A case series of interventional radiology in postpartum haemorrhage.

Postpartum haemorrhage (PPH) remains a significant cause of maternal morbidity and mortality in both developed and developing countries. In some instances, PPH can be anticipated and recent improvements in obstetric imaging techniques allow earlier and more reliable diagnosis of abnormalities associated with haemorrhage such as morbid placentation. However, the majority of PPH is unpredicted. Good practice notes published by the Royal College of Obstetricians and Gynaecologists state interventional radiology should be used as emergency intervention in PPH and should be considered when primary management has failed allowing arteries to be embolised to achieve haemostasis. Through collaboration between interventional radiology and maternity, appropriate guidelines need to be developed, on both emergency and elective of interventional radiology in the prevention and management of PPH. As there is mapping for neonatal services, in the future there should be consideration to develop obstetric trauma units. Maternity units which lack facilities for interventional radiology would be able to refer their cases (like placenta accreta) for safe management in units with 24 h interventional radiology services.

Body piercing: lifestyle indicator or fashion accessory?

A study was undertaken to assess the prevalence of body piercing (BP) in women attending a sexually transmitted disease (STD) clinic, and any associated demographic, socioeconomic and sexual indicators. One hundred and fifty-two new female patients attending the Southampton clinic were the subjects of the study; of these 52 (32%) had BP, the most common site being the navel (25%). BP was more common in women who had their ears pierced more than once (35:71, 49%). It was less common in women who were non-smokers, being present in 17:77 (22%), and in older women, only one of 18 (6%) women aged 35 or older having had BP done. The presence of BP was not associated with socioeconomic class, method of contraception, multiple partners, or the presence of any genital infection. The study supports the suggestion that most BP is done for fashion reasons.

Audit of outcome following positive chlamydial test results in family planning clinics in Southampton.

Chlamydia trachomatis is increasingly being identified outside of genitourinary medicine (GUM) clinics, concern has been expressed about the management of these patients. An audit was undertaken on a group of women identified with chlamydia in family planning clinics (FPCs) in Southampton. Forty-seven women were identified positive over a period of one year. Fifty-nine per cent attended a GUM clinic for treatment, 15% were treated at family planning clinics or by their general practitioners (GPs) but 26% remained untreated. The median time from knowing the positive result to attending GUM was more than 3 weeks in 27%. In those that attended GUM, 44% had an associated genital infection and 79% of named sexual partners were traced. As a result of the audit, a new protocol has been introduced in the family planning clinics for the management of women found to have chlamydia.

Current smoking habits and genital infections in women.

A study was undertaken to assess the relationship between current cigarette smoking and genital infections. Four hundred women attending a sexually transmitted disease clinic were the subjects of the study; of these 212 (53%) were cigarette smokers. In women under 20 years of age 70% were smokers. Women who smoked were more likely to have multiple partners and be in a lower socio-economic class or unemployed. The presence of genital warts was commoner in smokers. No association was shown between smoking and cervical inflammation or dysplasia. The findings suggest that cigarette smoking is a behavioural factor which should routinely be identified in the demographic details of women attending sexually transmitted disease clinics.

Mucopurulent cervicitis: a clinical entity?

Of 297 women attending a sexually transmitted disease clinic who were examined for the presence of mucopurulent cervicitis, 96 (32%) satisfied the diagnostic criteria. Mucopurulent cervicitis was strongly associated with the isolation of Chlamydia trachomatis and Neisseria gonorrhoeae. It was also associated with bacterial vaginosis, the use of oral contraceptives, and sexual contact with men who had non-gonococcal urethritis. Conversely, the presence of opaque cervical secretions did not show these associations, and the results indicated no difference in genital infections in women with clear cervical secretions whether or not more than 10 polymorphonuclear leucocytes per field (at a magnification of x 1000) were present. The findings support the suggestion that mucopurulent cervicitis is a definite clinical entity that requires investigation and treatment.

Zinc and genital infections.

The zinc status of 19 patients with chronic or recurrent genital infections and 18 patients with non-recurrent genital infections was assessed by measuring plasma and leucocyte zinc concentrations. Neither group of patients had plasma or leucocyte zinc concentrations that differed significantly from those of matched healthy controls. Each of six patients with chronic candidiasis had anergy to candidal antigen, as shown by delayed cutaneous hypersensitivity to intradermal injection of the antigen, but their zinc status was normal. This study provided no evidence of zinc deficiency in this small number of patients with acute non-recurrent or chronic recurrent genital infections.

Chlamydia trachomatis isolation in women attending a VD clinic in Auckland, New Zealand.

Chlamydia trachomatis was isolated from 120 of 504 women (24%) attending a VD clinic at Auckland Hospital. Epidemiological correlates indicated a sexual mode of transmission. The only symptom of significance was lower abdominal pain. Cervicitis was more common in women with chlamydia, especially if they were on hormonal contraceptives. Chlamydia was isolated more commonly in women with gonorrhoea (52%) and genital warts (37%). The high incidence of asymptomatic and unsuspected infection emphasizes the need for routine chlamydial culture in VD clinics.

Unsuspected Chlamydia trachomatis in females attending a sexually transmitted diseases clinic.

One hundred and five women attending Auckland sexually transmitted diseases clinic were reviewed because of positive cervical cultures for Chlamydia trachomatis. Their average age was 19 years, 70% were European; 28% were Maori. In half the patients the positive culture was a chance finding and therefore treatment was delayed resulting in six patients (12%) developing pelvic inflammatory disease. Eight out of nine male contacts, subsequently traced, had asymptomatic urethritis, one having epididymitis. One patient had no evidence of urethritis but was chlamydia positive. Associated pathogens present in the women were Neisseria gonorrhoeae (26%), Trichomonas vaginalis (6%), Gardnerella vaginalis (46%) and Candida albicans (19%). These findings support a need for routine chlamydial testing in female patients attending sexually transmitted diseases clinics and epidemiological treatment of female contacts of men with non-specific urethritis.

Candida albicans strain types from the genitalia of patients with and without Candida infection.

The strain phenotypes of 266 C. albicans isolates from patients attending a genitourinary clinic were determined on the basis of 9 biochemical tests. Analysis of the strain patterns of isolates from the genitalia showed that there were no statistically significant differences between types associated with clinically overt Candida infection and types isolated in the absence of symptoms of candidosis. This finding accords with the traditional view of C. albicans as an opportunistic pathogen, rather than a species containing some strains of high virulence. In cases where isolations were made from the same patient at different times, or from different anatomical sites in the same patient, it was found that usually, but not always, a patient carried the same phenotype at different sites and different times. Similarly, the same strain type was isolated from the genitalis of both partners in a majority of instances where strains were isolated from consorts; however, this was not the case for a substantial minority of couples, particularly in those where high promiscuity appeared to promote considerable mixture and interchange of the C. albicans genital microflora.

Gonorrhoea in women of differing ethnic origin in Auckland.

One hundred and forty-eight women with gonorrhoea attending the Auckland VD clinic were assessed for epidemiological factors, efficacy of diagnostic tests and differences relating to ethnic origin. Maoris and Polynesians showed a greater incidence than would be expected from population levels. One hundred and two (69 percent) were below the age of 25 years. Overall 34 (23 percent) were unemployed with a preponderance amongst the Maoris (32 percent). One hundred and twelve (76% percent) presented as contacts of men with gonorrhoea and 97 (66 percent) were asymptomatic. Immediate smears were positive in 130 (88 percent), and cultures in 144 (97 percent). Europeans had a higher incidence of rectal (36 percent) and throat (11 percent) involvement. The defaulter rate was high in Maoris (41 percent) and Polynesians (43 percent). Other factors considered are marital status, contraception, socioeconomic levels and associated infections. The findings are discussed in relation to ethnic origin and their implications as regards control and education.

Inguinal bubo due to cat-scratch disease.

A case of suppurative inguinal bubo due to cat-scratch disease in a young Caucasian man is described. The bubo was thought to have followed a laceration on the leg that occurred while the man was working in a slaughterhouse. The evidence for cat-scratch disease is considered, and its differentiation from other possible diagnoses, in particular lymphogranuloma venereum, is discussed.

Genital herpesvirus infection in women attending a venereal diseases clinic.

Routine cervical viral cultures (and cultures from lesions if present) were performed on 2630 female patients attending a venereal diseases clinic over a period of four years. Of these patients 96 (3.7%) had genital herpetic infection; of these 23 (24%) were asymptomatic. The association of herpesvirus with other genital infections is considered, but no increase in the incidence of Neisseria gonorrhoeae, Trichomonas vaginalis, and genital warts was found; there was an increased incidence of Candida albicans. A significantly higher percentage of the patients with herpesvirus took oral contraceptives. The findings are discussed and compared with previous reports.