Measuring the gap: from Home Office to the National Health Service in the provision of a one-stop shop sexual health service in a female prison in the UK.

The Genitourinary (GU) Medicine Service was transferred from the Home Office to the NHS from April 2006 at this female prison to give prisoners access to the same quality of health care as the general public. Medline search showed no published data on the prevalence of sexually transmitted infections (STIs) among female prisoners in the UK. The main aim was to develop a one stop sexual health shop and to determine the prevalence and risk factors for STIs, to determine the uptake rate for HIV testing, hepatitis B vaccination and cervical cytology along with requests for usage of contraceptive services. Challenges were met when introducing change to bring the services in line with the local GU medicine clinic. Review of the service at one year along with retrospective case note review from May 2006 to August 2007 was done. Of the 545 new patients seen, history of substance abuse, IVDU, sexual abuse, sex worker and past history of hepatitis C virus and chlamydia were 86%, 41%,12%, 6%, 17% and 24% respectively.The uptake rate for both STI screen and blood-borne viruses (BBVs) testing was high at 87% and 69.3% respectively. STI was diagnosed in 19.6%. Prevalence rates were: Trichomonas vaginalis (TV) 8.2%, chlamydia 5.3%, gonorrhoea 0.2%, genital warts 5.3%, HIV 0.8%, hepatitis C virus 12% and hepatitis B virus 11%. The uptake rate for 1(st) dose hepatitis B vaccination and cervical cytology were 70% and 92% respectively, 36 accessed contraceptive services. Provision of one stop shop in a female prison is feasible and practical. STIs, particularly TV, and BBVs prevalence is high among the female inmates. Prevention methods targeting this population needs to be intensified.

Stroke in pregnancy associated with syphilis.

The Incidence of Syphilis has increased in developed countries over recent years. This potentially could lead to a rise in the number of cases presenting in obstetrics and a resurgence of congenital syphilis. Syphilis is a treatable condition, screening in pregnancy is both cost effective and cost beneficial. We describe a rare presentation of syphilis in a young woman in early pregnancy. The patient presented with a stroke, at which time her partner was diagnosed with early latent syphilis. Her findings were thought to be consistent with meningovascular syphilis and treatment lead to resolution of her symptoms. Antenatal screening for syphilis is offered to all women in the UK. Changing migration patterns and high-risk behavior however, may cause cases to go undetected. Vigilant screening for syphilis is needed in pregnancy as prompt diagnosis and management will aim to cure the mother whilst preventing the adverse effects associated with congenital syphilis.

Pseudohepatic tumour associated with secondary syphilis in an HIV-positive male.

Inflammatory pseudohepatic tumours are unusual tumour-like conditions which can easily be mistaken for malignant lesions or liver abscesses. Patients usually present with fever, abdominal pain and loss of weight. The aetiology is unclear but the predominant inflammatory pattern of pathology and the associated systemic reactions suggest an underlying infectious agent. In the majority, microorganisms are not detected. As even routine imaging procedures usually fail to distinguish hepatic pseudotumours from liver neoplasms, biopsy is the definitive means of diagnosis. Until now, no case of pseudohepatic tumour has been reported as being associated with secondary syphilis. We believe secondary syphilis is the cause of this pseudohepatic tumour in our HIV-positive male.

Pigmented penile macules.

There are two opposing schools of thought regarding the management of pigmented penile macules. Allan and Spitz, as well as Pack and Davis, are of the opinion that almost all pigmented naevi present on the palms, soles and genitalia are junctional naevi and have a higher incidence of malignant change and, therefore, should be removed. On the other hand, because most cases of penile and urethral melanomas arise de novo with only a few arising from previous long-standing naevi and as precursor lesions are not identified in most cases, Scott et al. and Stegmaire et al. consider prophylactic excision unnecessary. A more practical approach has been taken up by Barnhill et al. and their view is that management should be individualized with multiple biopsies to establish the diagnosis. The purpose of this paper is to review the literature regarding the natural history, risk of melanoma development on the penis and the management of cases presenting with pigmented penile macules.