PTK and PDPT do not reduce re-infection rates in women with chlamydia compared with patient referral. However, PDPT may offer other advantages such as simplicity and cost compared with patient referral.
Objective To determine willingness of health professionals to adopt new interventions for treating sexual partners of women with chlamydia.Design Anonymous, self-administered questionnaires of doctors, practice nurses and community pharmacists regarding novel testing/treatment options for partners of women with chlamydia.Setting Local (Scotland) and national (UK) clinical meetings in reproductive health, and community pharmacy (Lothian).Population Doctors (general practice, gynaecology, family planning) and practice nurses who were delegates at selected meetings in reproductive health and community pharmacists attending pharmacy meetings.Methods Doctors and nurses were invited to complete a questionnaire indicating their preferred strategy for testing/ treating sexual partners of women with chlamydia if given choice of partner notification, postal testing kit (PTK), patient delivered partner medication (PDPM) with azithromycin or combined PDPM and PTK. Community pharmacists were invited to complete a questionnaire regarding their willingness to introduce chlamydia testing and treatment services.Main outcome measures Reported preferences of doctors and nurses for partner testing/treatment strategies and willingness of pharmacists to offer new services.Results Questionnaires were completed by 211 doctors, 73 practice nurses and 50 pharmacists. The most popular choice of doctors (30%) and nurses (23%) was a combination of PDPM with PTK, with partner notification the least popular (8 and 3%, respectively). One in four doctors had previously used PDPM for treating partners. Most pharmacists were willing to supply free PTKs (98%), offer testing (75%) and treatment services (100%) and give women PDPM for partners (80%).Conclusion Relevant health professionals, who are increasingly involved in managing chlamydia, are largely in favour of introducing new strategies for treating sexual partners.
Objective To compare 100 mg mifepristone with the standard Yuzpe regimen for emergency contraception.Design Randomised controlled trial.Setting Family Planning Clinic, Aberdeen.Sample One thousand women seeking emergency contraception within 72 hours after an episode of unprotected sexual intercourse. Methods Women were randomised to receive either 100 mg (half tablet) of mifepristone as a single dose or the Yuzpe regimen (two tablets each with 50 mg ethinyloestradiol and 0.25 mg levonorgestrel, to be repeated 12 hours later). Outcome measures Crude pregnancy rates, proportion of pregnancies prevented, side effects and patient acceptability. Results The crude pregnancy rates (95% CI) for the Yuzpe regimen and mifepristone were 3.6% (2.3 -5.7) and 0.6% (0.2 -1.8), respectively, with a significant difference between the two groups (RR 6.04; 95% CI 1.75 -20.75). Mifepristone prevented 92% of pregnancies and the Yuzpe regimen preventing 56%. An increasing coitus to treatment interval was associated with contraceptive failure in the Yuzpe group ( P ¼ 0.03) with no association seen with mifepristone. Following administration of mifepristone 24.5% and 13.1% given the Yuzpe regimen had a delayed period (RR 2.14; 95% CI 1.46-3.15). Overall, mifepristone was better tolerated than the Yuzpe regimen with significantly fewer side effects. More women were satisfied ( P < 0.0001) with mifepristone as an emergency contraceptive and would recommend it to a friend ( P ¼ 0.02). Conclusion Mifepristone administered in a 100 mg dose is a highly effective post-coital contraceptive with high patient acceptability and fewer side effects compared with the standard Yuzpe regimen. Delay in the onset of menstruation did not decrease patient acceptability.
Objective To determine if tampons lubricated with pH-balanced gel are effective at maintaining normal vaginal pH.Design Randomised controlled trial.Setting Urban family planning clinic and teaching hospital.Population Healthy volunteers using the combined oral contraceptive pill.Methods Women were randomised to use an existing lubricating gel (pH 5.1) or a lactic acid-buffered gel (pH 3.8-4.2) with regular size, non-applicator tampons. In the preceding control cycle, women used identical tampons without gel.Main outcome measures Vaginal pH £ 4.5, microbiology (candida and bacterial vaginosis [BV]) and colposcopic appearance within 72 hours of tampon use, subject acceptability and symptoms.Results Eighty-one out of 98 (83%) women completed the study. No significant difference was observed between tampons with the standard gel formulation, the pH-balanced gel and nonlubricated tampons in terms of vaginal pH, microbiological evidence of candida or BV, or colposcopic appearance. Acceptability scores were significantly higher for lubricated tampons compared with nonlubricated tampons (P < 0.05), although there was no difference in reported symptoms.Conclusions Tampons lubricated with pH-balanced gel do not control vaginal pH. There was no evidence of measurable health benefits of lubricated tampons, but women preferred tampons without lubrication.
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