Mondor's disease of the penis following a long-haul flight.

Mondor's disease of the penis, otherwise known as superficial thrombophlebitis (STP) or thrombosis of the dorsal vein, is an under-reported benign condition, the aetiology of which is poorly understood. It is characterized by a sudden, indurated swelling of the vein, often occurring after vigorous sexual activity. We report a case of Mondor's disease occurring 24 h following a 15-h flight. This gentleman also reported a history of STP of his left lower limb varicose veins following a similar-length flight three years previously. In the absence of any other clear predisposing factor, we propose long-haul flight as an important factor contributing to the development of dorsal vein thrombosis.

Persistence of Pseudomonas aeruginosa strains in respiratory infection in AIDS patients.

OBJECTIVES: To establish the clinical pattern of Pseudomonas aeruginosa respiratory infections in HIV-seropositive patients and to determine whether repeated isolation of the organism represents reinfection or recurrence and to assess whether common source, nosocomial infection occurred. DESIGN AND METHODS: Evaluation of the clinical pattern of P. aeruginosa respiratory infections by case note review and epidemiological characterization of P. aeruginosa by serotype determination and Xbal DNA macrorestriction analysis. Serum sensitivity testing of strains was performed to further define phenotypic characteristics of the isolated organisms. RESULTS: Seventy-three per cent (29 out of 40) of individuals had P. aeruginosa isolated on two or more occasions in the setting of clinical respiratory infection. Overall, 85% had evidence of P. aeruginosa to within 2 months of study completion or death. Epidemiological characterization revealed persistence of unique single strains in 93% of individuals where multiple isolates were available for testing, whereas only two patients harboured a common strain. The serotype distribution of strains was similar to that reported from non-HIV-positive patients. CONCLUSIONS: Once established, eradication of P. aeruginosa from the respiratory tract of HIV-seropositive individuals with advanced immunosuppression is problematic and a chronic infective state appears common. There was no evidence of nosocomial transmission. Serotype loss and development of sensitivity to normal human serum were both observed and were highly correlated. This represents truncation of O-antigenic lipopolysaccharide on the cell surface of P. aeruginosa and may reflect progression to phenotypes commonly associated with chronic infection in other clinical settings such as cystic fibrosis.

The sins of the fathers--Africans with HIV infection in London; lessons for others?

Many European countries have taken in immigrants from sub-Saharan Africa. The reasons for this are discussed and the particular problems experienced by HIV-infected Africans in London, and the approach to their care at St Thomas' Hospital, is delineated.

Sexually transmitted infections in Turkey.

Turkey is a Moslem country where lay knowledge regarding sexually transmitted infections (STIs) is poor. Surveillance arrangements are limited, and frequently ignored, with the result that the true incidence of STIs is unknown. The prevalence of syphilis is definitely increasing, and probably that of the other infections is too. Modern diagnostic techniques are not widely deployed and there is little standardization of medical arrangements. However, there has been a high level of governmental involvement in HIV prevention in recent years and it is now believed that most HIV transmission in Turkey is by the heterosexual route.

Sexually transmitted infections in the Russian Federation, the Baltic States and Poland.

PIP: This paper examines the prevalence of sexually transmitted infections (STIs) in the Russian Federation, the Baltic States, and Poland. The International Union against Sexually Transmitted Infections organized a number of visits to the Eastern European countries aimed at reducing the spread of STIs. A highly developed state system for the control and surveillance of syphilis and other STIs in the Russian Federation was based on clinical dermatovenereology. However, a national AIDS program was developed in 1987. This program was administratively and operationally separate from dermatovenereology service and had been originally focused on the compulsory screening and medical management of HIV infection. In Poland, the dermatovenereology service is well developed and highly Westernized, more than in any other Eastern Bloc country. Furthermore, the management of STIs is within the scope of dermatovenereologists, most of who are women and senior physicians trained under the former Russian system. The dermatovenereology services were provided through primary care centers.^ieng

Sexually transmitted infections in Estonia.

Estonia, one of the Baltic countries, regained its independence in 1991, after the collapse of the USSR. This process led to great changes in every sphere of life--in politics, in the economy and in medicine. The service providing care for sexually transmitted infections (STIs) was involved in the process of these changes, too. However, freedom was followed not only by great happiness, but also by social destabilization and transformation of the old moral norms, the most evident features of which were the dramatic rise in crime, a sexual revolution and public prostitution. These 2 great simultaneous transformations in the STI care system and public mores led to the rapid increase of STIs in Estonia in the first half of the 1990s. Now some stabilization, and even a fall in incidence has occurred.

Sexually transmitted diseases in Lithuania: some epidemiological and social aspects.

With political, economical and social changes in Lithuania following the break-up of the Soviet Union, the health-care system has changed. The old Soviet system has been abandoned and it has taken time to re-establish a system under the new government. Resources are limited in most aspects of health care, including sexually transmitted infections (STIs). This has, also limited the development of education packages on STIs which are so important when trying to combat the spread of HIV infection. Notifications of syphilis, in Lithuania, have increased 52 fold between 1990 and 1996 although, since then, the incidence has started to decrease. Syphilis has been more reliably notified than other STIs and serves as the most reliable indicator of STI trends.

Sexually transmitted infections in Estonia--syndromic management of urethritis in a European country?

Sexually transmitted infections (STIs) are considered a major public health problem, globally. In particular, increasing STI rates have been documented throughout eastern Europe and central Asia. The Russian Federation and adjacent countries have, traditionally, managed STIs on an aetiological basis. This approach is expensive in terms of laboratory costs and it may lead to delayed diagnosis and treatment. To overcome the limitations of the aetiological management of STIs, the World Health Organization (WHO) has placed an increased emphasis on integrated care using syndromic management at the primary care level, especially in developing countries. This article reviews the current aetiology of STIs in Estonia, an eastern European country bordering the Baltic Sea and formerly a part of the Soviet Union, with the aim of defining whether infection with Trichomonas vaginalis is common enough to include its management in a syndromic management protocol. The use of syndromic management, in general, is also discussed.

Inflammatory cytology, infection and intraepithelial neoplasia.

The prognostic implications of minor grades of abnormality on cervical cytology are unclear. Women attending genitourinary medicine clinics who had cytology showing inflammatory changes with or without koilocytosis or borderline dyskaryosis have a high incidence of cervical intraepithelial neoplasia and genital infection. Of 119 patients who had a colposcopically directed cervical biopsy after one smear showing these changes, 46 (38%) had cervical intraepithelial neoplasia. Seventy-eight (57%) of 138 women had genital infection of whom 26 (33%) had a sexually transmitted disease. We recommend vigilant follow-up of borderline cytology including colposcopy if adequate facilities exist.

Clinical management of HIV disease in intravenous drug-users.

Intravenous drug-users comprise a major group of HIV-infected individuals in the developed world and, whilst progression of HIV disease in them appears little different from other risk groups, their medical presentations may be altered by continuing drug use. Drug-users are particularly susceptible to bacterial infections irrespective of their HIV status; they may present with symptoms directly caused by their drugs, which can be difficult to differentiate from non-drug-related causes and may closely resemble symptoms directly attributable to HIV. In addition, the life style associated with drug use can make compliance difficult, but in clinics combining HIV care and methadone prescribing these problems can be overcome.

Urethritis due to Neisseria meningitidis in a London genitourinary medicine clinic population.

A retrospective study was performed in a department of genitourinary medicine to determine the prevalence and clinical features of urethral and cervical infection with Neisseria meningitidis among patients being screened for sexually transmitted diseases. During the 28 month period of the study 11 isolates (from 10 patients) of N. meningitidis were identified from 5571 urethral cultures from homosexual men (0.2%). This compares with an isolation rate of 4.7% for N. gonorrhoeae; 1.2% samples screened for chlamydial antigen were positive. There were no isolates from 8992 urethral cultures from heterosexual men or 15,976 cervical cultures. Eight of the cases identified had features of urethritis at diagnosis; 6 were diagnosed initially as non-specific urethritis (NSU) and 2 as gonorrhoea on the basis of microscopy of a urethral smear. Eight of the 10 patients were treated with amoxycillin and/or a tetracycline, and all but one had a clinical and microbiological cure. In the study population the prevalence of N. meningitidis infection was low and restricted to homosexual men; however, it may be associated with symptoms.

Female genital mutilation.

PIP: Female genital mutilation is perhaps currently the most dangerous traditional practice in terms of health. An estimated 100 million women worldwide have undergone this procedure, most commonly performed between the ages of 4 and 10 years old by a traditional birth attendant. In one study, acute complications occurred in 39% of procedures. Hemorrhage and infection leading to gangrene, septicemia, or tetanus are the main causes of mortality. Late complications are estimated to occur in 37% of women. Chronic pelvic inflammatory disease and dysmenorrhea occur in 14-65%. Persistence of female genital mutilation is based, in part, on cultural beliefs about women, a perceived need to reduce sexual desire, and assurance of virginity and marriageability. Women who do not comply face social ostracism. In 1982, the World Health Organization recommended that female genital mutilation should not be carried out by any health professional under any circumstances. Although legislation outlawing the practice is important, it may be unenforceable in many areas. Key to the eradication of this practice are attitudinal changes through the education of both men and women and improvements in women's status.^ieng

Genitourinary medicine services in the United Kingdom are failing to meet current demand.

Recent increases in the incidence of sexually transmitted disease (STD) in the UK have given rise to concerns over the ability of genitourinary medicine (GUM) services to cope with increased demands. We conducted a postal survey to assess the capacity of GUM clinics to meet patient demand for both routine and emergency consultations. A questionnaire was sent to all lead GUM physicians in the UK. The response rate was 80%. In some clinics, patients had to wait for up to 28 days for routine appointments. Urgent appointment patients were seen within 24 h by only 54% of clinics and some had to wait for at least one week (5% of clinics). Prolonged waiting times were reported nationwide in addition to widely expressed concerns about the increasing workload. Additional resources should be made available to GUM services if the population's sexual health is to be improved.

An open, comparative, study of the efficacy of 0.5% podophyllotoxin lotion and 25% podophyllotoxin solution in the treatment of condylomata acuminata in males and females.

The efficacy and safety of topical treatment for external condylomata acuminata with either self-applied 0.5% podophyllotoxin (PT) or hospital-applied 25% podophyllin (PODO) solution was compared in 138 males and 67 females in an open multicentre study. After one week of treatment, wart clearance was observed in 53% of males and 37% of females in the PT group as compared with 19% of males and 19% of females in the PODO group (P < 0.001 in males; P = 0.13 in females). At 5 weeks after commencing treatment, clearance of warts had been achieved in 86% males and 72% females in the PT group as compared with 78% of males and 62% females in the PODO group (P = 0.08 in males; P = 0.14 in females). Treatment had cleared 81% of 180 treated sites in all PT recipients as compared with 61% of 95 treated sites in all PODO recipients (P < 0.001). The increased speed of action of PT was associated with an increased incidence of symptoms and signs of inflammation at treatment sites in both males and females (P < 0.001). These were generally mild, did not interfere with continuing treatment, and were more frequent in those patients whose warts were eradicated most rapidly. Home-based treatment with 0.5% podophyllotoxin lotion in appropriately instructed patients of either sex is superior in efficacy to outpatient applied 25% podophyllin and has the potential to reduce the number of hospital attendances required in genital wart eradication.

Radioactively labelled diethylene triamine penta acetate lung scan in Pneumocystis carinii pneumonia and asymptomatic HIV-positive patients.

The objective of this study is to establish normal ranges for the assessment of lung permeability, using 99mTc DTPA (diethylene triamine penta acetate) aerosol by measuring the half-time of transfer from the lung in asymptomatic HIV-positive patients. Also to audit the use of the test in the clinical management of outpatients with symptoms suggestive of Pneumocystis carinii pneumonia (PCP). A retrospective analysis of data from outpatients' notes for the audit of symptomatic patients, and prospective acquisition of 'normal' data for HIV-positive asymptomatic patients who were non-smokers and smokers was performed. Over a period of 8 years, DTPA scans were performed on 400 asymptomatic HIV-positive patients (121 non-smokers and 279 smokers) and 188 symptomatic HIV-positive patients with symptoms suggestive of PCP. A biphasic curve of transfer of 99mTc DTPA with a half-time of less than 4 min, was considered diagnostic of PCP. The mean half-times (+/-SEM) for asymptomatic non-smokers was 61.4 +/- 3 min and for smokers was 21.9 +/- 0.8 min. In the symptomatic patients, 106 were treated for PCP and in 97 (91.5%) of these, the transfer was biphasic. Of the remaining 82 patients with respiratory pathology other than PCP, 71 (86.6%) had normal scans. The results show that smokers may have abnormal baseline scans 16/ 279 (5.7%) and therefore a baseline scan before symptoms should be recorded or a higher false positive rate can be expected. The test is however highly sensitive for the detection of PCP and allows the attending physician to initiate PCP treatment without delay.

The treatment of inveterate vulvo-vaginal candidosis.

The antifungal treatment of recurrent vulvo-vaginal candidosis is described. Factors which predispose to the condition are discussed and details of their investigation and management mentioned. The problem of reinfection, both from a sexual contact and from the bowel is reviewed, and the general features of management considered.

Vulvo-vaginal candidosis--an overview.

Genital candidosis is extremely common and its incidence appears to be rising. The epidemiology, clinical features, predisposing factors and treatment of the condition are reviewed.