Genitourinary Medicine最新文献

{"title":"Kaposi sarcoma presenting as severe haemoptysis.","authors":"S M el-Gadi, J Banks, K Yoganathan","doi":"10.1136/sti.73.6.575","DOIUrl":"https://doi.org/10.1136/sti.73.6.575","url":null,"abstract":"Case report In spring 1995, a 36 year old HIV positive African man with CD4 count of 10 x 106/1 presented at Singleton Hospital with severe life threatening haemoptysis. Careful examination of the skin and oral cavity showed no evidence of Kaposi sarcoma (KS). On admission his investigations revealed a platelet count of 30 x 109/1 and a drop of 5 g/dl of haemoglobin to 6.8 g/dl compared with a haemoglobin of 11 6 g/dl 3 weeks previously. Chest radiograph showed persistent shadowing in the right mid zone and computed tomography (CT) revealed bilateral perihilar pulmonary infiltrates with small bilateral pleural effusions. Extensive bleeding KS lesions throughout the bronchial tree were found on bronchoscopy (fig). He was transfused and commenced on tranexamic acid. His clotting times were slightly abnormal, which were corrected with fresh frozen plasma and intravenous vitamin K. Although he received only one dose of parenteral vincristine and bleomycin, the haemoptysis gradually settled over 3 weeks. The patient's condition' deteriorated and he developed hepatomegaly with obstructive jaundice. Blood culture was negative but culture for mycobacterium avium complex (MAC) was not performed. The ultrasound appearance","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 6","pages":"575-6"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.6.575","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20502902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic balanitis: an unusual localisation of necrobiosis lipoidica.","authors":"F el Sayed, S Elbadir, J Ferrere, M C Marguery, J Bazex","doi":"10.1136/sti.73.6.579-a","DOIUrl":"https://doi.org/10.1136/sti.73.6.579-a","url":null,"abstract":"CASE REPORT A 26 year old male veterinarian consulted us for a mildly scaly patch with irregular, well delimited active borders localised on the dorsal surface of the shaft (fig). The lesion was about 1-5 x 2 cm in size. A smaller papular lesion (0-5 x 1 cm) was also present nearby. These totally asymptomatic lesions had appeared 15 days before. There were no lesions in the groin or elsewhere. Microscopic examination of the scales from the margins of the lesion in 10% KOH preparation showed multiple septate hyphae. Culture in Sabouraud's media revealed growth of colonies identified as Microsporum canis. Direct microscopic examination as well as culture from scrotum, crural folds, palms, and fingernails were negative. Therapy with econazole nitrate cream applied twice a day for 2 weeks induced a complete healing of the lesions. A follow up skin examination after 1 month was negative for dermatophytosis.","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 6","pages":"579"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.6.579-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20502905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cefaclor, an alternative to third generation cephalosporins for the treatment of gonococcal urethritis in the developing world?","authors":"F Crabbé, T M Grobbelaar, E van Dyck, Y Dangor, M Laga, R C Ballard","doi":"10.1136/sti.73.6.506","DOIUrl":"https://doi.org/10.1136/sti.73.6.506","url":null,"abstract":"OBJECTIVE: To reassess the in vivo and in vitro efficacy of cefaclor for the treatment of uncomplicated gonococcal infection. DESIGN: Open clinical trail conducted in South Africa among consecutive male patients with symptoms and signs of uncomplicated urethritis and laboratory evidence of gonorrhoea. METHODS: Patients were treated with 3 g of cefaclor plus 1 g probenecid as a single dose. Urethral specimens were cultured for Neisseria gonorrhoeae at the initial visit and at follow up. Patients were considered cured if follow up cultures were negative. Treatment was considered to have failed in the patients infected with identical gonococcal strains at the initial and at the control visit. Those with evidence of infection at the follow up visit were administered 400 mg of ofloxacin and doxycycline 100 mg twice daily for 7 days. Minimal inhibitory concentrations (MICs) of cefaclor were determined by an agar dilution technique on the gonococcal isolates from the study subjects. The results were compared with those of isolates from three other African countries. RESULTS: Of 155 patients evaluated, 151 were cured (97%). Thirty per cent of the patients complained of adverse effects, mainly gastrointestinal. Even though MICs for the isolates from the three other African countries were significantly higher than those for the isolates from the study, none was considered resistant to cefaclor in vitro. MICs were markedly influenced by the type of test medium used. CONCLUSION: The trial demonstrated the efficacy of a single oral dose of cefaclor with probenecid for the treatment of uncomplicated gonococcal urethritis in South Africa. Its potential as an alternative therapy to third generation cephalosporins deserves to be further investigated.","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 6","pages":"506-9"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.6.506","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20503690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Editors Trial Amnesty (META)","authors":"Richard Smith, M. Shahmanesh, I. Roberts","doi":"10.1136/STI.73.6.431","DOIUrl":"https://doi.org/10.1136/STI.73.6.431","url":null,"abstract":"","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"58 1","pages":"431 - 431"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76160499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hepatitis C Handbook","authors":"R. Gilson","doi":"10.1136/sti.73.6.580-b","DOIUrl":"https://doi.org/10.1136/sti.73.6.580-b","url":null,"abstract":"I welcome the imminent arrival of type specific antibody tests for herpes' which will help in the management of certain clinical situations. However, I am not convinced that these tests should be used to screen large sections of the population until a more thorough evaluation of the costs, benefits, and harm that such a programme would generate has been undertaken. There are other pressing needs in sexual health and GU medicine cannot afford to back a poor horse. Given the high prevalence of HSV 2 in STD clinic patients further attention to promoting safer sex in these patients and in the wider population may be more beneficial than costly technological interventions. DAVID M COKER Department of Genitourinary Medicine, Furness General Hospital, Dalton Lane, Barrow in Furness, Cumbria 1 Ashley RL, Corey L. HSV type specific antibody tests: patients are ready, are clinicians? Genitourin Med 1997;73:235-6.","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"30 1","pages":"580 - 580"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76383710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type 1 cytokine response and treatment outcome of genital HPV lesions.","authors":"G Stellato,&nbsp;P Nieminen,&nbsp;M Aho,&nbsp;T Lehtinen,&nbsp;M Lehtinen,&nbsp;J Paavonen","doi":"10.1136/sti.73.5.387","DOIUrl":"https://doi.org/10.1136/sti.73.5.387","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the role of type 1 cytokines as predictors of response to treatment of genital HPV lesions with laser ablation with or without adjuvant systemic interferon alpha 2b (IFN-alpha).</p><p><strong>Methods: </strong>Measurement of serum interleukin 2 (IL-2), IL-2 soluble receptor alpha (sIL-2 alpha), interferon gamma, and human papilloma virus (HPV) DNA in patients undergoing treatment of genital HPV lesions with carbon dioxide laser and systemic IFN-alpha. A randomised, placebo controlled study of 92 cases with 6 months of follow up.</p><p><strong>Results: </strong>High IL-2/sIL-2 alpha was associated with 60% to 70% protection against recurrences both in the IFN-alpha and placebo groups (OR = 0.4, 90%, CI 0.1-2.5; OR = 0.3, 90% CI 0.0-1.8, respectively). Diagnostic phase serum IL-2 predicted favourable outcome (OR = 0.2, 90% CI 0.0-1.0) in women with high load of HPV DNA or HPV 16/18 DNA regardless of the adjuvant therapy.</p><p><strong>Conclusions: </strong>Serum IL-2 determinations may identify women with good prognosis following laser ablation of genital HPV lesions.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 5","pages":"387-90"},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual relationships, risk behaviour, and condom use in the spread of sexually transmitted infections to heterosexual men.","authors":"B A Evans,&nbsp;R A Bond,&nbsp;K D MacRae","doi":"10.1136/sti.73.5.368","DOIUrl":"https://doi.org/10.1136/sti.73.5.368","url":null,"abstract":"<p><strong>Objective: </strong>To examine the effect of patient defined non-regular sexual relationships and other risk behaviours on the incidence of sexually transmitted infections in heterosexual men and the role of condom use in the prevention of their spread.</p><p><strong>Design: </strong>A prospective cross sectional study of sexual behaviour reported by a standardised self administered questionnaire in new patients who presented for screening and diagnosis.</p><p><strong>Setting: </strong>A genitourinary medicine clinic in west London.</p><p><strong>Subjects: </strong>957 consecutive newly attending heterosexual men who completed a sexual behaviour questionnaire in 1993/94.</p><p><strong>Main outcome measures: </strong>Variables relating to sociodemographic status, sexual behaviour, condom use, sexually transmitted infections and testing for HIV infection, stratified by the reporting of non-regular partners.</p><p><strong>Results: </strong>We found that the 65% of men who reported non-regular sexual partners were more likely to be white collar class (d = 7.5%, 95% CI = 1.3, 13.7) and to have had sexual intercourse with non-United Kingdom born women (d = 7.8%, 95% CI = 3.5, 12.2). They also reported coitarche before 16 years of age (d = 13.4%, 95% CI = 8.0, 18.8) and many more sexual partners both in the last year (d = 13.1%, 95% CI = 10.2, 16.0) and in their lifetime (d = 27.9%, 95% CI = 21.6, 34.2). They were significantly more likely to practise anal intercourse (d = 8.7%, 95% CI = 3.3, 14.1), to smoke (d = 16.3%, 95% CI = 9.8, 22.6), to drink alcohol (d = 4.9%, 95% CI = 1.2, 8.6), and to have chlamydial infection (d = 5.7%, 95% CI = 2.2, 9.2), of which 30% was subclinical. Increasing condom use with regular partners correlated with decreasing incidence of urethral infection (gonorrhoeal and/or chlamydial infection) (p < 0.03) and candidal balanitis (p < 0.03) and a greater likelihood of no infection being detected (p = 0.0002). Use of condoms with non-regular partners was much more frequent than with regular partners (d = 21.4%, 95% CI = 16.7, 26.1). However, we found evidence of oral transmission of urethral gonorrhoea and chlamydial infection among men who reported always using condoms. HIV infection was found in only two men (0.2%), both of whom reported intercourse with non-United Kingdom born women.</p><p><strong>Conclusions: </strong>Heterosexual men who reported non-regular sexual relationships compensated for their increased risk lifestyle by using condoms more frequently and showed only an increased incidence of chlamydial infection. More consistent condom use with regular partners was significantly associated with the absence of sexually transmitted infection. These findings suggest that transmission between regular partners has been underestimated.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 5","pages":"368-72"},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20459760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapy for genital herpes in immunocompromised patients: a national survey. The Herpes Simplex Advisory Panel.","authors":"A Scoular,&nbsp;S Barton","doi":"10.1136/sti.73.5.391","DOIUrl":"https://doi.org/10.1136/sti.73.5.391","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the extent of aciclovir refractory herpes simplex virus (HSV) infection in HIV coinfected patients in the United Kingdom and survey clinicians on their approaches to its management.</p><p><strong>Design: </strong>Questionnaire survey of representative sample of one third of United Kingdom HIV physicians.</p><p><strong>Main outcome measures: </strong>Use of antiviral therapies for genital HSV infections in HIV positive patients, reported frequency of aciclovir refractory HSV infection, its therapy, and access to antiviral susceptibility testing facilities.</p><p><strong>Results: </strong>53 responses were obtained (response rate 61%), representing a sample size of 23% of United Kingdom HIV physicians. Use of non-standard antiviral regimens for HSV infections in HIV coinfected patients was widely practised, irrespective of the clinical characteristics of the HSV infection. Aciclovir refractory HSV infection has been observed by 37 (70%) respondents. Although foscarnet was the most frequently used therapy, used by 27/37 (73%) respondents, in only seven of these 27 (19%) was it a first line treatment for aciclovir refractory cases, frequently being used at a late stage in the clinical course. Antiviral susceptibility testing facilities were available to 46 (87%) clinicians. No respondents reported any evidence of transmission of aciclovir resistant strains.</p><p><strong>Conclusions: </strong>HIV coinfection has a stronger influence on therapeutic choice than clinical immunosuppression or severity of herpetic infection. Aciclovir treatment failure is commoner than hitherto recognised. There is a need for wider awareness of use of foscarnet at an earlier stage in management of refractory HSV infection.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 5","pages":"391-3"},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Society for the Study of Venereal Disease seventy fifth spring meeting: Oxford 1997.","authors":"A Winter,&nbsp;J Ross","doi":"10.1136/sti.73.5.418","DOIUrl":"https://doi.org/10.1136/sti.73.5.418","url":null,"abstract":"Keble College, Oxford hosted the 75th spring meeting of the MSSVD from 3 to 6 July 1997. A chill reminder of past global catastrophe greeted the 320 delegates on the first morning-a huge dinosaur skeleton which dominates the concourse of the university museum where the main lectures were held. This set the scene for a meeting with a refreshingly global perspective. Themes of epidemiology, disease control, and the catastrophe of untreated or even untreatable infections ran through most of the 10 keynote addresses which we review here. In addition, 31 oral presentations were given and 62 posters presented.","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 5","pages":"418-20"},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20457070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of genital warts in England and Wales: 1971 to 1994.","authors":"I Simms,&nbsp;C K Fairley","doi":"10.1136/sti.73.5.365","DOIUrl":"https://doi.org/10.1136/sti.73.5.365","url":null,"abstract":"<p><strong>Objective: </strong>To describe the epidemiology of genital warts in England and Wales over the period 1971 to 1994.</p><p><strong>Method: </strong>Retrospective study of available statistics.</p><p><strong>Results: </strong>The rate of attendance for genital warts increased by 390% and 594% for men and women respectively between 1971 and 1994. Most of this increase occurred between 1980 and 1986. From 1986 to 1991 virtually no change occurred, but since 1992 the rate of attendance has risen by 15%. The ratio of male to female cases has declined steadily from 1.85 in 1971 to 1.34 in 1994. Rates of attendance for first attack in men were highest in the 20 to 24 year age group whereas for women it peaked in those aged 16 to 24 years. Regional data indicate that the rate of attendance has increased consistently over England and Wales during this period.</p><p><strong>Conclusions: </strong>Rates of genital warts have risen substantially over the past 25 years. If these are a reflection of changes in sexual behaviour then the rise since 1992 is of considerable concern particularly for the incidence of cervical cancer in the coming decades.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 5","pages":"365-7"},"PeriodicalIF":0.0,"publicationDate":"1997-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.5.365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20459759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}