Journals watch: HPV vaccination, maternal depression, fertility treatment and antidepressant use

Dr Gwen Lewis selects the latest papers of interest to GPs including HPV vaccination in patients attending sexual health services, maternal depression, fertility treatment, emergency contraception and antidepressant use

HPV vaccine requires 80% uptake to improve cervical cancer rates (Photo: SPL)
HPV vaccine requires 80% uptake to improve cervical cancer rates (Photo: SPL)

HPV vaccination in patients attending sexual health services

Sex Transm Infect 2014; 90: 315-21

The HPV vaccination programme requires an uptake of 80% to have significant impact on cervical cancer rates, but in the first three years, it was only 66%. This study looked at ways of increasing uptake.

Women aged 13-19 years attending 32 sexual health clinics in the UK were surveyed in 2011 about HPV vaccination. In total, 2,247 women completed the questionnaire.

It was found that compared with national data, these women had higher smoking rates (48% compared with 14%), higher rate of coitarche under the age of 16 (52% compared with 38%), previous STI (25% compared with 4%) and an increased proportion not in education, employment or training.

Of this group, 74% had been offered HPV vaccination, with lower rates in London, non-white ethnicities, those aged 17-19, smokers and those with a history of STI. Completion rate of HPV vaccination was 47%. It was suggested there was an opportunity to offer HPV vaccination to eligible women in these clinics.

Maternal depression

- BJOG 2014; doi: 10.1111/1471-0528.12837

In this prospective study of 1,507 women from Melbourne, Australia, it was found that depression is more common at four years postpartum than at any other time in the first 12 months after delivery.

The women completed the questionnaires at three, six, 12 and 18 months postnatally and finally at four years. Scores of 13 or more indicated depression.

Almost one in three women reported depression at least once in the four-year period following delivery. The authors suggested that screening for depression should be continued for a prolonged time after delivery.

Fertility treatment outcomes

- Fam Practice 2014; 31(3): 290-7

In this study from Sweden, researchers assessed the results of fertility treatment in infertile couples undergoing work-up and treatment.

The couples were followed up for 30 months between December 2005 and May 2008 and all underwent fertility work-up, including examination and hysterosalpingogram, hormone profiling, screening for infections and semen analysis. The mean age of the female partner at the time of inclusion was 33.2 years.

By November 2010, 57.3% of the women had given birth. Of these, 11.3% conceived spontaneously, while 14.5% became pregnant after intra-uterine insemination (IUI), 4.2% after ovarian hyperstimulation and ovarian induction, and 28.4% after IVF.

Anti-Mullerian hormone (AMH) correlated significantly with follicle count and age, and was significantly raised in those women who became pregnant after IUI.

Predictive factors for pregnancy were AMH in the group undergoing IUI and duration of infertility in the group aged 38 years or more.

These figures should be useful in consultations with patients who are undergoing fertility treatment.

Emergency contraception

- J Fam Plann Reprod Health Care doi: 10.1136/jfprhc-2013-100733

This study in Liverpool from April 2012 to March 2013, involving 6,110 episodes of emergency contraception, sought to assess which of the three available methods was used and follow-up contraceptive choice.

In the study, levonorgestrel was used in 69.2%, ulipristal acetate in 26% and a copper IUD in 4.2%.

Over the 12-month period of the study, there was a quarter by quarter small decline in use of levonorgestrel and a significant increase in use of ulipristal. It was found that only 54.2% were offered all three methods of emergency contraception.

Those choosing levonorgestrel were more likely to start hormonal contraception after emergency contraception and to continue oral contraception, while those choosing ulipristal were more likely to use condoms after the event.

Longer-term antidepressant use

- Fam Practice 2014 doi: 10.1093/fampra/cmu 019

There is little evidence to guide GPs in the follow-up of patients on longer-term antidepressants.

In this study, a cohort of patients receiving antidepressants continuously for at least two years was identified from four general practices' medical records.

The frequency of review for these patients decreased with increasing years of use of antidepressants.

Those patients who had an overt mental health reason for use of antidepressants were reviewed more frequently, as were those who had been referred to community mental health teams.

The authors suggest that a chronic disease management approach to depression in primary care would be advantageous.

  • Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals
CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Review your practice uptake of HPV vaccination and compare it with the study's uptake.
  • Perform a database search and review those women who presented for the six-month postnatal check.
  • Develop a practice strategy on how to improve access to emergency contraception.

Save this article and add notes with your free online CPD organiser at gponline.com/cpd

Take clinical tests and claim certificates for CPD at myCME.com/gp

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