Subject(s)
Disease Management , Disease Outbreaks/prevention & control , Gonorrhea/prevention & control , Heterosexuality , Adolescent , Disease Outbreaks/statistics & numerical data , Female , Gonorrhea/epidemiology , Gonorrhea/microbiology , Gonorrhea/transmission , Humans , Male , Molecular Typing , Neisseria gonorrhoeae/classification , Neisseria gonorrhoeae/genetics , Neisseria gonorrhoeae/isolation & purification , Young AdultABSTRACT
OBJECTIVE: To investigate whether a cohort of human immunodeficiency virus-positive (HIV+) women were having annual cervical cytology as recommended by the English National Health Service cervical screening programme (NHSCSP) guidelines. METHODS: An audit of cervical cytology in an HIV+ cohort of 187 women by obtaining their last cervical cytology result and recall from local cytology services. RESULTS: Of the 187 women in the audit, two were ineligible, leaving 185 women, 167 (90.3%) of whom were aged 25-64 years and eligible for screening. Of the 185 women, 126 (68.1%) had a cytology history, 50 (27%) had never had cervical cytology and nine (4.9%) had inadequate details to ascertain whether or not they had a cytology history. Of the 126 with a cytology record, 34 (27%) had a current cytological abnormality, which was low grade in 25 (19.8%) and high grade in nine (7.1%). Among women aged 25-64 years attending the clinic, these percentages were significantly higher than expected for England as a whole (P < 0.001). Of 126 women with a cytology record, 29 (23%) were overdue for their recall date and of these the previous test was abnormal in 14 (48.3%). Cytology tests were taken within the community setting in 61 (48.4%), whereas 65 (51.6%) were seen either at an HIV sexual health clinic or were under colposcopy follow-up. Of 91 women with negative cytology only 50 (54.9%) were recommended for repeat in 12 months. CONCLUSION: This audit demonstrates a high rate of cytological abnormalities among HIV+ women compared with the screening population at large. Implementation of NHSCSP guidelines has been difficult and requires improved care pathways between HIV clinics, primary care and laboratories.
Subject(s)
Cervix Uteri/pathology , HIV Seropositivity/complications , Medical Audit , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Neoplasms/diagnosis , Adult , Cohort Studies , Colposcopy , Comorbidity , Diagnostic Tests, Routine , Female , Guideline Adherence , Humans , Middle Aged , Vaginal Smears/statistics & numerical dataABSTRACT
We report an unusual case of a male patient with a colovesical fistula secondary to diverticulitis presenting in the genitourinary medicine clinic as non-gonococcal urethritis.
