A re-audit of the management of gonorrhoea.

A re-audit of the management of gonorrhoea was undertaken in 2014. Six out of nine auditable outcomes were met in the second audit (2014) compared with three out of eight in the first audit (2012). The new measures that were introduced following the original audit may have helped to improve outcomes. However, electronic patient records were introduced in December 2012. Documentation was much improved with the use of patient record templates and this has contributed considerably to the improved outcomes.

The management of lichen sclerosus in a genitourinary medicine setting: a 12-month retrospective case-notes review.

A retrospective case-notes review was undertaken of all women with lichen sclerosus seen during a 12-month period to review their characteristics and care. A total of 273 case-notes were reviewed. The mean age was 61 years (range, 14-94), and the mean duration of symptoms was 6.4 years (range, 1-50). The mean age at diagnosis was 55 years (range, 7-92). Sixty-two (23%) had at least one other autoimmune condition. Autoimmune conditions were seven times more frequent overall compared with United Kingdom prevalences. On-going symptoms were reported as none/minimal in 196 (72%), moderate in 65 (24%) and severe in 12 (4%). A total of 233 women (85%) had on-going treatment with clobetasol propionate (Dermovate) ointment with a mode of eight applications per month (range, 0-30). Forty-three women (16%) reported sexual dysfunction and 13 (5%) had needed at least one surgical procedure to restore sexual function. Eighty-six (32%) had undergone at least one biopsy. Nine squamous cell cancers (3%) had been diagnosed in six women (2%). These patients were managed in line with all current guidance. It is surprising that there is still no evidence to direct long-term management.

Measuring patient satisfaction: three years' data and experience of using a validated patient questionnaire.

A validated patient satisfaction questionnaire for use in sexual health clinics was run throughout the southwest region (the UK) three times over three years (13 clinics in January 2012 and 12/13 clinics in January 2013 and the same 12 clinics again in January 2014). The questionnaire covered aspects of pre-appointment, performance of health care professionals, facilities, privacy, respectful communication, information on leaving and overall experience. Data from 1750 questionnaires are presented with means and 95% confidence intervals. Patients under the age of 25 were less likely to rate care as excellent and/or very good (P = 0.001) compared with those above the age of 25. There was no difference in satisfaction levels according to gender or sexual orientation. Time in clinic was strongly associated with satisfaction levels - those in clinic for over 90 min expressed less satisfaction (P = 0.0005). We hope that other clinics may find it useful to use the validated questionnaire to look at their own performance and compare it against the southwest data. The main value is to identify areas where changes to service delivery could translate into improved practice and improved satisfaction, particularly where performance is identified as less than the 95% confidence intervals.

Rectal Chlamydia in heterosexual women: more questions than answers.

The aim of this study was to observe the proportion of concurrent rectal Chlamydia (RCt) infection in women who have cervical Chlamydia (CCt) and to observe whether there was any correlation with receptive anal intercourse (RAI). Untreated CCt-positive women were invited to take part. Women chose either to have a physician-collected or self-taken rectal swab. Treatment was then commenced. 17 samples were physician-collected and 80 were self-collected. 75/97 (77.3%, 95% Confidence Interval [95%CI] 69.0-85.7%) were RCt positive. 25/97 (25.8%, 95%CI 17.1-34.5%) reported RAI. There was no difference in the positivity rate whether RAI was reported (80%) or not (76%) (P = 0.71); or whether swabs were physician-collected (65%) or self-taken (80%) (P = 0.17). Only one of those with RCt reported rectal symptoms. One woman had concurrent gonococcal infection. 34/97 (35%) had a history of past sexually transmitted infections. Verified contact attendance was 0.52 and 72% of verified contacts were Chlamydia positive. Reported RAI may not be helpful in guiding RCt testing. RCt infection in women may be more prevalent than previously thought. We do not know whether RCt infections are clinically significant or whether they may act as a reservoir for re-infection. RCt infections in women require further study.

Patient-delivered partner therapy in the UK: what do patients think?

The aim of this study was to determine the proportion of genitourinary (GU) medicine patients attending a mixed urban/rural clinic who would welcome patient-delivered partner therapy (PDPT) as a partner management option. Five hundred patients completed the questionnaire. Acceptability of traditional partner referral was 87% (435), partner referral with infection specific guidance was 82% (411) and PDPT was 81% (405). Significantly fewer patients, 71% (354) would find a partner home sampling kit acceptable and provider referral was the least popular option at 23% (117). PDPT is not used in the UK mainly due to concerns of health professionals regarding the legal status of PDPT and the lack of UK evidence. The outcome of the Medical Research Council randomized controlled trial on accelerated partner therapy (which fits in with General Medical Council advice on remote prescribing) is eagerly awaited as professionals would welcome evidence-based guidance and our study suggests that patients are willing to consider this form of partner management as an additional treatment option.

Patient-delivered partner therapy in the UK: what do the professionals think?

The aim of this study was to investigate consultant genitourinary (GU) physicians' and health advisers' views regarding acceptability of patient-delivered partner therapy (PDPT) in the United Kingdom (UK). A postal questionnaire was sent to all consultant GU physicians and senior health advisers: 206 (65%) physician questionnaires and 153 (77%) health-adviser questionnaires were returned. One hundred and three (50%) physicians and 31 (22%) health advisers reported ever having used PDPT. Approximately one-third of professionals are strongly opposed to PDPT. However, the majority of both professional groups are cautiously prepared to consider PDPT, but only if there is no other option and only if a health professional first makes contact with the partner. Chief concern among health professionals is the legal status of PDPT in the UK. Here, the current General Medical Council (GMC) guidance on remote prescribing is helpful. The outcome of the Medical Research Council randomized controlled trial on accelerated partner therapy, which fits in with GMC guidance, is eagerly awaited as professionals would welcome evidence-based national guidance.

Vulval herpetic adhesion: a steroid success story.

Vulval adhesion is a rare but recognized local complication following genital herpes infection. We believe this is only the second reported case of successful resolution of vulval herpetic adhesion using topical potent corticosteroid as the primary early treatment.

The management of first episode genital herpes in genitourinary medicine clinics: a national audit in 2006.

A national audit of the management of first episode genital herpes (GH) was undertaken by non-consultant career grade doctors working in genitourinary (GU) medicine clinics in the United Kingdom. In total, 1620 data collection forms were completed (794 men and 826 women). Virus culture is the main detection method (1150, 71%), although polymerase chain reaction (PCR) use is increasing (442, 28%). PCR was significantly associated (P<0.0001) with fewer negative isolates (29/442, 6.6%) compared with virus culture (174/1150, 15%). Herpes simplex virus type 1 was isolated in 552 cases (46%). For 243 cases (15%), there was no evidence of counselling about GH. A total of 1355 (84%) were screened for other sexually transmitted infections. Serological testing for syphilis was undertaken in 72%. GU medicine clinics are managing first episode GH as broadly outlined in the guidelines. Areas identified for improvement are to increase counselling/written information/testing for syphilis towards 100%.

Clinching the contacts: a tale of two audits before and after the introduction of a contacts' clinic.

Contact tracing outcomes were good (0.8 contacts per case) at the Plymouth genitourinary (GU) medicine clinic when it was a 'walk-in' service. After moving to an appointments-only service, less than 0.5 contacts were seen. From October 2004, we introduced weekly contacts' clinics, which provided early appointments for partners of chlamydia-positive patients. We undertook audits of contact-tracing outcomes before (2004) and after (2005) the introduction of the contacts' clinics. Before, in 2004, 0.46 (95% confidence interval [CI] 0.36-0.56) contacts per case were seen within four weeks of the initial partner notification interview. After, in 2005, 0.66 (95% CI 0.57-0.75) contacts were seen within four weeks (P=0.005). Partner notification outcomes were significantly associated with follow-up (P<0.001). There was no difference in success whether the follow-up was by re-attendance or by telephone. This simple change in the clinic schedule has allowed the specialty's evidence-based National Outcome Standards to be met.

Effective role redesign: an audit of outcomes following the introduction of a new nurse-led service.

Genitourinary medicine services have had to modernize to try to meet the growth in demand. Changes should be audited to ensure standards remain high. We introduced a 'comprehensive care nurse-led service' for patients presenting for asymptomatic screening and as asymptomatic contacts (partners of known positive patients). Following implementation we audited outcomes and patient satisfaction. During the audit period (01/07/2005 to 30/11/2005), 446 patients were seen. A sexual health screen was performed in 433 (216 females: 217 males). Forty-one patients (9.5%) were chlamydia-positive by enzyme-linked immunosorbent assay testing (background clinic rate 8.5%). Forty-six (10.6%) were treated epidemiologically as chlamydia-negative contacts of chlamydia-positive index patients and 18 (4.1%) were treated as chlamydia-negative urethritis/cervicitis. Uptake of HIV testing was 71.2% (311/433). Average wait-to-appointment was three days (background clinic wait 2-3 weeks). Nurse-led clinics were judged successful in terms of outcomes, improving access and patient satisfaction.

The management of Chlamydia trachomatis in genitourinary medicine clinics: a national audit in 2004.

The first national audit of the management of Chlamydia trachomatis was undertaken by non-consultant career grade doctors working in genitourinary (GU) medicine clinics in the UK. During the audit period of January--March 2004, 1670 data collection forms were completed (from 830 men and 840 women with chlamydia). In all, 99% (1647) were treated appropriately; 76% (1261) were followed up, of which 12% (154) required re-treatment; 71% (1186) were managed appropriately within four weeks and 942 partners (0.56 per index case) were managed satisfactorily within four weeks of the initial partner notification interview. Partner notification outcomes were significantly more successful when the index patient was followed up (P<0.0001). Outcome standards were not associated with age, gender or sexuality, but were significantly associated with ethnicity (P<0.004). GU medicine clinics are delivering high-quality care and evidence-based national outcome standards are being met.

Improving access to genitourinary medicine by satellite clinics: an evaluation of the use of pump-priming funding.

Pump-priming funding was used to implement a three-month pilot project of two satellite clinics. We conducted a review to determine the impact of the satellite clinics on the local genitourinary (GU) medicine service and the level of success with reference to priorities in the National Strategy for Sexual Health and HIV. A total of 140 patients attended a university clinic and 52 attended a market town clinic. In all, 14% of university clinic and 15% of market town patients were chlamydia positive. Targets for offering/uptake of HIV testing (as outlined in the National Strategy) for 2004 were all met, and those for 2007 were all met except for one. Both satellites were judged successful. After effective implementation of a satellite service, staffing could be transferred to general practitioners with special interest in GU medicine/nurse specialists. This could allow additional satellites to be developed without compromising the main service, helping to improve access to local GU medicine services and promoting local clinical networks.

A survey of study leave entitlement in 2002 amongst non-consultant career grade doctors in genitourinary medicine.

Non-consultant career grade (NCCG) doctors perform a significant proportion of the clinical work in genitourinary medicine (GUM) and it is essential that their training and educational needs are met. Seven hundred questionnaires were posted to NCCGs in the UK to investigate whether employing trusts supported the educational needs of NCCG doctors by granting/funding study leave. A summary of the 220 replies (31% response) is presented. One hundred and twenty (55%) were not granted study leave to attend the 2002 national GUM NCCG conference. Study leave was less likely to be granted to those who held posts as clinical assistant or hospital practitioner and to those doctors who were working three or fewer sessions per week in GUM. It appears from our survey that many NCCG doctors who are seeing a significant proportion of the clinical workload in GUM are not supported by their employing trusts to keep up to date.

Southwest Regional Genitourinary Physicians' Audit Group: setting regional benchmarks for patient satisfaction.

The Southwest Regional Genitourinary Physicians' Audit Group conducted a survey to determine regional benchmarks for patient satisfaction with quality of care received in genitourinary medicine (GUM) clinics. Eight clinics participated, producing 1747 responses. Most patients were very satisfied with the standard of care in southwest GUM clinics resulting in high regional averages (74-90% very satisfied--score 5 on linear analogue scale 1-5). Revalidation/appraisal guidance suggests that physicians should actively participate in validated surveys relevant to their practice to provide evidence of relationships with patients. This questionnaire (with suggested improvements) may be used as part of that monitoring process.

An audit to evaluate the accessibility, cost, impact on work place absence and convenience of attending genitourinary medicine clinics in London and Plymouth.

We conducted a survey to assess the accessibility, cost, impact on work place absence and convenience of attending two genitourinary medicine (GUM) clinics, one in London and one in Plymouth. Nine hundred and fifty-eight questionnaires were collected for analysis (448 from London [L] and 510 from Plymouth [P]). The majority in London used public transport whereas the majority in Plymouth used private transport. Journey costs were less than 5 for the majority (75% L and 59% P). Of those in employment 229/678 (44%) had to take time off from work to attend. Women were significantly less likely (13/308, 4%, 95% confidence interval (CI) 2-6.5%) than men (51/370, 14% 95% [CI] 10.317.3%) to give up annual leave to attend. Both clinics were judged accessible, affordable and convenient by the majority of clinic users.

A five-year audit of the treatment of extensive anogenital warts by day case electrosurgery under general anaesthesia.

A retrospective five-year audit of patients with extensive anogenital warts (AGW) treated by day case electrosurgery was undertaken to determine clearance rates and recurrence rates. Published studies using these treatment modalities are few and most involve small numbers of patients. We present a series of 213 patients. One hundred and seventy-six patients underwent single procedures, 35 underwent repeat procedures and two (1%) spontaneously cleared before surgery. The outcome was known in 137 patients. Sixty-five (57%) of the single procedures, 18 (78%) of the repeat procedures and 83 (61%, [95% confidence interval [CI] 52.4-68.8%]) of the whole sample were clear by three months. Recurrence rates were 27 (24%), six (23%) and 33 (24%, [95 CI 16.9-31.2%]) respectively. These figures appear to be consistent with published data using electrocautery and surgical/scissor excision. There was a higher prevalence of smokers (compared to general population) but there was no difference in outcome between smokers and non-smokers.

A survey of non-consultant career grade doctors in genitourinary medicine: their knowledge of guidelines and their access to information technology 2001.

Non-consultant career grade (NCCG) doctors in genitourinary medicine (GUM) perform a large proportion of the clinical work. To ensure quality of service delivery to patients, it is essential that these doctors keep up to date. Seven hundred questionnaires were sent to NCCGs in the UK to evaluate their knowledge of national guidelines and access to information technology. A summary of the 224 replies (31% response) is presented. Knowledge of guidelines (76%-86%) and access to the Internet at work (39%-44%) varied according to the number of sessions worked in GUM per week and by grade of doctor. Knowledge of relevant websites was poor, ranging from 40%-54% for the Medical Society for the Study of Venereal Diseases (MSSVD) website and 21%-39% for the Association of Genitourinary Medicine (AGUM) website. This survey highlights areas for concern, especially with regard to NCCGs who work three or less GUM sessions per week.