A comparison of referral patterns and characteristics of patients with first episode symptomatic genital HSV-1 and HSV-2 infections in Sheffield.

OBJECTIVE: To ascertain factors associated with HSV-1 and HSV-2 isolates in patients attending a genitourinary medicine clinic with symptomatic first episode genital herpes (FEGH). DESIGN: Retrospective study. SUBJECTS: A total of 606 females and 333 males presenting with culture positive FEGH between 1990-94. SETTING: Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK. METHODS: Group comparison of referral patterns, demographic data, prior and concurrent episodes of STD, recent partner change. RESULTS: HSV-1 infected patients of either sex were more likely to be general practitioner (GP) referred, to be white, and less likely to have had preceding STD episodes. Recent sexual partner change had occurred significantly more often in HSV-2 infected females but there was no similar difference between HSV-1 and HSV-2 infected males. CONCLUSION: The relative HSV-1:HSV-2 isolate ratio in FEGH is influenced by the referral patterns. HSV-1 isolates predominate in patients presenting to GPs who refer the patients to GUM clinics for accurate diagnosis, counselling, follow up and screening for other STDs.

Hospital service utilization by HIV/AIDS patients and their management cost in a provincial genitourinary medicine department.

The hospital management of 108 HIV/AIDS patients cared for by the genitourinary medicine department, Sheffield, UK between 1984-93 was retrospectively studied to quantify the services utilized by these patients and to detail the management costs (1993 price) of outpatient (OP) services, inpatient (IP) care, investigational services and therapeutic provisions. The services utilized and cost are presented separately for the different clinical stages of the infection and as per patient year. Of the 108 patients, 95 (88%) were males and 13 (12%) females; most males (76.8%) acquired the infection through homosexual exposure, while 46% of females acquired it heterosexually. The mean number of OP consultation per asymptomatic, symptomatic non-AIDS and AIDS patient years were 11.6, 16.4 and 32.8 respectively; the mean number of IP episodes for each of these clinical groups were 0.15, 0.83 and 3.88 with IP stays 0.7, 3.5 and 40.6 days per patient year respectively. The annual costs of OP care (45.26 pounds per consultation), drugs and investigations were, respectively 525 pounds, 213 pounds and 153 pounds per asymptomatic patient year, 742 pounds, 2097 pounds and 224 pounds per symptomatic non-AIDS patient year and 1485 pounds, 2928 pounds and 382 pounds per AIDS patient year. The average annual OP drug cost per patient year showed little change since 1988. However, in the AIDS group, contributions from differing drug classes showed significant changes; while the contribution of antiretroviral drugs fell from 80.2% of the drug cost per AIDS patient year in 1990 to 31.3% in 1993, that from antibiotics rose from 0.3% in 1990 to 26.4% in 1993 and other antivirals from 9.4% in 1988 to 22.6% in 1993. These changes were related to lower recommended daily dosage of zidovudine and to wider prescription of antibiotics for atypical mycobacterial infections and domiciliary gancyclovir for CMV infection. The costs of annual mean IP care, IP drugs, IP investigations and IP procedures per AIDS patient year were 5926 pounds (146 pounds per IP stay), 2983 pounds, 282 pounds and 145 pounds respectively. The overall management cost of one AIDS patient year was 14,131 pounds and lifetime AIDS management cost, based on a mean survival of 17 months, a little more than 20,000 pounds. The annual management cost of an asymptomatic and symptomatic non-AIDS patient year is approximately 1/14th and 1/4th of the cost of an AIDS patient year.