Objectives:To assess the variability in time taken for a patient to be seen in a genitourinary (GUM) clinic in the United Kingdom having contacted that clinic by telephone and compare this with GUM physicians' expectations. Methods: A postal questionnaire was sent to lead GUM physicians asking when they thought patients with two specific clinical scenarios would be seen in their clinics. Following this, healthcare personnel contacted individual units posing as patients with the same clinical scenarios and asked to be seen as soon as possible. Results: 202/258 (78%) lead clinicians responded to the postal questionnaire. All clinics claimed to have procedures allowing patients with acute symptoms to be assessed urgently and estimated that such patients would be seen within 48 hours of the initial telephone contact. In 243 of 311 (78%) clinic contacts, the patient was invited to attend the clinic within 48 hours. For the remaining 68 contacts (22%) the patient could not be accommodated within 48 hours and, of these, 49 could not be seen for more than 1 week. Conclusions:No clinician estimated that patients with acute severe symptoms would be seen more than 48 hours after the initial telephone contact, but in reality, for 22% of the patient contacts this was the case. This study may well underestimate the diYculties the general public may have in accessing GUM services. We hypothesise that this situation could be ameliorated by establishing process standards and addressing issues of resource allocation. (Sex Transm Inf 2001;77:12-14)
Results: 70 patients per group were randomised and started treatment; 101 firstepisode warts, 91 male. No treatment-related serious adverse events were reported.Follow-up at week 12 was 85%. By intention-to-treat analysis, clearances at 4 and 12 weeks were higher in the combination group (60.0% and 60.0% respectively) than with cryotherapy alone (45.7%, 45.7%) although not statistically significant (relative risk 1.31; 95% CI 0.95, 1.81). By week 24 there was no difference between the groups (68.6% and 64.3% respectively, RR 1.07; CI 0.84, 1.35). At week 4, wart clearance was higher in men (p=0.001) and those with a past history of warts (p=0.009), but these differences were not detected at week 12. There was some evidence for a higher relapse rate in the group receiving cryotherapy alone. Conclusions:Initial combination therapy with podophyllotoxin/cryotherapy was well tolerated and may have resulted in earlier clearance in some patients, compared to cryotherapy alone, however overall differences in clearance rates were not statistically significant.3
Summary: Streptococci of Lancefield Group B (GBS) are known to cause maternal sepsis and neonatal infection, whereas streptococci Lancefield Group A (GAS) cause vulvo-vaginitis in both children and adults. Prevalence of SGB colonization of the lower genital tract of normal women is between 4-18%, with higher rates found in hospital personnel and delivery rooms. Such high carriage rates may be a significant factor in nosocomial transmission of GBS to neonates. Symptomatic infection is uncommon and usually secondary to other pathological states. Amnionitis is a complication of vaginal carriage of GBS and there is now evidence that chorioamnionitis is associated with pre-term labour and its attendant problems. GBS infection of the male genitalia has also been described. Intrapartum chemoprophylaxis has been shown to prevent early onset GBS disease of the neonate. Prevalence of GAS in the genital tract is lower than that for GBS, but is more likely to be symptomatic. The response to penicillin is usually prompt. Optimal drug regimens need to be determined, particularly for use in pregnancy.
We present a 21-year-old woman with a short history of pelvic pain. The history was unremarkable apart from that of undergoing a surgical termination of pregnancy (TOP) some three-and-half years ago. Examination revealed a foreign body at the cervical os. Subsequent investigations revealed more foreign bodies within the cervical canal and uterine cavity, which were removed. Histologically these were found to be bones. Removal of the bone fragment initially discovered lead to an improvement of symptoms. Although the patient was treated for pelvic-inflammatory disease, no infective cause could be established. The condition of intrauterine retained fetal bones is recognized, but rare. Patients experiencing pelvic pain usually present sooner after TOP than did this patient. Although rare, it is an important condition to diagnose as it represents a treatable cause of infertility.
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