Mark Pakianathan - Academia.edu (original) (raw)

Papers by Mark Pakianathan

Sexual health, 2018

This Special Issue of Sexual Health examines research and healthcare practice relating to sexuali... more This Special Issue of Sexual Health examines research and healthcare practice relating to sexualised drug use among gay, bisexual and other men who have sex with men (GBMSM), colloquially known as 'chemsex' or 'party and play' (PnP). It draws together evidence relating to the epidemiology, sociology and psychology of chemsex, as well as the policy, community and clinical interventions that are required to ensure men have access to high-quality health care that meets their needs and reduces harm. Findings and discussions within the Issue emphasise the need to sensitively, non-judgementally and meaningfully engage with gay men about their engagement in chemsex in order to help improve their sexual health and wider wellbeing.

Sexually Transmitted Infections, 2016

Sexually Transmitted Infections, 1994

Objectives-To examine the incidence of urethral stricture in men in Scotland during the years 198... more Objectives-To examine the incidence of urethral stricture in men in Scotland during the years 1982-1991 in relation to the changing incidence of gonococcal and non-gonococcal urethritis (NGU) over the past 20 years. Design-Retrospective study of incidence of urethral stricture in Scotland. Method-The number of new men in 1970 72 74 76 78 80 82 84 86 88 90 increase in incidence over the study period within each age group. Conclusion-As the interaction between age and time was not significant, it is concluded that urethritis associated with sexually transmitted organisms is an uncommon cause of urethral stricture in Scotland.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2010

International Journal of STD & AIDS, 2003

There are few data on the use of highly active antiretroviral therapy in HIV-positive patients wi... more There are few data on the use of highly active antiretroviral therapy in HIV-positive patients with end-stage renal disease. We describe the tolerability, safety and efficacy of an efavirenz-containing regimen in one such patient on continuous ambulatory peritoneal dialysis.

International Journal of STD & AIDS, 2006

International Journal of STD & AIDS, 1996

It has long been recognized that sexually transmitted diseases (STDs) may occur concurrently henc... more It has long been recognized that sexually transmitted diseases (STDs) may occur concurrently hence necessitating screening in individuals attending GenitoUrinary Medicine (GUM) clinics. However there are few data on individuals with more than one concurrent STD. Individuals attending the GUM Department in the Royal Infirmary of Edinburgh between 1990 and 1994 with the diagnosis of HIV infection, genital warts, genital herpes, non-specific genital infection (NSGI), gonorrhoea and syphilis were included in the study. A multivariate comparison was made between those presenting with multiple concurrent STDs and a control group comprising individuals with a solitary STD with respect to year of attendance, social class, location of acquisition of infection, sex, sexual orientation and age using a logistic regression model. A total of 680 of 9265 patients in the study period had more than one concurrent STD. Individuals in lower socio-economic class were at higher risk and older individual...

International Journal of STD & AIDS, 1999

Our objective was to determine the prevalence of intestinal protozoa in homosexual men attending ... more Our objective was to determine the prevalence of intestinal protozoa in homosexual men attending a sexually transmitted diseases (STD) clinic, to compare it with the prevalence in a previous study from the same clinic, and to examine the relationship, if any, between the presence of protozoa and sexual practices. Men who consecutively attended the clinic and who gave a history of having had recent sexual contact with another male were invited to provide a stool sample for protozoological examination. Diarrhoeal samples were examined by direct microscopy for trophozoites and cysts and, after staining, for Cryptosporidium spp. In all cases, a modified formol-ether method was used to concentrate protozoal cysts before microscopy. One hundred and seventy-five of the 257 men invited to participate in the study provided a stool sample. At least one species of protozoan was found in 99 (57%) men. Giardia intestinalis was identified in only 5 (3%) men. Blastocystis hominis was found in 46 (26%) men, but the presence of this protozoan was not associated with diarrhoea. Other than the prevalence of Entamoeba dispar/histolytica and G. intestinalis, which remained unchanged, the proportion of men who harboured the non-pathogenic protozoa was significantly increased from 1981/82. A correlation between oral-anal sex or peno-insertive or peno-receptive anal intercourse and the prevalence of protozoa was not found. There was also no correlation between the number of species of protozoa carried and these sexual practices. The presence of protozoa was not associated with a history of foreign travel or sexual contact with a man who had recently travelled outside the UK. The study showed that, although the prevalence of infection is low, giardiasis is still transmissible amongst homosexual men. A correlation between individual sexual practices and the prevalence of intestinal protozoa was not found.

International Journal of STD & AIDS, 2006

Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for ... more Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for 90% of all penile cancers. Its association with balanitis xerotica obliterans (BXO) is a rare though recognized occurrence. We describe a case of a 46-year-old Caucasian male who first presented to our open-access clinic with a mild phimosis. An elective circumcision was performed and histological examination of the circumcision specimen showed BXO. He was lost to follow-up but re-presented three years later with a persistent tender penile ulcer which on biopsy showed no obvious sinister pathology. He returned a further two years later with a short history of bleeding from the ulcer, and another biopsy now confirmed penile squamous cell carcinoma. Our case emphasizes the importance of regular review of patients with BXO, in particular those with persistent symptoms.

Current Opinion in Infectious Diseases, 2007

HIV postexposure prophylaxis is often recommended following potential sexual exposure to HIV. Rec... more HIV postexposure prophylaxis is often recommended following potential sexual exposure to HIV. Recent data address the effectiveness of postexposure prophylaxis and prevention counseling, cost-effectiveness, antiretroviral options, challenges with nonoccupational postexposure prophylaxis among adolescents and children and following sexual assault in high HIV prevalence areas, and a successful program in Amsterdam. Postexposure prophylaxis is not completely protective. Seroconversion may result from antiretroviral failure or from ongoing exposures. Postexposure prophylaxis associated risk reduction counseling results in reductions in subsequent risk behavior. Programs that target outreach and limit prescriptions to those with exposure sources who are at risk of being HIV infected are cost-effective. Less restrictive guidelines result in more prescriptions for low-risk exposures; this practice is not cost-effective. The ideal antiretrovirals for postexposure prophylaxis use have not been established. Tenofovir has several attractive properties. Developing systems to support the effective delivery of postexposure prophylaxis among children and adolescents and following sexual assault in high HIV prevalence, resource limited settings is challenging. Numerous national and international guidelines recommend postexposure prophylaxis following potential sexual exposure to HIV. Maximizing adherence and minimizing subsequent HIV exposures will be critical to enhancing the effectiveness of this HIV prevention intervention.

Annales d'Endocrinologie, 2005

Current Opinion in Infectious Diseases, 2002

Genital chlamydial infection, with its possible long-term morbidity, is a serious public health p... more Genital chlamydial infection, with its possible long-term morbidity, is a serious public health problem. The number of new diagnoses is rising rapidly and, in the UK, recent evidence suggests that the infection rate in young women exceeds 10%. Screening programmes can reduce the population prevalence of infection, but uncertainty remains as to the ideal screening model. This may prove to be opportunistic screening of sexually active young women, less than 25 years of age, in primary care settings, and contact tracing of the partners of those with chlamydia. Recent literature on the practicalities of genital chlamydia screening is reviewed. Curr Opin Infect Dis 15:31±36. # 2002

... fertilisation (IVF) treatment: Poor responders intervention trial (PRINT). Author: Sunkara Se... more ... fertilisation (IVF) treatment: Poor responders intervention trial (PRINT). Author: Sunkara Sesh ; Coomarasamy Arri ; Khalaf Yakoub ; Braude Peter. Abstract: Abstract. Background. Poor response to ovarian stimulation with exogenous ...

Medicine, Science and the Law

Chemsex refers to the use of specific drugs before or during sex to sustain, enhance, disinhibit,... more Chemsex refers to the use of specific drugs before or during sex to sustain, enhance, disinhibit, or facilitate the sexual experience, primarily amongst a minority of gay, bisexual and other men who have sex with men (MSM). This is a subset of the broader concept of sexualized drug use, which includes any drug use in a sexual context without an inference of the intent behind their use or specific cultural context. Chemsex has a complex association with healthcare, criminal justice and social care systems and has been identified as an area of clinical and societal need by the UK Home Office. Limited services have emerged in relation to Chemsex within the NHS and the voluntary sector but they have not been focussed on, nor are sufficiently equipped to address, the needs of those who offend in the Chemsex context. In this editorial, we initially summarise what is currently known regarding Chemsex, health and crime. We then highlight the current paucity of high quality data on the association between Chemsex, mental illness and offending. We conclude by calling for improved cultural competency of professionals and clinicians in the offender pathway and a multi-agency, cross-boundary approach to improving our understanding of crime in a Chemsex context to support the development of evidence-based solutions. Drugs commonly consumed as part of Chemsex include: crystal methamphetamine (“crystal”, “Tina”, “T”); gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL – “G”) and mephedrone. Chemsex is typically facilitated by geosocial networking apps. It may involve multiple sexual partners and prolonged periods of sexual activity, sometimes over several days, and one reason behind its appeal is a feeling of euphoria, confidence, stamina and heightened sexual arousal. Yet there are complex biological, psychological, and social factors that influence why someone may choose to engage in Chemsex. Qualitative interviews have implicated stigma, marginalization and minority stress as risk factors that can, in turn, influence internalised homophobia, loneliness, and perceptions of intimacy. Prevalence data suggest that it is a minority practice and varies considerably between studies, likely because of inconsistent definitions of Chemsex, under-reporting due to stigma, as well as selection bias in how study participants are identified. The European Men Who Have Sex with Men Internet Survey (EMIS) in 2017 found that 5.2% of respondents reported having had Chemsex in the preceding month, while 10% had Chemsex in the preceding year with large variations between cities. Another study found that the prevalence ranged from 4% of MSM under secondary care for Human Immunodeficiency Virus (HIV) treatment to 41% of MSM attending sexual health clinics for postexposure prophylaxis. There is a substantial body of evidence showing an association between being LGBTQ+ and poorer mental health. Rees et al. found that LGBTQ+ people often have experiences of mental health services that reinforced stigma and had a lack of understanding of what their specific needs were. These findings of increased health inequalities are also reflected in Stonewall’s LGBT in Britain Health Report, the Unhealthy Attitudes research project, and the Lesbian, Gay, Bisexual and Trans Public Health

Medicine

Abstract There is a growing body of evidence that the syndemic health inequalities in the areas o... more Abstract There is a growing body of evidence that the syndemic health inequalities in the areas of mental health and substance and alcohol use in lesbian, gay, bisexual and transsexual (LGBT) people can drive greater inequalities in sexual health. This is a diverse population where additional individual behavioural factors and wider structural socioeconomic and legal factors also play a part. Lesbian women have increased susceptibility to bacterial vaginosis, while trans women and gay and bisexual men have greater vulnerability to sexually transmitted infections and human immunodeficiency virus compared with cis-gendered heterosexuals. Consideration must be given to non-genital clinical examination and sampling according to sexual history. Cultural competence and holistic clinical assessments, which include assessments of mental health, substance and alcohol use, can enable opportunities for interventions to prevent transmission of infection and improved well-being.

Sexually transmitted infections, 2016

The 2014 Public Health England draft strategic framework highlights the disproportionately poorer... more The 2014 Public Health England draft strategic framework highlights the disproportionately poorer health and well-being of gay, bisexual and other men who have sex with men (GBMSM) in the areas of sexual health, mental health and substance use.1 Unlike other clinical settings, GUM clinics are unique in routinely establishing sexual orientation information from patients and are therefore also well placed for the early identification of mental health …

Sexually Transmitted Infections

standard deviation 11.48). Patients from both groups were involved in all behaviours, however MSM... more standard deviation 11.48). Patients from both groups were involved in all behaviours, however MSM clinic patients were more likely to engage in risky sexual activity in London (p = 0.021) and source casual partners online (p = 0.029) compared to the GU clinic population. Discussion/conclusion The MSM clinic attracted a population with riskier sexual behaviours. Patients cited non-judgemental acceptance and understanding of MSM sexual practices as pivotal for attending. Perceived reduction in stigma, rapid HIV testing and tailored advice has encouraged service engagement; this provides a valuable opportunity to screen and vaccinate patients at high risk of sexually transmitted infections.

Sexually Transmitted Infections, 2015

Discussion/conclusion As the trend of chemsex and sex parties continues, it is likely there will ... more Discussion/conclusion As the trend of chemsex and sex parties continues, it is likely there will be an increase in STIs linked to households. Better geospatial analysis of STI trends and collaborative working with public health is essential for rapid identification and control of outbreaks.

Sexual health, 2018

This Special Issue of Sexual Health examines research and healthcare practice relating to sexuali... more This Special Issue of Sexual Health examines research and healthcare practice relating to sexualised drug use among gay, bisexual and other men who have sex with men (GBMSM), colloquially known as 'chemsex' or 'party and play' (PnP). It draws together evidence relating to the epidemiology, sociology and psychology of chemsex, as well as the policy, community and clinical interventions that are required to ensure men have access to high-quality health care that meets their needs and reduces harm. Findings and discussions within the Issue emphasise the need to sensitively, non-judgementally and meaningfully engage with gay men about their engagement in chemsex in order to help improve their sexual health and wider wellbeing.

Sexually Transmitted Infections, 2016

Sexually Transmitted Infections, 1994

Objectives-To examine the incidence of urethral stricture in men in Scotland during the years 198... more Objectives-To examine the incidence of urethral stricture in men in Scotland during the years 1982-1991 in relation to the changing incidence of gonococcal and non-gonococcal urethritis (NGU) over the past 20 years. Design-Retrospective study of incidence of urethral stricture in Scotland. Method-The number of new men in 1970 72 74 76 78 80 82 84 86 88 90 increase in incidence over the study period within each age group. Conclusion-As the interaction between age and time was not significant, it is concluded that urethritis associated with sexually transmitted organisms is an uncommon cause of urethral stricture in Scotland.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2010

International Journal of STD & AIDS, 2003

There are few data on the use of highly active antiretroviral therapy in HIV-positive patients wi... more There are few data on the use of highly active antiretroviral therapy in HIV-positive patients with end-stage renal disease. We describe the tolerability, safety and efficacy of an efavirenz-containing regimen in one such patient on continuous ambulatory peritoneal dialysis.

International Journal of STD & AIDS, 2006

International Journal of STD & AIDS, 1996

It has long been recognized that sexually transmitted diseases (STDs) may occur concurrently henc... more It has long been recognized that sexually transmitted diseases (STDs) may occur concurrently hence necessitating screening in individuals attending GenitoUrinary Medicine (GUM) clinics. However there are few data on individuals with more than one concurrent STD. Individuals attending the GUM Department in the Royal Infirmary of Edinburgh between 1990 and 1994 with the diagnosis of HIV infection, genital warts, genital herpes, non-specific genital infection (NSGI), gonorrhoea and syphilis were included in the study. A multivariate comparison was made between those presenting with multiple concurrent STDs and a control group comprising individuals with a solitary STD with respect to year of attendance, social class, location of acquisition of infection, sex, sexual orientation and age using a logistic regression model. A total of 680 of 9265 patients in the study period had more than one concurrent STD. Individuals in lower socio-economic class were at higher risk and older individual...

International Journal of STD & AIDS, 1999

Our objective was to determine the prevalence of intestinal protozoa in homosexual men attending ... more Our objective was to determine the prevalence of intestinal protozoa in homosexual men attending a sexually transmitted diseases (STD) clinic, to compare it with the prevalence in a previous study from the same clinic, and to examine the relationship, if any, between the presence of protozoa and sexual practices. Men who consecutively attended the clinic and who gave a history of having had recent sexual contact with another male were invited to provide a stool sample for protozoological examination. Diarrhoeal samples were examined by direct microscopy for trophozoites and cysts and, after staining, for Cryptosporidium spp. In all cases, a modified formol-ether method was used to concentrate protozoal cysts before microscopy. One hundred and seventy-five of the 257 men invited to participate in the study provided a stool sample. At least one species of protozoan was found in 99 (57%) men. Giardia intestinalis was identified in only 5 (3%) men. Blastocystis hominis was found in 46 (26%) men, but the presence of this protozoan was not associated with diarrhoea. Other than the prevalence of Entamoeba dispar/histolytica and G. intestinalis, which remained unchanged, the proportion of men who harboured the non-pathogenic protozoa was significantly increased from 1981/82. A correlation between oral-anal sex or peno-insertive or peno-receptive anal intercourse and the prevalence of protozoa was not found. There was also no correlation between the number of species of protozoa carried and these sexual practices. The presence of protozoa was not associated with a history of foreign travel or sexual contact with a man who had recently travelled outside the UK. The study showed that, although the prevalence of infection is low, giardiasis is still transmissible amongst homosexual men. A correlation between individual sexual practices and the prevalence of intestinal protozoa was not found.

International Journal of STD & AIDS, 2006

Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for ... more Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for 90% of all penile cancers. Its association with balanitis xerotica obliterans (BXO) is a rare though recognized occurrence. We describe a case of a 46-year-old Caucasian male who first presented to our open-access clinic with a mild phimosis. An elective circumcision was performed and histological examination of the circumcision specimen showed BXO. He was lost to follow-up but re-presented three years later with a persistent tender penile ulcer which on biopsy showed no obvious sinister pathology. He returned a further two years later with a short history of bleeding from the ulcer, and another biopsy now confirmed penile squamous cell carcinoma. Our case emphasizes the importance of regular review of patients with BXO, in particular those with persistent symptoms.

Current Opinion in Infectious Diseases, 2007

HIV postexposure prophylaxis is often recommended following potential sexual exposure to HIV. Rec... more HIV postexposure prophylaxis is often recommended following potential sexual exposure to HIV. Recent data address the effectiveness of postexposure prophylaxis and prevention counseling, cost-effectiveness, antiretroviral options, challenges with nonoccupational postexposure prophylaxis among adolescents and children and following sexual assault in high HIV prevalence areas, and a successful program in Amsterdam. Postexposure prophylaxis is not completely protective. Seroconversion may result from antiretroviral failure or from ongoing exposures. Postexposure prophylaxis associated risk reduction counseling results in reductions in subsequent risk behavior. Programs that target outreach and limit prescriptions to those with exposure sources who are at risk of being HIV infected are cost-effective. Less restrictive guidelines result in more prescriptions for low-risk exposures; this practice is not cost-effective. The ideal antiretrovirals for postexposure prophylaxis use have not been established. Tenofovir has several attractive properties. Developing systems to support the effective delivery of postexposure prophylaxis among children and adolescents and following sexual assault in high HIV prevalence, resource limited settings is challenging. Numerous national and international guidelines recommend postexposure prophylaxis following potential sexual exposure to HIV. Maximizing adherence and minimizing subsequent HIV exposures will be critical to enhancing the effectiveness of this HIV prevention intervention.

Annales d'Endocrinologie, 2005

Current Opinion in Infectious Diseases, 2002

Genital chlamydial infection, with its possible long-term morbidity, is a serious public health p... more Genital chlamydial infection, with its possible long-term morbidity, is a serious public health problem. The number of new diagnoses is rising rapidly and, in the UK, recent evidence suggests that the infection rate in young women exceeds 10%. Screening programmes can reduce the population prevalence of infection, but uncertainty remains as to the ideal screening model. This may prove to be opportunistic screening of sexually active young women, less than 25 years of age, in primary care settings, and contact tracing of the partners of those with chlamydia. Recent literature on the practicalities of genital chlamydia screening is reviewed. Curr Opin Infect Dis 15:31±36. # 2002

... fertilisation (IVF) treatment: Poor responders intervention trial (PRINT). Author: Sunkara Se... more ... fertilisation (IVF) treatment: Poor responders intervention trial (PRINT). Author: Sunkara Sesh ; Coomarasamy Arri ; Khalaf Yakoub ; Braude Peter. Abstract: Abstract. Background. Poor response to ovarian stimulation with exogenous ...

Medicine, Science and the Law

Chemsex refers to the use of specific drugs before or during sex to sustain, enhance, disinhibit,... more Chemsex refers to the use of specific drugs before or during sex to sustain, enhance, disinhibit, or facilitate the sexual experience, primarily amongst a minority of gay, bisexual and other men who have sex with men (MSM). This is a subset of the broader concept of sexualized drug use, which includes any drug use in a sexual context without an inference of the intent behind their use or specific cultural context. Chemsex has a complex association with healthcare, criminal justice and social care systems and has been identified as an area of clinical and societal need by the UK Home Office. Limited services have emerged in relation to Chemsex within the NHS and the voluntary sector but they have not been focussed on, nor are sufficiently equipped to address, the needs of those who offend in the Chemsex context. In this editorial, we initially summarise what is currently known regarding Chemsex, health and crime. We then highlight the current paucity of high quality data on the association between Chemsex, mental illness and offending. We conclude by calling for improved cultural competency of professionals and clinicians in the offender pathway and a multi-agency, cross-boundary approach to improving our understanding of crime in a Chemsex context to support the development of evidence-based solutions. Drugs commonly consumed as part of Chemsex include: crystal methamphetamine (“crystal”, “Tina”, “T”); gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL – “G”) and mephedrone. Chemsex is typically facilitated by geosocial networking apps. It may involve multiple sexual partners and prolonged periods of sexual activity, sometimes over several days, and one reason behind its appeal is a feeling of euphoria, confidence, stamina and heightened sexual arousal. Yet there are complex biological, psychological, and social factors that influence why someone may choose to engage in Chemsex. Qualitative interviews have implicated stigma, marginalization and minority stress as risk factors that can, in turn, influence internalised homophobia, loneliness, and perceptions of intimacy. Prevalence data suggest that it is a minority practice and varies considerably between studies, likely because of inconsistent definitions of Chemsex, under-reporting due to stigma, as well as selection bias in how study participants are identified. The European Men Who Have Sex with Men Internet Survey (EMIS) in 2017 found that 5.2% of respondents reported having had Chemsex in the preceding month, while 10% had Chemsex in the preceding year with large variations between cities. Another study found that the prevalence ranged from 4% of MSM under secondary care for Human Immunodeficiency Virus (HIV) treatment to 41% of MSM attending sexual health clinics for postexposure prophylaxis. There is a substantial body of evidence showing an association between being LGBTQ+ and poorer mental health. Rees et al. found that LGBTQ+ people often have experiences of mental health services that reinforced stigma and had a lack of understanding of what their specific needs were. These findings of increased health inequalities are also reflected in Stonewall’s LGBT in Britain Health Report, the Unhealthy Attitudes research project, and the Lesbian, Gay, Bisexual and Trans Public Health

Medicine

Abstract There is a growing body of evidence that the syndemic health inequalities in the areas o... more Abstract There is a growing body of evidence that the syndemic health inequalities in the areas of mental health and substance and alcohol use in lesbian, gay, bisexual and transsexual (LGBT) people can drive greater inequalities in sexual health. This is a diverse population where additional individual behavioural factors and wider structural socioeconomic and legal factors also play a part. Lesbian women have increased susceptibility to bacterial vaginosis, while trans women and gay and bisexual men have greater vulnerability to sexually transmitted infections and human immunodeficiency virus compared with cis-gendered heterosexuals. Consideration must be given to non-genital clinical examination and sampling according to sexual history. Cultural competence and holistic clinical assessments, which include assessments of mental health, substance and alcohol use, can enable opportunities for interventions to prevent transmission of infection and improved well-being.

Sexually transmitted infections, 2016

The 2014 Public Health England draft strategic framework highlights the disproportionately poorer... more The 2014 Public Health England draft strategic framework highlights the disproportionately poorer health and well-being of gay, bisexual and other men who have sex with men (GBMSM) in the areas of sexual health, mental health and substance use.1 Unlike other clinical settings, GUM clinics are unique in routinely establishing sexual orientation information from patients and are therefore also well placed for the early identification of mental health …

Sexually Transmitted Infections

standard deviation 11.48). Patients from both groups were involved in all behaviours, however MSM... more standard deviation 11.48). Patients from both groups were involved in all behaviours, however MSM clinic patients were more likely to engage in risky sexual activity in London (p = 0.021) and source casual partners online (p = 0.029) compared to the GU clinic population. Discussion/conclusion The MSM clinic attracted a population with riskier sexual behaviours. Patients cited non-judgemental acceptance and understanding of MSM sexual practices as pivotal for attending. Perceived reduction in stigma, rapid HIV testing and tailored advice has encouraged service engagement; this provides a valuable opportunity to screen and vaccinate patients at high risk of sexually transmitted infections.

Sexually Transmitted Infections, 2015

Discussion/conclusion As the trend of chemsex and sex parties continues, it is likely there will ... more Discussion/conclusion As the trend of chemsex and sex parties continues, it is likely there will be an increase in STIs linked to households. Better geospatial analysis of STI trends and collaborative working with public health is essential for rapid identification and control of outbreaks.