Sexually transmitted diseases and HIV-1 infection among homosexual men in England and Wales.

OBJECTIVE: To examine surveillance data for evidence of changing sexual behaviour and continuing transmission of HIV-1 among men who have sex with men. DESIGN: Analytic study of surveillance data on sexually transmitted diseases. SETTING: England and Wales. MAIN OUTCOME MEASURES: Number of cases of rectal gonorrhoea and newly diagnosed HIV infection in homosexual men. RESULTS: New cases of gonorrhoea among men attending genitourinary medicine clinics increased by 7.7% in 1989 and by 4.2% in 1990. Reports of rectal isolates of Neisseria gonorrhoeae also rose and the male to female ratio for patients with rectal gonorrhoea changed from 0.3:1 during 1988-9 to 2.6:1 in 1990-1. Although the overall number of cases of acute hepatitis B fell during 1988-91, 81 and 82 homosexual men were infected in 1990 and 1991 respectively compared with 50 and 42 in 1988 and 1989. 1526 men had HIV-1 infection diagnosed in 1991, the largest number since 1987. Twenty eight of the 97 (29%) men who seroconverted between January 1989 and December 1991 were aged less than 25. The proportion of men aged 15-19 who were found to be infected with HIV-1 at their first test increased from an average of 2.4% up to 1990 to 4.7% in the first nine months of 1991. The prevalence of HIV infection in men under 25 attending genitourinary medicine clinics in London was 17% compared with 7.8% outside London. CONCLUSION: Unsafe sexual behaviour and HIV transmissions have increased among homosexual men after a period of decline. Recent HIV transmissions may disproportionately affect younger men.

Performance assessment of neonatal dried blood spot testing for HIV antibody.

A study was undertaken to assess the performance of laboratories participating in the UK unlinked anonymised neonatal screening programme for the detection of HIV antibody. A coded panel of 100 contrived dried blood spots prepared form well characterised anti-HIV-1 and anti-HIV-2 positive sera and an anti-HIV negative serum was distributed to eight testing centres. Fifty-one out of 52 anti-HIV-1 positive samples were identified by all eight laboratories: five laboratories identified all 52 specimens. Only one laboratory detected all four anti-HIV-2 positive spots. None of the laboratories reported a seronegative spot as reactive. The sensitivity of anonymised neonatal anti-HIV-1 screening was deemed satisfactory in all participating laboratories but the margin of sensitivity was insufficient to allow pooling of dried blood spot eluates before testing. Technical modifications would be necessary to increase sensitivity for anti-HIV-2 were HIV-2 infection to be reported more frequently in the UK. Performance assessment of the screening programme should be repeated at regular intervals.

Exercise test for growth hormone deficiency.

An exercise test measuring energy expenditure was performed on a bicycle ergometer by 98 patients in the outpatient clinic. Results concordant with the final diagnosis were obtained in 89% of the 75 children referred because of short stature and in 65% of the 23 children with associated chronic disorders.

Pertussis: what percentage of children can we immunise?

The immunisation records of 584 children who were born between 1978 and 1982, in a general practice of average social class distribution, were examined: 3.5% of the children would have been excluded from starting a course of vaccination including pertussis using contra-indications established by the Department of Health and Social Security. A further 3.5% had reactions to immunisation that were judged severe enough to prevent completing the course of vaccination. In 1981 and 1982 13% of parents refused pertussis vaccination, considerably fewer than from 1978 to 80. Concomitantly, immunisation against pertussis rose from 51% to 84% over the five year period. Given the incidence of contra-indications and the level of parental refusal, it is concluded that a pertussis uptake of 80% would be a reasonable target for any population.