SUMMARY A 58 year old man presented with what seemed to be a simple penile lesion, but which on subsequent histological examination proved to be a malignant melanoma. The lesion was excised by circumcision. No further treatment was considered to be necessary.
This paper reports the results of a double-blind study of miconazole nitrate compared with chlordantoin for the treatment of vaginal candidiasis.
Material and methodsAll female patients who attended the Special Treatment Centre for sexually-transmitted diseases at Stoke-onTrent for the first time between January and midDecember, 1973, were questioned and examined according to a defined protocol. Those with evidence of vaginal candidiasis were included in this trial.Vaginal, cervical, and urethral swabs were collected for laboratory tests and a urine specimen was examined. The swabs were examined by direct microscopy of wet films and Gram-stained smears; for culture they were transported in Stuart's transport medium with added charcoal and examined by standard microbiological techniques. Vaginal candidiasis was diagnosed if blastospores or mycelia were seen in direct films of vaginal secretion or if Candida albicans was cultured. After treatment patients were considered to be cured if their symptoms were absent and Candida could not be demonstrated in direct films or by culture over a mean period of 6 5 weeks (range 2 to 14 weeks).Of 569 new patients, 99 showed evidence of vaginal candidiasis; twelve of the 99 had no symptoms. Each was treated with a cream containing an antifungal agent, the identity of which was unknown to the investigators until all the clinical data had been collected. The creams and their containers appeared identical but they contained either 2 per cent. miconazole nitrate or 1 per cent. chlordantoin.Each patient was given a tube of antifungal cream sufficient for ten nightly treatments, each of 5 gm. A plastic applicator for intravaginal use was supplied. The patients were asked to record how many applications of cream were necessary before they experienced relief of symptoms; they were re-examined 4 to 6 days after completing the course and then 2 weeks and 4 weeks later. When Candida persisted, a second 10-day course of the same cream (as identified by its code number) was given and the patient re-examined as before.Sixteen patients defaulted so that the results here apply only to the 83 women who completed their course of treatment and who had subsequent tests of cure.
Routine screening for sexually transmitted diseases in new patients attending the Genitourinary Clinic in Stoke-on-Trent includes a culture for Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU). A retrospective study was carried out on 400 female patients to ascertain whether there were any significant differences between the group positive for MH and UU and the negative control group. The positive group were found to be younger on average, but to have similar sexual histories to the negative control group. An association was found between the presence of genital mycoplasmas and Gardnerella vaginalis. An odourous vaginal discharge was more common in the positive group. Erythromycin was ineffective in eradicating the organisms in 62.5% of patients with MH, and 70% of those with UU. Continuing work is required to identify those women in whom the presence of MH or UU could have pathogenic effects. Treatment regimens for this group of women need to be carefully reassessed, in the light of increasing antibiotic resistance.
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