HIV diagnosis: why and how do we miss important clues?

Research has found that a significant proportion of patients diagnosed late with HIV infection had been in contact with healthcare professionals in the preceding year with symptoms attributable to HIV. We report a unique case of late HIV diagnosis missed when seen by a number of specialists and discuss whether with better communication the diagnosis could have been alerted earlier.

Anorectal manifestations of sexually transmitted infections.

Sexually transmitted infections have a wide range of clinical presentations, including involvement of the anal verge, anal canal and rectum. This review focuses on anorectal sexually transmitted infections which may cause diagnostic difficulty when encountered by the coloproctologist. An approach to the diagnosis of a variety of sexually transmitted infections is set out, with a discussion of the role of biopsy and a summary of relevant histopathological findings. The value of early antibiotic treatment is discussed. Problems related to HIV/AIDS are highlighted, as clinical presentation may be atypical in immunosuppressed individuals. Sexually transmitted oncogenic viruses and their role in anal neoplasia are also briefly summarized.

Recurrent bacterial vaginosis--an old approach to a new problem.

Bacterial vaginosis (BV) is a common cause of abnormal malodorous vaginal discharge and can be frustrating to manage in its recurrent form. Metronidazole is the standard treatment, but is unacceptable to many women when given repeatedly. Results of treating recurrent BV using a single vaginal washout with 3% hydrogen peroxide are analysed. A total of 30 symptomatic women with clinically confirmed recurrent BV in the absence of other genital infections were recruited after informed consent. Hydrogen peroxide (3%) was instilled into the vagina, left for 3 minutes and drained. Reassessment was at 3 weeks after treatment. A total of 23 women completed the study. Symptoms cleared completely in 78% (18/23), improved in 13% (3/23) and remained unchanged in 9% (2/23). All the 3 women with improved symptoms had a mild vaginal discharge, but only one of them was still able to perceive the malodour. The amine test was negative in all 23 women including the 2 (9%) who felt no change in their symptoms following treatment. Mixed anaerobes isolated in all women before treatment were not re-isolated, and microscopy did not show 'clue cells' in the vaginal discharge following treatment. Vaginal acidity was restored to normal in all but one (96%). No side-effects were observed in the treated women. Hydrogen peroxide (3%) used as a single vaginal wash was as effective as any other agent in current use in clearing the vaginal malodour of bacterial vaginosis at 3 weeks after treatment.

Managing women with human papillomavirus changes in cervical cytology.

Of 86 women with cervical cytological evidence of human papillomavirus (HPV) infection who underwent colposcopy, 55 yielded histological confirmation of HPV infection and 17 of them had cervical intraepithelial neoplasia (CIN). Of 51 women followed up six months after cryotherapy of their cervical lesions, 46 showed no evidence of HPV infection in their cervices. Of the patients with CIN lesions, only one out of the 16 followed up had persistent CIN II six months after treatment, which gave a clearance rate of 94% for early CIN lesions treated by this method. Of 62 sexual partners examined, 48 had sexually transmitted infections, 38 of them genital warts. The use of colposcopy with directed punch biopsy is a practical way of managing patients whose cervical smears suggest HPV infection. Cryotherapy is effective in treating histologically confirmed cervical HPV and associated minor CIN lesions. Contact tracing and screening for other sexually transmitted diseases is an integral part of managing genital warts.

Osteomyelitis presenting as a swollen elbow in a patient with the acquired immune deficiency syndrome.

A patient suffering from the acquired immune deficiency syndrome (AIDS), who developed swelling of the left elbow four weeks after Staphylococcus aureus septicaemia is reported. The cause was osteomyelitis of the olecranon process.