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1.  Study of STD clinic attenders in England and Wales, 1978. 2. Patterns of diagnosis. 
A study of diagnostic patterns in patients attending sexually transmitted disease clinics in England and Wales during 1978 showed that homosexuals contributed 10% of all male cases but 15% of gonococcal infections. In heterosexual and homosexual men only 6% of disease episodes included more than one positive diagnosis compared with 16% in women. One or more diseases occurred concurrently in over 30% of cases of gonorrhoea, trichomoniasis, candidosis, genital herpes, and genital warts in women. Men with multiple episodes of disease contributed a disproportionate number of gonococcal infections but were less likely to have candidosis or genital herpes than patients with only one disease episode. Thus, counting cases treated appears to be an inadequate way of measuring the problems caused by STDS. To enable more rapid identification of the diseases which are the most difficult to control, STD statistics should include the sexual orientation of male patients and differentiate between genuine "new" attenders at clinics and those previously seen.
PMCID: PMC1045950  PMID: 6895342
2.  Current routine statistics in the United Kingdom room for improvement? 
A substantial number of problems are associated with the present notification system on sexually transmitted diseases. Since a comprehensive and uniform system is vitally important to all clinicians in indicating changes in disease incidence and patterns, some modifications are proposed to make the system of more direct clinical relevance.
PMCID: PMC1045880  PMID: 6894259
3.  Practices in STD clinics in England and Wales. A reassessment based on the numbers of cases seen. 
Data previously collected on the facilities and diagnostic criteria used in clinics for sexually transmitted diseases in England and Wales were reanalysed to established how different consultant policies affected the management of individual cases. Several discrepancies were found between conclusions based on percentages of clinics and those based on numbers of cases. Full-time facilities for contact tracing were available to more cases than previously suggested and rectal sampling in women was more widespread. Laboratory facilities were limited and cultural facilities lacking in small clinics, which thus affected only a small number of cases. Previous indications that diagnostic criteria were fairly standardised in the diagnosis of non-specific urethritis were found to be invalid. Variation in the management of individual cases was found to lead to inconsistencies in the notification of STDs to the Department of Health and Social Security.
PMCID: PMC1045928  PMID: 6895045
4.  Study of STD clinic attenders in England and Wales, 1978. 1. Patients versus cases. 
A study was carried out to quantify and describe patients seen in sexually transmitted diseases clinics in England and Wales during 1978. Nine per cent of male patients were homosexual and 58% of female patients were under 25 years compared with only 42% of heterosexual men. Homosexual men had a higher mean number of cases per patient during the year than heterosexual men or women, largely because thay were more likely to have multiple episodes of disease. Female patients also had a higher mean number of cases than heterosexual men, because they often had several concurrent infections. There were 100,000 fewer patients than cases (322,000 compared with 432,000); 41% were seen in clinics in London. These findings show that current statistics for STDs are inadequate. Some quantification and categorisation of patients treated would be useful in analysing the trends in the incidences of the STDs.
PMCID: PMC1045949  PMID: 6895341
5.  Observer variation in the interpretation of Gram-stained urethral smears: implications for the diagnosis of non-specific urethritis. 
A study was carried out to determine whether the diagnosis of non-specific urethritis was affected by differences in the microscopical interpretation of urethral smears between individual observers (interobserver variation) and the same observer on separate occasions (intraobserver variation). A marked degree of both intraobserver and interobserver variation was found which--depending on the diagnostic criteria adopted--could affect both the diagnosis and treatment of many patients attending a clinic of genitourinary medicine.
PMCID: PMC1045889  PMID: 6163500
6.  Consulting patterns after a television programme on sexually transmitted diseases. 
The effect on the work load in one of two clinics featured in a television programme devoted to the sexually transmitted diseases was monitored. The patients' source of referral was recorded before and after the programme and the number of telephone inquiries noted during the same periods. For the two weeks after the programme 18% of the male patients and 13% of the female patients attending the clinic came as a result of watching it. A sexually transmitted disease was diagnosed in 30% and 22% of those men and women respectively. This proportion of positive diagnoses was lower than for other sources of referral. The mean number of telephone inquiries rose by 56% after the programme.
PMCID: PMC1046062  PMID: 6896666
7.  Teaching of genitourinary medicine (venereology) to undergraduate medical students in Britain. 
Twenty-six medical schools in the United Kingdom have recently taken part in a survey on the teaching of genitourinary medicine (venereology) to undergraduates. Four of the schools were unable to run their own formal lecture courses and a further three could not offer clinical attachments. The mean number of lectures given per centre was six, clinic attendances 10 hours, and total teaching time (lectures and clinical attachment combined) 15 hours. This represents a reduction in teaching hours over the last 15 years and contrasts with the ever-increasing clinical problems associated with the sexually transmitted diseases.
PMCID: PMC1045909  PMID: 6894559
8.  Regional variations in the sexually transmitted disease clinic service in England and Wales. 
The provision of the sexually transmitted disease clinic service in the regional health authorities of England and Wales has been compared by relating the opening hours of clinics to the size of the population served. Relatively low levels of service were provided in the West Midlands and South-west Thames regions and high levels in the North-east and North-west Thames regions. When the service in the Greater London area health authorities was examined in relation to both resident and day-time populations, provision was relatively high in both instances, particularly in certain central London areas. Valid conclusions, however, about the equality of the service in different areas can only be drawn if the needs of the population for that service are known.
PMCID: PMC1045873  PMID: 6894101
11.  Morbidity associated with pelvic inflammatory disease. 
To identify the long-term sequelae and morbidity associated with acute pelvic inflammatory disease (PID) patients with acute PID and matched controls were interviewed at five-monthly intervals for about 21 months after entry into the study. In some instances morbidity among the patients was increased, particularly at five months after admission to hospital. Significantly more patients than controls had visited hospital as outpatients, been admitted to hospital and undergone abdominal operations, and had to alter their normal daily routine and take time off work. The cumulative rates for all of these, except for time off work, were significantly higher in the patients than in the controls. Differences between the two groups both at early and later interviews and cumulatively were evident in the incidence of abdominal pain (other than menstrual pain), change in menstruation (longer and more painful), and pain during sexual intercourse, which persisted in one-fifth of patients after the initial acute episode.
PMCID: PMC1046036  PMID: 7082978
12.  Current approaches to the diagnosis, treatment, and reporting of trichomoniasis and candidosis. 
The current approach to the management of trichomoniasis and candidosis in sexually transmitted disease (STD) clinics in England and Wales is described. Microscopy alone was used in the diagnosis of trichomoniasis in 44% of clinics and of candidosis in 35% of clinics. Oral metronidazole was used for the treatment of trichomoniasis in women in 92% of clinics. Vaginal pessaries containing nystatin or clotrimazole were routinely used to treat candidosis in 95% of clinics. Male sexual contacts of female patients with candidosis and trichomoniasis were invited to attend for examination in 88% of clinics. Physicians in 81% of clinics prescribed treatment on epidemiological grounds for male contacts of female patients with trichomoniasis. A more uniform approach to the diagnostic categories used for the quarterly returns for cases treated epidemiologically is recommended.
PMCID: PMC1045582  PMID: 427516
13.  Diagnostic, treatment, and reporting criteria for non-specific genital infection in sexually transmitted disease clinics in England and Wales. 2: Treatment and reporting criteria. 
The current methods of treating and reporting non-specific genital infection (NSGI) are described. The most commonly used drug was tetracycline in one or other form. Epidemiological treatment was widely used, particularly for female sexual contacts. There was considerable variation in the reporting criteria for the quarterly returns. The establishment of acceptable and uniform criteria for notification of NSGI is discussed.
PMCID: PMC1045563  PMID: 581654
14.  Diagnostic, treatment, and reporting criteria for non-specific genital infection in sexually transmitted disease clinics in England and Wales. 1: Diagnosis. 
The current methods of diagnosis for non-specific genital infection (NSGI) in clinics in England and Wales are described. In most clinics (92%) microscopical findings were used by consultants to establish the diagnosis of non-specific urethritis (NSU) in male patients. However, the microscopical criteria that they used in reaching a diagnosis varied between clinics. The most commonly applied criterion was that of less than five leucocytes per high power field. NSGI in female patients and non-specific proctitis in passive homosexuals were recognised as distincy in 60% of clinics and the latter in 57%. Among those who recognised these conditions the diagnostic criteria varied. The establishment of acceptable and uniform criteria for diagnosis are discussed.
PMCID: PMC1045562  PMID: 367527
15.  Current approaches to the diagnosis of herpes genitalis. 
The current methods of diagnosing and treating herpes genitalis in clinics for sexually transmitted diseases in England and Wales are reported. Virus cultures were used as a diagnostic test in some or all patients in nearly two-thirds of clinics. Darkground examinations were performed on all or selected patients in most clinics, but fewer than half the clinics performed them on three or more separate occasions. In over 80% of clinics attempts were made to see some or all contacts of patients with herpes. The treatments prescribed varied, the commonest being saline washes, idoxuridine, and oral antibiotics. Serological tests were repeated after the disappearance of the lesions in 90% of clinics, while in 60% of clinics women with herpes genitalis were advised to have cytological examination at regular intervals in future. The importance of excluding syphilis in patients presenting with genital ulceration, the most appropriate treatments for herpes, and the possible association between the disease and cervical carcinoma are discussed.
PMCID: PMC1046373  PMID: 638718
16.  Diagnostic treatment and reporting criteria for gonorrhoea in sexually transmitted disease clinics in England and Wales. 1: Diagnosis. 
The current methods used in the diagnosis of gonorrhoea are reported. The sites sampled in symptomatic patients who were not gonorrhoea contacts and those sampled in symptomless contacts are described. Urethral specimens were taken routinely from all male heterosexual and active homosexual patients with a urethral discharge but in only 81% and 82% respectively of these patients if they were symptomless gonorrhoea contacts. Not all consultants would repeat investigations (smear and/or cultures) in gonorrhoea contacts if the initial ones were negative; heterosexual male and active homosexual patients were less likely to be seen again. Smears and cultures were performed routinely on women in 97% of clinics, but for men this was so in only 81% of clinics. The wider use of cultures for men, the policy with regard to the taking of urethral specimens from asymptomatic male heterosexual and active homosexual patients who are gonorrhoea contacts, and the number of diagnostic investigations required are discussed.
PMCID: PMC1045463  PMID: 346167
17.  Diagnostic treatment and reporting criteria for gonorrhoea in sexually transmitted disease clinics in England and Wales. 2: treatment and reporting criteria. 
The current methods of treatment and reporting are described. The most common form of treatment for gonorrhoea in men and women was a single dose of oral ampicillin, usually 2 g. In proportionately more of the clinics treating women, treatment was given over several days. The wide use of ampicillin represents a marked change in treatment practice during the last decade. Procaine penicillin was the most commonly used parenteral preparation. The two dosages used most often for men were 1.2 and 2.4 megaunits. In women the commonest regimen was 2.4 megaunits and again there was a tendency for treatment to be given over several days. Epidemiology treatment was used widely and in one-third of clinics this occurred without confirmation that the patient was a true contact. Consultants used varying diagnoses on the quarterly returns for patients treated epidemiologically in whom the smears and/or cultures were negative. Most clinics classified these cases as 'other conditions requiring treatment' (D2) but as many as 19% of clinics designated these cases as being 'true' gonorrhoea. It is suggested that this results in an overestimate of the number of cases of 'real' gonorrhoea treated in England and Wales.
PMCID: PMC1045464  PMID: 638713
18.  Facilities and diagnostic criteria in sexually transmitted disease clinics in England and Wales. 
A study was conducted to collect information from consultants about the facilities and diagnostic criteria used in clinics for sexually transmitted diseases in England and Wales. Most of the information was obtained by personal interview with a response rate of 92%. Half the clinics were open for 10 hours or less a week, the mean length of time for all clinics was 14 1/2 hours a week. Eighty per cent of clinics had a full or part-time contact-tracing service. All the clinics had microscopical and serological services and almost all (99%) had cultural facilities. The policy concerning the most efficient use of these facilities is discussed.
PMCID: PMC1045462  PMID: 580411

Results 1-18 (18)