A national survey of nurse-led and delivered services within sexual health across the United Kingdom.

This was a cross-sectional study using an online survey to evaluate the provision of nurse-led and delivered services within genitourinary medicine in the UK. Results showed that such services are being widely utilised and are generally well supported by medical staff. The delivery of nurse-led and delivered services appears to be quite variable. Clinical guidelines and standards may help to ensure a more uniform approach to these services and help to maintain high standards of care.

Survey of prioritizing/triaging of appointments in genitourinary medicine clinics in the UK: a British Co-operative Clinical Group survey.

A questionnaire was circulated to all lead genitourinary (GU) medicine physicians in the UK in November 2003 to obtain data on access, waiting times and triaging. Of the 143 responders, 92.3% departments had limited access to some or all GU medicine clinics. Where access was limited, 5.3% had no identifiable process in place to see urgent patients. The mean waiting times in clinics with an open appointment system only for a routine female and male appointment were 2.9 weeks and 2.8 weeks (range 2 days-10 weeks), respectively, and for an urgent appointment, two days (range same day-14 days), for both sexes. The survey has raised concerns that a number of departments did not consider as urgent for prioritizing, patients with documented untreated gonorrhoea, syphilis, or HIV, or contacts of patients with these conditions. This survey has highlighted a need for the national specialist society to provide guidance on prioritizing patients where access is limited.

Are sexually transmitted infections associated with scabies?

Sexually transmitted infections (STIs) have been previously reported to be associated with scabies in sexually active people. The UK national guidelines on STIs recommend screening for other STIs in patients with scabies attending a genitourinary medicine (GUM) clinic. However, there is a paucity of literature on this association, which we reviewed. We looked at the sexual behaviour and the coincidence of STIs in patients with scabies attending a GUM clinic and in inmates from a young offender institution (YOI) attending between 1 January 1998 and 31 December 1999. A total of 47 patients with scabies were identified in the GUM clinic population during this period and 15 patients in the YOI group. Consecutive new and rebooked sex-matched patients served as a control group. Among the GUM clinic attendees 36% of patients with scabies had multiple sexual partners in the preceding 3 months compared with 21% in the control group (P=0.11). Thirty-four per cent of patients with scabies had a previous history of STI vs 17% in the control group (P=0.058). The number of patients with coexistent STIs was not significantly different in both groups (49% vs 44%, P=0.68). The number of patients in the YOI group was too small for a statistical analysis. This study showed that patients with scabies had comparable rates of STIs as with the GUM clinic population. It therefore supports the national guidelines in recommending screening for other STIs in patients with scabies.

Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: a case control study.

BACKGROUND AND OBJECTIVES: Bacterial vaginosis and vaginal douching are both reported to be more common in African-American and Caribbean than white women. It is also thought that douching alters the vaginal milieu. This study was conducted to examine associations between genital cleaning practices, bacterial vaginosis, and ethnic group. STUDY DESIGN: Case-control study of 100 women with bacterial vaginosis, diagnosed by Nugent's criteria, and 100 women without bacterial vaginosis attending a sexually transmitted diseases clinic in an ethnically heterogeneous inner-city area in London, England. RESULTS: Bacterial vaginosis was more common among black Caribbean than white women (OR, 2.1; 95% CI, 1.1-4.1). Vulval use of bubble bath or antiseptic solutions and douching with proprietary or homemade solutions were significantly more common in women with bacterial vaginosis than without. After controlling for use of vulval and vaginal antiseptics and bubble bath, douching, and a history of bacterial vaginosis, there was no ethnic difference in the occurrence of the condition (adjusted OR, 1.1; 95% CI, 0.5-2.5). CONCLUSIONS: Ethnic differences in genital hygiene behaviors can explain a twofold increase in the risk of bacterial vaginosis in black Caribbean compared with white women. The role of vulval and vaginal cleaning practices in the development of bacterial vaginosis should be examined further in longitudinal or randomized controlled studies.

Genital colonisation and infection with candida in heterosexual and homosexual males.

OBJECTIVES: To determine the penile, perianal, and oropharyngeal candidal colonisation rates among homosexual and heterosexual males attending an STD clinic. To determine the prevalence of balanitis and candidal balanitis in the two groups. SUBJECTS: 252 heterosexual and 210 homosexual male patients attending consecutively the STD clinic in Coventry, England. DESIGN: A prospective study recording sexual behaviour, relevant history, symptoms, and examination. Specimens for candida culture were collected from the glans penis, perianal area, and oropharynx. RESULTS: Among the 462 men studied, penile, perianal, and oropharyngeal colonisation rates were 74 (16%), 70 (15%), and 116 (25%) respectively. On examination, 47 (10%) were found to have balanitis. Of the 74 patients with penile colonisation, 26 (37%) were symptomatic and 20 (27%) had balanitis. The 223 heterosexual and the 196 homosexual males who had sexual intercourse within 3 months had comparable colonisation rates of candida on the penis, perianal area, and oropharynx. Balanitis was seen in 31 heterosexuals (14%) and candidal balanitis in 16 (7%); the incidence was significantly less in homosexuals where balanitis was seen in 12 (6%) and candidal balanitis in four (2%). CONCLUSIONS: Itching or burning sensations after sex were the most common symptoms associated with penile colonisation with candida and were present in more than one third. Candidal balanitis was commoner in those who had vaginal than those who had anal intercourse within 3 months.