Genitourinary Medicine最新文献

Objectives: To review the management of a cohort of patients with positive treponemal serology and psychiatric and/or neurological disorders.

Methods: A retrospective case note review of 172 patients with positive treponemal serology attending the Patrick Clement's Clinic, Central Middlesex Hospital between December 1990 and November 1995 was performed.

Results: 101 men and 71 women were new attenders diagnosed with positive treponemal serology. A neurological problem was identified in 27 patients (12 women and 15 men) with psychiatric and/or neurological disorders, of whom 20 (six women and 14 men) underwent investigation of the cerebrospinal fluid (CSF). With the medical history and results of CSF-RPR and FTA tests, white cell count (WCC), and total protein level in the CSF, 10 patients (eight men and two women) were diagnosed with likely neurosyphilis and 17 with neurological disorders not thought to be caused by syphilis. The clinical features in those having neurosyphilis were sensorineural hearing loss (n = 5) and tabes dorsalis (n = 5). In the seven patients diagnosed with neurosyphilis who underwent CSF examination one patient had a reactive CSF-FTA, elevated protein, and elevated WCC; one patient had a reactive CSF-FTA and RPR with elevated protein; the total protein only was elevated in three cases and the WCC elevated in one case. Nine of the 10 patients with neurosyphilis received adequate neurosyphilitic treatment; one patient was lost to follow up.

Conclusions: The management of patients with positive treponemal serology and psychiatric and/or neurological disorders was consistent. Patients with suspected neurosyphilis or patients with neurological signs compatible with neurosyphilis (who did not undergo CSF examination) were treated with adequate neurosyphilitic therapy.

Objectives: To investigate the provision for sexual health care of adolescents in genitourinary medicine clinics in the United Kingdom.

Methods: A questionnaire was sent to all 170 consultants in charge of genitourinary medicine clinics in the United Kingdom.

Results: Completed questionnaires were received from 119 consultants in charge of clinics. Eleven per cent of attenders during April-June 1995 were aged under 20 years. Attenders aged under 16 years and from 16-19 years old were found to have significantly higher rated of gonorrhoea than those aged over 19. The same applied to male attenders with chlamydia. Female attenders aged 16-19 had significantly higher rates of anogenital warts than those aged over 19. Thirty six per cent of female cases of gonorrhoea occurred under the age of 20 years. In most clinics (74%) it was policy for a new clinic attender aged under 16 years to see a health adviser. Most clinics (79%) provided emergency contraception, but few (14%) had a full contraception service. Most clinics participated in STD/HIV/sexual health education in the local community, especially in schools (74%) and colleges (70%). Seventy five per cent of health authorities had medical services designated for young people, but only 18% had such services which offered screening for STDs. Only 4% of genitourinary medicine clinics held sessions which were designated for young people (upper age limit 21 years or less).

Conclusions: Genitourinary medicine clinics in the United Kingdom provide a range of services, including extensive education in the community, to promote sexual health among adolescents. A critical evaluation of the quality of health education activity by genitourinary medicine clinics would be of interest.

Objective: To determine the seroprevalence of treponemal infection and possible risk factors among children aged 0-14 in the general population of a rural Tanzanian village.

Methods: The survey was conducted as a part of a cross section study of a total village population on HIV and sexually transmitted disease. Among 1708 registered children aged 0-14, the 553 first attending were tested for treponemal infection with both rapid plasma reagin test (RPR) and Treponema pallidum Haemagglutination test (TPHA). These children belonged to a household cohort--also including their parents, siblings, and other household members--with 1339 members; 1224 (91.4% participated in the survey and 82.1% of these were tested for treponemal infection.

Results: The overall prevalence for the TPHA test was 6.4% among girls and 1.1% among boys (odds ratio, OR = 6.5; 95% confidence interval, CI: 1.9-22.3). The sex difference was most pronounced in the age group 10-14; 11.1% among girls versus 1.0% among boys (OR = 12.8; CI: 1.6-101.9). Among the 20 children who were TPHA positive, we found two cases of active, congenital syphilis. There was a lack of association between positive serology in children and positive serology in their parents.

Conclusion: The highly significant predominance of girls testing positive for TPHA, and the concomitant lack of association between parents' and children's serostatus might point to sexual transmission as being the most common route of transmission of treponemal infection in girls during childhood in this village. The sources of infection for the seropositive girls are possibly found outside the family.

Objectives: To monitor the prevalence of HIV infection among heterosexual and male homo/bisexual STD patients and assess the effect of HIV test refusers on the HIV prevalences.

Methods: A voluntary confidential HIV test was offered to all people diagnosed with an STD at the Swiss Network of Dermatovenerology Policlinics (SNDP) between July 1990 and June 1995. Anonymous sociodemographic and behavioural information was collected for each patient regardless of whether s/he accepted or refused the HIV test.

Results: The prevalence of HIV was 1.6% among heterosexuals and 22.4% homo/bisexual men and remained stable between July 1990 and June 1995. Refusal rates were 17.5% among heterosexuals and 16.0% among homo/bisexual men and did not change significantly over time. To assess the potential effect of HIV test refusers on the monitored HIV prevalences, we analysed test refusers by multivariate logistic regression. Among heterosexuals, refusal rates were significantly higher among patients with relatively low risk behaviours (patients reporting 0-1 sexual partners in the previous 6 months) while among homo/bisexual men they were significantly higher in those with high risk behaviours (patients reporting 10 or more sexual partners in the previous 6 months).

Conclusions: We found high and stable HIV prevalences among patients treated for an STD at the SNDP. It appears that HIV test refusers biased HIV prevalences among heterosexuals and homo/bisexual men in different directions: in heterosexuals HIV prevalences were overestimated and in homo/bisexuals they were underestimated. A regular analysis of the characteristics of HIV test refusers should be an integral part of surveillance systems which use voluntary confidential HIV testing.

Objectives: To examine the incidence of herpes zoster in HIV-1 infection. To assess the prognostic significance of the occurrence of herpes zoster and progression to AIDS or death

Design and methods: 146 homosexually active men with known times of HIV-1 seroconversion were identified through the Sydney AIDS Prospective Study and the clinic records of a private medical practice with large caseload of HIV infected homosexual men. Medical records were reviewed for a history of herpes zoster, CD4+ lymphocyte counts, and HIV-1 disease status. Cox's proportional hazards model was used to determine whether herpes zoster predicted progression to AIDS or death.

Results: After a mean follow up of 54 months, 30 men (20%) had an episode of herpes zoster and three of these men had one recurrence. The overall incidence of herpes zoster was 44.4 episodes per 1000 person years (95% CI 30.0-63.5). Herpes zoster was not found to be a marker of deteriorating immune functions as measured by CD4+ lymphocyte counts. CD4+ counts did not differ significantly between those with and without zoster at 1 year (551 v 572.10(6)/1, p = 0.79), 2 years (451 v 557, p = 0.11), and 3 years (424 v 481, p = 0.50) following HIV-1 seroconversion. There was no statistically significant difference in progression to AIDS (RR = 1.89, 95% CI 0.80-4.46, p = 0.15) or death (RR = 0.90, 95% CI 0.31-2.65, p = 0.85) from HIV-1 sero-conversion in those who did and those who did not develop herpes zoster.

Conclusion: The incidence of herpes zoster was consistent with the findings of other studies. There was no association between the occurrence of herpes zoster and progression of HIV-1 disease.

In this article we review the field of HIV liaison psychiatry and illustrate the manner in which psychiatric care can contribute to the health and quality of life of this group of patients. To illustrate our discussion we review experience and findings in relation to affective illness, cognitive impairments, and personality disorder in HIV infection. We also highlight some of the areas where psychiatric care of people with HIV infection is unique from other types of psychiatric liaison work.

We report a patient who presented with the suspected diagnosis of syphilis. Clinical findings included a penile ulcer, positive history of syphilis more than 20 years ago, and positive syphilis serology (TPHA, FTA-Abs). A biopsy showed a plasma-cell rich inflammation with granuloma formation. Since a birefractory structure was observed in the biopsy possibly corresponding to a foreign body, the patient's occupational exposure was investigated. Working in the fiber reinforced plastics industry, he was heavily exposed to glass fibre that was even detected on the inside of his underwear. Taking the serological pattern into account that was not consistent with active syphilis, a penile ulcer following a foreign body reaction was diagnosed. This case report demonstrates the difficulties of differentiating foreign body granuloma of the genital region from venereal diseases with granuloma formation.

Objectives: Few studies have evaluated the relation between male and female sexual behaviour and STD among married African women. The objectives of this study were to identify male and female sexual behaviour associated with female STD, and to explore whether incorporating male and female sexual behaviour and male symptoms can improve algorithms for STD management in married African women.

Methods: 99 married couples with one symptomatic member (58 males, 41 females) attending an STD clinic in Lusaka, Zambia were interviewed separately about sexual and contraceptive behaviour, and had physical examinations. Diagnostic tests for Neisseria gonorrhoeae (GC), Trichomonas vaginalis (TV), and HIV were performed. Bivariate and multivariate odds ratios for the association between sexual behaviour and STD were calculated. Predictive algorithms based on current Zambian guidelines for management of STD in women were created.

Results: Among women at baseline, 10% were positive for GC, 14% for TV, 52% for HIV. Female alcohol use before sex, a male's paying for sex, and a couple's having sex unprotected by condoms or spermicides were associated with female STD. Incorporation of these behaviours along with symptoms of urethral discharge and dysuria among husbands increased the predictive ability of algorithms for management of STD in women.

Conclusions: The addition of male and female sexual behaviour and male STD symptoms to diagnostic algorithms for female STD should be explored in other settings. Both husbands' and wives' behaviour independently predict STD in these women; risk reduction programmes should target both men's and women's sexual behaviour.

Objective: To compare the B and T lymphocyte subset levels of otherwise healthy women suffering from frequently recurrent vaginal candidosis with a healthy control group.

Subjects: 26 unselected otherwise healthy women of reproductive age with at least four attacks of vaginal candidosis in the past year and more than three vaginal isolates of a moderate or heavy growth of Candida albicans. Controls were 26 patients or clinical and laboratory staff (asymptomatic for genital infection) matched for time of day and age within 5 years. Only three patients accepted an HIV test. All proved HIV negative. No controls were tested.

Main outcome measures: T lymphocyte subsets (CD4 and 8) and B lymphocytes (CD 19) as estimated from the total lymphocyte count and flow cytometry.

Results: No statistically significant difference between patients and controls.

Conclusion: No significant difference was found between patients and controls in levels of lymphocyte subsets.