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This study evaluated the psychological impact caused by genital warts and whether this altered over time. Eighty-four patients with genital warts and a group of 28 appropriately matched volunteers from the local general population were recruited. The patients were divided into three groups of 28 according to the Health Protection Agency classification codes for genital warts. A comprehensive health questionnaire was completed by all participants. Patients with first attack genital warts experienced significantly more distress, anxiety and depression and were less satisfied with their lives than all the other groups. They also reported less satisfaction with the practical support they received. The recurrent episode genital warts group experienced significantly high levels of emotional distress and the re-registered group reported significantly less emotional and practical support according to their needs. While the first attack genital warts group experienced the most psychological effects, it is clear that those effects did not disappear as an individual came to terms with their diagnosis. The choice of vaccine to prevent cervical cancer will not prevent clinical warts occurring and therefore will not help prevent the psychological morbidity associated with this condition.

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Common warts, particularly plantar warts, are difficult to treat at the best of times and are likely to be even more difficult to treat when the patient is HIV positive. This case report highlights the successful treatment of profuse common warts of both hands and both feet in an HIV-positive patient using imiquimod 5% cream, following unsuccessful regular cryocautery therapy.

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The potential complications of pelvic inflammatory disease (PID) make optimizing its management a high priority. A clinical audit of PID against current national management guidelines was conducted in 14 departments of genitourinary medicine in the West Midlands for women presenting with PID between January and December 2005. There were a total of 810 diagnoses of PID made from a total of 49,390 female attendees for that year, giving an incidence of 164 cases per 10,000 attendees. Of these 810 cases, data collection and analysis for this audit were performed on 139. An ofloxacin 400 mg twice daily (b.i.d.) based regimen was prescribed in 91 (65%, 95% confidence interval [CI] 57-73%) cases. Doxycycline 100 mg b. i. d. for 14 days plus metronidazole 400 mg b. i. d. for 5-14 days was prescribed in 44 (32%, 95% CI 25-40%) cases, but a third-generation cephalosporin was only given with this regimen in three cases. Partner notification was performed in 101 (73%, 95% CI 65-79%) cases. A total of 130 male contacts were recorded on the data collection forms, and of these 58 (45%) were traced and 51 (39%), treated. A follow-up appointment was given to 133 (96%, 95% CI 91-98%) women, although in most cases this was for seven days or more, and 104 (78%, 95% CI 67-81%) women attended for follow-up. Adherence to the national guidelines in this cohort of patients did not reach the national standard for choice of treatment regimen nor did it attain the target for proportion of male partners traced. Barriers preventing adherence to the national guidelines need to be explored and appropriate assistance given to physicians to help meet national standards of care.

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Human papillomaviruses (HPVs) types 6 and 11 are usually associated with benign genital condylomata, but here we describe an extreme case of verrucous carcinoma associated with HPV 6 in a patient too embarrassed to seek early medical advice.

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OBJECTIVE: To determine the prevalence of hepatitis B virus (HBV) infection in heterosexual patients attending two genitourinary medicine (GUM) clinics in the West Midlands and to examine whether heterosexual activity is a risk factor for acquiring HBV infection with the view to extend HBV vaccination policies to cover this group. DESIGN: HBV markers were determined in the GUM study group and compared with that of the control groups. Responses to a questionnaire were used to examine sexual behaviour patterns that may be related to heterosexual acquisition of HBV infection. SETTING: The West Midlands, UK April 1992-January 1993. SUBJECTS: 788 male patients and 688 female patients attending GUM clinics were compared with 498 male blood donors and 563 females attending antenatal clinics for the seroprevalence of HBV markers. Potential risk factors related to heterosexual activity were assessed in 1436 patients in the study group. MAIN OUTCOME MEASURES: Prevalence of HBV markers in the GUM study group and the controls. The possible use of the risk factors examined as predictors for acquiring HBV infection. RESULTS: The seroprevalence of hepatitis B core antibody (anti-HBc) in GUM patients was 1.9% and 0.5% in the control group. In the study groups the prevalence of anti-HBc from Birmingham was 3.2% while that from Coventry was 0.8%. The low seroprevalence of HBV prevented a multiple logistic analysis. A limited regression analysis showed that being non-white (p < 0.001) and duration of sexual activity (p = 0.013) were risk factors for HBV infection. However, these two factors were poor predictors of the risk to exposure to HBV infection. CONCLUSION: The prevalence of HBV infection in heterosexual patients in the West Midlands is very low and does not provide any indications to broaden HBV vaccination into heterosexual patients attending GUM clinics. Risk factors were poor predictors of the exposure to HBV infection. This is partially due to the low prevalence of HBV infection in this study. Further studies are required before definitive conclusions are made regarding the potential predictive value of risk factors.

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OBJECTIVES: To determine the penile, perianal, and oropharyngeal candidal colonisation rates among homosexual and heterosexual males attending an STD clinic. To determine the prevalence of balanitis and candidal balanitis in the two groups. SUBJECTS: 252 heterosexual and 210 homosexual male patients attending consecutively the STD clinic in Coventry, England. DESIGN: A prospective study recording sexual behaviour, relevant history, symptoms, and examination. Specimens for candida culture were collected from the glans penis, perianal area, and oropharynx. RESULTS: Among the 462 men studied, penile, perianal, and oropharyngeal colonisation rates were 74 (16%), 70 (15%), and 116 (25%) respectively. On examination, 47 (10%) were found to have balanitis. Of the 74 patients with penile colonisation, 26 (37%) were symptomatic and 20 (27%) had balanitis. The 223 heterosexual and the 196 homosexual males who had sexual intercourse within 3 months had comparable colonisation rates of candida on the penis, perianal area, and oropharynx. Balanitis was seen in 31 heterosexuals (14%) and candidal balanitis in 16 (7%); the incidence was significantly less in homosexuals where balanitis was seen in 12 (6%) and candidal balanitis in four (2%). CONCLUSIONS: Itching or burning sensations after sex were the most common symptoms associated with penile colonisation with candida and were present in more than one third. Candidal balanitis was commoner in those who had vaginal than those who had anal intercourse within 3 months.

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OBJECTIVE: To assess the relationship between sexual behaviour, urinary symptoms, urinalysis and bacteriuria in men attending STD clinics. DESIGN: A prospective study recording sexual behaviour, urinary symptoms and collecting mid-stream urine specimens. SETTING: Two West Midlands STD clinics, UK. SUBJECTS: 1086 new male patients. RESULTS: 704 patients had had sexual intercourse (SI) within 14 days of testing, 424 had urinary symptoms and 122 had pyuria. All 13 patients with positive culture had SI < 14 days before testing, urinary symptoms and pyuria. No association was found between sexual orientation, type of SI, number of sexual partners, condom usage and bacteriuria. CONCLUSION: Bacteriuria does not behave as an STD but SI may be a factor in acquiring bacteriuria. Dysuria with or without urethral discharge is the most predictive symptom of bacteriuria. Pyuria has a high sensitivity for predicting bacteriuria among males.

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A case of pyogenic granuloma of the prepuce is presented. This to our knowledge, is the first reported case of this condition affecting this site.

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Self sampling of the secretions of the female genital tract for microbiological investigations for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis was assessed in female attenders of the genitourinary medicine clinic in Coventry and Warwickshire Hospital. The purpose of the study was to evaluate the possibility of offering this method of investigation to workers in the sex industry, who are reluctant to attend GUM Clinics. This Pilot Study aimed at assessing the feasibility and acceptability of self sampling of the secretions of the lower genital tract by female patients and its reliability in the detection of sexually transmitted infections. The analysis of the data from 75 participants, indicated that 7 infections were detected on patient sampling as compared to 11 on samples taken by a physician. Self sampling may prove a valuable alternative for the sex industry workers who are reluctant to attend GUM clinics.

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BACKGROUND AND OBJECTIVES: To evaluate and compare the efficacy and adverse effects of trichloracetic acid and cryotherapy (using liquid nitrogen) in the treatment of external genital warts. STUDY DESIGN: Eighty-six patients were enrolled into a randomized clinical trial in the Genitourinary Medicine Department of the Coventry and Warwickshire Hospital (Coventry) between November 1990 and June 1991. External genital warts were treated with either trichloracetic acid or cryotherapy (using liquid nitrogen) on a once weekly basis. They received up to six treatments of either therapy. RESULTS: Complete clearance of warts in patients who received up to six treatments of cryotherapy were observed in 86% of cases and in 70% of patients who received up to six treatments of trichloracetic acid. Thirty percent of patients who were treated with trichloracetic acid developed ulcerations at the site of its application. CONCLUSION: In this study we found that cryotherapy (using liquid nitrogen) is more effective than that of trichloracetic acid for the treatment of external genital warts. It is also less likely to cause ulceration.

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A review of all the patients diagnosed to have Pediculosis pubis (P pubis) during a 2 year period 1989-1991 was carried out. They constituted the index group and were compared with 140 consecutive patients seen during the month of June 1990, who served as controls. Both groups were comparable with respect to age and use of modern contraception. Coexisting sexually transmitted diseases (STDs) were found in 37% of the index group. Incidence of STDs was 51% among the controls. In the preceding 3 months, patients in the index group had significantly more sexual partners p < 0.005. These findings emphasize the need to offer full STD screening and health education to sexually active people who present with P pubis.

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A national survey of the methods used in the diagnosis and treatment of cervical intraepithelial neoplasia (CIN) in the departments of genitourinary medicine (GUM) in the United Kingdom had been conducted through a postal questionnaire. The findings indicate that at present of 157 responders to the questionnaire, 43 (27.3%) take an active part in the management of CIN. The different modes of management and follow-up are presented.

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Eighty-six patients with balanitis/balanoposthitis who presented at the department of genitourinary medicine in Coventry between October 1989 and August 1990 were investigated. While 34 (41%) cases had no specific aetiological factor Candida spp. accounted for 26 cases (30%), and group B beta haemolytic streptococci for 11 cases (13%) (one patient, a diabetic, was culture positive for both Candida spp. and group B beta haemolytic streptococci). The remaining 14 patients had other miscellaneous causes of balanitis/balanoposthitis.

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Prostitution may be seen as an adolescent's cry for help. A review into the background of the problem, the groups and individuals involved and the incidence of sexually transmitted diseases amongst them is presented. Psychological analysis and behavioural trends, especially in relation to attitudes towards sex, sexually transmitted diseases and intravenous drug abuse are examined.

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