Genitourinary Medicine最新文献

Three community trials of the impact of STD treatment interventions on HIV incidence in rural populations have been completed or are in progress in Uganda and Tanzania. Investigators from these trials met for a joint technical workshop in Baltimore in May 1996. This report summarises the consensus of the workshop, with the aim of providing useful input to research on HIV intervention strategies. Issues discussed include: (i) the role of community randomised trials; (ii) strategies for STD management; (iii) epidemiological and statistical issues in the design and analysis of community randomised trials; (iv) diagnostic methods for STDs in population surveys; (v) treatment regimens for STDs in rural Africa; and (vi) ethical issues in community trials.

Objectives: To asses changes in sexual behaviour and use of contraceptive methods in Danish adolescents from the period before the advent of AIDS up to the present.

Design: Comparative study comparing data obtained from two identical cross sectional surveys

Setting: Grenaa Gymnasium, Denmark.

Subjects: 626 high school students in 1982 and 499 high school students in 1996.

Methods: An anonymous standardised self administered questionnaire handed out to high school students at Grenaa Gymnasium in spring 1982. In spring 1996 an identical questionnaire was handed out to every high school student at the same gymnasium.

Main outcome measures: Age at first sexual intercourse, contraceptive use, and reasons for choice of contraceptive strategy.

Results: Today more males had experienced the first sexual intercourse before their 16th birthday (p = 0.047) compared with 1982, the reverse held for females (p = 0.003). From 1982 to 1996 condom use increased in males with no regular partner (p = 0.009). In females with no regular partner, there was during the same period an increase in considering the condom a personal contraceptive method (p = 0.017). In 1982 and 1996 protection from sexually transmitted diseases was given as reason for the choice of contraceptive strategy by 21% and 72% of males with no regular partner (p < 0.001), and by 7% and 32% of males with a regular partner (p < 0.001). The corresponding figures for females in 1982 and 1996 were 10% and 71% (p < 0.001) for those with no regular partner and 4% and 21% (p < 0.001) for those with a regular partner.

Conclusion: Condom use has increased among adolescents with no regular partner brought up under the widespread awareness of AIDS, and the reason for this is to be protected from sexually transmitted diseases. A future decline in the incidence of various sexually transmitted diseases may be expected, and information on safe sexual practices should be continued.

Aims: To objectively assess the psychological and psychosexual morbidity of patients with vulvar vestibulitis.

Methods: 30 patients with variable degrees of vulvar vestibulitis were recruited from a vulval clinic. Each patient underwent a detailed history and clinical examination. Friedrich's criteria were used for the diagnosis of vulvar vestibulitis. Standardised questionnaires to assess psychological and psychosexual function were completed by the patient before review. These questionnaires were the STAI and a modified psychosexual questionnaire introduced by Campion.

Results: Patients experienced considerable psychological dysfunction compared with controls. All aspects of psychosexual dysfunction were affected.

Conclusions: When managing patients, psychosexual and psychological issues must be considered in addition to other conventional types of therapy. Vulvar vestibulitis may be a risk factor for developing psychosexual complications including vaginismus, low libido, and orgasmic dysfunction. Consideration of these factors must be an integral part of the management of patients with all chronic vulval conditions.

Objective: To investigate, by use of the Amplicor PCR in a routine setting, the recovery rate of Chlamydia trachomatis in ano-rectal and pharyngeal swab samples obtained from males and females attending an STD clinic in relation to sexual practices, symptoms, and signs.

Design: Data regarding sexual practices, and symptoms and signs related to the rectum and pharynx, were obtained from 196 females and 208 males, including 31 homosexuals and eight bisexuals. Swab samples were obtained from the urethra, rectum, and pharynx from all the patients. An additional endocervical swab sample was obtained from the females.

Methods: All samples were analysed by the Amplicor PCR (Roche).

Setting: Rudolph Bergh's Hospital, a clinic for sexually transmitted diseases situated in the centre of Copenhagen, Denmark.

Results: The overall prevalence of urogenital C trachomatis infection was 9.2% (37/404). The specificity of the Amplicor PCR was 100% for both ano-rectal and pharyngeal swab samples. In females three (13%) of the 23 infections were detected only by testing an ano-rectal or throat swab sample. In homosexual males two (67%) of three infections were detected only by the anorectal swab sample. Ano-rectal intercourse without use of condom was reported by 44% of females and by 52% of homosexual males. Fellatio without condom use was reported by 91% of females, and 80% of heterosexual males practised cunnilingus. Pharyngeal infection, however, occurred only in females, and the presence of pharyngeal symptoms or signs seemed predictive for pharyngeal C trachomatis infection, for which the time of incubation or colonisation exceeded 3 months. The presence of ano-rectal signs or symptoms was not predictive for an ano-rectal C trachomatis infection.

Conclusion: The Amplicor PCR can be used on ano-rectal and pharyngeal swab samples. Ano-rectal swab samples should be obtained in females and homosexual males at high risk of being infected. Pharyngeal samples should be taken in females at high risk of being infected, especially when pharyngeal signs or symptoms are present.

Objective: To define risk factors for gonococcal infection.

Methods: A case-control study comparing 200 gonorrhoea cases with 400 patients with non-gonococcal genitourinary infections and 400 patients with various skin diseases, all of them attending City Department for Skin and Venereal Diseases In Belgrade (Yugoslavia) from October 1993 to December 1994.

Results: According to multivariate logistic regression analysis the following factors were significantly related to gonorrhoea in men: education level, sexual contact same day as meeting, condom use, history of prior gonorrhoea, and casual and/or new sex partner in the past month. Age, sexual contact same day as meeting, number of partners in the past year, and frequency of sexual intercourse in the past month were independently, significantly related to gonorrhoea in women. Also, in females, gonorrhoea was significantly more frequent in industrial workers and supported people.

Conclusion: Since sexual behaviour, low education level, younger ages, and low socioeconomic status were found to be related to gonococcal infection, health education at early age seems to be the most appropriate means of altering high risk behaviour.

Objectives: To determine the current utilisation of genitourinary medicine (GUM) services by general practitioners (GPs) and any changes likely to occur with moves towards a primary care led NHS.

Methods: A questionnaire survey of practising GPs appearing in the Medical Directory in England and Wales to determine the effect of geographical location, fundholding status, and potential effect of total fundholding on referrals to GUM clinics.

Results: Referral patterns for STDs varied according to the genital infection concerned, being highest for gonorrhoea and lowest for Trichomonas vaginalis infection. Referral patterns were little affected by geographic location of the practice or fundholding status. The reported intention on becoming total fundholding was a modest shift towards more STDs being treated in the community which varied according to the genital infection concerned.

Conclusions: Although some GPs elect to always treat some STDs in the community most refer patients to GUM clinics. There appears to be little enthusiasm among GPs, should they become total fundholders, to extend their range of services to include STD provision.

Objective: To determine the prevalence of asymptomatic and unrecognised genital tract infections among women attending a family planning clinic in rural South Africa.

Methods: 189 consecutive women had genital samples taken to diagnose infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Treponema pallidum, and HIV, and to diagnose bacterial vaginosis.

Results: Mean age was 25 years; 155 (82%) were unmarried, 156 (83%) were currently using contraception, and 41 (22%) reported having an STD treated in the preceding 12 months. Although none volunteered abnormal urogenital symptoms, 74 (39%) had at least one elicited by direct questioning. 119 women (63%) had at least one genital infection: N gonorrhoeae (eight; 4%), C trachomatis (14; 8%), T vaginalis (26; 14%), C albicans (56; 30%), active syphilis (15; 8%), HIV (44; 24%), and bacterial vaginosis (29; 15%). 49 women (26%) had multiple infections. Most infections (71; 60%) were asymptomatic. Symptomatic women failed to recognise and report their symptoms, and routine services failed to detect the infections.

Conclusion: Prevalence of genital tract infection is high among these women, most infections are asymptomatic, and symptomatic infections are frequently not recognised. Women attending family planning clinics in such settings should be screened for syphilis and offered testing for HIV infection. Strategies to detect and treat other genital infections need to be developed.