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In large metropolitan areas, which typically have the highest rates of gonorrhea, the identification of chains of transmission by use of partner notification is problematic, and there is an increasing interest in applying molecular approaches, which would require new discriminatory high-throughput procedures for recognizing clusters of indistinguishable gonococci, procedures that identify local chains of transmission. Sequencing of internal fragments of 2 highly polymorphic loci, from 436 isolates recovered in London during a 3-month period, identified clusters of antibiotic-resistant and antibiotic-susceptible isolates with indistinguishable genotypes, the vast majority of which were also identical or closely related by other methods, and defined groups of individuals who typically had similar demographic characteristics. This discriminatory sequence-based approach produces unambiguous data that easily can be compared via the Internet and appears to be suitable for the identification of linked cases of gonorrhea and the timely identification of transmission of antibiotic-resistant strains, even within large cities.

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Although similar findings have been reported in men who report same sex behaviour, 21 to our knowledge no other population study has focused specifically on sexual problems in bisexual as distinct from homosexual men.We thank Josephine Woolf for her collaboration in obtaining funding; Alice Gladwin, Monique Cloherty, and Üta Drescher for their assistance in collecting the data; and Bob Blizard for his statistical advice on the project. Contributors: See bmj.com Funding: health service research project grant provided by the Wellcome Trust (reference 991026); the North and Central Thames Research Network (NoCTeN) provided service support costs involved with the recruitment at the general practices. Competing interests: None declared. Ethical approval: Two London local research ethical committees approved the study. The need for estimates of the extent of sexual function problems in the general population has become more urgent given recent debates surrounding the identification and definition of "sexual dysfunction," the increased availability of pharmacological interventions, and possible changes in our expectations of what constitutes sexual function and fulfilment. 1 We report results from the national survey of sexual attitudes and lifestyles (Natsal 2000). Participants, methods, and resultsNatsal 2000 was a stratified probability sample survey done between May 1999 and February 2001 of 11 161 men and women aged 16-44 years resident in Britain.2 3 The response rate was 65.4%. A computer assisted self interview asked participants about their sexual lifestyles and attitudes. We asked questions about their experience of sexual problems based on those used in the US national health and social life survey, 4 which measured the main dimensions of sexual dysfunction, as defined in ICD-10 (international classification of diseases, 10th revision). We analysed data in STATA accounting for the sample's stratification, clustering, and weighting. A total of 34.8% of men and 53.8% of women who had at least one heterosexual partner in the previous year reported at least one sexual problem lasting at least one month during this period ( in sex, premature orgasm, and anxiety about performance; and among women, inability to experience orgasm and painful intercourse.Persistent sexual problems-lasting at least six months in the previous year-were less prevalent among men (6.2%) than among women (15.6%). The most common persistent problem among men was premature orgasm and among women, lack of interest in sex.Among people who had sexual problems, 32.5% (95% confidence interval 29.7% to 35.3%) of men and 62.4% (60.4% to 64.3%) of women avoided sex because of their problems. Only 10.5% (8.8% to 12.4%) of men and 21.0% of women (19.3% to 22.7%) with problems in the previous year sought help. People with persistent problems were more likely to have sought help (20.5% (15.8% to 26.3%) of men and 31.9% (28.4% to 35.5%) of women). Among people seeking help, 63.8% (54.6% to 72.1%) of men and 74.3% (70.1% to 78.1%) of women consulted the...

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