ABSTRACT
Many STIs are known to disproportionately affect men who have sex with men (MSM) in the UK; therefore, regular asymptomatic screening that is easy to access is vital among this group. Asymptomatic screening pathways can reduce long clinic waits, which may encourage more people to attend for screening. We therefore developed and trialled an asymptomatic pathway for MSM within our service. This extended our previous pathway, which allowed asymptomatic service users to fill in a questionnaire and see a healthcare support worker, to include MSM, as it previously had not. The service has been implemented and rolled out successfully. We believe that this model for asymptomatic screening among MSM can reduce clinic visit duration. This should increase accessibility and also allow trained staff to manage more complex patients, while allowing for risk identification and health promotion among those MSM who may be at higher risk.
Subject(s)
Health Services Accessibility/organization & administration , Health Services Research , Homosexuality, Male , Mass Screening/organization & administration , Patient Care Management/organization & administration , Sexually Transmitted Diseases/diagnosis , Adult , Health Care Surveys , Homosexuality, Male/statistics & numerical data , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Patient Care Management/methods , Referral and Consultation , Sexually Transmitted Diseases/prevention & control , Sexually Transmitted Diseases/transmissionABSTRACT
A 36-year-old Caucasian homosexual man was found to have HIV infection on routine screening. He had an eight-year history of chronic diarrhoea, which pre-dated the HIV diagnosis and did not improve after the introduction of combination antiretroviral therapy. After referral to the Gastroenterology department, he underwent fibreoptic colonoscopy. Colonic biopsies revealed the presence of intestinal spirochaetosis. He received a two-week course of metronidazole, which led to complete resolution of his diarrhoea. Intestinal spirochaetosis should be considered in the differential diagnosis of patients with HIV infection and chronic diarrhoea without other apparent cause.
Subject(s)
Diarrhea/etiology , Diarrhea/pathology , HIV Infections/complications , Spirochaetales Infections/diagnosis , Spirochaetales Infections/pathology , Adult , Anti-Infective Agents/administration & dosage , Biopsy , Chronic Disease , Colonoscopy , Diarrhea/drug therapy , Homosexuality, Male , Humans , Male , Metronidazole/administration & dosage , Spirochaetales Infections/drug therapy , Treatment OutcomeABSTRACT
This case describes a young white British man with a one-year history of recurrent genital ulceration managed by the GP. Initially this was thought to be a drug reaction; however, presentation at our genitourinary medicine clinic and onward review with dermatology allowed the diagnosis of Behçet's disease to be made. The clinical diagnosis was made based on painful oral and genital ulcers, eye irritation, erythema nodosum and positive pathergy test. Treatment with oral prednisolone was initiated by dermatology, which resulted in rapid improvement in the genital ulceration. This case highlights that clinicians should consider Behçet's disease in patients with recurrent genital ulceration to ensure prompt diagnosis and prevention of systemic involvement.
