Testicular microlithiasis: is it significant?

Previously considered to be a benign finding on scrotal ultrasonography, testicular microlithiasis (TM) is now recognized as a condition associated with the development of testicular neoplasia. Despite this the management of TM remains unclear. We review the evidence for this association and suggested management strategies.

Mollaret's meningitis and herpes simplex virus type 2 infections.

Benign recurrent aseptic meningitis is a rare disorder described by Mollaret in 1944. When initially described, this form of aseptic meningitis had no identifiable infecting agent. New sophisticated diagnostic tools have now identified herpes simplex type 2 virus as the most commonly isolated agent. Antiviral treatment has been used successfully for prophylaxis and treatment.

Botulinum toxin for urogenital conditions.

SUMMARY: Botulinum neurotoxin has been shown to be effective when used in the management of lower urinary tract dysfunction, prostatic disorders and more recently vaginismus in women suffering with pelvic floor muscle tension. Here we provide an overview of the use and efficacy of botulinum toxin in these conditions.

Anaerobic bacteria and non-gonococcal urethritis.

Anaerobic bacteria are frequent inhabitants of the urethra of both normal men and men with non-gonococcal urethritis. All microbiologically-based studies have shown them not to have a role in the aetiology of the condition. However, Bacteroides ureolyticus continues to be an enigma having been isolated more commonly from men with urethritis in some studies, not confirmed by others, as well as in treatment-based studies in which the organism has been implicated by some authors. Few studies related to anaerobic organisms in the male genital tract have been conducted during the last decade.

Serological prevalence of herpes simplex virus type 2 amongst GUM clinic attenders in a district general hospital setting.

Our objective was to determine the seroprevalence of herpes simplex virus (HSV) type 2 infection amongst genitourinary medicine (GUM) clinic attenders at a district general hospital using a commercially available enzyme immunoassay (EIA). In a prospective study, heterosexual patients attending the Department of GUM at Trafford General Hospital attending with a new clinical problem and having a blood sample taken for routine syphilis serology had the same sample tested for HSV type 2 antibodies. The prevalence of HSV type 2 seropositivity amongst participants was 9.9% (24/242) for men and 18.7% (46/246) for women. With respect to undiagnosed, asymptomatic infection the seroprevalence was 8.6% and 17% respectively. For those attenders locally resident the seroprevalence was 10.1% and 17.5% respectively, and undiagnosed, asymptomatic infection 8.5% and 17.1% respectively. Although seroprevalence figures in this study are lower than the only previous report in the UK, these results, nevertheless, show that seropositivity is not confined to large urban centres. Patients attending GUM clinics are likely to have high rates of undiagnosed HSV type 2 infection.

Application of 'Clearview Chlamydia' for the rapid detection of cervical chlamydial antigen.

In a study to evaluate the Clearview chlamydia test in a genitourinary medicine clinic, the sensitivity and specificity were 76.4% and 99.4% respectively when compared with the DAKO IDEIA chlamydia test processed in a department of medical microbiology. The time taken to perform and read the Clearview chlamydia test 'on site' did not interfere with the normal routine functioning of the clinic and the nurses who performed it as part of their routine duties found it simple and easy to use.

Utilisation of genitourinary medicine services by general practitioners: effect of geographic location, fundholding status, and potential effect of total fundholding.

OBJECTIVES: To determine the current utilisation of genitourinary medicine (GUM) services by general practitioners (GPs) and any changes likely to occur with moves towards a primary care led NHS. METHODS: A questionnaire survey of practising GPs appearing in the Medical Directory in England and Wales to determine the effect of geographical location, fundholding status, and potential effect of total fundholding on referrals to GUM clinics. RESULTS: Referral patterns for STDs varied according to the genital infection concerned, being highest for gonorrhoea and lowest for Trichomonas vaginalis infection. Referral patterns were little affected by geographic location of the practice or fundholding status. The reported intention on becoming total fundholding was a modest shift towards more STDs being treated in the community which varied according to the genital infection concerned. CONCLUSIONS: Although some GPs elect to always treat some STDs in the community most refer patients to GUM clinics. There appears to be little enthusiasm among GPs, should they become total fundholders, to extend their range of services to include STD provision.

Survey of the management of genital herpes in general practice.

In a questionnaire survey of the management and treatment of genital herpes in the community by general practitioners (GPs) in 16 UK cities considered to have good access to genitourinary services, the mean number of cases seen per GP in the previous 12 months was 1.37 for first episodes and 0.96 cases for recurrent episode genital herpes. First episode genital herpes was regularly managed solely in the community by 21% of responding GPs, while 45% of those referring directly to the genitourinary medicine clinic initiated treatment prior to referral; the vast majority prescribing acyclovir. Overall, three-quarters of GPs prescribed oral acyclovir for first episode genital herpes. Recurrent genital herpes was regularly treated solely in the community by 47% of responding GPs, while 53% of those referring directly to the genitourinary medicine clinic initiated treatment prior to referral. There was almost equal usage between acyclovir cream and tablets in the treatment of recurrent infections.

Patients with genital warts: how are they managed by general practitioners?

This study was carried out to assess the management by general practitioners of patients with genital warts. An anonymized postal questionnaire was sent to 2060 general practitioners in the north west of England; 1260 (61.2%) completed questionnaires were returned. A total of 76.69% of GPs saw one or more cases per quarter. Of 468 (37.1%) GPs who managed patients in-house, 393 (83.9%) used podophyllin of concentration between 0.5 and 50%; 169 (43%) did not specify the podophyllin concentration and 112(23.9%) used podophyllotoxin. Of 395 GPs (31.3%) prescribing patient self-treatment, 259 (65.6%) prescribed podophyllin, but 60.23% did not specify the concentration; 134(33.9%) prescribed podophyllotoxin. Screening for selected sexually transmitted infections (STIs) was performed by 258/618 (41.7%) GPs. Only 74 (11.97%) screened for Chlamydia trachomatis and Neisseria gonorrhoeae and Trichomonas vaginalis. Partner notification was advised by 1138 (90.3%) and condom use by 1027 (81.5%). Only 333 (26.4%) referred all patients to GUM departments. Many GPs manage patients in-house, most using podophyllin solutions which vary in concentration, are non-standardized and potentially hazardous. Most GPs who instigate patient self-treatment prescribe podophyllin which is not licensed for this usage. Podophyllotoxin 0.5% is a safe, effective alternative. Few non-referring GPs screened for the 3 common STIs, thus putting patients at risk of complications such as pelvic inflammatory disease. Non-referral of patients with genital warts to GUM departments may have costly medical and financial consequences.

Lifetime cost of treating a person with HIV infection.

A study was conducted to examine the inpatient, outpatient and drug therapy costs incurred from initial presentation with HIV infection or AIDS to death, where death occurred between 1990 and 1994. The average lifetime cost per patient was 18,729 pounds being made up of 8428 pounds for inpatient care, 2086 pounds for outpatient care and 8215 pounds for drug therapy. Sixty per cent of patients died at home. Active cytomegalovirus infection was the most common condition encountered in the high cost patients. Escalating drug costs may eventually lead to priority setting for the management of certain opportunistic infections.

Comparison of clotrimazole, fluconazole and itraconazole in vaginal candidiasis.

Women attending a genitourinary medicine clinic (n = 229) with mycologically confirmed acute vulvovaginal candidiasis were randomised to receive either clotrimazole (500 mg pessary and 1% cream), fluconazole (150 mg single oral dose) or itraconazole (200 mg bd oral dose for 1 day). Mycological cure rates were 96% in the itraconazole group, 95% in the clotrimazole group, and 83% in the fluconazole group (P = 0.008). The proportion of patients who were clinically cured showed a similar pattern (itraconazole 80%, clotrimazole 80%, fluconazole 62%). This suggests that itraconazole or clotrimazole are more effective than fluconazole in the treatment of acute vaginal candidiasis.