The chemotactic activity of urethral exudate and the effect of treatment were assessed in 67 patients with nongonococcal urethritis (NGU) or gonorrhea. All samples demonstrated chemotactic activity related to the number of neutrophils seen on Gram's staining of the urethral smear. Chemotactic activity decreased after treatment in patients with Chlamydia-positive NGU (mean +/- SE, 21.1 +/- 2.7 cells/high-power field [hpf] before treatment; 8.7 +/- 2.2 after treatment; P < .004) and gonorrhea (25.6 +/- 5.2 cells/hpf before treatment; 1.6 +/- 0.7 after treatment; P < .015). Chemotactic activity increased again in Chlamydia-positive NGU patients to 21.0 +/- 3.3 cells/hpf (P < .05) 2-3 weeks after cessation of therapy in the absence of demonstrable infection or further intercourse. There was no significant decrease in chemotactic activity after therapy in the Chlamydia-negative NGU or persistent urethritis groups. These data suggest a previously unrecognized persistent chemotactic stimulus in urethral exudate from patients with urethritis.
The aim of this study is to analyse the epidemiology of gonorrhoea in the Coventry area between 1991-1994 and the implementation and outcome of partner notification. A total of 404 episodes in 382 patients comprised the study group. In Coventry, 97% of episodes were managed in the STD clinic. There was a decrease in female and heterosexual male cases from 172 cases in 1991 to 37 cases in 1994 and increase in homosexual male cases from 8 in 1991 to 13 in 1994 (P<0.0001). Chlamydial coinfection was found in 38%. Among patients with gonorrhoea, 33% were asymptomatic and 40% with gonorrhoea and chlamydia were asymptomatic. Ten per cent of index cases were asymptomatic as were 83% of contact cases (P<0.0001). The health advisers (HAs) interviewed 82% immediately and 94% at some time after diagnosis. Of the average 1.5 partners per patient identified, 0.31 partners per patient were already screened, another 0.4 partners per patient were traced, 0.37 partners per patient were not traced, and for 0.41 partners per patient notification outcome was unknown or unconfirmed. Partner notification of 278 index cases traced 163 primary or tertiary contacts, 115 were new cases of gonorrhoea.
This study evaluated the psychological impact caused by genital warts and whether this altered over time. Eighty-four patients with genital warts and a group of 28 appropriately matched volunteers from the local general population were recruited. The patients were divided into three groups of 28 according to the Health Protection Agency classification codes for genital warts. A comprehensive health questionnaire was completed by all participants. Patients with first attack genital warts experienced significantly more distress, anxiety and depression and were less satisfied with their lives than all the other groups. They also reported less satisfaction with the practical support they received. The recurrent episode genital warts group experienced significantly high levels of emotional distress and the re-registered group reported significantly less emotional and practical support according to their needs. While the first attack genital warts group experienced the most psychological effects, it is clear that those effects did not disappear as an individual came to terms with their diagnosis. The choice of vaccine to prevent cervical cancer will not prevent clinical warts occurring and therefore will not help prevent the psychological morbidity associated with this condition.
The practice of hepatitis B screening and vaccination in genitourinary medicine clinics in the West Midlands Region is audited against the standards set by 1999 Medical Society for the Study of Venereal Disease National Guidelines.
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