Experience of setting up a genitourinary medicine in-reach clinic in a male prison.

Department of Genitourinary Medicine, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, UK.
International Journal of STD & AIDS (Impact Factor: 1). 05/2007; 18(4):228-30. DOI: 10.1258/095646207780658908
Source: PubMed

ABSTRACT A fortnightly in-reach genitourinary (GU) medicine Service to a medium security male prison has been provided since April 2004. Patients are seen either by referrals from the prison general practitioner (GP), or at an individual's request. Problems have arisen due to a lack of space and time - the health adviser and doctor have to share a room. Since the prisoners have to leave Health Care by 1130 hours, if one inmate has complicated issues, it can result in these not being dealt with, or in patients not being seen as there is no flexibility. There has been an unexpectedly high DNA rate, which is multifactorial. Some prisoners have been moved to another prison since the request to be seen was made, some are on court attendances or have legal visits. Additionally some men choose not to come when sent for on the day. A few men who attend do so mistakenly, thinking that GUM is the dentist. This is particularly a problem where English is not the first language. The attendance of prisoners at the GU medicine service is noted in their prison health record, with relevant information, such as referral for management of hepatitis C. Of the 219 men seen in the first year, 55% had a GU medicine screen. The most common infections were chlamydia 10.5%, warts 12.1% and HCV 9%. The clinic has been well supported by patients and prison staff. High rates of infections are being detected and managed. The men have been happy to be screened, and despite initial concerns all are happy to provide urine specimens for chlamydia screening.

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    ABSTRACT: Sexually transmitted diseases (STD) are a public health issue in prison. As inmates are eventually released, it is also a community concern. There are very few data on the entire spectrum of STDs, particularly condyloma among prisoners. To determine the prevalence of all STDs: infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus (HSV), Chlamydia trachomatis, Neisseria gonorrhoea, syphilis, and condyloma among entering inmates. A cross-sectional study was conducted in France from November 2000 to June 2003. Male adults entering a prison remand center in Caen had a medical consultation and physical examination including external genital organs and perianal area for condyloma and herpes infection, a urethral swab for Chlamydia trachomatis and Neisseria gonorrhoea detection, and a blood sample for HBV, HCV, HIV, and syphilis serology. Five hundred and ninety-seven inmates agreed to participate in the study. Sixteen percent had at least one STD: 4.0% had condyloma, 4.0% chlamydia infection, and 4.9% were positive for HCV antibodies. Two had early syphilis and 1 had acute HBV, but no HIV infection, neither genital herpes nor gonorrhea. The analysis of the STD risk behaviors did not show any difference between the infected and uninfected participants, except that HCV-positive participants were more likely to be intravenous drug users. Results suggest that a systematic screening of all STDs should be at least proposed to every entering inmate since no demographic or sexual characteristics are consistently associated with STDs.
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