ABSTRACT
Patients with symptomatic azole-resistant Candida albicans or non-albicans candida are difficult to manage. Treatment is largely anecdotal due to the relatively small number of patients. We present six case reports which highlight our own observation in clinical practice including four patients who were treated successfully with topical amphotericin B/flucytosine vaginal gel for 14 days (Stoke-on-Trent formula).
Subject(s)
Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Candida albicans/drug effects , Candidiasis, Vulvovaginal/drug therapy , Candidiasis, Vulvovaginal/microbiology , Drug Resistance, Fungal , Flucytosine/administration & dosage , Adolescent , Adult , Aged , Antifungal Agents/pharmacology , Azoles/pharmacology , Candida albicans/isolation & purification , Female , Humans , Middle Aged , Treatment Outcome , Vaginal Creams, Foams, and Jellies/administration & dosage , Young AdultABSTRACT
Non-consultant career grade doctors in genitourinary (GU) medicine have been called 'a reliable silent backbone of the specialty' and 'a spare pair of hands' [Hiscock E. Non-consultant career grade staff in GU medicine; a reliable backbone or, a spare pair of hands? Int J STD AIDS 1996;7:375-7]. But are they adequate pairs of hands? This survey, conducted in July 2007, examined the work, qualifications and experience of these doctors. A summary of the 154 (19%) responses is presented. Respondents contributed 773 sessions per week, including 164 special interest sessions; 30 (19.5%) were doing regular HIV work. Non-clinical work was described by 134 (87%), especially teaching (132 [86%]) and management roles (26 [17%]). Postgraduate qualifications were cited by 148 (96%), including DipGUM or Dip Ven (51 [33%]), contraception qualifications such as DFFP, MFFP or FFFP (110 [71%]), MRCGP (43 [8%]) and qualifications in psychosexual medicine/therapy (10 [6.5%]). Over half were trained in general practice. Certificate of completion of specialist training or equivalent was held by 55 (36%), including two in GU medicine. These doctors are well qualified, and an asset to the specialty.
Subject(s)
Clinical Competence , Data Collection , Female Urogenital Diseases , Male Urogenital Diseases , Physicians , Urology , Certification , Consultants , Education, Medical, Continuing , Female , Humans , Male , Surveys and Questionnaires , United Kingdom , Urology/education , WorkforceABSTRACT
A survey of the accuracy of applying the KC60 diagnostic code for genital herpes: first attack (C10A) was undertaken by non-consultant career-grade doctors working in genitourinary (GU) medicine in England, Wales and Northern Ireland. In total, 148 forms were returned (58% response). Overall, 88/148, 59.5% (95% confidence interval 51.5-67.4%) applied the correct codes for all the clinical scenarios presented. Of doctors who personally assigned codes to clinical episodes, 57/104 (54.8%), were correct compared with 31/44 (70.5%) who did not personally apply codes. There was no difference between these two groups (P=0.08). The main error was assigning code C10A on clinical grounds only when there was no laboratory confirmation of herpes simplex virus. The authors suggest that the KC60 C10A code for first attack genital herpes should be simplified to accept a clinical diagnosis rather than insisting on viral confirmation. Alternatively, consideration could also be given to adopting a more comprehensive system (such as the Scottish example) for first attack genital herpes. We believe that either option would help improve the accuracy of GU clinic data relating to genital herpes.
