No abstract

Lichen sclerosus (LS) is a chronic inflammatory disorder of the skin and mucosa, presenting to genitourinary physicians and dermatologists. It affects both sexes and all age groups. Although the exact aetiology is uncertain, genetic predisposition, infections and autoimmune factors have been implicated in its pathogenesis. Symptoms include pruritus and soreness, but asymptomatic presentations are not uncommon. The classical clinical picture is of atrophic white plaques in the anogenital region. Histopathology is specific with basal cell degeneration, upper dermal oedema, homogenization of collagen and a chronic inflammatory infiltrate. Short courses of potent topical corticosteroids form the mainstay of treatment. The condition tends to be remitting and relapsing, with spontaneous regressions reported in a few. In men, the term balanitis xerotica obliterans is sometimes used to describe late and severe LS of the penis. Scarring and progression to squamous cell carcinomas can occur in chronic LS, resulting in significant morbidity. A multidisciplinary approach to care and the need for long-term monitoring cannot be overemphasized.

Two cases are described of treatment-resistant vulvodynia that responded well to gabapentin. Gabapentin, an anti-epileptic drug, has been used in the treatment of neuropathic pain such as diabetic neuropathy and post-herpetic neuralgia. However, there has been little experience of its use in the relief of symptoms in vulvodynia and we add our observations to the one report of its use in these circumstances that has been published so far.

Nurse led community based GUM services, such as the one provided at the Merseyside Brook Centre, appeal to young people and our success should encourage others to consider similar ventures.

SummaryThe drugs used in HIV medicine often have toxic side effects; additionally, the risk of drug interactions is high because of the frequent necessity to prescribe multiple drugs. This article covers common or important drug side effects and interactions. 2-8% 5) although the range of reactions is similar. The commonest observed reaction is a generalised maculopapular rash, which may be pruritic, occurring one to two weeks after starting treatment (box 1).A study comparing trimethoprim-sulphamethoxazole with trimethoprim-dapsone found that although both treatments were equally effective in the treatment of mild/moderate first episodes of Pneumocystis carinii pneumonia (PCP), twice as many major events were recorded in those receiving cotrimoxazole.6 The incidence of chemical hepatitis (aspartate transaminase, alanine transaminase and/or alkaline phosphatase increased to five times normal levels) and neutropenia (< 750 neutrophils/mm3) was very much more common in the cotrimoxazole group, although rash and fever occurred with equal frequency in both groups. Other reactions to cotrimoxazole are summarised in box 2.Cotrimoxazole increases the antifolate effects ofmethotrexate, pyrimethamine and phenytoin (plasma concentration is also increased.) The effects of sulphonylureas, nicoumalone and warfarin are also enhanced.

A case history is described of an HIV-seropositive man who presented with a swelling on the right cheek and a history of disseminated molluscum contagiosum. Electron microscopy of the abscess aspirate showed pox virions indicative of molluscum contagiosum. This is an unusual presentation of molluscum contagiosum and the authors review the literature of other presentations.

An iron preparation suitable for intramuscular injection should conform to the following criteria: (a) it should be rapidly absorbed from the muscle and the total iron content should be available for haemoglobin synthesis, (b) in order to avoid pain, the pH and tonicity should approximate to those of normal tissue fluids, (c) it should be stable in the presence of protein and electrolytes, (d) it should possess a low toxicity, and be stable on storage, (e) in order to keep the injection volume down to a minimum, the solution should contain at least 5% w/v of iron.Previous workers have described the subcutaneous or intramuscular administration of compounds containing either ionic iron (Brownlee, 1942; Goldberg and Hutchison, 1953) colloidal ferric hydroxide, or saccharated oxide of iron (Slack, 1949), but preparations which contained sufficient iron to be useful in the treatment of hypochromic anaemia were found to be either toxic or painful.Initially, we investigated two series of iron compounds. In the first series, the iron was present as a co-ordination compound, e.g., ferrous calcium ethylenediaminetetraacetate, and other ferrous or ferric alkali, alkaline earth, or organic base salts of ethylenediaminetetraacetic acid. In the second series, the preparations were based on saccharated oxide of iron, but other sugars were used in place of sucrose. On investigation in animals, compounds of the first series caused systemic haemorrhage and were rejected; none of the preparations in the second series showed satisfactory absorption from muscle, and some were, in addition, very toxic.Iron is stored in the body as a macromolecular protein complex, ferritin, and is also transported in combination with the protein, al-globulin. It was decided, therefore, to investigate the substitution of the protein moiety by other macromolecules; a third series was therefore investigated in which the 2C

Letters to the Editor study population (12.75%). Thus we can confirm that the presence of vaginal and cervical ulcers may be considered an additional risk factor for HIV transmission. Although our study was performed on sera belonging to women considered at risk for HIV infections, only 2% of them were certainly infected by HIV-1 and none was infected by HIV-2. This percentage is consistent with another study on an analogous sample of 100 women in February 1993 (data not shown). During the last 10 years, the war in Angola has greatly limited movement of people between Luanda province and the bordering provinces of Congo, Zaire and Zambia. Probably the low prevalence of HIV in Luanda is due to the partial isolation of the city during the spread of HIV pandemic in Sub Sahara Africa.