Audit of partner notification for chlamydia infection in the genitourinary medicine clinic at the University Hospital of Hartlepool: 2004-2008.

Partner notification is essential for the control of chlamydia infection, which is on the rise. The aim of this study was to assess the performance of partner notification for chlamydia infection in the genitourinary medicine clinic at the University Hospital of Hartlepool, UK from 2004 to 2008. Overall 1.37 partners were declared per index patient, with male patients declaring 1.59 partners and female patients declaring 1.19 partners. For each chlamydia index patient 0.52 partners were screened (38 per cent of declared partners). Fifty-seven percent of the screened patients were positive for chlamydia and this increased from 33% in 2004 to 66% in 2008. The number of index cases needed to interview to get a new positive chlamydia was 3.37 over the study period and varied from 6.74 in 2004 to 2.74 in 2008. This audit highlights the need to improve partner notification for chlamydia infection.

Paromomycin treatment of recalcitrant Trichomonas vaginalis.

We report a 49-year-old woman with a five-year history of persistent Trichomonas vaginalis infection. Treatment with several courses of metronidazole and tinidazole failed to resolve her symptoms. A single course of intravaginal paromomycin was effective in clearing the infection.

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.

Asymptomatic HIV patient with cardiomyopathy and nephropathy: case report and literature review.

We report a previously asymptomatic HIV patient with high CD4 lymphocyte count and low HIV1 viral load who developed cardiac and renal disease. Management with ACE inhibitor, diuretics and triple antiretroviral combination therapy yielded a rapid clinical response. An understanding of the spectrum of renal and cardiac derangements is essential for clinicians in managing patients with HIV disease.

Neisseria gonorrhoeae in Newcastle upon Tyne 1995-1997: increase in ciprofloxacin resistance.

Fluoroquinolones and third generation cephalosporins are the most effective antimicrobial agents for the treatment of gonorrhoea. However, clinically significant resistance to fluoroquinolones in Neisseria gonorrhoeae has been reported worldwide including Britain. The aim of this analysis was to study the factors relating to ciprofloxacin resistance and treatment failure. A total of 201 patients attending the Newcastle Genitourinary Medicine (GUM) clinic from 1995-1997 who were diagnosed with culture positive gonorrhoea was analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) was measured for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant range (>0.05 microg/ml) were reviewed to determine the clinical outcome. The ciprofloxacin resistance with treatment failure was seen in 5% (8/160). All the 8 cases of treatment failure were heterosexual and had isolates resistant to penicillin and 4 cases (50%) were also resistant to tetracycline. All were sensitive to spectinomycin and ceftriaxone. Most of the cases probably acquired their infection from the Far East. As ciprofloxacin resistance seems to be associated with overseas exposure, changes in the standard treatment of gonorrhoea are not justified but consideration should be given to appropriate alternatives when the infection may have arisen from where such resistant strains are endemic. Monitoring fluoroquinolone resistance is now essential for ensuring adequate treatment of infections with resistant strains and for maximizing the time of usage of fluoroquinolones to treat gonorrhoea.

An indolent penile herpetic ulcer in a patient with previously undiagnosed human immunodeficiency virus infection.

We report a case of an atypical penile herpetic ulcer in a man with previously undiagnosed human immunodeficiency virus (HIV) infection. Swabs of the lesion were negative for herpes simplex virus (HSV) by culture and electron microscopy. However, histopathology of biopsy material showed characteristic herpetic multinucleate giant cells. Immunochemistry using polyclonal antibodies was positive for HSV1 and HSV2. The lesion completely resolved after treatment with aciclovir and the patient subsequently tested positively for HIV antibodies.

Meningococcal carriage: prevalence and sex-related risk factors.

A retrospective analysis was done to examine whether sexual behaviour was associated with meningococcal carriage. Over the 4 month period from January to April 1994, 136 (27.4%) of the 496 consecutive new/re-registered genito-urinary medicine clinic attenders showed meningococcal carriage. Two (15.4%) of 13 homosexual men compared with 134 (27.7%) of 484 heterosexual men and women had evidence of meningococcal carriage. Relative risk (RR) of meningococcal carriage was 1.8 with > 10 lifetime partners and 1.2 with 3-10 partners (P < 0.007). RR with age group of 16-25 was 4.2 and for 26-35 it was 3.5. There was no relationship with meningococcal carriage and pharyngeal symptoms, sexual orientation, intravenous drug use, number of partners per month and orogenital sex. Further longitudinal studies may be of value in order to determine whether a high number of sexual partners is a marker for meningococcal carriage. In addition, further study may show whether there is an increased risk of meningococcal carriage and disease in those who live with meningococcal carriers.

Musculoskeletal disorders: genitourinary medicine perspective.

The association of musculoskeletal disorders and genitourinary symptoms is reviewed. Reactive arthritis, Sjögren's syndrome and rheumatoid arthritis can present with a variety of genitourinary symptoms. Similarly sexually transmitted diseases including gonorrhoea, syphilis, HIV and other viral infections can affect the musculoskeletal system. Reiter's syndrome may be a consequence of a sexually transmitted infection although its presentation can suggest that also in post-dysenteric cases. The fact that conditions may present to various medical specialties requires doctors outside departments of GUM to allow their patients an opportunity and the time to discuss sexual matters.

Sterile pyuria: consider chlamydial infection.

We report the cases of two men referred to a genitourinary medicine clinic with sterile pyuria and subsequently found to have their urethras infected with Chlamydia trachomatis. Chlamydial infection should be considered in the differential diagnosis of sterile pyuria, particularly in young, sexually active males. We discuss the consequences of inadequate treatment of the index case.

Dyspareunia in undiagnosed Sjogren's syndrome.

A case of superficial dyspareunia in a 46-year-old women is described. Clinical suspicion, examination and investigations supported a diagnosis of Sjogren's syndrome.

High prevalence of herpes simplex virus type 1 in female anogenital herpes simplex in Newcastle upon Tyne 1983-92.

This retrospective study was undertaken to evaluate the prevalence of the viral types and temporal epidemiology in patients with ano-genital herpes between 1983-92. One thousand one hundred and thirty-five patients with anogenital herpes were available for analysis. The annual incidence of anogenital herpes nearly tripled over the period of 7 years (1986-92) from 59 to 171 cases. The percentage of HSV-1 infection in female cases (63-79%) was much higher than in other reported studies and remained relatively constant over the study period.

Hypopituitarism: a difficult diagnosis in elderly people but worth a search.

Hypopituitarism is uncommon in elderly people. We report 12 cases of hypopituitarism diagnosed after the age of 60 (range 63-89, mean 74.9) years over a 10-year period. Aetiology was evident in eight cases, viz. pituitary tumour in six and previous post-partum haemorrhage and giant aneurysm of carotid artery in one each. The presentation was often non-specific with symptoms such as lethargy, pallor, falls, urinary incontinence, confusion, fever and flexion contractures. Subtle clues to the condition were missed in four cases resulting in delayed diagnosis. Although levels of pituitary trophic hormones are generally low in this condition, the thyrotrophin (TSH) was normal in seven cases in the present series. Normal levels of serum sodium and potassium did not exclude cortisol deficiency. Hormone replacement therapy resulted in improved quality of life. Physicians dealing with elderly patients should bear this easily treated condition in mind.