Sexual history: its importance in averting detrimental misdiagnosis and delayed diagnosis.

Two cases where the sexual history proved important in reaching the diagnosis are presented. Case 1 concerns a 37-year-old HIV positive homosexual man, who presented with symptoms of rectal pain associated with bleeding. He was unsuccessfully treated for Crohn disease. A subsequent review of his sexual history led to investigations for venereal infections. A final diagnosis of proctitis secondary to lymphogranuloma venereum was made. The patient was successfully treated with doxycycline and spared an unnecessary colectomy. Case 2 concerns a 22-year-old Caucasian woman under investigation for possible lymphoma. However, the doctor carrying out the biopsy experienced a needle stick injury and the ensuing investigations revealed the patient's HIV positive status and thus the explanation for her hitherto undiagnosed lymphadenopathy. A prior review of her sexual history could have hastened the diagnosis and prevented the need for invasive tests.

A retrospective audit of the management and complications of pelvic inflammatory disease.

Our objective was to examine the management of pelvic inflammatory disease (PID) in Southend Hospital against the British Association for Sexual Health and HIV guidelines. In addition, we reviewed the Genito-Urinary (GU) Medicine and Gynaecology notes for patients who failed treatment for PID in GU medicine. This was to reveal their complications and subsequent management. Thirty of 249 patients diagnosed with PID failed treatment. Chlamydia was found in 30% of these patients, gonorrhoea in 10%, with the rest being categorized into presumed anaerobic/other aetiology. Appropriate antibiotic regimens were used in 96.6% of patients and the 66.7% of contacts who were traced and treated. Eighteen of the 30 patients had a laparoscopy. Findings were: confirmed PID in 5.6%; endometriosis in 27.8%, adhesions with no evidence of PID in 27.8%; and 38% had no abnormalities found. Laparoscopy has an important role in excluding other pathology in patients who have failed to respond to appropriate conservative management.

Offering the vaccine and accepting it: an audit of hepatitis B vaccination in West Midlands region.

The practice of hepatitis B screening and vaccination in genitourinary medicine clinics in the West Midlands Region is audited against the standards set by 1999 Medical Society for the Study of Venereal Disease National Guidelines.

Vulvar carcinoma presenting during pregnancy, associated with recurrent bone marrow hypoplasia: a case report and literature review.

BACKGROUND: Carcinoma of the vulva has predominantly been a disease of the elderly. Although occasionally it occurs in women under the age of 40 years, carcinoma of the vulva has been rarely diagnosed in pregnancy. Bone marrow hypoplasia can occur as a transient, pregnancy-related event; however, the recurrence of this pathology in future pregnancies is quite rare in the literature. CASE: A 29-year-old woman in her second pregnancy that was complicated by bone marrow hypoplasia had developed a squamous vulvar carcinoma. Each of these two conditions are quite rare in pregnancy, they may have occurred by chance, but there is a hypothetical possibility that bone marrow hypoplasia is an autoimmune disorder, with vulvar carcinoma occurring as a further complication in this immunoimpaired individual. CONCLUSION: This case also emphasizes the need to consider malignancy as a differential diagnosis in vulvar ulcers occurring in young women.