An evaluation of the performance of OraQuick ADVANCE Rapid HIV-1/2 Test in a high-risk population attending genitourinary medicine clinics in East London, UK.

To date, no data have been published on the use of OraQuick ADVANCE Rapid HIV-1/2 Test (OraQuick) in the UK. We report preliminary findings of an ongoing evaluation of OraQuick in UK genitourinary (GU) medicine clinics. A total of 820 samples from patients in high-risk groups for HIV were tested with OraQuick and results were compared with standard HIV antibody testing. HIV prevalence (enzyme immunoassay [EIA]) was 5.73%, sensitivity of OraQuick was 93.64% (95% CI 82.46-98.66%), specificity 99.87% (99.28-100%), positive predictive value 97.78% (88.27-99.94%) and negative predictive value 99.61% (98.87-99.92%). This includes three false-negatives considered to be due to observer error and now rectified by further training. This has increased test sensitivity to 100%. Our observed test performance of OraQuick compares well with EIA and with other rapid tests. We believe that simple, non-invasive antibody detection tests such as OraQuick can increase HIV testing and diagnosis in UK GU medicine and community settings.

Chlamydial urethritis in heterosexual men attending a genitourinary medicine clinic: prevalence, symptoms, condom usage and partner change.

A prospective study of 356 consecutive heterosexual male patients attending the Department of Genitourinary Medicine at University College Hospital was carried out to determine the prevalence of Chlamydia trachomatis. Patients were asked about their symptoms, use of condoms and change of sexual partner. The prevalence of non-gonococcal urethritis (NGU--chlamydia positive and negative urethritis) was 37% (131 of 356). C. trachomatis was shown to be the causative organism in 24% (31 of 131) of patients with NGU. The prevalence of other STDs in men with C. trachomatis and with non-chlamydial urethritis was 15% and 10% respectively. Men with C. trachomatis were significantly more likely than men with non-chlamydial urethritis to be asymptomatic (56% vs 35%). The prevalence of C. trachomatis was highest in men who had changed partner in the previous 3 months (20 of 32 men). A third of men never used condoms in the first 3 months of a new relationship and over half failed to use them after 3 months. There was no evidence that the reported use of condoms reduced the rate of infection with C. trachomatis.

Management of early pregnancy bleeding in the accident and emergency department.

Over a period of 6 months, from February to July 1987, 26,837 patients attended St Mary's A&E Department. Of these, 179 (0.7%) were complaining of bleeding in pregnancy of less than 20 weeks gestation. In May 1987 new management guidelines were introduced. These emphasised the importance of vaginal examination and the use of ultrasound to determine the viability of the pregnancy. As a result, the incidence of admission fell from 15 of 53 (28%) to 7 of 58 (12%), referral to the on-call gynaecologist from 23 of 53 (44%) to 13 of 58 (22%) and reattendance rates from 11 of 53 (15%) to 4 of 58 (4%) (all changes P less than 0.05).