The outcome of contact tracing for gonorrhoea in the United Kingdom.

Tracing and treating contacts (partner notification, PN) is a crucial part of the control of sexually transmitted infections but few studies have quantified its outcome. A retrospective national study obtained information from 155 clinics on 1308 patients with gonorrhoea, 59% of all UK patients attending in January to March 1995. These gave 1887 contacts (1:1.5) of whom 621 attended, 75% being found to be infected. The ratio of contacts attending to index patients was 0.5 (621/1260). The ratio was not influenced by gender or ethnicity, but was affected by orientation, being 0.5 for contacts of male heterosexuals, 0.3 for contacts of male homosexuals (P <0.001). PN outcome was less good in metropolitan (0.3) than provincial clinics (0.5), suggesting that further research is necessary on the reasons for this difference. Reliable ongoing outcome audit will require good communication between clinics to verify that contacts have attended. The contact:index ratio is suitable for evaluation of PN as it relates to actual outcome rather than to the patient's account of contact numbers. Local work can be assessed against these national figures.

Success and failure in gonorrhea control.

This article has shown that all the necessary components for successful control of gonorrhea are available. In developed countries, general improvements in economic conditions and advances in treatment and diagnosis have resulted in the lowest incidence rates of gonorrhea ever. Within these countries, however, control is failing, and gonorrhea is becoming hyperendemic among specific populations who tend to be disadvantaged and marginalized and who may have limited access to health care. Managing gonorrhea in individual patients and ensuring that their sexual partners receive appropriate treatment will contribute to reducing the transmission of infection in the community. Innovative school- and community-based interventions targeted to vulnerable populations will further help to reduce the incidence and contribute to improvements in the sexual health of the population.

Video display terminal very low frequency measurements: the need for protocols in assessing VDT user "dose".

It has been well established that video display terminals (VDTs) which employ the use of a cathode ray tube produce electric and magnetic fields of varying frequencies. Numerous studies have attempted to relate magnetic field exposure from VDTs in the extremely low frequency (ELF) and very low frequency (VLF) bands to adverse pregnancy outcome. Initial studies utilized VDT use time as a surrogate assessment of exposure, while later studies have obtained actual measurements. These measurements have been typically obtained at fixed distances from the screen. While VDT measurement criteria have been established for measuring VDT fields, criteria for the assessment of VDT user exposure has not. VLF magnetic and electric field measurements from approximately 140 and 40 different VDTs, respectively, were obtained over a 3-y period at the following positions: 0.50 m from the vertical centerline of the screen and at the approximate location of VDT user reproductive organs--0.30 m above the seat of the VDT operator in the working position. The measurement results of the two aforementioned locations were compared and demonstrate very little correlation. This lack of correlation indicates that VDT operator exposure assessment criteria are needed to determine any dose-response relationship between VDT electric and/or magnetic fields and adverse health implications.

Effect of epidemiological treatment of contacts in preventing recurrences of non-gonococcal urethritis.

Clinical investigations of the usefulness of routine epidemiological treatment of sexual contacts of men with non-gonococcal urethritis (NGU) have produced conflicting results that could have been due to the selection of patients. In this study, which was undertaken in a provincial city, 100 men with untreated sexual partners and 100 demographically similar men with treated sexual partners were reviewed for recurrences of NGU over 12 months. Prolonged courses of tetracyclines were found to be beneficial particularly when the sexual partner gave positive results to tests for chlamydiae. There was, however, no clinical evidence that the men benefited from routine epidemiological treatment of their sexual partners.

Asherman's syndrome. A comparison of therapeutic methods.

The authors compared two methods of managing Asherman's syndrome. One group (nine patients) was treated with dilatation and curettage (D & C), followed by conjugated estrogens and progestin therapy. A second group (26 patients) was treated with hysteroscopic evaluation of therapy, followed by placement of an intrauterine contraceptive device (IUD) and antibiotics in addition to a D & C and hormonal therapy. Although the series was small, the pregnancy rate was higher in the second group. This is felt to be related to the hysteroscopic localization of synechiae as well as the postoperative insertion of an IUD.