This retrospective study was undertaken to evaluate the prevalence of the viral types and temporal epidemiology in patients with ano-genital herpes between 1983-92. One thousand one hundred and thirty-five patients with anogenital herpes were available for analysis. The annual incidence of anogenital herpes nearly tripled over the period of 7 years (1986-92) from 59 to 171 cases. The percentage of HSV-1 infection in female cases (63-79%) was much higher than in other reported studies and remained relatively constant over the study period.

Hypopituitarism is uncommon in elderly people. We report 12 cases of hypopituitarism diagnosed after the age of 60 (range 63-89, mean 74.9) years over a 10-year period. Aetiology was evident in eight cases, viz. pituitary tumour in six and previous post-partum haemorrhage and giant aneurysm of carotid artery in one each. The presentation was often non-specific with symptoms such as lethargy, pallor, falls, urinary incontinence, confusion, fever and flexion contractures. Subtle clues to the condition were missed in four cases resulting in delayed diagnosis. Although levels of pituitary trophic hormones are generally low in this condition, the thyrotrophin (TSH) was normal in seven cases in the present series. Normal levels of serum sodium and potassium did not exclude cortisol deficiency. Hormone replacement therapy resulted in improved quality of life. Physicians dealing with elderly patients should bear this easily treated condition in mind.

Prior to 2006, diagnoses of heterosexually acquired syphilis were rare in Teesside (an area in the north east of England, UK). Since 2006, there has been an increase in such cases, with 24 cases diagnosed in 2006 and 22 in 2007. There was a marked reduction in cases in 2008 with six cases reported, but a large increase in diagnoses in 2009 (34 cases). There have been 14 cases to date in 2010. Of concern is the increase noted in women and younger age groups. Geographical mapping of cases shows a wide dispersion across Teesside although some clusters were identified, mostly in areas of high deprivation. Little detailed information is available to help identify social and sexual networks widely and target intervention. A multiagency outbreak control team is addressing this problem, based on the principles of partner notification, increased awareness, increased screening and health promotion activities. A range of measures, including a detailed communications plan, have been implemented.

HighlightsCondylomata lata are a cutaneous manifestation of secondary syphilis and can be misdiagnosed as condylomata acuminata (warts caused by human papillomavirus), anal cancer, chancroid, haemorrhoids, tuberculosis and lymphogranuloma venereum.Condylomata lata are flesh coloured or hypo pigmented, macerated papules or plaques.We present a case of a 49-years-old gentleman who initially presented to primary care with perianal pain and peri-anal skin changes who was referred to the colorectal clinic under the two-weeks rule with suspected anal cancer. The diagnosis was confirmed by biopsy and positive standard tests for syphilis.Once condylomata lata is suspected or diagnosed, refer promptly to sexual health clinic for further investigations, treatment, contact tracing and follow up.Early treatments with intramuscular benzathine benzylpenicillin prevent serious neurological and cardiac complication.

Fluoroquinolones and third generation cephalosporins are the most effective antimicrobial agents for the treatment of gonorrhoea. However, clinically significant resistance to fluoroquinolones in Neisseria gonorrhoeae has been reported worldwide including Britain. The aim of this analysis was to study the factors relating to ciprofloxacin resistance and treatment failure. A total of 201 patients attending the Newcastle Genitourinary Medicine (GUM) clinic from 1995-1997 who were diagnosed with culture positive gonorrhoea was analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) was measured for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant range (>0.05 microg/ml) were reviewed to determine the clinical outcome. The ciprofloxacin resistance with treatment failure was seen in 5% (8/160). All the 8 cases of treatment failure were heterosexual and had isolates resistant to penicillin and 4 cases (50%) were also resistant to tetracycline. All were sensitive to spectinomycin and ceftriaxone. Most of the cases probably acquired their infection from the Far East. As ciprofloxacin resistance seems to be associated with overseas exposure, changes in the standard treatment of gonorrhoea are not justified but consideration should be given to appropriate alternatives when the infection may have arisen from where such resistant strains are endemic. Monitoring fluoroquinolone resistance is now essential for ensuring adequate treatment of infections with resistant strains and for maximizing the time of usage of fluoroquinolones to treat gonorrhoea.

This study aims to detect the prevalence of Chlamydia trachomatis in women attending the colposcopy clinic. The aim of the study is to evaluate whether routine screening for C. trachomatis should be continued as part of the colposcopy examination. All new patients attending the colposcopy clinic were screened for C. trachomatis during the period January 2000--December 2002. Results indicate a chlamydia infection rate of 3.4%. We suggest that routine screening for C. trachomatis needs to be carried out within the colposcopy clinic.

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Result disclosure following routine HIV testing can be challenging. We present an interesting real life scenario regarding a young heterosexual Caucasian male patient, who was diagnosed as having a positive HIV antibody result following a routine HIV screening test, his confirmatory test result was HIV negative. This article covers important lessons learnt from the case.