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1.
Int J STD AIDS ; 19(12): 810-3, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19050209

ABSTRACT

SUMMARY: Attendees at Newcastle sexually transmitted infections foundation (STIF) courses since 2002 were sent a postal questionnaire to ascertain views about the course, its effect on practice and the desire for further education. Totally 156 forms were returned (48% response). The majority 97% were satisfied with the course, 97% wanted updates, 57% annually and 33% biennially. Following a STIF course, 69% provided HIV testing (only 14% of those, prior to attendance). However, only 39% routinely offered HIV testing and only 34% routinely offered syphilis testing to patients whom they considered to be at risk of a sexually transmitted infection. Common reasons for not offering testing were lack of time for counselling, lack of confidence, no perceived need or anonymity concerns resulting in referral to genitourinary medicine. This was despite training, which encourages routine HIV testing with a pretest discussion rather than 'counselling' and education about recent outbreaks of syphilis.


Subject(s)
Diagnostic Tests, Routine , Education, Nursing , Foundations , HIV Infections/diagnosis , Physicians, Family/education , Sexually Transmitted Diseases/diagnosis , AIDS Serodiagnosis , HIV Infections/virology , Humans , Primary Health Care , Sexually Transmitted Diseases/microbiology , Sexually Transmitted Diseases/prevention & control , Sexually Transmitted Diseases/virology , Surveys and Questionnaires , Venereology
2.
Int J STD AIDS ; 17(10): 677-80, 2006 Oct.
Article in English | MEDLINE | ID: mdl-17059637

ABSTRACT

Following concerns about asymptomatic people having to wait 2-3 weeks for a standard appointment for screening a new 'I'm OK?' drop-in, nurse-led clinic for the worried well was devised and evaluated after the first 21 weeks (509 patients). Without overt advertising the clinic has run to near capacity and has proved popular, with 98% stating that they would attend such a clinic in the future. The chlamydia detection rate was 9% in women and 4% in men, with one case of asymptomatic rectal gonorrhoea and two of HIV infection diagnosed allowing early treatment intervention. HIV testing was accepted by 94% of attendees and initial hepatitis B vaccination by 93% of homosexual/bisexual men. This approach deflects such routine cases, potentially allowing increased time at standard clinic sessions for those with clinical problems staffed by more experienced nurses and doctors. Its success has encouraged us to develop this concept as a cost-effective way of addressing 48-hour genitourinary medicine access.


Subject(s)
Carrier State/prevention & control , Healthy People Programs , Mass Screening , Sexually Transmitted Diseases/prevention & control , Adult , Carrier State/diagnosis , Chlamydia Infections/diagnosis , Female , Gonorrhea/diagnosis , HIV Infections/diagnosis , Hepatitis B/prevention & control , Hepatitis B Vaccines/administration & dosage , Humans , Male , Outpatients , Rectal Diseases/diagnosis , Retrospective Studies , Sexually Transmitted Diseases/diagnosis , United Kingdom , Vaccination
3.
Int J STD AIDS ; 17(3): 200-2, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16510011

ABSTRACT

Recent increases in the incidence of early infectious syphilis have been particularly noted in men who have sex with men (MSM). Case-notes of 40 consecutive patients with infectious syphilis and follow-up data for one year were audited. Of the 40 patients, six were HIV co-infected. In all, 31 men received benzathine penicillin as first line while the remaining had other treatments. About 17 (42.5%) failed to attend for any post-treatment serological tests. Of the remainder, 17 (42.5%) attended for the first appointment and only 13 (32.5%) attended for the full one year follow-up. In all, 40 men in the study had 362 sexual contacts of which only 44 (12.2%) elected to be screened. This study illustrates the successful use of benzathine penicillin as first-line treatment, lack of patient compliance with post-treatment serological follow-up and difficulty with partner notification.


Subject(s)
Contact Tracing , Medical Audit , Penicillin G Benzathine/therapeutic use , Sexually Transmitted Diseases/drug therapy , Syphilis/drug therapy , Adolescent , Adult , Female , Humans , Male , Middle Aged , Penicillin G Benzathine/administration & dosage , Sexually Transmitted Diseases/cerebrospinal fluid , Sexually Transmitted Diseases/complications , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/transmission , Syphilis/diagnosis , Syphilis/epidemiology , Syphilis Serodiagnosis
5.
Int J STD AIDS ; 14(9): 630-1, 2003 Sep.
Article in English | MEDLINE | ID: mdl-14511501

ABSTRACT

The aim of the audit was to assess the need for a microbiological test of cure for gonorrhoea when a sensitive antibiotic has been used. All cases of gonorrhoea attending our clinic in 2001 were reviewed. One hundred and seventy-three cases were diagnosed, 137 men and 36 women. Of the 126 cases where tests of cure were taken, none were positive from an infective site when a sensitive antibiotic was used. Cases of gonorrhoea from year 2000 were then analysed for test of cure. Of 125 tests of cure again none were positive. These results question the need for routine tests of cure which current national guidelines state are usually performed in UK practice. The implications of abandoning a test of cure visit are discussed.


Subject(s)
Appointments and Schedules , Continuity of Patient Care/standards , Gonorrhea/drug therapy , Medical Audit , Practice Guidelines as Topic , Anti-Bacterial Agents/therapeutic use , Databases, Factual , Female , Gonorrhea/diagnosis , Guideline Adherence , Hospital Departments , Humans , Male , Patient Compliance , United Kingdom
6.
Int J STD AIDS ; 14(7): 448-50, 2003 Jul.
Article in English | MEDLINE | ID: mdl-12869223

ABSTRACT

The aim of this study was to assess if patient characteristics could influence the sensitivity of enzyme immunoassay (EIA) testing used for chlamydia screening. Our cohort consisted of 56 patients who were known polymerase chain reaction-positive for chlamydia, but with variable EIA results. Characteristics analysed included those already known to influence the EIA (menstruation, pregnancy, difficult examination) and those suspected from clinical observation (including presence of symptoms or signs, coexistent gonorrhoea, duration from last sexual exposure). An unexpected finding was that significantly more cases of bacterial vaginosis were found in those chlamydia EIA-negative compared to those with positive results. We postulate that an enzyme produced in bacterial vaginosis, proline aminopeptidase, may cause destruction of the chlamydial cell wall, therefore affecting the EIA adversely. Further research is needed to explore this hypothesis.


Subject(s)
Chlamydia Infections/diagnosis , Chlamydia trachomatis/isolation & purification , Mass Screening/methods , Neisseria gonorrhoeae , Vaginosis, Bacterial/diagnosis , Cohort Studies , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Polymerase Chain Reaction , Sensitivity and Specificity , United Kingdom
8.
Int J STD AIDS ; 13(2): 133-4, 2002 Feb.
Article in English | MEDLINE | ID: mdl-11839170

ABSTRACT

Current teaching on Reiter's syndrome is that keratoderma blennorrhagica lesions appear characteristically on the soles of feet, although they can be seen on other parts of the body infrequently. We therefore thought that it would be interesting to report the case of keratoderma blennorrhagica lesions found on the glans penis of a circumcised patient with Reiter's syndrome.


Subject(s)
Arthritis, Reactive/complications , Arthritis, Reactive/diagnosis , Keratosis/etiology , Penis/pathology , Foot/pathology , Humans , Keratosis/pathology , Male , Middle Aged
9.
Int J STD AIDS ; 13(12): 805-8, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12537730

ABSTRACT

Neisseria gonorrhoeae isolates that were resistant to ciprofloxacin and/or penicillin were analysed to investigate the escalating problem of antibiotic-resistant gonorrhoea in the north east of England. Opa-typing (outer membrane opacity protein) was carried out on isolates resistant to ciprofloxacin and of nutrient nonrequiring (NR) auxotype. In the year 2000 there were 265 cases of gonorrhoea, of which 44 (16.6%) were resistant to penicillin and 12 (4.5%) were resistant or had reduced sensitivity to ciprofloxacin (with only four of these acquired outside the UK). Three (7.5%) of the non-beta-lactamase penicillin-resistant isolates were imported from abroad. By Opa-typing of ciprofloxacin-resistant strains, one pair of the isolates was similar, two were unique and one was similar to the Oldham/Rochdale outbreak strain described early in 2000. This marked increase in the prevalence of indigenous ciprofloxacin resistance requires continued surveillance and may soon necessitate an alteration in our first line treatment.


Subject(s)
Anti-Infective Agents/pharmacology , Ciprofloxacin/pharmacology , Gonorrhea/drug therapy , Neisseria gonorrhoeae/drug effects , Penicillins/pharmacology , Adolescent , Adult , Anti-Infective Agents/therapeutic use , Bacterial Outer Membrane Proteins/analysis , Bacterial Typing Techniques/methods , Ciprofloxacin/therapeutic use , Drug Resistance, Bacterial , England/epidemiology , Female , Gonorrhea/epidemiology , Gonorrhea/microbiology , Humans , Male , Middle Aged , Neisseria gonorrhoeae/classification , Penicillins/therapeutic use , Population Surveillance , Prevalence
11.
Int J STD AIDS ; 10(5): 290-3, 1999 May.
Article in English | MEDLINE | ID: mdl-10361916

ABSTRACT

Fluoroquinolones and third generation cephalosporins are the most effective antimicrobial agents for the treatment of gonorrhoea. However, clinically significant resistance to fluoroquinolones in Neisseria gonorrhoeae has been reported worldwide including Britain. The aim of this analysis was to study the factors relating to ciprofloxacin resistance and treatment failure. A total of 201 patients attending the Newcastle Genitourinary Medicine (GUM) clinic from 1995-1997 who were diagnosed with culture positive gonorrhoea was analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) was measured for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant range (>0.05 microg/ml) were reviewed to determine the clinical outcome. The ciprofloxacin resistance with treatment failure was seen in 5% (8/160). All the 8 cases of treatment failure were heterosexual and had isolates resistant to penicillin and 4 cases (50%) were also resistant to tetracycline. All were sensitive to spectinomycin and ceftriaxone. Most of the cases probably acquired their infection from the Far East. As ciprofloxacin resistance seems to be associated with overseas exposure, changes in the standard treatment of gonorrhoea are not justified but consideration should be given to appropriate alternatives when the infection may have arisen from where such resistant strains are endemic. Monitoring fluoroquinolone resistance is now essential for ensuring adequate treatment of infections with resistant strains and for maximizing the time of usage of fluoroquinolones to treat gonorrhoea.


Subject(s)
Anti-Infective Agents/therapeutic use , Ciprofloxacin/therapeutic use , Gonorrhea/epidemiology , Adult , Drug Resistance, Microbial , England/epidemiology , Female , Gonorrhea/drug therapy , Heterosexuality , Homosexuality, Male , Humans , Male , Middle Aged , Neisseria gonorrhoeae
12.
Br J Dermatol ; 138(2): 334-6, 1998 Feb.
Article in English | MEDLINE | ID: mdl-9602886

ABSTRACT

We report a case of an atypical penile herpetic ulcer in a man with previously undiagnosed human immunodeficiency virus (HIV) infection. Swabs of the lesion were negative for herpes simplex virus (HSV) by culture and electron microscopy. However, histopathology of biopsy material showed characteristic herpetic multinucleate giant cells. Immunochemistry using polyclonal antibodies was positive for HSV1 and HSV2. The lesion completely resolved after treatment with aciclovir and the patient subsequently tested positively for HIV antibodies.


Subject(s)
HIV Infections/complications , Herpes Genitalis/complications , Herpesvirus 1, Human , Herpesvirus 2, Human , Penile Diseases/virology , Ulcer/virology , Adult , Chronic Disease , HIV Infections/diagnosis , Herpes Genitalis/diagnosis , Humans , Immunohistochemistry , Male
14.
Br J Clin Pract ; 50(3): 166-7, 1996.
Article in English | MEDLINE | ID: mdl-8733337

ABSTRACT

We report the cases of two men referred to a genitourinary medicine clinic with sterile pyuria and subsequently found to have their urethras infected with Chlamydia trachomatis. Chlamydial infection should be considered in the differential diagnosis of sterile pyuria, particularly in young, sexually active males. We discuss the consequences of inadequate treatment of the index case.


Subject(s)
Chlamydia Infections/microbiology , Chlamydia trachomatis , Pyuria/microbiology , Adolescent , Humans , Male
16.
Int J STD AIDS ; 6(5): 348-50, 1995.
Article in English | MEDLINE | ID: mdl-8547416

ABSTRACT

It has been proposed that changes in sexual behaviour arising out of concerns regarding HIV infection can be inferred by changes in the incidence of gonorrhoea. We have reviewed data on gonococcal isolates in Newcastle over the last 13 years and looked at changes in relation to HIV test requests, new cases of HIV infection and media campaigns. HIV testing has been available in the clinic since late 1985. There was a steady decline in cases of gonorrhoea from 1985-1991 and then as in other areas an increase in incidence was seen among homosexual and bisexual men. The majority of this recent increase was due to pharyngeal infection. Sexual behaviour may have changed but this cannot be purely attributed to HIV concerns. HIV testing began after the incidence of gonorrhoea in England was already falling and we found no relationship between trends in gonorrhoea, HIV test requests and new cases of HIV infection.


Subject(s)
Gonorrhea/epidemiology , HIV Infections/epidemiology , HIV Infections/prevention & control , Sexual Behavior , Adolescent , Adult , Biomarkers , England/epidemiology , Female , Health Education , Humans , Incidence , Longitudinal Studies , Male , Mass Media , Middle Aged , Population Surveillance , Urban Health
17.
Genitourin Med ; 70(6): 389-93, 1994 Dec.
Article in English | MEDLINE | ID: mdl-7705855

ABSTRACT

OBJECTIVES: The primary objective was to determine if six weeks treatment with subcutaneous interferon alpha-2a (IFN) and podophyllin 25% W/V administered twice per week, preceded by IFN alpha-2a three times weekly for one week showed a greater complete response rate in patients with primary condylomata acuminata when assessed at week 10 than treatment with podophyllin and placebo injections in the same schedule. The secondary objective was to compare recurrence rates in complete responders at six months in the two treatment groups. DESIGN: Randomised, double-blind parallel group study. SETTING: Multicentre study in six genitourinary clinics within the U.K. PATIENTS: One hundred and twenty-four patients with primary anogenital warts. MAIN OUTCOME MEASURES: Complete response rate at week 10, and recurrence rate at week 26 in complete responders. RESULTS: At week 10 analysis of the efficacy population showed complete response in 36% (15/42 patients) of IFN-treated group and 26% (11/43 patients) in the placebo group (no significant difference). Analysis of the safety population at week 26 showed persistence of the complete response in 57% (8/14 patients) of the IFN-treated group and 80% (12/15 patients) of the placebo group (no significant difference). Adverse effects were more common in IFN-treated patients, involved particularly application site reaction and malaise but were generally mild. CONCLUSIONS: At the dose and with the regime described treatment with IFN alpha-2a in combination with podophyllin is no more effective in the treatment of primary anogenital warts than podophyllin alone and is associated with more adverse events.


Subject(s)
Anus Diseases/therapy , Condylomata Acuminata/therapy , Genital Diseases, Female/therapy , Genital Diseases, Male/therapy , Interferon-alpha/therapeutic use , Podophyllin/therapeutic use , Adolescent , Adult , Aged , Anus Diseases/virology , Condylomata Acuminata/virology , Double-Blind Method , Drug Therapy, Combination , Female , Genital Diseases, Female/virology , Genital Diseases, Male/virology , Humans , Male , Middle Aged , Recurrence , Time Factors , Treatment Outcome
18.
Br J Clin Pract ; 48(6): 343, 1994.
Article in English | MEDLINE | ID: mdl-7848808

ABSTRACT

The serendipitous presentation of a rectoperineal fistula in a 34-year-old nulliparous woman is described. This surgically correctable cause of an anogenital discharge posed a risk (if unrecognised) of producing a rectovaginal fistula at the time of vaginal delivery.


Subject(s)
Exudates and Transudates , Feces , Fistula/complications , Perineum , Rectal Fistula/complications , Adult , Female , Humans , Rectovaginal Fistula/prevention & control
19.
Int J STD AIDS ; 5(5): 359-61, 1994.
Article in English | MEDLINE | ID: mdl-7819356

ABSTRACT

This retrospective study was undertaken to evaluate the prevalence of the viral types and temporal epidemiology in patients with ano-genital herpes between 1983-92. One thousand one hundred and thirty-five patients with anogenital herpes were available for analysis. The annual incidence of anogenital herpes nearly tripled over the period of 7 years (1986-92) from 59 to 171 cases. The percentage of HSV-1 infection in female cases (63-79%) was much higher than in other reported studies and remained relatively constant over the study period.


Subject(s)
Anus Diseases/epidemiology , Anus Diseases/virology , Herpes Genitalis/epidemiology , Herpesvirus 1, Human , Population Surveillance , England/epidemiology , Female , Humans , Incidence , Male , Prevalence , Retrospective Studies , Sex Distribution , Sexual Behavior , Time Factors , Urban Population
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