Availability of services for subjects of sexual assault in genitourinary medicine clinics.

The aim of this study is to gain an understanding of the services available to subjects of sexual assault at genitourinary medicine (GU medicine) clinics throughout the United Kingdom, and to determine whether these services are adequate. By means of a questionnaire, consultants in 106 clinics provided information on the number of patients who reported sexual assault and the services available to them. The study found a marked regional variation in attendances by subjects of sexual assault. However, only a minority of clinics kept accurate data (36.7% regarding female victims and 37.75% regarding male victims). The number of subjects who were aged under 16 years was disproportionately high (under 16s: 6.9% of female victims and 1.2% male victims; 16 and over: 1.3% of female victims and 0.14% of male victims). This survey highlights deficiencies in services that need to be addressed by clinics, management and the speciality.

Reducing waiting times for GU medicine appointments: the impact of a new appointment system.

Our objective was to reduce the 'did not attend' (DNA) rates and waiting times by introducing a new confirmatory appointment system prior to their attendance at both Hartlepool and Middlesbrough genitourinary (GU) medicine departments. In Middlesbrough it was previous day appointment confirmation, whereas at Hartlepool it was 10 days. Both systems achieved significant attendance rates of 83.4% and 79.1% at Hartlepool and Middlesbrough, in comparison to 68.7% and 75.0% prior to the new system. The new system will improve the departmental capacity.

Seroprevalence of antibodies to herpes simplex virus types 1 and 2 among two sexually active female populations in Middlesbrough, England.

Herpes simplex virus (HSV) infection occurs worldwide but its epidemiology varies between different countries and between groups of individuals. Seroprevalence of HSV-1 and HSV-2 antibodies is a more accurate method of determining epidemiology of this infection. In this cross-sectional study, 467 blood samples were obtained from women attending the genitourinary medicine clinic (GUM) and antenatal clinic (ANC) in Middlesbrough, England. Analysis of their blood samples showed that 69.5% GUM patients had HSV-1 antibodies and the figure was 54.5% in the ANC patients, p < 0.0001, with odds ratio 1.9 (95% CI 1.30 to 2.78) for higher prevalence in the GUM group. Also, for HSV-2 antibodies, the seroprevalence was 21.6% for GUM and 8.1% for ANC patients, p < 0.0001, with an odds ratio of 3.13 (95% CI 1.70 to 6.02) for higher prevalence in the GUM group. The overall prevalence for HSV-1 is 63.2% and for HSV-2 is 15.8%. Many of these patients were asymptomatic and constitute a potential source for spreading the virus. Knowledge of HSV seroprevalence can help in planning sexual health promotion strategies.

A comparison of two methods for detection of Chlamydia trachomatis in the male urethra.

Several methods have been put forward for screening people for Chlamydia trachomatis infection of the urogenital tract. It is often believed that culture is the gold standard. However, newer and faster methods are being developed. This study reports the result from the comparison of two methods.

Audit of hepatitis B immunization at the genitourinary medicine department in Middlesbrough, UK.

The outcomes of hepatitis B immunization programme at the genitourinary medicine (GUM) department in Middlesbrough during a period of five years were examined. The majority of those immunized were male homosexuals who had earlier requested an HIV test. All participants had preimmunization hepatitis B serology, and were negative. The default rate was high at 20/42 (47.6%). However, among those who completed all the processes, seroconversion rate was high at 21/22 (95.5%). The only non-responder was a man who was HIV-positive. The type of vaccine and immunization regimen are discussed.

Genital thrush in women: the attitudes and practice patterns of General Practitioners in Teesside and north Yorkshire.

This study was performed in order to determine the attitudes and practice patterns of some of the GPs on Teesside and North Yorkshire in the management of their female patients complaining of genital thrush, a term often used to mean vulvo-vaginal candidosis an extremely common condition (Tobin, 1995; Elliott, 1998; Lopez-Martinez et al, 1984). Postal questionnaires were sent to 65 GPs on Teesside and the bordering areas of North Yorkshire. There were 45(69%) completed replies. Nearly all the GP's believed that antibiotic usage was associated with the development of this disorder; less than half (44%) of the patients seen had a confirmatory microbiological test in the form of examination of a high vaginal swab (HVS). The most frequently prescribed antifungal compound was found to be clotrimazole.

The cellular immune system in female patients with or without genital warts: a study of peripheral white blood cell components.

The immune system plays a vital role in the fight against infections. The commonest viral infections treated in the genitourinary medicine (GUM) departments are genital warts. Knowledge about the status of the immune system in these patients may help in their clinical management. This study compares the values of various blood cell components in the peripheral blood of 2 groups of female patients--those with genital warts against those without genital warts. The mean monocyte count was lower among patients with genital warts.

Traditional medicine in Nigeria and modern obstetric practice: need for cooperation.

OBJECTIVES: To determine the prevalent use of traditional medicine in pregnancy and labour and to find out if there is any association between the use of traditional medicine and obstetric outcomes. DESIGN: A cross sectional structured interview survey and case notes review. SETTING: Department of Obstetrics and Gynaecology, Ogun State University Teaching Hospital (OSUTH), Sagamu, Nigeria. SUBJECTS: 300 parturient mothers. MAIN OUTCOME MEASURES: a) Use or non-use of traditional medicines in pregnancy and labour. b) Maternal morbidity and mortality. c) Perinatal morbidity and mortality. RESULTS: 160 (53.3%) patients admitted to the use of traditional medicine in pregnancy and labour. The two groups (users and non-users) were similar with respect to age, parity and level of education. The three maternal deaths occurred in the users' group. The perinatal mortality was 91 per 1,000 among the users and 61.2 per 1,000 for the non-users. CONCLUSION: Mothers and neonates in the users' group fared worse than the controls. Delay in seeking hospital care was the major factor in the poorer outcomes for the users' group. Since the use of traditional medicine in pregnancy and labour is common among the population, efforts should be made by the two groups of physicians (traditional and Western) to co-operate.

PIP: The association between the use of traditional medicine and obstetric outcomes was determined using a cross-sectional structured interview and case notes at the Department of Obstetrics and Gynecology, Ogun State University Teaching Hospital in Sagamu, Nigeria. The subjects were 300 parturient mothers, who were divided into two groups. The 160 patients who used traditional medicine constituted the users or study group while the 140 nonusers were the control group. Both groups were similar with respect to maternal age, parity, and level of formal education. The perinatal mortality rates were 91/1000 for the study group and 61.2/1000 for the control group. Three maternal deaths occurred in the study group. A woman who used traditional medicine had a relative risk of 1.64 of morbidity, while a non-user had a relative risk of 1.43 of being delivered by caesarian section. Some patients used more than one traditional medicine. Use of traditional medication was suggested by in-laws in 49 cases (30%), by parents in 44 cases (27.5%), by the husband in 33 cases (20.6%), and by others in the 10 remaining cases (6.3%). In this survey, there are medical differences in the obstetric outcomes between the two groups. These differences are not statistically significant enough to justify the wholesale condemnation of traditional medicine in modern obstetrics. Delay in seeking hospital care was the major factor in the poorer outcome for the users' group. Considering the prevalence of the use of traditional medicine in pregnancy and labor among the population, efforts should be made by traditional and Western physicians to share knowledge and cooperate.

Podophyllin 0.5% or 2.0% v podophyllotoxin 0.5% for the self treatment of penile warts: a double blind randomised study.

OBJECTIVE: To compare the effectiveness and cost of self treatment of penile warts with a commercial preparation of podophyllotoxin 0.5% (PDX 0.5%) with podophyllin 0.5% and podophyllin 2.0% sourced from Podophyllum emodii. DESIGN: A prospective double blind randomised study. SUBJECTS: 315 patients with penile warts attending two departments of genitourinary medicine. MAIN OUTCOME MEASURES: Absence of warts, cessation of treatment due to severe side effects at 5 weeks. RESULTS: Of the 315 patients, 244 conformed to the protocol. Analysis was on an intention to treat basis. At 5 weeks no significant differences were found in the extent of healing of warts or in side effects for the three treatment groups. The costs of drug treatment (excluding staff time) are at least pounds 10.00 less for podophyllin than podophyllotoxin. A fourfold variation in the active constituents of the podophyllin preparations did not produce appreciably different clinical responses. In a subanalysis no evidence of deterioration in effectiveness of podophyllin over time was demonstrated. CONCLUSIONS: Penile warts in selected cases can be safely treated with 0.5-2.0% podophyllin self applied by the patient at a fraction of the cost of commercially available podophyllotoxin. The shelf life of the podophyllin extracts is at least 3 months. These findings may be especially relevant in countries where resources for health care are limited.