTIVES-Prior studies suggest that the composition of the vaginal microbiome may positively or... more OBJECTIVES-Prior studies suggest that the composition of the vaginal microbiome may positively or negatively affect susceptibility to sexually transmitted infections (STI) and bacterial vaginosis (BV). Some female hormonal contraceptive methods also appear to positively or negatively influence STI transmission and BV. Therefore changes in the vaginal microbiome that are associated with different contraceptive methods may explain, in part, effects on STI transmission and BV. STUDY DESIGN-We performed a retrospective study of 16S rRNA gene survey data of vaginal samples from a subset of participants from the Human Vaginal Microbiome Project at Virginia Commonwealth University. The subset included 682 women who reported using a single form of birth control that was condoms, combined oral contraceptives (COCs), depot medroxyprogesterone acetate (DMPA), or the levonorgestrel-releasing intrauterine system (LNG-IUS).
Uploads
Papers by Phillip Hay