Phylogenetic analysis of multiple heterosexual transmission events involving subtype b of HIV type 1.

Between 1996 and 1999 thirteen cases of HIV infection were detected in Doncaster, a small town in the north of England (population approximately 250,000). A complex network of shared sexual histories involving local nightclubs linked these cases, with the only known risk factor being heterosexual intercourse. A series of frozen blood samples was collected in 1998-1999 and amplified by PCR to generate full-length gp120 clones. Sequencing demonstrated that all the transmission events in this heterosexual group involved the B subtype of HIV-1. When relationships between the samples were assessed it became clear that these 13 cases represented at least three separate strains of HIV-1, indicating that HIV is well established in this community. Eleven of the 13 cases were related, forming two distinct groups. Further investigation revealed that one group contained five patients whose general health was good and who were not receiving HAART. In contrast, the second group of six patients, including the putative index case, were symptomatic, receiving HAART, and may have been infected with a CXCR-4-utilizing virus. Several of the cases that were linked by genetic criteria were not linked by contact tracing, implying that further undiagnosed cases may exist in this community. To our knowledge, this is the largest outbreak of HIV studied within the heterosexual community in the United Kingdom to date, suggesting that this route of infection is becoming more common within the United Kingdom.

Natural history of adhesional small bowel obstruction: counting the cost.

BACKGROUND: The aim of this study was to identify patients admitted with adhesional obstruction to determine if there was an identifiable pattern to the type of initial operation, the type of treatment used for the obstructive episode and the subsequent need for further treatment. METHODS: Patients with adhesional obstruction were identified retrospectively in a cross-sectional study using ICD codes relating to admissions in the years 1990 to 1996. The case notes were used to assess their outcome. RESULTS: Fifty-nine case notes from a total of 175 identified initially satisfied the inclusion criteria. These patients had a mean age at presentation of 51 (range 16-88) years and had undergone a total of 122 operations. Thirty-one patients (53 per cent) had a single previous operation with a median time to presentation with obstruction of 5.5 years (range 11 days to 34.7 years); 33 patients (56 per cent) were treated conservatively on their first admission. There was no statistically significant difference in the outcome in patients who received either conservative or surgical treatment. The length of stay in patients treated surgically (median 11 (range 2-47) days) was significantly longer than that for those treated conservatively (median 6 (range 1-39) days) (P< 0.001). A flow chart was constructed demonstrating the eventual outcome of the patients in the study, enabling the cost of adhesional obstruction to be calculated. CONCLUSION: This type of approach could be used to assess the potential effect of different treatment strategies for adhesional obstruction.

A study of the prevalence of male intrameatal warts using meatoscopy in a genitourinary medicine department.

A cross-sectional study is undertaken to determine the prevalence of male intrameatal and distal urethral warts, using meatoscopy. A group of 169 patients presenting for anogenital warts and a group of 74 unselected patients attending the Department for a variety of reasons during the study period, were examined. Twenty-one patients (13.5%) out of 155 patients with anogenital or related warts had external warts at the meatus. Of these 21 cases, 12 (57.1%) had further extension of their warts into the distal urethra. Fifteen other cases of intrameatal and distal urethral warts were detected in the absence of external warts at the meatus. Twenty-three cases out of 107 males with genital warts (21.5%) were found to have intrameatal or distal urethral warts, thus reflecting the common occurrence of these lesions. A highly significant association between the presence of intrameatal/distal urethral warts and the presence of male genital warts was found (P = 0.003). One hundred and fifty-three repeat meatoscopic examinations were carried out, 6 weeks after their first examination. Three new cases of intrameatal/distal urethral warts were found. Intrameatal and distal urethral warts occurred from a depth of 5 mm to 25 mm. One hundred and eighty-three female partners of the study patients were examined. An association between the presence of intrameatal/distal urethral warts and female anogenital warts was found (P = 0.028). No corroborating association between the presence of male and female anogenital warts was found (P = 0.47). This observation may have a bearing on disease transmission and control. The detection of intrameatal/distal urethral warts will be important in achieving successful treatment of male anogenital warts.

Sampling for vaginal candidosis: how good is it?

In defined patient populations attending a genitourinary medicine department, screening for vaginal candidosis resulted in 26.3% positive rate. Microscopy using Gram-stained slide was useful in early diagnosis and resulted in the detection of 64.8% of symptomatic cases. Samples from the anterior fornix proved most sensitive for culture diagnosis while the left lateral vaginal wall proved least sensitive (positive predictive value 0.88 cf 0.81).

The value of primary colposcopy in genitourinary medicine--a six year review.

OBJECTIVE: To evaluate the effectiveness of primary colposcopy in the genitourinary medicine setting by comparing the cervical cytology and punch biopsy results for women identified as having an abnormal cervical transformation zone. METHOD: A retrospective audit of six years' findings in primary colposcopy was carried out. The punch biopsy findings of 1338 women were compared with their last cervical cytology results. A small sample of biopsies were subjected to in situ hybridisation for human papilloma virus types 6, 11, 16, 18 and cytomegalovirus. RESULTS: The tabulated results demonstrated the variability between histology and cytology. This was explored with reference to other studies. The viral typing showed the dominance of low oncogenic risk human papilloma virus types. CONCLUSION: The findings are discussed against the overall concept of sexual health. Primary colposcopy facilitates empowerment of the patient and her partner through the opportunity for demonstration and explanation of disease processes and options for management. Experience and expertise gathered in six years of primary colposcopy confirm the value of primary colposcopy not only in improved diagnosis and management but also in teaching, audit and research.

Lichen sclerosus and acute urinary obstruction.

A case of acute urinary obstruction due to early lichen sclerosus disease is described. In this case both histological corroboration and efficacy of potent topical steroid have been beneficial.

Evidence of infection with Chlamydia trachomatis in patients with pelvic inflammatory disease: value of partner investigation.

A retrospective analysis was made of the records of 71 women with clinically diagnosed PID presenting to the Department of Genito Urinary Medicine in Doncaster. Twenty-nine of the 71 women (40.8%) showed evidence of active chlamydial infection. Six women (8.5%) had infection with N. gonorrhoeae. Of the 45 male partners investigated, 16 (35.6%) had recoverable C. trachomatis in the anterior urethra. Only four (8.9%) had gonorrhea.