Medicine 2019: Infectious diseases and sexual health

Professor Margaret Johnson, consultant in HIV/AIDS medicine and professor of medicine at Royal Free London, chaired a session on infectious diseases and sexual health.

First to speak was Professor Simon Barton, consultant physician and divisional medical director at Chelsea and Westminster Hospital NHS Foundation Trust, who looked at sexually transmitted infections: ‘past, present and future’. His presentation started 103 years ago with the passing of a law for venereal disease healthcare and the HIV epidemic in the 1980s.

For the present he outlined the increase of gonorrhoea and syphilis, and the major problem of gonococcal treatment resistance. He said: ‘We may be looking at a future of patient admissions for intravenous treatment which would shatter the confidentiality of sexual healthcare’. Looking at the future, Professor Barton discussed automated services for sexually transmitted infection (STI) testing, but emphasised that they will not be the whole answer as the future of sexual healthcare will depend on medicine itself and the collaboration between different specialties in which STIs can present, such as dermatology and neurology.

We may be looking at a future of patient admissions for intravenous treatment which would shatter the confidentiality of sexual healthcare

Professor Simon Barton, consultant physician and divisional medical director at Chelsea and Westminster Hospital NHS Foundation Trust

AIDS was next in the spotlight with Dr Olwen Williams, consultant in sexual health and president of the British Association for Sexual Health and HIV, asking can we end the AIDS epidemic by 2030? After providing an overview of the HIV epidemic in the UK to date, she discussed the challenges and tools available to eradicate HIV in the UK by 2030, in line with the fast-track strategy from UNAIDS.

Dr Williams focused on an elimination strategy which includes HIV testing programmes, anti-retroviral treatment as a prevention tool, pre-exposure prophylaxis (PrEP), and tackling stigma and discrimination. She concluded: 'Will we achieve our goal to eradicate HIV by 2030? We need buy-in from healthcare professionals, treatment as prevention, political will and eradication of stigma. It starts with you.’

Professor Onn Min Kon, respiratory physician at Imperial College London, was last to present in this session and focused on tuberculosis: new risks and new treatments. He discussed how tuberculosis (TB) continues to be a clinical and public health issue both nationally and globally, and that the social and medical complexity of TB cases is increasing. Focusing on how multi-drug resistance TB is an emerging threat, he highlighted how molecular diagnostic tools and whole genome sequencing are an advance in our approach to TB diagnosis and control. At the end of his talk he said ‘the good news is that we are getting to a point where more people are focusing on TB – watch this space’. He also advised those treating patients with TB to not do it alone as a multidisciplinary approach to treatment is key.

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