Outcome of contact tracing for Chlamydia trachomatis in a district general hospital.

The outcome of contact tracing (partner notification) for Chlamydia trachomatis in a district general hospital during the 5-year period between 1991-1995 was surveyed. During the 5-year period 1027 cases of C. trachomatis were diagnosed. The health adviser saw 928 (90%) of cases who reported 1132 (1.2) sexual contacts. Out of 682 sexual contacts sought by the health adviser, 472 (69.5%) were seen. Following a consultation with the health adviser, over two-thirds (86%) of index cases chose to inform their contacts themselves. Over two-thirds (71%) of contacts informed by these index cases were seen. A higher proportion of regular and first or most immediate contacts were seen as a result of contact tracing. A significantly higher proportion of partners of index cases who themselves returned for test of cure were seen. A consultation with the health adviser facilitated uptake of partner notification by the index patients. Patient referral led to a majority of contacts being seen in a genitourinary medicine (GUM) clinic. Follow-up visits by index patients may improve outcome of contact tracing and should continue irrespective of need for test of cure.

Managing vulvar lichen sclerosus in U.K. genitourinary medicine clinics.

OBJECTIVE: To survey genitourinary physicians in the United Kingdom on their approaches to the management of vulvar lichen sclerosus. STUDY DESIGN: Questionnaire survey of United Kingdom genitourinary consultants. RESULTS: Seventy-one percent of genitourinary physicians biopsy vulvar lichen sclerosus. For treatment, 78% of clinicians use a high-grade topical corticosteroid, such as 0.05% clobetasol propionate. Topical sex steroids are used by a minority of clinicians. Cases are followed by 80% of respondents. Having made the diagnosis of this condition, 30% of respondents refer the case to either a dermatologist or gynecologist for further management. Fifty-two percent refer only after treatment failure. CONCLUSION: Genitourinary physicians in the United Kingdom see and manage cases of vulvar lichen sclerosus in genitourinary medicine clinics. However, a majority of clinicians refer these cases at some stage. A coordinated and multispecialty approach between genitourinary physicians, dermatologists and gynecologists would provide coherent management of vulvar lichen sclerosus.

Emergency unit care of sexually transmitted infections.

The aim of the study was to assess provisions for management of sexually transmitted infections (STIs), emergency contraception and pregnancy test in UK emergency departments. Postal questionnaires were sent to all consultant-led emergency departments in the UK in January 1996. The response rate was 64%. Most departments made direct referrals to genitourinary medicine (GUM) clinics and most had access to appropriate clinics. While 55% had facilities for diagnosis of at least one of the 3 common STIs (Chlamydia trachomatis, Neisseria gonorrhoeae and herpes simplex), only 6.25% had facilities for all 3. A minority of units provided training in the management of STIs. Emergency physicians should be trained in the early management of STIs and a coordinated working relationship should be developed between emergency and GUM departments to provide optimal sexual health care.

Provision of emergency contraception by nurses: a way forward to increased access.

OBJECTIVES: The objectives of the study were to assess the suitability of a service for provision of emergency hormonal contraception by nurses. METHODS: Retrospective analysis was carried out of data obtained from the case records of 500 consecutive women who attended ABACUS (a city center-based family planning clinic in Liverpool, UK) for emergency contraception during the 7th and 9th months of the first year (1994) of the service. Similar data were collected for 100 consecutive women during 1 month of the third year (June 1996). The number of women who received emergency hormonal contraception was noted. In particular, details pertaining to the reasons for referral to the doctor and the trend of referrals were noted. RESULTS: The results indicate that during the first year the nurses independently issued emergency hormonal contraception to 37% of the women. They referred the remaining 63% to the medical staff. One-third of referrals were for ongoing contraception, especially oral contraception. Another third of referrals appeared to be due to 'nurse anxiety', as no medical or other cause was found for these referrals. During the third year, nurses dispensed emergency hormonal contraception to 64% of women. Among the remaining 36% of women who were referred to the doctor, 19% needed hormonal contraception. Referral reflecting 'nurse anxiety' significantly declined (1%) compared to the first year of service. CONCLUSIONS: Ongoing contraception, particularly initiation of oral contraception, was one of the main reasons for referral during the first year. Referral due to 'nurse anxiety' significantly declined with continued experience and may have reflected initial anxiety and the learning curve. With increased experience over the first 2 years, the outcome of this service showed encouraging improvement. The nurses now dispense emergency hormonal contraception to a majority of women.