Audit on routine HIV testing in patients attending genitourinary medicine clinics.

The Sexual Health Strategy was published in 2001. One of the recommendations was that all patients attending genitourinary (GU) medicine clinics for a sexual health screen should be offered an HIV test. This audit was undertaken in the GU medicine clinic at Portsmouth, offering a routine HIV antibody test to patients attending the clinic. This audit shows that patients will accept HIV testing when offered, during a routine GU medicine clinic visit. This initiative is important especially in areas with high HIV prevalence to identify undiagnosed HIV infections. Early diagnosis and intervention are important to reduce the morbidity and mortality of HIV infection.

Using chlamydia positivity to estimate prevalence: evidence from the Chlamydia Screening Pilot in England.

Studies have suggested that positivity can be used to estimate the prevalence of Chlamydia trachomatis in large-scale chlamydia screening programmes. A recent pilot of opportunistic screening in England estimated that the prevalence among 16-24-year-old women in Portsmouth and Wirral was 9.8% and 11.2%, respectively. This study assessed the continued validity of positivity as an approximate for prevalence. We re-analysed data from the Chlamydia Screening Pilot to estimate positivity,calculated as total positive tests divided by total tests, and compared these estimates with the previously reported prevalence, measured as the number of women testing positive divided by the total number of women screened. Overall positivity was 9.4% in Portsmouth and 11.0% in the Wirral; these estimates were not statistically different from prevalence, regardless of health-care setting, age group or symptoms. We conclude that positivity can be used as a proxy for prevalence.

Prone and left lateral positioning reduce gastro-oesophageal reflux in preterm infants.

AIM: To examine the effect of body position on clinically significant gastro-oesophageal reflux (GOR) in preterm infants. METHODS: Eighteen preterm infants with clinically significant GOR were studied prospectively using 24 hour lower oesophageal pH monitoring. Infants were nursed in three positions (prone, left, and right lateral) for 8 hours in each position, with the order randomly assigned. Data were analysed using analysis of covariance. RESULTS: The median (range) reflux index (RI) for the group was 13.8% (5.8-40. 4). There was no significant difference in the mean time spent in each position. RI (mean % (SEM)) was significantly less in prone (6. 3 (1.7)) and left lateral positions (11.0 (2.2)), when compared with the right lateral position (29.4 (3.2)); p<0.001. The mean (SEM) longest episodes (mins) of GOR were reduced by prone and left positions (8.6 (2.2) and 10.0 (2.4), respectively) compared with the right position (26.0 (3.9)); p<0.001. The mean (SE) number of episodes was reduced by prone (15.4 (2.8)) and left (24.6 (3.5)) positions when compared with right (41.6 (4.6)) (p<0.001). CONCLUSIONS: Prone and left lateral positions significantly reduce the severity of GOR, by reducing the number of episodes and the duration of the longest episodes. Such positioning offers a useful adjunct to the treatment in hospital of preterm infants with gastro-oesophageal reflux.

Screening for genital chlamydia infection: DNA amplification techniques should be the test of choice.

Our objective was to compare the sensitivities for the detection of Chlamydia trachomatis, of the ligase chain reaction (LCR) on first voided urine (FVU) specimens and enzyme immunoassay (EIA) on pooled endocervical/endourethral swabs from women and endourethral swabs from men. Men and women taking part in the UK chlamydia screening pilot were tested for chlamydia using LCR on a FVU. Patients attending genitourinary medicine clinics also had cervical and/or urethral swabs taken for chlamydia testing by EIA. In women, EIA on pooled swabs detected 575 of the 785 chlamydia positives and in men, EIA detected 209 of 351 positives. The sensitivity of EIA was 73% and 60% in women and men respectively. By using the EIA test, therefore, 27-40% of patients infected with chlamydia will be given a false negative result. We propose that it is unethical to use non-molecular testing in the future.

Which treatment for genital tract Chlamydia trachomatis infection?

A national opportunistic chlamydia screening programme, mainly targeting young sexually active women, is gradually being introduced across the UK and in future will predominantly occur in primary care sites. The relative efficacy of recommended antibiotic treatments for chlamydia has been poorly studied and especially that of single dose azithromycin. In Portsmouth, 1536 patients treated for chlamydia, with four different antibiotic regimens, during the Department of Health pilot study, were asked to return for test of cure. No difference in treatment outcome was found using doxycycline, oxytetracycline, erythromycin or azithromycin. Directly observed therapy with azithromycin may be especially helpful in treating young chlamydia-positive patients.

Re-infection of Chlamydia trachomatis in patients presenting to the genitourinary medicine clinic in Portsmouth: the chlamydia screening pilot study - three years on.

Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in the UK. The Department of Health set up an opportunistic screening programme for genital chlamydia infection, focusing on sexually active 16-24-year-old women and some men. This study identified those patients re-attending the genitourinary medicine (GUM) clinic and followed them up until September 2002. We examined the reasons for attendance and re-infection with chlamydia. Two hundred and eighty-five patients re-attended the clinic. Two-thirds of these had changed their sexual partners in the follow-up period. Fifty-six patients were diagnosed with genital chlamydia infection in subsequent clinic visits. The majority of them had changed their sexual partners, suggesting new acquisition of infection. This suggests that in this age group re-screening should be offered at a year interval. Patients diagnosed with genital chlamydia infection should be referred to the GUM clinic for further STI screening and partner notification.

Opportunistic chlamydia screening; should positive patients be screened for co-infections?

This study examines the requirement for testing patients for other sexually transmitted infections (STIs) and bacterial vaginosis (BV) when diagnosed with genital chlamydia during opportunistic screening. Data were collected on all patients participating in the Department of Health chlamydia screening pilot study in Portsmouth. One thousand two hundred and forty-five women and 490 men with genital chlamydia were seen in Portsmouth genitourinary medicine (GUM) department. Of the women screened in GUM, 28% had coexisting STIs and 21% had BV. The corresponding figures for those initially screened in the community were 4% and 17%. An increased number of female sexual partners of male patients (76%) and male partners of female patients (55%) of the GUM group had co-infections; 58% of male partners from the community group had another STI. The increased morbidity associated with these infections warrants screening of all patients with chlamydia for other STIs and BV.

Triage clinics: a way forward in genitourinary medicine.

Our objective was to evaluate the effectiveness of a nurse-led triage clinic in genitourinary medicine (GUM). A prospective study was made of 200 consecutive patients attending the triage clinic in the GUM Department, Portsmouth. These patients were seen by the triage nurse and treated according to clinic guidelines. The consultants reviewed the case notes to assess the appropriateness of management. During the 6-week study period, 3009 patients were seen in the department. Of the 200 patients seen in the triage clinic, 38 were referred to a doctor during the initial visit. One or more sexually transmitted or associated infections were found in 61 female and 58 male patients. Six female and 4 male patients were not treated according to the clinic guidelines. Given appropriate education and training and working within a supportive framework the nurse undertaking a triage role in GUM can provide a highly effective and high-quality service to patients.

Effects of vagal and splanchnic section on food intake, weight, serum leptin and hypothalamic neuropeptide Y in rat.

Truncal vagotomy can cause reduced food intake and weight loss in humans and laboratory animals. In order to investigate some of the factors that might contribute to this effect, we studied changes in ingestive behaviour, whole body and organ weights, serum leptin and hypothalamic neuropeptide Y in rats with bilateral vagal section, bilateral splanchnic nerve section and combined vagotomy plus splanchnectomy. Pyloromyotomy was combined with vagotomy to lessen effects of vagotomy on gastric emptying. Animals with vagotomy or vagotomy plus splanchnectomy lost weight and decreased their daily food intake relative to animals with splanchnectomy alone, rats with bilateral sham exposure of one or both nerve, or rats with pyloromyotomy alone. Serum leptin and white fat mass, 4 weeks after vagotomy, were about 20% of the values in the sham-operated animals at this time. No effect for splanchnic nerve section alone was observed. Pyloromyotomy caused no reduction in weight or fat mass, but reduced serum leptin. Following vagotomy with or without splanchnic nerve section, neuropeptide Y was elevated in the arcuate nucleus relative to values for the other four groups. Changes in neuropeptide Y were inversely correlated with levels of serum leptin. It is concluded that the effect of vagotomy could be due to the loss of a feeding signal carried by vagal afferent neurons, or to changed humoral signals, for example, increased production of a satiety hormone. However, it cannot be attributed to signals that reduce feeding (for example, gastric distension) reaching the central nervous system via the splanchnic nerves. The changes were sufficient to cause weight loss even though serum leptin was decreased, a change that would be expected to increase food intake.

Development of multimetal binding model and application to binary metal biosorption onto peat biomass.

Biosorption of Cr(3+), Cu(2+) and Cd(2+) from binary metal solutions onto peat in the batch systems was investigated at pH 4. The order of maximum uptake was Cr>or=Cu>Cd and maximum uptake levels of ca. 0.4 mmol/g were observed for chromium and copper while cadmium was taken up to a maximum of ca. 0.2 mmol/g. Co-ion competition resulted in up to 70 percent decrease of primary metal uptake. A novel approach to multicomponent sorption modelling involving regression to the total metal taken up was adopted. Two extended Langmuir-type models were found to exhibit good fit to the experimental data. Using the simpler model of these, three-dimensional sorption surfaces were generated which describe the metal uptake as a function of equilibrium concentrations of both metals. These methods allow prediction of metal uptakes over a continuum of concentrations of both metals in binary systems.

Fungal melanins and their interactions with metals.

Fungal melanins are dark brown or black pigments located in cell walls. They also exist as extracellular polymers. Melanized fungi possess increased virulence and resistance to microbial attack as well as enhanced survival while under environmental stress. Melanins contain various functional groups which provide an array of multiple nonequivalent binding sites for metal ions. Pigmented Cladosporium cladosporoides was shown to biosorb 2.5- to four-fold more Ni, Cu, Zn, Cd, and Pb than albino Penicillium digitatum and at four- to six-fold higher rates. Metal desorption was significantly lower for extracellular melanin than from pigmented or albino biomass which indicated the strength of the melanin-metal bond. At equilibrium, tributyltin chloride (TBTC) concentrations of 2.5 mM, pigmented and albino Aureobasidium pullulans absorbed approximately 0.9 and 0.7 mumol TBTC mg -1 dry wt, respectively, whereas purified extracellular melanin exhibited uptake levels of approximately 22 mumol TBTC mg-1 dry wt at an equilibrium concentration of only 0.4 mM. Addition of melanin to the growth medium reduced the toxic effect of CuSO4 and TBTC due to melanin metal binding and sequestration.

Competitive sorption of platinum and palladium on chitosan derivatives.

Glutaraldehyde-cross-linked chitosan (GCC), thiourea derivative of chitosan (TGC) and rubeanic acid derivative of chitosan (RADC) have previously been shown to be very efficient at removing platinum and palladium from single component dilute acidic solutions. This study examines the competitive sorption of these metal anions in bi-component mixtures for GCC, TGC and RADC. Palladium sorption is less sensitive to the presence of platinum than the reverse: the maximum sorption capacity decreases less for palladium than for platinum in the presence of the competitor anion (the metals being in their chloro-metal forms). Moreover, the Langmuir-shape of the sorption isotherm for palladium is unaffected (with the usual plateau reached at low residual palladium), while in the case of platinum sorption, the isotherms exhibit a significant decrease of the sorption capacity at high residual platinum concentration which increases with increasing concentrations of palladium. RADC is more selective for palladium over platinum than the other chitosan derivatives. A preliminary study of the competitive sorption kinetics in both batch and fixed bed systems is presented for RADC and confirms the higher affinity of the sorbent for palladium than for platinum.

An LC-MS method for the determination of pharmaceutical compounds in wastewater treatment plant influent and effluent samples.

Pharmaceuticals are continually introduced into the environment as a result of industrial and domestic use. In recent years they have emerged as environmental pollutants. An analytical method has been developed allowing for simultaneous detection and identification of 20 pharmaceutical compounds from various therapeutic classes using solid phase extraction (SPE) followed by liquid chromatography-electrospray ionisation mass spectrometry (LC-MS/MS). The limits of detection and limits of quantitation for the method were in the ng/L-microg/L range. The method was applied to influent and effluent samples from three wastewater treatment plants (WWTPs). Fifteen compounds were identified in the sample matrix with salicylic acid and ibuprofen being the most abundant at 9.17 and 3.20 microg/L respectively.

Inorganic tin and organotin interactions with Candida maltosa.

As a consequence of the widespread industrial and agricultural applications of organotins, contamination of various ecosystems has occurred in recent decades. Understanding how these compounds interact with microorganisms is important in assessing the risks of organotin pollution. The organotins, tributyltin (TBT), trimethyltin (TMT) and inorganic tin, Sn(IV), were investigated for their physical interactions with non-metabolising cells and protoplasts of the yeast Candida maltosa, an organism that is often associated with contaminated environments. Uptake, toxicity and membrane-acting effects of these compounds, at concentrations approximating those found in polluted environments, were assessed. Sn(IV) and TBT uptake occurred by different mechanisms. Uptake of Sn(IV) was 2-fold greater in intact cells than protoplasts, underlining the importance of cell wall binding, whereas TBT uptake levels by both cell types were similar. TBT uptake resulted in cell death and extensive K+ leakage, while Sn(IV) uptake had no effect. TMT did not interact with cells. Of the three compounds, TBT alone altered membrane fluidity, as measured by the fluorescence anisotropy of 1,6-diphenyl-1,3,5-hexatriene incorporated into cells. Anisotropy of 1-(4-trimethylaminophenyl-6-phenyl-1,3,5-hexatriene) was not affected, implying that TBT is not confined to the surface of the cytoplasmic membrane, but acts within membrane lipids. These results indicate that the cell wall is the dominant site of Sn(IV) interactions with yeast, while lipophilic interactions play an important role in uptake and toxicity of TBT.

Action of inorganic tin and organotins on a hydrocarbon-using yeast, Candida maltosa.

Two inorganic tin compounds, as well as mono- and tri-substituted methyl-, butyl-, and phenyltins were examined for their interactions with a hydrocarbon-using strain of Candida maltosa. Neither of the inorganic tins (SnII and SnIV) inhibited growth at concentrations up to 0.8 mM while binding to the yeast cells occurred to levels of 0.3 and 0.23 mM Sn/g cells, respectively. Neither inorganic tin caused leakage of potassium from the yeast cells. Among the organotins, tributyl- and triphenyltins caused total viability loss and near maximum potassium loss at initial concentrations of 0.08 mM. For these compounds binding to the cells increased with increasing initial concentrations to maximum values of 0.51 and 0.65 mM Sn/g cells respectively. The other organotin compounds were not inhibitory and did not cause potassium leakage from the cells. Tin from them became cell associated only in the cases of monobutyl- and monophenyl tin, which were bound at markedly lower levels (<0.1 mM Sn/g cells). These results are consistent with the conclusion that the inhibitory compounds can act on the yeast cell membrane but, although binding to the cells is a prerequisite for growth inhibition and cell leakage, no simple correlation was established between binding levels and toxicity effects.

Mechanisms of strontium uptake by laboratory and brewing strains of Saccharomyces cerevisiae.

Laboratory and brewing strains of Saccharomyces cerevisiae were compared for metabolism-independent and -dependent Sr2+ uptake. Cell surface adsorption of Sr2+ to live cells was greater in the brewing than in the laboratory strain examined. However, uptake levels were greater in denatured (dried and ground) S. cerevisiae, and the relative affinities of Sr2+ for the two strains were reversed. Results for the brewing S. cerevisiae strain were similar whether the organism was obtained fresh from brewery waste or after culturing under the same conditions as for the laboratory strain. Reciprocal Langmuir plots of uptake data for live biomass were not linear, whereas those for denatured biomass were. The more complex Sr2+ binding mechanism inferred for live S. cerevisiae was underlined by cation displacement experiments. Sr2+ adsorption to live cells resulted in release of Mg2+, Ca2+, and H+, suggesting a combination of ionic and covalent bonding of Sr2+. In contrast, Mg2+ was the predominant exchangeable cation on denatured biomass, indicating primarily electrostatic attraction of Sr2+. Incubation of live S. cerevisiae in the presence of glucose resulted in a stimulation of Sr2+ uptake. Cell fractionation revealed that this increased Sr2+ uptake was mostly due to sequestration of Sr2+ in the vacuole, although a small increase in cytoplasmic Sr2+ was also evident. No stimulation or inhibition of active H+ efflux resulted from metabolism-dependent Sr2+ accumulation. However, a decline in cytoplasmic, and particularly vacuolar, Mg2+, in comparison with that of cells incubated with Sr2+ in the absence of glucose, was apparent. This was most marked for the laboratory S. cerevisiae strain, which contained higher Mg2+ levels than the brewing strain.

Attendance by older patients at a genitourinary medicine clinic.

OBJECTIVES: To determine how patients aged 50 and above had been referred to a department of genitourinary medicine (GUM), why they had attended, their sexual histories, and what diagnoses were made. To identify any special sexual health needs in this group of patients. METHODS: A case note review was undertaken of all patients aged 50 and over attending the Portsmouth GUM department over a 3 month period. RESULTS: There was a marked difference in reason for attendance between men and women in this older age group. Men were more likely to attend for a sexual health screen, often with minimal or no symptoms, following an extramarital or casual liaison. Women more commonly had symptoms causing difficulties with sexual intercourse with their regular partner. CONCLUSIONS: Older people present to GUM departments with a wide range of sexually associated problems. The diagnostic and management expertise available in GUM departments makes them ideal providers of sexual health care for this as well as younger age groups.

Are we failing our teenagers? Value of a family planning service for teenagers within the sexually transmitted disease clinic.

Out of 100 teenage girls attending a sexually transmitted disease clinic for the first time, 77 were found to be using a reliable method of contraception and had similar characteristics to teenage girls attending a family planning clinic. The 23 girls not using any reliable contraception exhibited a different pattern of sexual behaviour and were at high risk of unplanned pregnancy. Subsequently, another group of 23 girls not using contraception when seen at the sexually transmitted disease clinic were actively encouraged to attend a family planning clinic. Their risk of unplanned pregnancy was much reduced, although their pattern of sexual activity was unchanged. Ready availability of contraceptive advice for unprotected teenagers in sexually transmitted disease clinics would reduce their high risk of unplanned pregnancy.