{"title":"Natural history of HIV","authors":"Alison Cox, Penny Lewthwaite","doi":"10.1016/j.mpmed.2026.02.010","DOIUrl":"10.1016/j.mpmed.2026.02.010","url":null,"abstract":"<div><div>Medical knowledge of human immunodeficiency virus (HIV) has evolved rapidly in the 40 years since acquired immune deficiency syndrome (AIDS) was first described, leading to increased understanding of the disease, its immunology and its clinical manifestations. Effective antiretroviral therapy (ART) now allows people with HIV to have normal life expectancies and not pass their infection on. Advances in treatment continue and new long-acting injectable therapies are now available. Worldwide, strategies including universal HIV testing and the roll-out of ART have reduced transmission. Of people with HIV, 87% are now aware of their status and the number of new HIV diagnoses is falling. Despite this, nearly half of patients in the UK present with advanced HIV, with a CD4 count <350 cells/mm<sup>3</sup> and this population is increasingly affected by frailty. It remains essential that all healthcare providers are alert to the possibility of HIV in their patients, and ensure individuals are tested and treated before the development of HIV-related infections, cancers and complications.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 354-360"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828313","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":"Female pelvic pain: an overview","authors":"Emily E Lord, Neda Taghinejadi","doi":"10.1016/j.mpmed.2026.02.004","DOIUrl":"10.1016/j.mpmed.2026.02.004","url":null,"abstract":"<div><div>Pelvic pain in women and people assigned female at birth is common and complex, with causes spanning gynaecological, urological, gastrointestinal, musculoskeletal and psychosexual domains. It can be acute or chronic, cyclical or non-cyclical, and often involves overlapping conditions. This article reviews the epidemiology, classification, aetiology, diagnostic approach and management of pelvic pain, highlighting the need for a multidisciplinary and holistic approach.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 339-343"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828277","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":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2026.02.017","DOIUrl":"10.1016/j.mpmed.2026.02.017","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 371-375"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828311","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":"AIDS and non-AIDS related malignancy","authors":"Alessia Dalla Pria, Mark Bower","doi":"10.1016/j.mpmed.2026.02.016","DOIUrl":"10.1016/j.mpmed.2026.02.016","url":null,"abstract":"<div><div>Immunodeficiency, whether congenital or acquired, iatrogenic (e.g. allograft recipients) or infectious (e.g. human immunodeficiency virus (HIV)), is associated with an increased risk of malignancy. In the case of HIV-related immunodeficiency, most cancers are associated with oncogenic virus co-infection. Although the overall risk of any cancer is increased 2–3-fold in HIV, there are three acquired immune deficiency syndrome (AIDS)-defining cancers whose relative risk is dramatically higher: Kaposi sarcoma, high-grade B cell non-Hodgkin lymphoma (including primary cerebral lymphoma) and invasive cervical cancer. Since the introduction of combination antiretroviral therapy, the incidence of AIDS-defining malignancies has declined. In contrast, the effect on the incidence of other cancers has been small; however, the increased longevity of people living with HIV and the ageing of this population mean that there has been a rise in number of cases of non-AIDS-defining malignancies. Recent advances in the management of malignancy in people with HIV have led to outcomes similar to those of the general population.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 366-370"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828310","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":"Chronic pelvic pain in men: neurological and pelvic floor contributions","authors":"Johnny Boylan, Bill Taylor","doi":"10.1016/j.mpmed.2026.02.013","DOIUrl":"10.1016/j.mpmed.2026.02.013","url":null,"abstract":"<div><div>Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects around 8% of men, significantly impacts quality of life and is a frequent presentation in sexual health clinics. Its multifactorial pathophysiology includes pelvic floor muscle overactivity, neurological contributions and central sensitization. This case-based review illustrates how recognizing nociceptive, neuropathic and nociplastic mechanisms supports multidisciplinary, patient-centred care. Four clinical cases are presented. Two highlight the medical management of CP/CPPS in genitourinary medicine settings, demonstrating the value of an early explanation of the pelvic pain–anxiety feedback loop, pelvic floor relaxation strategies and judicious use of α-adrenoceptor blockers and/or low-dose tricyclic antidepressants. Two further cases illustrate pudendal and genitofemoral neuralgia, demonstrating the role of neurodynamic assessment and neural mobilization; they show substantial improvement with pelvic floor down-training and load management. Across all cases, outcomes improved most when interventions addressed high pelvic floor tone and were delivered within a multidisciplinary team framework.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 334-338"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828276","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":"Genital ulceration","authors":"Elizabeth Foley, Raj Patel","doi":"10.1016/j.mpmed.2026.02.008","DOIUrl":"10.1016/j.mpmed.2026.02.008","url":null,"abstract":"<div><div>Genital ulceration can represent one of the more complex presentations encountered within genitourinary medicine. There are a wide range of causes, which can make accurate diagnosis a challenge. These include common and rare sexually transmitted infections (STIs), dermatological conditions and trauma. This chapter aims to provide an overview of genital ulceration secondary to STIs. The most common causes of genital ulceration secondary to STI diagnoses in the developed world are genital herpes, primary syphilis and lymphogranuloma venereum. The rarer STI presentations of donovanosis and chancroid typically present in travellers returning from endemic areas. We highlight the typical course and pattern of symptoms for each diagnosis alongside relevant diagnostic tests and current recommended treatment regimens. When not caused by an STI, genital ulceration can occur after local trauma or as a manifestation of an underlying dermatological condition.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 316-321"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828272","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":"Vulval pain: vulvodynia","authors":"Ling Li, Inge Kreuser-Genis, Anne Edwards","doi":"10.1016/j.mpmed.2026.02.012","DOIUrl":"10.1016/j.mpmed.2026.02.012","url":null,"abstract":"<div><div>Vulvodynia is defined as pain or discomfort of the vulva usually present for at least 3 months, without an identifiable medical cause. It can have a significant impact on the physical and psychological well-being of affected women. It should be considered within the differential diagnosis in a number of gynaecological presentations, including superficial dyspareunia, apparent persistent/recurrent candidiasis and chronic vulval symptoms such as discomfort and itch. Although vulvodynia is widely considered to be an idiopathic pain syndrome and a diagnosis of exclusion, research continues into its pathogenesis. There is no ‘one-size-fits-all’ approach to treatment; successful management often relies upon a multimodal and multidisciplinary approach. Despite its high prevalence, vulvodynia remains a poorly recognized condition, and women often experience barriers in accessing diagnosis and treatment. Promoting increased awareness of vulvodynia among clinicians and the wider public is therefore an important endeavour.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 344-348"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828309","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":"Genital rash (including warts, infestations and mpox)","authors":"Annabelle Leong, Sarah K Edwards","doi":"10.1016/j.mpmed.2026.02.007","DOIUrl":"10.1016/j.mpmed.2026.02.007","url":null,"abstract":"<div><div>Genital rashes are commonly found in attendees at sexual health clinics. They can be caused by infections (including sexually transmitted infections), infestations, malignancies and dermatoses. They can also be indicators of or worsened by other medical conditions. The diagnosis is usually made from the clinical appearance and can be supported by clinical signs elsewhere, especially with genital dermatoses. Normal variants seen in both men and women should also be considered in the differential diagnosis.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 308-315"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828271","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":"Opportunistic infections in HIV","authors":"Jozef Shaw, Nashaba Matin","doi":"10.1016/j.mpmed.2026.02.015","DOIUrl":"10.1016/j.mpmed.2026.02.015","url":null,"abstract":"<div><div>Despite significant advances in the field of HIV, people with HIV remain at risk of opportunistic infections (OI) if they have a low CD4 T cell count, resulting in advanced immunosuppression. This can occur after a late diagnosis or with insufficient adherence to effective antiretroviral therapy (ART), which in itself can result from a number of different barriers. People with HIV are still at risk of common infections affecting the general population, such as influenza. When people with HIV present unwell, it is important to obtain a thorough history including current ART, HIV viral load and CD4 count, and any history of HIV-associated conditions (e.g. previous OI). Acute illness should be investigated and treated as per local guidelines. The extent of immunosuppression, defined by CD4 T cell count, determines the likelihood of different OIs. Patients frequently present with simultaneous, coexisting OI conditions. Symptoms and signs should be assessed, and empirical therapy should be initiated where clinically indicated and where delay can risk severe disability or death. Appropriate investigations (e.g. blood tests) and cross-sectional imaging are used to confirm a suspected OI diagnosis and guide further management. Transfer to a specialist HIV inpatient centre for continuing management of suspected OIs should be considered at the earliest opportunity.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 349-353"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828312","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":"Non-infective complications for people living with HIV","authors":"Dylan Z Salih, Andrew T Read, Tristan J Barber","doi":"10.1016/j.mpmed.2026.02.014","DOIUrl":"10.1016/j.mpmed.2026.02.014","url":null,"abstract":"<div><div>In 2024, 40.8 million (estimated between 37.0 and 45.6 million) people globally had HIV, with 31.6 million (27.8–32.9 million) accessing antiretroviral therapy. Women and girls accounted for 45% of all new HIV cases. HIV is, for most, a treatable chronic health condition, and people diagnosed with HIV at an early stage can expect to live long and healthy lives with access to antiretroviral therapy. There is evidence, however, that people with HIV are more likely to develop certain age-related diseases, including cardiovascular disease, chronic airway disease, kidney failure, liver failure, cancer, type 2 diabetes and other complications. People with HIV also continue to experience intersecting social stigma, which affects their health outcomes compared with the general population. Amid recent US-led cuts to foreign aid, which risk threatening the long-term stability of the global HIV response, it is vital that clinicians maintain a working knowledge of HIV and its potential complications because, in the absence of international support, robust clinical expertise will become increasingly important in ensuring continuity of care, safeguarding vulnerable populations and protecting decades of progress.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 5","pages":"Pages 361-365"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828314","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}