D J Kellock, R Barlow, S K Suvarna, S Green, A Eley, K E Rogstad
A 21 year old woman presented with painful groin lymphadenopathy and malaise. Lymph node biopsy, to exclude atypical infection and malignancy, suggested the diagnosis of lymphogranuloma venereum. This diagnosis was confirmed by serology and polymerase chain reaction, with the patient subsequently admitting to a casual sexual contact within the United Kingdom. Alternative methods of investigation of this disease are discussed.
{"title":"Lymphogranuloma venereum: biopsy, serology, and molecular biology.","authors":"D J Kellock, R Barlow, S K Suvarna, S Green, A Eley, K E Rogstad","doi":"10.1136/sti.73.5.399","DOIUrl":"https://doi.org/10.1136/sti.73.5.399","url":null,"abstract":"<p><p>A 21 year old woman presented with painful groin lymphadenopathy and malaise. Lymph node biopsy, to exclude atypical infection and malignancy, suggested the diagnosis of lymphogranuloma venereum. This diagnosis was confirmed by serology and polymerase chain reaction, with the patient subsequently admitting to a casual sexual contact within the United Kingdom. Alternative methods of investigation of this disease are discussed.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457065","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}
Case report (Dr R F Miller) A 33 year unemployed white man was admitted to hospital in January 1994 complaining of a 1 week history of diarrhoea, passing up to 30 stools per day. The stool consisted of watery yellow fluid without blood or mucus. He reported associated anorexia with intermittent nausea and vomiting together with left lower quadrant colicky abdominal pain and sweats but no fever. The patient had been seen in a local casualty department 4 days previously at which time he had reported 3 days of diarrhoea. At that time he reported that he was HIV antibody positive and examination had revealed no abnormalities. Investigations revealed normal urea and electrolytes, a haemoglobin of 10.4 g/dl, a total white blood count of 6.8 x 109/l, and a platelet count of 68 x 109/l. This latter finding was ascribed to the effects of HIV infection. The patient was treated symptomatically and discharged. On admission to hospital in January 1994 the patient reported that 72 months previously he had developed night sweats, gingivitis, and oral candidiasis. He had been admitted to another hospital in April 1988 with a chest infection and, in May of that year following a party, he had been admitted to the Middlesex Hospital with diarrhoea and vomiting. He subsequently reported that he had passed malaena stools and, in addition, stated that he had been found to be HIV positive in October 1987; this positive result was performed on a sample of serum stored from 1982. The investigation had been carried out at another hospital. On that admission in 1988 examination (including rectal examination) was unremarkable. Sigmoidoscopy and biopsy were normal and the patient was noted to have an inappropriate effect with a rather dramatic story. Investigations revealed a normal full blood count. During the admission the patient was counselled and underwent HIV testing: the results were positive. The diagnosis at that time was one of Munchausen's/malingering. Subsequently, the patient had experienced chronic diarrhoea and had attended many different clinics. In the year before his admission with diarrhoea Cryptosporidium parvum had been isolated repeatedly in the stool. Six months before admission the patient had experienced recurrent episodes of perianal herpes simplex virus infection and began aciclovir suppression. Two months before admission his CD4 count had fallen from 290 x 106/1 to 110 x 106/1. The patient had declined antiretroviral therapy but had begun co-trimoxazole as primary prophylaxis against Pneumocystis carinii pneumonia. At this stage the patient also reported that in 1987 he had cytomegalovirus (CMV) colitis and hepatitis which were treated with foscarnet. This episode had occurred at another hospital. Contact with that hospital revealed no patient of that name. On further inquiry the patient reported a family history of haemophilia, he was unable to say of what sort. His social history revealed that he was unemployed but had worked in several differe
{"title":"Haemolytic uraemic syndrome complicated by disseminated extraneural cryptococcosis.","authors":"A L Pozniak, S B Lucas, R F Miller","doi":"10.1136/sti.73.5.410","DOIUrl":"https://doi.org/10.1136/sti.73.5.410","url":null,"abstract":"Case report (Dr R F Miller) A 33 year unemployed white man was admitted to hospital in January 1994 complaining of a 1 week history of diarrhoea, passing up to 30 stools per day. The stool consisted of watery yellow fluid without blood or mucus. He reported associated anorexia with intermittent nausea and vomiting together with left lower quadrant colicky abdominal pain and sweats but no fever. The patient had been seen in a local casualty department 4 days previously at which time he had reported 3 days of diarrhoea. At that time he reported that he was HIV antibody positive and examination had revealed no abnormalities. Investigations revealed normal urea and electrolytes, a haemoglobin of 10.4 g/dl, a total white blood count of 6.8 x 109/l, and a platelet count of 68 x 109/l. This latter finding was ascribed to the effects of HIV infection. The patient was treated symptomatically and discharged. On admission to hospital in January 1994 the patient reported that 72 months previously he had developed night sweats, gingivitis, and oral candidiasis. He had been admitted to another hospital in April 1988 with a chest infection and, in May of that year following a party, he had been admitted to the Middlesex Hospital with diarrhoea and vomiting. He subsequently reported that he had passed malaena stools and, in addition, stated that he had been found to be HIV positive in October 1987; this positive result was performed on a sample of serum stored from 1982. The investigation had been carried out at another hospital. On that admission in 1988 examination (including rectal examination) was unremarkable. Sigmoidoscopy and biopsy were normal and the patient was noted to have an inappropriate effect with a rather dramatic story. Investigations revealed a normal full blood count. During the admission the patient was counselled and underwent HIV testing: the results were positive. The diagnosis at that time was one of Munchausen's/malingering. Subsequently, the patient had experienced chronic diarrhoea and had attended many different clinics. In the year before his admission with diarrhoea Cryptosporidium parvum had been isolated repeatedly in the stool. Six months before admission the patient had experienced recurrent episodes of perianal herpes simplex virus infection and began aciclovir suppression. Two months before admission his CD4 count had fallen from 290 x 106/1 to 110 x 106/1. The patient had declined antiretroviral therapy but had begun co-trimoxazole as primary prophylaxis against Pneumocystis carinii pneumonia. At this stage the patient also reported that in 1987 he had cytomegalovirus (CMV) colitis and hepatitis which were treated with foscarnet. This episode had occurred at another hospital. Contact with that hospital revealed no patient of that name. On further inquiry the patient reported a family history of haemophilia, he was unable to say of what sort. His social history revealed that he was unemployed but had worked in several differe","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457068","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}
P R Arlett, E H Lee, M Hooker, J H Darbyshire, A M Breckenridge
{"title":"Reporting adverse drug reactions in HIV infection.","authors":"P R Arlett, E H Lee, M Hooker, J H Darbyshire, A M Breckenridge","doi":"10.1136/sti.73.5.335","DOIUrl":"https://doi.org/10.1136/sti.73.5.335","url":null,"abstract":"","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457912","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}
Objective: To estimate the number of prevalent HIV infections in England and Wales at the end of 1991 and 1993.
Method: A direct method was used whereby population estimates derived from the National Survey of Sexual Attitudes and Lifestyle (NATSAL) and prevalence data from the Unlinked Anonymous HIV Prevalence Monitoring Programme (UAPMP) were combined to produce estimates of the number of adults infected and alive in the population.
Results: In the population of England and Wales the numbers of prevalent infections for defined transmission categories, at the end of 1993, were as follows: 12,600 through sex between men, 2500 through injecting drug use, and 6900 through heterosexual intercourse. The overall estimate was 22,800 HIV seropositive individuals.
Conclusions: The direct method attempts to provide an estimate of the number of HIV infections using population based survey data. These estimates are consistent with other approaches using independent methods. Such methods are essential for inferring recent HIV incidence, projecting future AIDS cases, and for healthcare planning.
{"title":"Direct estimates of prevalent HIV infection in adults in England and Wales for 1991 and 1993: an improved method.","authors":"A Petruckevitch, A Nicoll, A M Johnson, D Bennett","doi":"10.1136/sti.73.5.348","DOIUrl":"https://doi.org/10.1136/sti.73.5.348","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the number of prevalent HIV infections in England and Wales at the end of 1991 and 1993.</p><p><strong>Method: </strong>A direct method was used whereby population estimates derived from the National Survey of Sexual Attitudes and Lifestyle (NATSAL) and prevalence data from the Unlinked Anonymous HIV Prevalence Monitoring Programme (UAPMP) were combined to produce estimates of the number of adults infected and alive in the population.</p><p><strong>Results: </strong>In the population of England and Wales the numbers of prevalent infections for defined transmission categories, at the end of 1993, were as follows: 12,600 through sex between men, 2500 through injecting drug use, and 6900 through heterosexual intercourse. The overall estimate was 22,800 HIV seropositive individuals.</p><p><strong>Conclusions: </strong>The direct method attempts to provide an estimate of the number of HIV infections using population based survey data. These estimates are consistent with other approaches using independent methods. Such methods are essential for inferring recent HIV incidence, projecting future AIDS cases, and for healthcare planning.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20459756","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}
{"title":"Genitourinary medicine and the Internet No 8.","authors":"R K Lau","doi":"10.1136/sti.73.5.415","DOIUrl":"https://doi.org/10.1136/sti.73.5.415","url":null,"abstract":"","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457069","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}
Management of a 42 year old female patient diagnosed with trichomoniasis is described. She failed to respond to recommended oral and high dose oral and topical metronidazole. Various options used in previously reported cases of metronidazole resistant trichomoniasis also failed to cure her condition. MIC showed the organism to be resistant to metronidazole. Cure was achieved with the use of topical intravaginal paromomycin.
{"title":"Metronidazole resistant trichomoniasis successfully treated with paromomycin.","authors":"D D Coelho","doi":"10.1136/sti.73.5.397","DOIUrl":"https://doi.org/10.1136/sti.73.5.397","url":null,"abstract":"<p><p>Management of a 42 year old female patient diagnosed with trichomoniasis is described. She failed to respond to recommended oral and high dose oral and topical metronidazole. Various options used in previously reported cases of metronidazole resistant trichomoniasis also failed to cure her condition. MIC showed the organism to be resistant to metronidazole. Cure was achieved with the use of topical intravaginal paromomycin.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457064","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}
Introduction Condylomata acuminata are caused by human papilloma virus (HPV) infections and epidemiological and molecular-biological evidence points to an association between HPV infection and anogenital dysplasia.' Human immunodeficiency virus (HIV) infection has been implicated as a promoting factor.2 In Zimbabwe the National Cancer Registry reports cervical carcinoma as the most common malignancy and recently an increase in reported squamous cell carcinoma of the penis has been observed, from one case per annum in 1993 and 1994 to six cases in 1995 and five cases in 1996.3 I report here a patient with AIDS who rapidly developed squamous cell carcinoma of the penis in conjunction with longstanding condylomata acuminata.
{"title":"Condylomata acuminata of the penis progressing rapidly to invasive squamous cell carcinoma.","authors":"C J Sanders","doi":"10.1136/sti.73.5.402","DOIUrl":"https://doi.org/10.1136/sti.73.5.402","url":null,"abstract":"Introduction Condylomata acuminata are caused by human papilloma virus (HPV) infections and epidemiological and molecular-biological evidence points to an association between HPV infection and anogenital dysplasia.' Human immunodeficiency virus (HIV) infection has been implicated as a promoting factor.2 In Zimbabwe the National Cancer Registry reports cervical carcinoma as the most common malignancy and recently an increase in reported squamous cell carcinoma of the penis has been observed, from one case per annum in 1993 and 1994 to six cases in 1995 and five cases in 1996.3 I report here a patient with AIDS who rapidly developed squamous cell carcinoma of the penis in conjunction with longstanding condylomata acuminata.","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457066","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}
E Mallon, J S Ross, D A Hawkins, M Dinneen, N Francis, C B Bunker
{"title":"Biopsy of male genital dermatosis.","authors":"E Mallon, J S Ross, D A Hawkins, M Dinneen, N Francis, C B Bunker","doi":"10.1136/sti.73.5.421-a","DOIUrl":"https://doi.org/10.1136/sti.73.5.421-a","url":null,"abstract":"","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.421-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457072","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}
Human immunodeficiency virus (HIV) can cause both primary and secondary brain diseases. Numerous neuropathological studies have shown that up to 90% of patients with acquired immune deficiency syndrome (AIDS) have lesions in the nervous system. In this review, we discuss the entry of HIV into the brain, the general features of HIV associated neuropathology, the role of different brain cells in HIV mediated neuronal damage, and the putative molecular mechanisms involved. We conclude by correlating which factors might be important in the development of HIV associated dementia.
{"title":"From human immunodeficiency virus (HIV) infection of the brain to dementia.","authors":"G Trillo-Pazos, I P Everall","doi":"10.1136/sti.73.5.343","DOIUrl":"https://doi.org/10.1136/sti.73.5.343","url":null,"abstract":"<p><p>Human immunodeficiency virus (HIV) can cause both primary and secondary brain diseases. Numerous neuropathological studies have shown that up to 90% of patients with acquired immune deficiency syndrome (AIDS) have lesions in the nervous system. In this review, we discuss the entry of HIV into the brain, the general features of HIV associated neuropathology, the role of different brain cells in HIV mediated neuronal damage, and the putative molecular mechanisms involved. We conclude by correlating which factors might be important in the development of HIV associated dementia.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20459755","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}
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