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We start 2016 with an editorial that looks towards the future shape of sexually transmitted infection (STI) services and research. Chen et al1 introduce the recent RECORD guidelines, and extension of the STROBE guidelines (http://www.strobe-statement.org/) which covers Reporting of studies Conducted using Observational Routinely collected Data. We have published a growing number of studies using electronic health record data, many from Australia where use of fully electronic records is widespread. Although the challenges of collecting and interpreting such data are considerable, as discussed in an interesting study by Brook et al and a BASHH column, the use of electronic health records is opening a new era in health research. At STI journal we strongly encourage the use of guidelines, such as those promoted by the Equator Network (http://www.equator-network.org). Large scale routine health dataset enables us to increase the scale, detail and coverage, while introducing new opportunities for error and ambiguity. Research has traditionally built on customized data collection tools, but now even Randomised Controlled Trials are now being conducted using routine records for outcome assessment. Our next generation of researchers will need to develop the skills to work with, link and enhance routine datasets, and to address openly and transparently the very real challenges and opportunities of the electronic data age.
Routine electronic health records also provide new opportunities to improve risk assessment and the targeting of services, and we need to look at ways to do this simply and efficiently, at scale. Lee et al report a simple risk assessment tool with good performance in identifying higher risk clients in the UK,2 while in the USA Gaydos et al report the use of a “risk quiz” to explore the relationship between behaviour and online test positivity.3 Falasinnu et al similarly attempt a clinical prediction rule, reporting a sensitivity of 86% in a Canadian setting.4 With growing pressure on clinical services, and increasing demands to simplify, streamline and reduce their cost, commissioners and insurers will expect us to understand and use opportunities to target complex services to those at greatest risk. We should however be cautious in our embrace of new technologies as solutions for patient care, as Nunˇez-Forero et al remind us in a report on still weak performance of point of care tests, especially for Chlamydia trachomatis.5
Two studies address the still mysterious role of Mycoplasma genitalium, with a follow up from the POPI study6 reporting that it disappeared as a risk for pelvic inflammatory disease after adjustment for baseline Chlamydia trachomatis. Van de Veer et al estimate in the Netherlands that up to 6% of symptomatic STI in males could be due to M. Genitalium, where Trichomonas vaginalis remains uncommon among males. The epidemiology of Trichomonas vaginalis in Europe and most other developed countries is still in striking contrast to extremely high prevalence reported in the USA, this month by Alcaide et al.7
Our clinical readers will be interested in a report on the role of Haemophilus influenzae and parainfluenzae in male urethritis. How often is this missed through lack of testing, as we switch to nucleic acid testing? Widespread contamination of clinical services by HPV is also a concern.8
HIV testing, and its disclosure to partners in South Africa is interestingly explored by Doherty et al,9 while Ding et al report incident HSV in HIV discordant couple.10 HIV incidence in a community cohort of MSM in Spain is reported by Ferrer et al.11
Other themes this month include medicated sex in the UK National Study of Sexual Attitudes and Lifestyles,12 the interaction between drug use and location of risk in MSM,13 HPV in transsexuals and the need to interpret chlamydia surveillance trends in the light of laboratory related effects. Something for all of our readers, we hope. Happy New Year.
Competing interests None.
Provenance and peer review Commissioned; Not peer reviewed.