Genitourinary Medicine最新文献

英文中文

Managing Family Planning in General Practice 在全科医学中管理计划生育

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/STI.73.4.327

C. Thomas

引用次数: 3

Microbiological diagnosis of gonorrhoea. 淋病的微生物诊断。

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.245

A E Jephcott

Gonorrhoea is caused by Neisseria gonorrhoeae. This is a delicate and fastidious organism which dies rapidly if exposed to desiccating or oxidising conditions and requires a moist carbon dioxide enriched atmosphere and a nutrient medium if it is to be cultured successfully. For these reasons diagnosis by culture was regarded as difficult and uncertain, but many decades ago the problems were overcome, and culture became the method of first choice for diagnosis, and remains the "gold standard" against which others are measured.' However, culture is by no means the only method available for diagnosis of gonorrhoea, and others offer alternative advantages such as speed, robustness, or technical simplicity, and no single method is appropriate in all situations. In the typical UK microbiology laboratory specimens to be examined for gonococci will usually have been taken from patients in whom there is a significant likelihood of infection, and, on the results obtained, therapy is likely to be administered. Prevalences will vary, but are likely to be highest in patients attending genitourinary medicine clinics and somewhat lower in other patient groups. However, specimens may also be received as part of continuous or intermittent monitoring of particular population groups such as antenatal clinic patients. Here the aim, while including the treatment of any infected patients identified, is primarily to establish background knowledge of the prevalence of infection in that community. Tests employed in these differing situations will need to meet different performance criteria. Where a clinician is seeking to identify infection in an individual patient the sensitivity of the test (that is, the likelihood of a genuine infection being detected by the test) is of paramount importance, whereas the risk of encountering a false positive result-which relates to the specificity of the test, will be of lesser importance.2 However, in a situation where infection rates are low the problems of encountering false positive results will become more significant, so that the specificity of the test system employed will take on increasing importance and some sensitivity may have to be sacrificed. Moreover, in any situation the likelihood of any test result, either positive or negative, being accurate (the so called positive and negative predictive values) will depend on the number of genuine cases present in the population tested, as well as on the sensitivity and specificity of the test.2 Thus, when numbers are low specificity becomes increasingly important, whereas in a population with a high prevalence of infection, optimal sensitivity should be sought. Elsewhere in the world the availability of laboratory facilities, and the technical expertise available in these, can be very different from those normally found in the UK, and the prevalence of infection may well be far higher. All these variables will affect the choice of the optimal test to employ-as will financial consi

{"title":"Microbiological diagnosis of gonorrhoea.","authors":"A E Jephcott","doi":"10.1136/sti.73.4.245","DOIUrl":"https://doi.org/10.1136/sti.73.4.245","url":null,"abstract":"Gonorrhoea is caused by Neisseria gonorrhoeae. This is a delicate and fastidious organism which dies rapidly if exposed to desiccating or oxidising conditions and requires a moist carbon dioxide enriched atmosphere and a nutrient medium if it is to be cultured successfully. For these reasons diagnosis by culture was regarded as difficult and uncertain, but many decades ago the problems were overcome, and culture became the method of first choice for diagnosis, and remains the \"gold standard\" against which others are measured.' However, culture is by no means the only method available for diagnosis of gonorrhoea, and others offer alternative advantages such as speed, robustness, or technical simplicity, and no single method is appropriate in all situations. In the typical UK microbiology laboratory specimens to be examined for gonococci will usually have been taken from patients in whom there is a significant likelihood of infection, and, on the results obtained, therapy is likely to be administered. Prevalences will vary, but are likely to be highest in patients attending genitourinary medicine clinics and somewhat lower in other patient groups. However, specimens may also be received as part of continuous or intermittent monitoring of particular population groups such as antenatal clinic patients. Here the aim, while including the treatment of any infected patients identified, is primarily to establish background knowledge of the prevalence of infection in that community. Tests employed in these differing situations will need to meet different performance criteria. Where a clinician is seeking to identify infection in an individual patient the sensitivity of the test (that is, the likelihood of a genuine infection being detected by the test) is of paramount importance, whereas the risk of encountering a false positive result-which relates to the specificity of the test, will be of lesser importance.2 However, in a situation where infection rates are low the problems of encountering false positive results will become more significant, so that the specificity of the test system employed will take on increasing importance and some sensitivity may have to be sacrificed. Moreover, in any situation the likelihood of any test result, either positive or negative, being accurate (the so called positive and negative predictive values) will depend on the number of genuine cases present in the population tested, as well as on the sensitivity and specificity of the test.2 Thus, when numbers are low specificity becomes increasingly important, whereas in a population with a high prevalence of infection, optimal sensitivity should be sought. Elsewhere in the world the availability of laboratory facilities, and the technical expertise available in these, can be very different from those normally found in the UK, and the prevalence of infection may well be far higher. All these variables will affect the choice of the optimal test to employ-as will financial consi","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20318301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 38

Psychological factors in recurrent genital herpes. 复发性生殖器疱疹的心理因素。

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.253

J Green, A Kocsis

Objectives: To review recent research into psychological aspects of genital herpes and assess possible implications for clinical practice.

Methods: Review of all papers in the field on Medline 1985-96.

Results: Much attention has been paid to possible links between stress and recurrent genital herpes. There is no convincing evidence that stress in itself causes recurrences. It may be that recurrences are preceded by a prodromal period of altered mood. Patients with recurrences show considerable stress as a result of the disease, although most individuals eventually adjust psychologically. The impact of social support on adjustment remains unclear. The little evidence available suggests that antiviral treatments can help adjustment and the effects may perhaps outlast the period of active treatment.

Conclusions: Existing research gives some clues to optimal patient management but there is a need for future research to focus much more clearly on clinical issues, particularly on means of alleviating psychological distress and on the impact of antivirals.

目的:回顾最近对生殖器疱疹的心理方面的研究，并评估可能对临床实践的影响。方法:查阅Medline 1985- 1996年该领域的所有论文。结果:压力与复发性生殖器疱疹之间可能存在的联系引起了人们的广泛关注。没有令人信服的证据表明压力本身会导致复发。可能在复发之前有一段情绪改变的前驱期。复发的病人由于疾病表现出相当大的压力，尽管大多数人最终在心理上进行了调整。社会支持对调整的影响仍不清楚。现有的少量证据表明，抗病毒治疗可以帮助调整，其效果可能比积极治疗持续更长时间。结论:现有的研究为优化患者管理提供了一些线索，但未来的研究需要更加明确地关注临床问题，特别是减轻心理困扰的方法和抗病毒药物的影响。

引用次数: 47

Pyrexia of undetermined origin in advanced HIV disease. 晚期HIV疾病中不明原因的发热。

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.308

C M Tang, C P Conlon, R F Miller

引用次数: 0

Sexual health: what's in a name? 性健康:名字有什么关系?

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.323

A Dillon, B Anderson, B Donovan

引用次数: 0

Photosensitivity due to saquinavir. 沙奎那韦引起的光敏性。

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.323-a

A J Winter, J M Pywell, J M Ilchyshyn, J Fearn, D Natin

引用次数: 7

Genital ulceration revealing a primary cutaneous anaplastic lymphoma. 生殖器溃疡显示原发性皮肤间变性淋巴瘤。

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.325

B Cribier, D Lipsker, E Grosshans, C Duhem, C Capesius, M Dicato

general population in this high risk area, HIV test requests in the general practice sentinel network in Amsterdam have been recorded from 1989 to 1992, and from September 1994 to September 1996. The coverage of the network was reduced from 10% (198992) to 7% (1994-5) and 2% (1995-6) of the Amsterdam population, but it remained representative in terms of distribution of practices over the city and sex-age distribution. Through the years, homosexual men accounted for 15-20% of the HIV test requests and drug users for 3-6%. The average yearly incidence of test requests between 1989 and 1992 was 5-3 (4.7-5.5) per 1000 patients, after which it decreased to 3.9 (1994-5) and 2-6 (1995-6). The average percentage of positive test results between 1989 and 1996 was 7.0 (5.9-9 0), with peaks in 1991 (8.6%) and 1994-5 (9.0%). In the nationwide general practice sentinel network, which covers about 1% of the Dutch population, the yearly incidence of HIV test requests per 1000 patients rose steadily from 0-8 (1988) to 1-8 (1993). Of the tests performed, an average of 1% were positive.2 The higher incidence of test requests and positive test results in general practices in Amsterdam confirm the status of Amsterdam as a high risk area for HIV. The marked decline since 1992, in the incidence of test requests in general practices in Amsterdam is interesting, as it contradicts the trend seen elsewhere in the Netherlands. This may well reflect a certain saturation towards HIV testing among the general population in a high risk area. Towards the end of 1996, the new effective combination treatment for HIV became available.3 This is expected to stimulate HIV test requests from individuals who have been at risk for HIV but have not tested before. Given the trend described here, it remains to be seen if a rise in HIV test requests will occur in Amsterdam. L WIGERSMA Department of General Practice, Academic Medical Centre, Meibergdreef 15, 1105 AZ Amsterdam, Netherlands

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引用次数: 9

A comparison of the sensitivity of the InPouch TV, Diamond's and Trichosel media for detection of Trichomonas vaginalis. InPouch TV、Diamond’s、Trichosel培养基检测阴道毛滴虫的灵敏度比较。

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.297

K A Borchardt, M Z Zhang, H Shing, K Flink

Objective: This study compared the ability of three culture media (InPouch TV, Diamond's, and Trichosel) to support the growth of clinical isolates of Trichomonas vaginalis and their relative sensitivity for detection of the organism.

Methods: The majority of the clinical isolates were obtained from two San Francisco Bay Area clinics. T vaginalis was subcultured in 4 ml of one of the InPouch, Diamond's, or Trichosel media for 24-48 hours before evaluation. Twenty isolates were initially cultured in the InPouch test, 13 with Diamond's, and 10 with Trichosel. A haemocytometer was used to measure the initial concentrations of the organisms. Then serial dilutions were made in saline to yield approximately 2.0 x 10(4), 2.0 x 10(3), and 2.0 x 10(2) motile T vaginalis per ml. A 30 microliter inoculum from each dilution was transferred into 4 ml aliquots of the three media (387 individual tests, 43 x 3 dilutions x 3 media). Microscopic examinations for viable trichomonads were made at 24, 48, and 96 hours. Microscopy was through the pouch wall for the InPouch medium, and through a cover slipped slide with one drop of Diamond's and Trichosel media.

Results: At 24 hours, the InPouch demonstrated 84/129 positive, Diamond's 23/129, and Trichosel 18/129. At 48 hours, an accumulative positive rate for the InPouch was 98/129, for Diamond's 55/129, and Trichosel 47/129. At 96 hours the total positives for each test were 112/129 for the InPouch, 78/129 for Diamond's, and 74/129 for Trichosel.

Conclusions: The InPouch TV test was significantly more sensitive than either Diamond's or Trichosel (at 0.01 level of significance, pInPouch > pDiamond's; pInPouch > pTrichosel on all three dilutions at 24, 48, and 96 hours). This increased sensitivity was the result of either a reduced generation time or the larger volume of media examined microscopically.

目的:比较三种培养基(InPouch TV、Diamond’s和Trichosel)支持阴道毛滴虫临床分离株生长的能力及其检测该生物的相对敏感性。方法:大多数临床分离株来自旧金山湾区的两家诊所。在评估前，阴道T细胞在4ml的InPouch、Diamond’s或Trichosel培养基中传代培养24-48小时。20个分离株在InPouch试验中培养，13个用Diamond’s, 10个用Trichosel。用血细胞计测量微生物的初始浓度。然后在生理盐水中进行连续稀释，得到每毫升约2.0 × 10(4)、2.0 × 10(3)和2.0 × 10(2)个阴道活动T细胞。每次稀释后的30微升接种物被转移到4毫升等分的三种培养基中(387个单独试验，43 × 3稀释× 3培养基)。24,48和96小时显微镜检查活滴虫。显微镜通过囊壁检查InPouch培养基，并通过覆盖滑动载玻片检查一滴Diamond's和Trichosel培养基。结果:24小时InPouch阳性84/129,Diamond阳性23/129,Trichosel阳性18/129。48小时时，InPouch的累计阳性率为98/129,Diamond为55/129,Trichosel为47/129。96小时时，InPouch、Diamond和Trichosel检测的总阳性率分别为112/129、78/129和74/129。结论:InPouch TV检测的敏感性显著高于Diamond’s和Trichosel (p < 0.01);在24、48和96小时的三种稀释条件下，均为pInPouch > pTrichosel)。这种增加的灵敏度是由于减少了代时间或在显微镜下检查了更大体积的培养基。

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引用次数: 50

Are reported stress and coping style associated with frequent recurrence of genital herpes? 报告的压力和应对方式是否与生殖器疱疹的频繁复发有关?

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.263

L Cassidy, J Meadows, J Catalán, S Barton

Objectives: This paper reports on the cross sectional data from the longitudinal study examining the impact of genital herpes simplex virus (HSV) infection on quality of life. In particular the report sought to study the relation between recurrence of genital HSV and coping style, mood, personality, and quality of life, among other factors.

Setting and subjects: 116 patients with a known history of genital herpes simplex infection attending the Department of Genitourinary Medicine at Chelsea and Westminster Hospital.

Methods: Psychosocial factors (stress, anxiety, depression, health locus of control, personality, social support, coping skills, and quality of life) and the reported frequency of genital herpes episodes were measured using self administered questionnaires designed to examine the relation between psychosocial status and the frequency of genital HSV episodes.

Results: The number of recurrences reported by patients was significantly related to the style of coping skills used. Higher recurrences were less likely to use problem focused coping skills of planning and active coping, and the emotion focused coping skills of positive reinterpretation and growth. There was a significant difference in the number of patients who believed that psychological stress was related to the number of recurrences they experienced. This belief was related to neuroticism on the Eysenck Personality Questionnaire scale, and not to any of the other measures investigated.

Conclusion: The findings suggest that it is the way individuals cope, and their personality characteristics rather than actual levels of psychological stress, that influence their belief in a link between recurrent genital HSV and stress. HSV may become the focus of existing concerns and be viewed as the physical manifestation of stress.

目的:本文报道了一项纵向研究的横断面数据，该研究考察了生殖器单纯疱疹病毒(HSV)感染对生活质量的影响。该报告特别试图研究生殖器HSV复发与应对方式、情绪、个性和生活质量等因素之间的关系。背景和研究对象:切尔西和威斯敏斯特医院泌尿生殖医学科116例有生殖器单纯疱疹感染史的患者。方法:采用自我管理的问卷，测量心理社会因素(压力、焦虑、抑郁、健康控制点、个性、社会支持、应对技能和生活质量)和生殖器疱疹发作频率，以检验心理社会状况与生殖器疱疹发作频率之间的关系。结果:患者报告的复发次数与应对技巧的使用方式有显著相关。高复发率的学生较少使用以问题为中心的计划应对和主动应对，以及以情绪为中心的积极重新诠释和成长应对。认为心理压力与他们经历的复发次数有关的患者人数有显著差异。在艾森克人格问卷量表中，这种信念与神经质有关，而与其他任何被调查的测量都无关。结论:研究结果表明，是个体应对的方式和他们的个性特征，而不是实际的心理压力水平，影响了他们对复发性生殖器HSV和压力之间联系的看法。HSV可能成为现有关注的焦点，并被视为压力的身体表现。

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引用次数: 27

Nosocomial transmission of tuberculosis in HIV/AIDS units in London. 伦敦艾滋病毒/艾滋病单位结核病的医院传播。

Genitourinary Medicine

Pub Date : 1997-08-01 DOI: 10.1136/sti.73.4.322

K M De Cock, R Miller, A Zumla, J Holton, I Williams

HIV infected individuals are at risk for nosocomially acquired tuberculosis because of increased exposure to tuberculosis in facilities where those with AIDS associated illnesses gather, susceptibility to infection and reinfection, and rapid progression to disease once infection is established.' Restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis isolates allows detection of clusters which may be epidemiologically associated.4 6 Among 79 patients in large clusters in New York City, 25 (32%) were shown to be epidemiologically linked, and 19 (76%) of these identified linkages were hospital associated.7 Since 1985, the HIV/AIDS inpatient unit at University College London Hospitals has seen a median number of 94 new patients with AIDS annually. A total of 73 culture confirmed cases of tuberculosis were diagnosed among this population of patients, for a median number annually (with new or prior AIDS diagnoses) since 1990 of 10 (fig). Three clusters of tuberculosis have been identified. In 1992, two patients developed tuberculosis after hospitalisation at the same time as a patient with pulmonary tuberculosis diagnosed at bronchoscopy.8 In 1994, two patients were shown to have similar RFLP pattems and to have shared time on the same ward. In 1996, RFLP analysis was performed on isolates from five patients with tuberculosis who had been hospitalised for overlapping periods; two who had also shared outpatient attendances for nebulised pentamidine treatment had similar RFLP pattems. One of these last two had been working abroad until he shared time with the other in our treatment facilities, making exposure from an unrelated common source less likely. In total, at least seven (17%) of the 41

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