[Show abstract][Hide abstract] ABSTRACT: This study aimed to investigate the origin of high-level azithromycin resistance that emerged in isolates of Neisseria gonorrhoeae in England and Wales in 2007, and to establish methods for identifying high-level azithromycin resistance.
The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) data from 2001-07 were examined for emerging trends in azithromycin susceptibility. Further to the identification of six high-level azithromycin-resistant isolates in GRASP 2007, an additional 102 isolates were selected on the basis of azithromycin susceptibility and geographic origin from the GRASP 2006 and 2007 collections. Susceptibility testing by Etest and disc diffusion was performed on all 108 isolates and 75 of these were typed by N. gonorrhoeae multiantigen sequence typing.
A slight drift towards higher MICs of azithromycin was observed in the gonococcal population since 2001. Of greater concern was the first example of a shift to high-level resistance observed in six isolates in 2007. All six isolates were sequence type 649, which was not observed in any of the lower-level azithromycin-resistant isolates from 2007 or in any isolates tested from the same geographical locations. Contact tracing data for one patient suggested a link with Scotland. Disc diffusion testing of all 108 isolates showed that azithromycin, but not erythromycin, discs can differentiate between low-level and high-level resistance.
High-level azithromycin resistance has emerged in England and Wales. Contact tracing and typing data suggest this may have originated from Scotland. Surveillance of azithromycin resistance will be key in controlling its further dissemination.
Preview · Article · Jun 2009 · Journal of Antimicrobial Chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A questionnaire was circulated to all lead genitourinary (GU) medicine physicians in the UK in November 2003 to obtain data on access, waiting times and triaging. Of the 143 responders, 92.3% departments had limited access to some or all GU medicine clinics. Where access was limited, 5.3% had no identifiable process in place to see urgent patients. The mean waiting times in clinics with an open appointment system only for a routine female and male appointment were 2.9 weeks and 2.8 weeks (range 2 days-10 weeks), respectively, and for an urgent appointment, two days (range same day-14 days), for both sexes. The survey has raised concerns that a number of departments did not consider as urgent for prioritizing, patients with documented untreated gonorrhoea, syphilis, or HIV, or contacts of patients with these conditions. This survey has highlighted a need for the national specialist society to provide guidance on prioritizing patients where access is limited.
No preview · Article · May 2006 · International Journal of STD & AIDS
[Show abstract][Hide abstract] ABSTRACT: This audit was conducted to look into the necessity of testing urine threads, in the diagnosis of non-gonococcal urethritis (NGU). In a sample of 280 NGU cases, it was found that in 8.8% of cases there was a risk of the diagnosis being missed, should Gram-stained urethral smears be totally relied on. The study showed that examining urine threads is beneficial in diagnosing NGU, especially, in symptomatic men with negative Gram-stained urethral smears. It should be noted, however, that in the group of patients studied for this audit, urine threads testing did not detect any chlamydia-positive NGU cases.
No preview · Article · Aug 2005 · International Journal of STD & AIDS
[Show abstract][Hide abstract] ABSTRACT: Genital warts are the commonest sexually transmitted viral infection seen in genitourinary medicine clinics. As common as warts are, with extensive previous studies, literature searches on genital warts in transsexuals were unfruitful. Due to the nature and rarity of such a case, it was felt that it would be interesting to detail its management.
No preview · Article · Jun 2005 · International Journal of STD & AIDS
[Show abstract][Hide abstract] ABSTRACT: Ciprofloxacin-resistant Neisseria gonorrhoeae had been rarely detected on Merseyside and when found was associated with beta-lactamase producing strains, imported from abroad. However, in August 2000, two cases of infection with ciprofloxacin-resistant beta-lactamase-negative strains occurred in sexually unrelated patients with no history of foreign travel. Over the next 18 months a total of 120 patients presented with ciprofloxacin-resistant gonococci, from which 99 patient strains were available for study. Gonococcal DNA was subjected to molecular fingerprinting by polymerase chain reaction amplification followed by Taq1 digestion of their opa genes. Twelve differing opa-types were found, but 79 patients were infected with a single genotype, opa-type 1. The sexual histories of the majority of this group indicated acquisition in Merseyside. This endemic strain was further characterized by having the same amino acid substitutions on gyrA and parC genes. An endemic clone of ciprofloxacin-resistant N. gonorrhoeae has been established on Merseyside necessitating the introduction of ceftriaxone as first-line treatment. Despite the presence of 11 other clones in the city, opa type-1 strains have not yet been displaced, raising the possibility that this strain is endowed with added virulence/endemicity traits or that a number of source patients have not yet been found.
No preview · Article · Jul 2003 · International Journal of STD & AIDS
[Show abstract][Hide abstract] ABSTRACT: Objectives: To examine the policy and practice of HIV testing in genitourinary medicine clinics in the United Kingdom. Design: All 176 consultants in charge of genitourinary medicine clinics in the United Kingdom were sent a policy and practice questionnaire. A self selected group of 53 clinics conducted a retrospective case note survey of the first 100 patients seen in each clinic in 1998. Setting: Genitourinary medicine clinics in the United Kingdom. Subjects: Consultants in charge of, and case notes of patients attending, genitourinary medicine clinics. Interventions: None Main outcome measures: Number of patients tested for HIV. Results: Consultants' assessments of their rate of HIV testing often exceeded the actual rates of testing in the clinic as a whole. The majority of patients deemed to be at high risk requested an HIV test. The exception were heterosexuals who had lived in sub-Saharan Africa. Among attenders at high risk of HIV who did not request a test, 57/196 (29%) were not offered one by clinic staff. Two fifths (51/130) of consultants felt the proportion of patients tested in their clinic was too low The commonest reason given for this was a lack of time, especially that of health advisers. Conclusions: A substantial minority of people with HIV infection attending genitourinary medicine clinics fail to have their infection diagnosed. Two major reasons were identified. Firstly, a test was not always offered to those at high risk of HIV. Secondly, a lack of resources, mainly staff, which prevents some clinics from increasing their level of testing.
No preview · Article · Aug 2000 · Sexually Transmitted Infections
[Show abstract][Hide abstract] ABSTRACT: Our objectives are to examine the extent to which genitourinary physicians participate in vulval clinics in thp UK; to determine the geographic distribution of such clinics and to study aspects of clinical practice and staffing of the vulval clinics identified in the survey. In February/March 1998 a questionnaire on vulvar clinics was distributed via regional representatives of the British Co-operative Clinical Group to all the 174 consultants in charge of genitourinary medicine clinics in the UK. One hundred and sixty-four replies were received which identified a total of 61 vulval clinics in the UK. All former health regions had at least one vulval clinic or equivalent. Three former regions had 7 vulval clinics each. Forty-six vulval clinics had a dermatologist; 38 a genitourinary physician, and 30 had a gynaecologist. Only 7 vulval clinics claimed to have a counsellor or health adviser present. Ninety-four per cent took biopsies but only half this proportion met with a pathologist to discuss the histology. Eighty per cent had colposcopes and cameras available but rather fewer actually used them. Twenty-nine per cent had performed research in the past 5 years and 24% had either published or presented this. The majority of vulval clinics would accept direct referrals from all the agencies. This survey has demonstrated an increased number of genitourinary physicians participating in vulval clinics. Other studies have demonstrated the value of such clinics in improving diagnosis and management. It is to be hoped that further such clinics will be set up, particularly in parts of the country which are poorly served at present.
No preview · Article · Apr 1999 · International Journal of STD & AIDS
[Show abstract][Hide abstract] ABSTRACT: Objective: To investigate the provision for sexual health care of adolescents in genitourinary medicine clinics in the United Kingdom. Methods: A questionnaire was sent to all 170 consultants in charge of genitourinary medicine clinics in the United Kingdom. Results: Completed questionnaires were received from 119 consultants in charge of clinics. Eleven per cent of attenders during April-June 1995 were aged under 20 years. Attenders aged under 16 years and from 16-19 years old were found to have significantly higher rates of gonorrhoea than those aged over 19. The same applied to male attenders with chlamydia. Female attenders aged 16-19 had significantly higher rates of anogenital warts than those aged over 19. Thirty six per cent of female cases of gonorrhoea occurred under the age of 20 years. In most clinics (74%) it was policy for a new clinic attender aged under 16 years to see a health adviser. Most clinics (79%) provided emergency contraception, but few (14%) had a full contraception service. Most clinics participated in STD/HIV/sexual health education in the local community, especially in schools (74%) and colleges (70%). Seventy five per cent of health authorities had medical services designated for young people, but only 18% had such services which offered screening for STDs. Only 4% of genitourinary medicine clinics held sessions which were designated for young people (upper age limit 21 years or less). Conclusions: Genitourinary medicine clinics in the United Kingdom provide a range of services, including extensive education in the community, to promote sexual health among adolescents. A critical evaluation of the quality of health education activity by genitourinary medicine clinics would be of interest.
No preview · Article · Dec 1997 · Genitourinary medicine
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy and safety of a 3 day course of 2% clindamycin cream in the treatment of bacterial vaginosis.
A prospective, randomised, double blind, placebo controlled study.
Department of Genitourinary Medicine, Royal Liverpool University Hospital.
55 female patients aged 18 years and over, and premenopausal, who spontaneously or after questioning complained of symptoms of bacterial vaginosis.
55 patients were enrolled. 44 patients were evaluable at Visit 1 when among the 23 who received clindamycin cream bacterial vaginosis was not present in 22 (95.6%) and only one failed treatment. Of the 21 patients in the placebo group only one (4.8%) patient was cured and 20 (95.2%) were failures. Of the 17 patients evaluable at Visit 2 in the clindamycin group, bacterial vaginosis was not present in 14 (82.4%) and had recurred in three. No serious adverse events were noted in either group.
This pilot study provides encouraging evidence of the efficacy and safety of a 3 day course of 2% clindamycin cream in bacterial vaginosis.
Preview · Article · May 1994 · Genitourinary medicine
[Show abstract][Hide abstract] ABSTRACT: To evaluate the outcome of "cold coagulation" as a treatment modality for major grade cervical pathology, cervical intraepithelial neoplasia (CIN 2 and 3) in a department of genitourinary medicine.
Prospective programme trial with 18 month follow-up of patients undergoing "cold coagulation" of the cervical transformation zone following colposcopic assessment and biopsy.
A genitourinary medicine colposcopy clinic.
125 female patients with histologically proven major cervical pathology (CIN 2 and 3). The mean age of the patients was 24.5 years; 73% were unmarried, 43% currently smoked and 62% had a history of exposure to the human papilloma virus.
Eradication of cervical abnormality with cytological findings at 4, 8 and 12 months and colposcopy at 18 months, with intervention colposcopic assessment if follow-up cytology was abnormal.
Eradication of CIN was achieved in 96.5% of patients, the majority of treatment failures being detected at first cytology. Attendance for follow-up was good, with only a 16% default rate. Final colposcopy yielded five treatment failures. No major complications were noted.
These results confirm that "cold coagulation" provides an acceptable, efficient and effective, low cost consumer friendly treatment for CIN 2 and CIN 3 in an out-patient genitourinary medicine colposcopy clinic.
Preview · Article · Mar 1993 · Genitourinary medicine
[Show abstract][Hide abstract] ABSTRACT: To investigate the expansion of colposcopy services within genito-urinary medicine (GUM) in England and Wales since 1985.
Data collected by postal and verbal communication from 189 genito-urinary medicine clinics in England and Wales in January 1990.
Consultant and junior genito-urinary physicians practising colposcopy.
Number of clinics providing colposcopy service; indication for colposcopy, treatment facilities available, waiting lists and training opportunities, compared with that in 1985.
Of the 189 genito-urinary medicine clinics contacted, 60 provided a colposcopy service and 55 of these returned completed questionnaires. There has been a 67% increase in the number of colposcopies in use and over 50% of clinics have the facilities to treat cervical pathology. Waiting lists were minimal for both examination and treatment. Both men and women are examined with the colposcope for a variety of indications. At present, 52% of career grade GUM physicians practise colposcopy compared to 24% in 1985 and 94% of senior registrars compared with 42% in 1985 were in training or trained in colposcopy.
No preview · Article · Mar 1992 · British Journal of Obstetrics and Gynaecology