No way back for quinolones in the treatment of gonorrhoea.

OBJECTIVES: To assess the changing prevalence of quinolone resistant Neisseria gonorrhoeae (QRNG) over 3 years following implementation of cephalosporin treatment (for gonorrhoea). METHODS: Case review of all episodes of gonorrhoea diagnosed in the genitourinary medicine clinic in Nottingham during the first 6 months of each year between 2002 and 2005. RESULTS: The prevalence of QRNG peaked at 52.5% in January 2002. Three years after third generation cephalosporins were implemented for the treatment of gonorrhoea, QRNG persists in the local population with a prevalence of 9.1% over the first half of 2005. CONCLUSIONS: The persistence of QRNG at a prevalence exceeding 5% precludes a return to quinolones for the treatment of gonorrhoea. The significant reduction in all cases of gonorrhoea identified over the same time is unlikely to be related to the change to treatment with cephalosporins.

Hypochondriacal concerns, somatosensory amplification, and primary and secondary cognitive appraisals.

This paper uses data from four studies (N = 150, 150, 154 and 79) to examine the associations between hypochondriacal concerns (HCs) and stress appraisals (primary and secondary). A search activity account of HCs suggests that increased levels of HCs should be associated with positive appraisals of a stressful situation (i.e., increased levels of perceived challenge and perceived control). However, the results indicated that in terms of primary appraisals, increased perceptions of threat and not challenge were consistently associated with increased levels of HCs. Further, the results indicated that the association between threat and HCs is mediated by somatosensory amplification. Consistent with the search activity account it is shown that increased levels of perceived control (secondary appraisals) are associated with increased levels of HCs. The association for perceived control remains once variance due to somatosensory amplification is partialled and generalizes to a sample of patients with a sexually transmitted infection. The results are interpreted in relation to the transactional model of the stress process.

Evaluation of a randomized controlled trial of HIV and sexually transmitted disease prevention in a genitourinary medicine clinic setting.

OBJECTIVE: To evaluate outcomes of a sexual health promotion intervention to prevent transmission of sexually transmitted diseases (STD) including HIV among genitourinary medicine clinic attenders. DESIGN: A randomized controlled trial using pre-test and post-test measurements after 4 months, with clinical follow-up at 18 months. SETTING: A genitourinary medicine clinic in Nottingham, UK. PATIENTS: A total of 492 patients were randomly assigned either to an individually focused counselling and skills training intervention, including written materials (n = 148), to receive written materials only (n = 162), or to usual clinic procedure (n = 182). INTERVENTION: Social learning theory provided the theoretical framework for the intervention, which was informed by previous research in this setting, and aimed to alter perception of risk for HIV infection, increase knowledge and attitudes to condoms, and increase condom use. MAIN OUTCOME MEASURES: The main outcomes of interest were self-reported condom use and behaviour change. Other outcomes of interest were knowledge and attitudes to condoms, and re-attendance at the clinic with a diagnosis of STD. RESULTS: Intervention subjects were significantly more likely than controls to report carrying condoms when anticipating sexual intercourse with a new sexual partner (P < or = 0.05), and were more likely to perceive themselves at risk of HIV infection (P < or = 0.001). There were no significant effects of the intervention on levels of knowledge about correct condom use, attitudes to condoms, self-reported condom use or incidence of STD. CONCLUSIONS: The limited effectiveness of the intervention suggests that condom promotion should continue, but that additional investment in clinic-based health promotion is unlikely to result in consequent health gain.

Age is no bar to sexually acquired infection.

Two hundred and forty-two patients aged 60 years or over attended genito-urinary clinics in Nottingham and Leicester (England) in a 2-year period. Sixty-nine per cent of men and 53% of women were sexually active and 58 were found to have sexually transmitted diseases.

AIDS-related risk perception and sexual behaviour among sexually transmitted disease clinic attenders.

Perception of risk has been suggested as an important element of sexual behaviour change among people who engage in behaviours which place them at risk of HIV infection. A study of the relationship between perception of risk of HIV infection and risk-related sexual behaviours was conducted in a genitourinary medicine clinic. The sample comprised 767 patients attending over a 3-month period; data collection was by self-completed questionnaire. A total of 574 questionnaires were suitable for analysis, representing a response rate of 75%. The majority of people in the sample reported behaviours which increased their risk of HIV infection, but only 19% (n = 112) of the sample perceived themselves to be personally 'at risk', despite adequate knowledge of HIV transmission and methods of risk reduction. Significant differences between social class groups were found for knowledge scores, with highest scores among professionals and lowest among unemployed subjects (Kruskal Wallis test chi 2 = 24.6, P less than or equal to 0.001). Increasing age was significantly associated with better knowledge; significantly more young people aged 16-20 years who did not perceive themselves 'at risk' (64%), had lower knowledge scores than older people who did not perceive themselves 'at risk' (41%). Among heterosexuals who reported having sex with other people in addition to their regular partner, 79% did not perceive themselves as 'at risk' of HIV infection, and of these, 64% reported only infrequent condom use with casual sexual partners. Significantly more heterosexual men (67%) than women (44%) reported multiple sex partners.(ABSTRACT TRUNCATED AT 250 WORDS)

The reliability of self-reported sexual behaviour.

The quality of data collected by surveys of sexual behaviour may be subject to sources of error involving reliability, validity, and non-participation bias. A preliminary study of sexual behaviour, including perception of risk for HIV infection, knowledge of HIV transmission and attitudes towards AIDS, was conducted in a genitourinary medicine clinic. The sample comprised 767 patients attending clinic over a 3-month period; comparisons were made between different methods of data collection (questionnaires and interviews) and between responders and non-responders. High levels of agreement were found between questionnaire and interview. Some sexual behaviours were more frequently reported at interview. No significant differences were found between responders and non-responders to either questionnaire or interview.

Measuring treatment compliance of men with non-gonococcal urethritis receiving oxytetracycline combined with low dose phenobarbitone.

Of 62 men with non-gonococcal urethritis who entered a study to assess compliance with treatment with oxytetracycline, only 33 could be evaluated. Traditional methods (interview and the absence of oxytetracycline in the urine) showed incomplete compliance in nine. Use of low dose phenobarbitone as a pharmacological marker showed incomplete compliance in a further five patients. In addition, phenobarbitone concentrations gave information on the extent to which individual patients had omitted treatment and provided direct, as opposed to circumstantial, evidence of good compliance by most (18) of those studied. Only three of the 33 patients whose compliance was assessed had evidence of continuing infection at follow up, and there was evidence of incomplete compliance in only one of these patients.

Prevalence of chlamydial infection in acute epididymo-orchitis.

The prevalence of sexually transmitted infection was studied in 40 men presenting with acute epididymo-orchitis in Leeds. Chlamydia trachomatis infection was identified in 13 of 29 men (45%) aged under 35 years. Neisseria gonorrhoeae was isolated from four of these 13 men with chlamydial urethritis. C trachomatis was isolated from the urethra of only one of 11 men (9%) aged over 35. Appreciable bacteriuria was found in six of these 11 men (55%). Noting details of sexual history and screening for sexually acquired pathogens is advocated in younger men with acute epidiymo-orchitis.

Aetiology of urinary symptoms in sexually active women.

Two hundred and fifty six unselected women, 50 of whom had urinary symptoms (frequency of urination or dysuria, or both), and who were attending a department of genitourinary medicine, were investigated. The urinary symptoms were associated both with pyuria and the isolation of undoubted pathogens from midstream urine (MSU) specimens. No associations were found between urinary symptoms and the isolation of Neisseria gonorrhoeae or Chlamydia trachomatis from the urethra or cervix; the recovery of Mycoplasma hominis from the urethra, cervix, or MSU; the recovery of Trichomonas vaginalis or Candida albicans from the vagina; or the presence of bacterial vaginosis. Urethral leucocytosis was associated with the isolation of T vaginalis but not with the recovery of N gonorrhoeae, C trachomatis, C albicans, or urinary pathogens. Pyuria was associated with the isolation of urinary pathogens and with the presence of trichomoniasis; it was not associated with the recovery of C trachomatis or M hominis.

Antimicrobial substances in urine of patients attending department of genitourinary medicine.

The prevalence of antimicrobial substances in the urine of new patients attending a genitourinary department and patients reattending with a new condition (rebook patients) was 4.1% (33 of 812 patients). Only 17 of 33 patients (52%) found to have an antimicrobial in the urine declared their antimicrobial intake at their initial physician interview and examination. The presence of antimicrobial substances had little influence on the diagnosis or management of patients.