Detecting re-infection in patients after an initial diagnosis of gonorrhoea: is routine recall for re-screening useful?

To assess the outcome of routine sexually transmitted infection re-screening after a three-month interval in unselected patients diagnosed with gonorrhoea, we sought to assess whether this active approach would result in an increase in the number of people attending clinic and subsequently diagnosed with gonorrhoea re-infection, compared with normal re-presentation rates. A recall group of patients were invited for re-screening three months after their initial diagnosis of gonorrhoea. Permission was sought to send a reminder two weeks prior to their scheduled recall appointment. Comparisons were made with a historical control group of patients with gonorrhoea in the absence of any formal recall. Of the 242 patients in the intervention arm, 96 (40%) re-attended within six months, and 15 (6%) tested gonorrhoea positive. Two hundred and two patients were assessed in the control group, of whom 45 (22%) re-attended within six months, and 13 (6%) tested gonorrhoea positive. Women were more likely than men to re-attend following active recall, but they were not at higher risk of re-attending while re-infected with gonorrhoea. Active recall following a gonorrhoea diagnosis significantly increases re-attendance rates for repeat screening but did not result in an increased number of subsequent gonorrhoea diagnoses.

European guideline for the organization of a consultation for sexually transmitted infections, 2012.

This guideline is intended to serve as a framework for those working in any location where sexually transmitted infections (STIs) are managed. It offers recommendations which will need to be adapted depending on local facilities and policies, and is not intended to be all encompassing. This guideline should be read in conjunction with other European guidelines on the management of specific infections (see http://www.iusti.org/).

Haemophagocytic lymphohistiocytosis complicating Hodgkin's lymphoma in an HIV-positive individual.

We report the case of an HIV-positive man who presented with pyrexia of unknown origin. Histological specimens from an inguinal lymph node and liver biopsy gave a diagnosis of Epstein Barr virus (EBV)-positive Hodgkin's lymphoma and haemophagocytic lymphohistiocytosis (HLH), respectively. HLH is a condition characterized by proliferation of activated macrophages that phagocytose leukocytes, erythrocytes and platelets. Clinical features include splenomegaly, fever and pancytopenia, all of which have a wide differential diagnosis in HIV-positive patients. HLH can be caused by infections, malignancy, drugs or autoimmune conditions. There have been a number of reports of HLH in HIV-positive patients, and it can be seen at all stages of HIV infection. HIV, lymphomas, EBV infection and haemophagocytic syndrome have a complicated pathophysiology. Unfortunately, HLH in this setting has a particularly aggressive course, often with a poor outcome. This case highlights the need for awareness of the syndrome to ensure prompt diagnosis and instigation of appropriate treatment.

The epidemiology and control of lymphatic filariasis on Lihir Island, New Ireland Province.

Clinical, parasitological and entomological surveys performed in 9 villages on Lihir Island, Papua New Guinea, before mass treatment with diethylcarbamazine (DEC), showed that lymphatic filariasis, caused by nocturnally periodic Wuchereria bancrofti, was endemic in 8 of them. Blood samples from 593 people revealed an overall microfilarial carrier rate of 24%. Amongst endemic villages, microfilarial carrier rates ranged from 5% to 43% and there was no significant difference in parasite prevalence between males and females. Obstructive filarial disease, defined as lymphoedema of the limbs or hydrocele, was observed in only 2% of 262 males examined. None of the 265 females examined had clinical symptoms. Entomological surveys yielded a total of 4095 mosquitoes including 3,692 anophelines and 241 culicines but only Anopheles farauti was found to harbour infective larvae of W. bancrofti. Pretreatment infection and infective rates of An. farauti were 7% and 1% respectively and up to 12 infective larvae were found in a single specimen. The microfilarial carrier rate in a cohort of people who received two DEC treatments dropped from 59% to 32% but the difference was not statistically significant. However, density of microfilaraemia decreased significantly from 170 to 10 mf/ml. Biannual mass treatment with DEC significantly reduced vector infection rates and transmission intensity on Lihir.

Predicting hypoxia in children with acute lower respiratory infection: a study in the highlands of Papua New Guinea.

Pneumonia accounts for nearly half of all admissions amongst children less than 5 years of age to health centres and hospitals in the highlands of Papua New Guinea. Until recently, the indications for the use of oxygen in the management of childhood pneumonia in Papua New Guinea had been confined to the detection of cyanosis and restlessness. Oxygen is, however, difficult to deliver to many parts of Papua New Guinea, leading to high transport costs and shortages. Health workers in rural areas are continually faced with decisions as to which children should be given oxygen when it is in short supply. This study related clinical signs to the oxygen saturation of the blood using a pulse oximeter, in order to offer rational criteria for the use of oxygen in health centres and hospitals in remote areas. Data were collected on 110 children who were admitted to Tari Hospital with a diagnosis of moderate or severe pneumonia. Following admission, assessments were repeated at 12-hourly intervals until the child was discharged from the intensive nursing ward. All clinical assessments and oximetry readings were taken by a registered nurse. A rule developed via quadratic discrimination analysis was able to correctly classify 80 per cent of children as having adequate/inadequate oxygen saturation, with 'inadequate oxygen saturation' defined as less than 85 per cent. This, however, involved a complicated equation which would not be suitable for general use in a developing country. The use of a 'clinical score' using a summation of the major clinical signs was not found to offer any advantage over the recognition of any one of four 'indicator' signs.(ABSTRACT TRUNCATED AT 250 WORDS)

The Highlands Physicians Forum: rediscovering the regional medical meeting in Papua New Guinea.

Physicians meeting together to discuss matters of professional interest has been the basis of many developments in the advancement and communication of medical knowledge. These meetings neither have to be large nor nationally based to provide a useful exchange of meaningful ideas. With this in mind, a group of physicians working in the highlands of Papua New Guinea decided to hold their own professional meeting which would focus on issues of relevance to the practice of medicine in the highlands. Other physicians were not excluded and several specialists from Port Moresby joined the group. The program was similar to that found to be so successful over the years at the annual medical symposia of the Medical Society of Papua New Guinea. All participants contributed papers to the meeting. The collegial atmosphere created by the small number of individuals fostered stimulating discussions and a greater depth of interchange than might have been the case with a larger number of participants. A range of topics was covered but the emphasis was on practical approaches to health problems. The meeting concluded with a workshop session discussing problems in rural health services, the utility of rural laboratories and a medical audit in the highlands. The Highlands Physicians Forum has now met for two consecutive years and has been the source of positive comments from all participants. We urge physicians all over Papua New Guinea to develop regional meetings. This should not be viewed as being in competition with the annual symposium but as a preparation for it.

Haemophilia A in the highlands: the investigation and management of two families in Tari.

A 12-year-old boy from Tari in the Southern Highlands of Papua New Guinea presented with prolonged bleeding from a minor injury to the lip. He had a history of profuse bleeding and joint swelling following minor trauma. He has two younger brothers with a similar history. It was demonstrated that they had a coagulation profile compatible with factor VIII deficiency and a family tree suggestive of haemophilia A. A further case was investigated some months later. Despite the neighbouring places of residence of the two families no familial connection could be established by involved discussions between family members. This was confirmed by reviewing the data held on the demographic surveillance system of the Tari Unit of the Papua New Guinea Institute of Medical Research. These families are considered against a background of the diagnosis and management of this condition in a rural part of Papua New Guinea. The long-term support of these patients and other similarly affected individuals presents difficult clinical and ethical problems for rural health services.