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1.  Health advisers (contact tracers) in sexually transmitted disease. 
Contact tracing has always been a vital element in the control of sexually transmitted disease (STD), and the early full time contact tracers were more effective than doctors in this work. Those appointed to the early posts had to train themselves and they concentrated on contact tracing. Training has now improved, and most contact tracers in Britain, now called Health Advisers in STD, have attended a full time five day residential training course, and it is hoped that better courses may be developed. A handbook has been produced and widely circulated. The Society of Health Advisers in STD holds regular regional meetings and an annual conference. Health advisers may discover personal problems and have an important role in education, both of which activities are covered in their role specification. Health advisers in STD have developed from contact tracers to undertake a broad range of functions, but the question is asked whether they could contribute to other aspects of health care within the clinic.
PMCID: PMC1046324  PMID: 6547628
3.  Isolation of Chlamydia from women attending a clinic for sexually transmitted disease. 
Cervical swabs for Chlamydia culture were collected from 638 unselected women attending a sexually transmitted diseases clinic with a fresh complaint. Chlamydia were isolated from 76 (12 per cent.) of the women. When the results were related to the patients' diagnoses, Chlamydia were present in 44 per cent. of women with gonorrhoea and in 22 per cent. of women who were contacts of men with nonspecific urethritis (women who may be regarded as having non-specific genital infection). Chlamydia were uncommon in women with no evidence of genital infection. Significant correlations were found between the presence of Chlamydia and cervical erosion, cervical cytological inflammatory change, and absence of symptoms. Isolates were obtained more frequently from women with non-specific genital infection who were primary contacts than from women who were secondary contacts. These findings support the concept that Chlamydia are pathogens in the genital tract and are sexually transmitted.
PMCID: PMC1045169  PMID: 1242683
4.  A method for recognising non-bacterial prostatitis: preliminary observations. 
Chronic non-bacterial prostatitis is a difficult condition to diagnose accurately either by symptoms and signs or by investigations. Four groups of patients were assessed for the number of leucocytes and the presence of pathogens in expressed prostatic secretions before and after treatment with co-trimoxazole two tablets twice daily for three months. The pretreatment findings suggest that the upper limit of normal for the number of leucocytes in expressed prostatic secretions is about five per microscope field (X 40 magnification) and that for the cell count about 0.5 X 10(9)/l using the method described. Increased microscopical cell estimations and cell counts in the expressed prostatic secretions of patients with symptoms of prostatitis and those with recurrent non-specific urethritis seem to indicate the presence of prostatitis.
PMCID: PMC1046214  PMID: 6604558
5.  How infectious is syphilis? 
In a study of the sexual contacts of patients with primary and secondary syphilis, 65 of 127 (51%) contacts at risk developed syphilis. There was no significant difference between figures for homosexuals (48/98, 49%) and for heterosexuals (17/29, 58%). Our findings are similar to those of the prepenicillin era, but the question, Why are so few contacts infected? remains unanswered.
PMCID: PMC1046186  PMID: 6871650
6.  Subpreputial carriage of aerobic micro-organisms and balanitis. 
Men attending a genitourinary medicine clinic had an appreciably higher prevalence of subpreputial infection with group B streptococci (GBS) than with Staphylococcus aureus or coliform bacilli. Carriage of GBS was similar in older and younger age groups and was higher in homosexuals than heterosexuals and in those with balanitis than those without. Thus, while GBS may cause balanitis in heterosexuals, sexual transmission is unimportant; in contrast sexual transmission of GBS may be more common among homosexuals but balanitis is rare.
PMCID: PMC1046156  PMID: 6338999
7.  Cryotherapy versus electrocautery in the treatment of genital warts. 
Forty-two male patients with ano-genital warts were randomly allocated to a single-blind study of cryotherapy versus electrocautery. There was no significant difference in the success rates of these two forms of treatment in patients followed for three months. Cryotherapy was qualitatively much more acceptable to the patients than electrocautery. It seems particularly suited to patients with widely scattered warts who are unable to attend for regular treatment.
PMCID: PMC1045940  PMID: 7272706
12.  Framboesiform lesions in primary herpes simplex infection: a case report. 
A 27 year old homosexual man developed unusual sacral lesions during a disseminated primary herpetic attack, which was confirmed by viral culture and rising antibody titre. The lesions had a striking framboesiform appearance and healed without ulceration or scarring. Review of modern and historical published reports suggests that this may be the first illustrated description of such infection.
PMCID: PMC1046352  PMID: 6237714
13.  Imported penicillinase producing Neisseria gonorrhoeae becomes endemic in London. 
We review all cases of gonorrhoea caused by penicillinase producing Neisseria gonorrhoeae (PPNG) seen between 1976 and 1983 at the sexually transmitted disease (STD) clinic of this hospital, which accounted for 11% of all such cases reported in that period in the United Kingdom. While the overall incidence of gonorrhoea remained relatively stable in this clinic, that of PPNG rose to 4.4% of all such cases by 1982. Until last year, 75% of these cases were imported, mainly from Nigeria and Ghana, but a marked change was seen in the second half of 1982, when 71% of cases were indigenous in origin. Casual partners and prostitutes in London were mentioned as the source of infection by 34% of patients, a much higher percentage than that seen previously. Such sources are notoriously difficult to trace and these figures show a very disturbing trend. Although rectal infection tends to be asymptomatic, PPNG was isolated in rectal cultures from two of five homosexuals and 19 of 26 women. There is therefore a risk that PPNG could spread rapidly through the homosexual population. We suggest that spectinomycin should no longer be the first drug of choice in the treatment of gonorrhoea caused by PPNG but should be replaced by the newer cephalosporins.
PMCID: PMC1046238  PMID: 6416607
14.  Treatment of anogenital warts. Comparison of trichloracetic acid and podophyllin versus podophyllin alone. 
Seventy-three patients with anogenital warts were randomly allocated to a double-blind comparison of treatment with trichloracetic acid (50%) and podophyllin (25%) versus podophyllin (25%) alone. There was no significant difference in the resolution of warts in the two treatment groups among patients followed for three months. Of patients free of warts at six weeks, treatment with trichloracetic acid/podophyllin required significantly fewer applications (mean 2.9) compared with podophyllin alone (mean 4.0). Five (17%) patients in the former group reported side effects but none in the latter group.
PMCID: PMC1046154  PMID: 6338998
15.  Gardnerella vaginalis and anaerobic bacteria in genital disease. 
In a study of Gardnerella vaginalis and anaerobic bacteria in non-specific vaginitis (NSV) and other genital disease 89 patients attending a genital medicine clinic had vaginal samples examined for conventional pathogens and for quantitative analysis of G vaginalis and aerobic and anaerobic bacterial flora. The overall incidence of G vaginalis was 20%; G vaginalis (mean concentration 7.0 log10/g of secretion) occurred predominantly in patients with NSV (57%) but also in sexual contacts of non-specific urethritis (NSU) (37.5%) and in patients with other conditions (11.8%). G vaginalis is therefore a relatively common isolate in patients with vaginal discharge. The concentration of aerobic and anaerobic bacteria ranged from 4.9-11.0 log10/g of secretion with an anaerobe-to-aerobe ratio of 10:1. Anaerobic bacteria, particularly anaerobic Gram-positive cocci (mean concentrations 7.7 log10/g), were present in patients with NSV and in association with G vaginalis, but they also occurred in other clinical groups and with other pathogens, particularly Trichomonas vaginalis. Anaerobic bacteria may therefore play an important role in the pathogenesis of vaginal infections.
PMCID: PMC1046151  PMID: 6600955
16.  Clotrimazole and econazole in the treatment of vaginal candidosis. A single-blind comparison. 
Clotrimazole and econazole used as treatment for vaginal candidosis are both effective when given for three days. In a single-blind controlled study of 110 women followed for 14 days the efficacy of treatment with clotrimazole and econazole for three days was equal. Eighty-six per cent of the group treated with clotrimazole were mycologically clear at 14 days compared with 90% of those treated with econazole. Both treatment regimens were equally acceptable to the patients and no side effects were reported.
PMCID: PMC1046132  PMID: 6337681
17.  Some characteristics of homosexual men. 
Although recognition of homosexuals is often important, many doctors lack the necessary skill or experience, so to assist them a group of 5,302 men was surveyed using a computer-based data system and 9-1 per cent. were recorded as homosexual. Analysis showed a relatively high proportion of homosexuals among men with syphilis and gonorrhoea, and a low proportion among men with nonspecific genital infection (non-specific urethritis and proctitis) and other infections. All men with secondary syphilis were homosexual. A relatively high proportion of men born in Eire, Spain, and North America were homosexual and a relatively high proportion of men living in the West End of London were homosexual. While these findings will be of most value to those working in STD clinics in London they may also be helpful to those working elsewhere and in other disciplines.
PMCID: PMC1045245  PMID: 1276863
18.  Topical acyclovir in the treatment of initial genital herpes. 
In a double-blind randomised placebo-controlled trial of topical acyclovir in initial (first episode) genital herpes 18 patients received acyclovir ointment and 22 matching placebo ointment. Acyclovir significantly reduced the duration of viral shedding from external and all genital lesions, the duration of vesicles, the time to crusting, the time to complete healing of external and all genital lesions, new lesion formation, and the duration of pain, itching, and all symptoms combined for all patients. In female patients alone the time to crusting was not significantly different and the duration of pain only approached significance but the effects were otherwise the same as for all patients. No patients reported any adverse effects of treatment. Topical acyclovir is well tolerated and effective in treating initial genital herpes.
PMCID: PMC1046152  PMID: 6338997
19.  Fluorimetric and microbiological assays of erythromycin concentrations in plasma and vaginal washings. 
Using a microbiological and a fluorimetric assay to determine penetration of erythromycin into vaginal fluids, concentrations were measured in plasma from nine men one hour after a single oral dose of erythromycin stearate 2 g and in vaginal washings and plasma samples taken simultaneously from 11 women two hours after the last dose of a 10-day course of erythromycin stearate (250 mg four times daily). Both assay methods gave accurate and reproducible results in plasma but only the fluorimetric method was capable of measuring concentrations of erythromycin in vaginal washings. The latter method had many advantages in estimating drug concentrations in body fluids such as vaginal washings and the results from it may provide an index of tissue penetration and of patient compliance in adhering to drug regimens.
PMCID: PMC1045938  PMID: 7272705
20.  Cervical cytology in genital infection. 
Papanicolaou-stained cervical smears taken from 203 female patients with either gonorrhoea, trichomoniasis, or candidosis were examined for the degree of inflammatory change. The results from these patients were compared with the results of smears taken from women who had no evidence of sexually-acquired infection after full assessment in the clinic. Gonorrhoea and trichomoniasis were associated with inflammatory changes but these were less marked in patients with candidosis. It is concluded that, before cytological inflammatory changes are attributed to non-specific genital infection, it is important to exclude gonorrhoea, trichomoniasis, and, to a lesser extent, candidosis.
PMCID: PMC1045173  PMID: 1201458
21.  Value of Papanicolaou-stained smears in the diagnosis of trichomoniasis, candidiasis, and cervical herpes simplex virus infection in women. 
In the diagnosis of trichomoniasis Papanicolaou-stained cervical smears gave marginally better results than cultures of vaginal secretion; stained cervical smears and wet films of vaginal material gave similar results. Culture of vaginal secretion on Sabouraud's medium gave the best results in the diagnosis of candidiasis; Papanicolaou-stained smears gave significantly fewer positive results than either cultures or Gram-stained vaginal smears. Papanicolaou-stained smears were reported as positive in only two of five patients with cervical herpes simplex virus infection. It is concluded that Papanicolaou smears are as good as wet films or cultures in the diagnosis of trichomoniasis but cannot be relied on for the diagnosis of candidiasis, or for detecting herpes simplex virus infection.
PMCID: PMC1045125  PMID: 165860
22.  Prostatitis after urethritis in Singapore. 
PMCID: PMC1045066  PMID: 4214582

Results 1-25 (43)