Genitourinary Medicine最新文献

{"title":"Sexually acquired herpes simplex virus infection of oropharyngeal cavity.","authors":"R R Jarvis, B P Goorney","doi":"10.1136/sti.73.4.323-b","DOIUrl":"https://doi.org/10.1136/sti.73.4.323-b","url":null,"abstract":"Sonnex et al presented the results of a survey of 150 of their British patients' preference for signposting for their clinic: 65% chose \"clinic 1A\", 23% opted for another euphemistic name-for example, \"Lydia clinic\", 25% chose \"department of genitourinary medicine\" or \"GU clinic\", 25% chose \"department of sexual health\" or \"sexual health clinic\" and only 8% chose \"genitomedical clinic\" (more than one choice was allowed). At that time their clinic apparently operated under the name \"clinic 1A-genitomedical clinic\".' Beginning with the then new Parramatta sexual health clinic in 1979, Australian \"STD clinics\" have, one by one, adopted the title \"sexual health clinic/centre\". Our own clinic changed its name in 1990. The new name was intended to reflect the broader clinical base: which includes family planning/reproductive medicine, sexuality and relationship counselling, and other general aspects of sexual health medicine. The name also implies a proactive population health approach rather than just providing a clinical service.2 As there has been little consumer consultation about our name change, we included a question on patients' preference for a clinic name as part of a satisfaction survey. In all, 563 consecutive general clinic patients completed a satisfaction survey questionnaire in 1996. Exclusion criteria were inability to read English and attendance at a special clinic-for example, HIV eye clinic, colposcopy/gynaecology, Thai, or Chinese clinic. The M:F ratio (1:0-6), mean age (30 years), ratio ofnew to return patients (1:1.6), and proportion bom in Australia (61 %) were all consistent with the clinic's general patient profile. The patients' (mutually exclusive) responses appear in the table. The majority of our patients responded favourably or indifferently to the centre's new name. About one in five preferred \"Nightingale clinic\" (a name that had been promoted in the 1980s) but it was unclear whether this was an expression of preference for a euphemistic name or a desire to commemorate the fact that the building in which the centre is located is the cradle of nursing in Australia. We were surprised at the unpopularity of the names \"STD clinic\" and \"genitourinary medicine clinic\" given that the former was the name of the centre 6 years previously and, relevant to the latter name, 15% of the sample were from the United Kingdom or the Republic of Ireland. Interpreting Sonnex et al's and our studies together, it appears that patients are relatively accepting of a variety of names for STD/HIV medicine services, particularly the name in current usage. However, \"STD clinic\" and \"genitourinary medicine clinic\" have not achieved wide acceptance. The British patients' apparent preoccupation with euphemism seems to contrast with the Australian patients' open minded attitude. It is possible that the broader service profile of Australian sexual health services has helped","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"323-4"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.323-b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20320106","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":"AIDS and leishmaniasis.","authors":"R N Davidson","doi":"10.1136/sti.73.4.237","DOIUrl":"https://doi.org/10.1136/sti.73.4.237","url":null,"abstract":"Transmission ofLeishmania Leishmania are protozoal parasites carried from one infected host to another by sandflies. Leishmania cause a range of cutaneous, mucocutaneous, and systemic (visceral) diseases in humans and animals. In Europe L infantum is enzootic among domestic dogs in the Mediterranean littoral, where approximately 10-30% of pet dogs have clinical or serological evidence of leishmaniasis.' 2 Dogs are generally unable to mount an effective cellular immune response against L infantum, so parasites remain in skin lesions, in circulation, or in tissue macrophages permanently. Canine leishmaniasis responds poorly to treatment, typically running a chronic, relapsing course until the parasites become unresponsive and the animal dies. Clinical leishmaniasis among immunocompetent humans is more than 1000-fold rarer than canine leishmaniasis, with only about 500 infections occurring annually in the Mediterranean area; children are mainly affected. Transmission of L infantum occurs during the summer and is focal, with small zones of transmission in suburban and semirural areas.","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"237-9"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20318299","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":"Comparative periurethral bacteriology of uncircumcised and circumcised males.","authors":"F Serour,&nbsp;Z Samra,&nbsp;Z Kushel,&nbsp;A Gorenstein,&nbsp;M Dan","doi":"10.1136/sti.73.4.288","DOIUrl":"https://doi.org/10.1136/sti.73.4.288","url":null,"abstract":"<p><strong>Background: </strong>It has been established that lack of circumcision increases the risk of urinary tract infection in infants. During the first six months, the presence of foreskin is associated with a greater quantity and a higher concentration of uropathogens in the periurethral area. Very little is known about this association in older males.</p><p><strong>Objective: </strong>To compare the periurethral bacteriology of uncircumcised healthy males of more than one year of age.</p><p><strong>Methods: </strong>The periurethral area of 125 uncircumcised and 46 circumcised healthy males (mean age, 26.5 and 28.3 years, respectively) was swabbed and cultured for facultative and anaerobic bacteria, genital mycoplasmas and Chlamydia trachomatis.</p><p><strong>Results: </strong>Facultative Gram positive cocci predominated in both groups (62% and 80%, respectively). Pure culture of facultative Gram negative rods was more common in uncircumcised males (17% v 4% in circumcised males, p = 0.01). Streptococci, strict anaerobes and genital mycoplasmas were found almost exclusively in uncircumcised males of more than 15 years of age. No case of C trachomatis was identified.</p><p><strong>Conclusions: </strong>The higher prevalence of potential uropathogens in the subpreputial space is in accordance with a previous finding of increased risk of urinary tract infection in uncircumcised young men. Our results also support the role of the prepuce as a reservoir for sexually transmitted organisms.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"288-90"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20319526","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":"Semen characteristics in HIV-1 positive men and the effect of semen washing.","authors":"A S Lasheeb,&nbsp;J King,&nbsp;J K Ball,&nbsp;R Curran,&nbsp;C L Barratt,&nbsp;M Afnan,&nbsp;D Pillay","doi":"10.1136/sti.73.4.303","DOIUrl":"https://doi.org/10.1136/sti.73.4.303","url":null,"abstract":"<p><p>We have undertaken an analysis of semen from HIV infected men with regard to sperm counts and motility, non-spermatozoal cells, and viral nucleic acid. Regression analysis showed that sperm concentration and motility were positively associated with blood CD4 cell count. By contrast, non-spermatozoal cell concentration (round cells) was inversely related to CD4 count. Extracellular HIV RNA was detected in the majority of semen samples and proviral DNA in a minority. Percoll gradient washing of 12 semen samples yielded six samples containing adequate sperm concentration for analysis. This washing procedure reduced prewash extracellular RNA to below detectable limits in all cases; proviral DNA present in two of the six prewash samples was also reduced to below detectable limits after washing. We conclude that semen washing before artificial insemination may reduce the risk of HIV transmission from an infected man to an uninfected woman. However, further evidence from prospective analyses of such an approach is required.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"303-5"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20319530","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":"Genitourinary medicine and the Internet No 7.","authors":"R K Lau","doi":"10.1136/sti.73.4.320","DOIUrl":"https://doi.org/10.1136/sti.73.4.320","url":null,"abstract":"","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"320-1"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20320102","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":"Decline in the incidence of HIV test request in general practices in Amsterdam after 1992.","authors":"L Wigersma","doi":"10.1136/sti.73.4.324-a","DOIUrl":"https://doi.org/10.1136/sti.73.4.324-a","url":null,"abstract":"urethral discharge was noted. Microscopy of a Gram stained urethral specimen revealed Gram negative, intracellular diplococci for which he was treated immediately with a dose of 400 mg of ofloxacin. A provisional diagnosis of first episode of herpes simplex virus infection of the oropharyngeal cavity was made, and he was advised to take aciclovir 200 mg x 5 for 5 days. The patient reported to have always practised homosexual orogenital sex and had never practised anal sex. The sexual history of the recent casual partner was not known. He admitted to having had a similar sexual contact with another male partner 10 weeks earlier. This was his previous regular partner for 5 years who had no known history of genital herpes. He retumed after 10 days when he was reported to be well and asymptomatic. On examination the oropharyngeal ulcers were noted to be almost healed. A test of cure for N gonorrhoeae from a urethral specimen was reported negative on microscopy. A blood sample was sent for a repeat estimation of HSV antibody. Herpes simplex virus type 1 (HSV-1) was isolated from the specimen from oropharyngeal ulcers in cell culture. The serum HSV-1 antibody level showed a significant rise from less than 1 in 10 during the first visit to more than 1 in 40 on the tenth day during the follow up visit. This rise in HSV-1 antibody level was consistent with seroconversion for HSV-1. Microscopy result of N gonorrhoeae from the urethra on his first visit was confirmed on culture. A pharyngeal specimen did not grow N gonorrhoeae. Isolation of a high proportion of HSV-1 among women with first episode of genital HSV infection was first reported from Sheffield.3 Since then an annually increasing prevalence of HSV-1 in female anogenital herpes has been reported by others.4 The practice of cunnilingus has been proposed as one of the possible causes of such a trend.5 It seems reasonable to assume that such sexual activity could similarly lead to a transmission ofHSV from the genital area to the oropharyngeal cavity. In the present case, the occurrence of herpetic lesions in the oropharyngeal cavity within 1 week of unprotected orogenital contact suggests possible transmission of HSV-1 from the genital area to the oropharynx. A first episode of genital HSV-1 infection almost always indicates a true primary infection with HSV.6 Thus, seroconversion for HSV-1 in the present case suggests primary infection with this virus and also substantiates the possibility of transmission of HSV from recent orogenital contact. The incidence of sexually acquired oropharyngeal herpes due to HSV may increase as a result of increased prevalence of orogenital sexual activity. Because of the risk of transmission of HSV from asymptomatic viral shedding, the prevalence of HSV carriage and shedding from the oropharynx of sexually active adults needs to be investigated. During counselling, the possibility of acquisition of HSV infection of the oropharyngeal cavity from the anogenital region,","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"324-5"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.324-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20320108","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":"Genital Chlamydia trachomatis infection in women in a Nigerian hospital.","authors":"T C Harry","doi":"10.1136/sti.73.4.326","DOIUrl":"https://doi.org/10.1136/sti.73.4.326","url":null,"abstract":"","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"326"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20320111","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":"Pancreatic abnormalities and AIDS related sclerosing cholangitis.","authors":"J P Teare,&nbsp;C A Daly,&nbsp;C Rodgers,&nbsp;S P Padley,&nbsp;R J Coker,&nbsp;J Main,&nbsp;J R Harris,&nbsp;D Scullion,&nbsp;G P Bray,&nbsp;J A Summerfield","doi":"10.1136/sti.73.4.271","DOIUrl":"https://doi.org/10.1136/sti.73.4.271","url":null,"abstract":"<p><strong>Objectives: </strong>Biliary tract abnormalities are well recognised in AIDS, most frequently related to opportunistic infection with Cryptosporidium, Microsporidium, and cytomegalovirus. We noted a high frequency of pancreatic abnormalities associated with biliary tract disease. To define these further we reviewed the clinical and radiological features in these patients.</p><p><strong>Methods: </strong>Notes and radiographs were available from two centres for 83 HIV positive patients who had undergone endoscopic retrograde cholangiopancreatography for the investigation of cholestatic liver function tests or abdominal pain.</p><p><strong>Results: </strong>56 patients had AIDS related sclerosing cholangitis (ARSC); 86% of these patients had epigastric or right upper quadrant pain and 52% had hepatomegaly. Of the patients with ARSC, 10 had papillary stenosis alone, 11 had intra- and extrahepatic sclerosing cholangitis alone, and 35 had a combination of the two. Ampullary biopsies performed in 24 patients confirmed an opportunistic infection in 16. In 15 patients, intraluminal polyps were noted on the cholangiogram. Pancreatograms were available in 34 of the 45 patients with papillary stenosis, in which 29 (81%) had associated pancreatic duct dilatation, often with associated features of chronic pancreatitis. In the remaining 27 patients, final diagnoses included drug induced liver disease, acalculous cholecystitis, gall bladder empyema, chronic B virus hepatitis, and alcoholic liver disease.</p><p><strong>Conclusion: </strong>Pancreatic abnormalities are commonly seen with ARSC and may be responsible for some of the pain not relieved by biliary sphincterotomy. The most frequent radiographic biliary abnormality is papillary stenosis combined with ductal sclerosis.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"271-3"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.271","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20318306","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":"Women with HIV disease attending a London clinic.","authors":"L Sherr,&nbsp;J Barnes,&nbsp;J Elford,&nbsp;A Olaitan,&nbsp;R Miller,&nbsp;M Johnson","doi":"10.1136/sti.73.4.274","DOIUrl":"https://doi.org/10.1136/sti.73.4.274","url":null,"abstract":"<p><strong>Objective: </strong>To examine ethnic, relationship, health, and mental health factors for a cohort of women with HIV infection attending an inner London clinic.</p><p><strong>Design and methods: </strong>Structured schedules were utilised to analyse ethnic group, family, and reproduction issues, mental and physical health for 100 women drawn consecutively from attenders at an inner London HIV clinic</p><p><strong>Results: </strong>51% of the women were non-ethnic minority groups and 49% were from ethnic groups. HIV testing was often as a result of symptoms or partner illness. One in five had disclosed their status to one person only or no one. Ethnic minority women were more likely to restrict disclosure. Forty seven per cent of the women had 100 children with more children reported in ethnic minority families; 28% of the children had been tested for HIV and five were confirmed HIV positive; 9% of children were born after HIV diagnosis. Nineteen women reported one or more termination of pregnancy, the majority before HIV diagnosis. Three quarters had a partner of whom 56 knew the partner's status. Women with HIV positive partners were more likely to have children. Women kept in ignorance of partner status were more likely to be ethnic minority women. Thirty two per cent had an AIDS diagnosis, diagnosed mostly in the UK. Medical and counselling service uptake was high. Gynaecological problems were common (49% had one or more problem) and 34% had at least one hospital admission. A wide range of counselling issues were recorded, with variations over time. Suicidal issues were relevant for 13% of women (69% ideation, 31% attempts). Significant life events were noted for many women with allied coping demands.</p><p><strong>Conclusions: </strong>There are a wide range of issues for women with HIV and systematic differences between ethnic and non-ethnic women and those with or without children.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"274-9"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20319523","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":"The vagina has reducing environment sufficient for activation of Trichomonas vaginalis cysteine proteinases.","authors":"J F Alderete,&nbsp;D Provenzano","doi":"10.1136/sti.73.4.291","DOIUrl":"https://doi.org/10.1136/sti.73.4.291","url":null,"abstract":"<p><strong>Background: </strong>Trichomonas vaginalis, a worldwide distributed sexually transmitted protozoan, is remarkable for synthesis of numerous, distinct cysteine proteinases, the significance of which is evidenced by the presence in vivo of soluble proteinases in secretions and antiproteinase antibody in serum of patients with trichomonosis. These proteinases purportedly play a role in host parasitism and immune evasion.</p><p><strong>Objective: </strong>It is known that for cysteine proteinases to be functional, they must be activated by disulphide reducing reagents. Whether or not the host vaginal environment has the reducing environment essential for activation of the trichomonad cysteine proteinases is unknown. Our goal, therefore, was to determine whether or not vaginal secretions had sufficient reducing power to activate the trichomonad proteinases.</p><p><strong>Methods: </strong>48 vaginal washes (VWs) from patients were assayed for reducing equivalents and a score in dithiothreitol (DTT) reducing equivalents was assigned to each VW. Activation of trichomonad cysteine proteinases was then tested under the range of reducing equivalents detected from VWs. The possible protective effect of hydrogen peroxide, an oxidising agent produced by some Lactobacillus species, on proteinase activity was also determined.</p><p><strong>Results: </strong>Nine of 48 VWs (18.7%) possessed < or = 10 microM DTT reducing equivalents, four VWs (8.3%) had from 20 microM DTT to 40 microM DTT reducing equivalents, and most (50%) were between 10 microM to 15 microM. Overall, the range in VWs was from approximately 10 microM to 40 microM reducing equivalents. Importantly, data suggest differential proteinase activation over this in vivo range of reducing level. Only two T vaginalis cysteine proteinase activities were stimulated at 2.5 microM DTT in contrast with all proteinase activities present at 40 microM DTT, albeit quantitatively diminished compared with the activity at 1 mM DTT, the concentration routinely used in vitro. Finally, hydrogen peroxide reversibly neutralised all trichomonad proteinases.</p><p><strong>Conclusions: </strong>These results show that the vagina of women has a reducing environment adequate for activation of trichomonad proteinases. The data underscore that the host environment plays a role in the host-parasite interrelation. Finally, hypotheses can now be formulated to help explain resistance and susceptibility to infection commonly reported among women and between men and women with trichomonosis.</p>","PeriodicalId":12621,"journal":{"name":"Genitourinary Medicine","volume":"73 4","pages":"291-6"},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/sti.73.4.291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20319527","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}