Genitourinary Medicine Department Research Articles

AN UNEXPECTED CAUSE OF ULCERATION IN THE ORAL CAVITY

<h3>Clinical Presentation</h3> A 38-year-old male patient presented to the local oral and maxillofacial surgery department with a 3-month history of a persistent ulcer on the left lateral border of the tongue. The ulcer had raised edges but was not painful to palpation. The patient was fit and well and a nonsmoker. Clinical photographs and an incisional biopsy were used to investigate the cause. <h3>Histology</h3> Histologic examination showed oral mucosa comprising parakeratinized, stratified squamous epithelium that centrally was ulcerated. A dense chronic inflammatory infiltrate dominated by plasma cells was identified within connective tissue extending into muscle. Numerous neutrophils were noted in the surface layers of the epithelium. The findings of special stains for fungal hyphae were negative; however, the finding of immunohistochemistry for <i>Treponema pallidum</i> was positive, highlighting the spirochete organisms. The lesion was diagnosed as a syphilitic ulcer. <h3>Further Investigations</h3> Following the histologic diagnosis, the patient was referred to the genitourinary medicine department for further investigations, including blood serology and definitive treatment. <h3>Discussion</h3> There has been a recent increase in the number of reported cases of syphilis. Primary presentation of the sexually transmitted disease is in the form a chancre, a solitary ulcer, at the site of infection. Although chancres typically present within the genital region, oral presentation is also possible and is perhaps overlooked as a differential diagnosis of ulceration within the oral cavity. We will discuss the case in detail, focusing on the clinical presentation, differential diagnoses, and treatment rationale.

Maurice William Beaver

Maurice William Beaver was brought up in London and Cornwall during the second world war and was educated at Ilford County High School for Boys. In 1949 he went to...

Point-of-care testing for HIV in an Irish prison setting: results from three major Irish prisons.

HIV is more prevalent in the prison population compared to the general population. Prison inmates are at an increased risk of blood-borne infections. Considerable stigma has been documented amongst inmates with HIV infection. In collaboration with the schools, healthcare facilities, prison authorities and inmate Irish Red Cross groups in Wheatfield, Cloverhill and Mountjoy prisons in Dublin, Ireland, the Department of Genito Urinary Medicine and Infectious Diseases at St James' Hospital in Dublin developed a campaign for raising awareness of HIV, educating inmates about HIV and tackling HIV stigma. Following this campaign, large-scale point-of-care testing for HIV was offered over a short period. In total, 741 inmates were screened for HIV. One inmate tested positive for HIV. We experienced a large number of invalid test results, requiring formal laboratory serum testing, and a small number of false positive results. Large-scale point-of-care testing in the Irish prison setting is acceptable and achievable.

Management of epididymo-orchitis in three different clinical settings: Streamlining pathways and improving care

Objective: This study represents the first direct comparison of management of epididymo-orchitis (EO) by Accident and Emergency (A&amp;E), Urology and Genito-Urinary Medicine (GUM) departments in a large tertiary care centre, and their compliance with international guidelines. Methods: Case notes of patients with EO who attended A&amp;E, Urology and GUM between January and June 2014 were analysed retrospectively. Results: A total of 127 men were seen (median age: 33, range: 15–79). Forty-four attended A&amp;E (median age: 35), 30 Urology (median age: 37), and 53 GUM (median age: 31). MSU was sent in 17/44 (38.6%) of A&amp;E, 11/30(36.7%) of Urology, and 35/53(66%) of GUM patients. Fifty-three of 53 (100%) of GUM, 14/44 (31.8%) of A&amp;E and four of 30 (13.3%) of Urology patients had chlamydia and gonorrhoea NAAT testing. Of these, 90.9% of A&amp;E, 93.3% of Urology and 100% of GUM patients were prescribed antibiotics. Twelve A&amp;E and one Urology patient were referred to GUM. Conversely, only three of 11 A&amp;E and zero of five GUM patients aged over 50 were referred for urological follow-up. Conclusion: The management of EO, especially in younger men at risk of STIs by A&amp;E and Urology, and older men at risk of urological problems by GUM, is an area for significant improvement. Closer co-operation between departments, unifying local management protocols, abandoning the traditional demographic divide, and ensuring effective referral pathways are essential to improving care.

P6.005 Multidisciplinary Approach to Managing a Syphilis Outbreak in Southend-On-Sea, Essex UK

BackgroundIn 2012 the Essex Health Protection Unit of the Health Protection Agency(HPA) was alerted to a significant rise in syphilis in Southend. 27 cases were diagnosed in 2011 and 15...

Testing times: testing patient acceptance and ability to self-screen for a No-Talk Testing service

Genitourinary medicine (GUM) departments need to be resource efficient to manage the increasing numbers of patients seeking to access services. At the Edinburgh GUM department, we wished to develop a new No-Talk Testing (NTT) clinic for asymptomatic, low-risk patients attending for routine sexually transmitted infection (STI) screening. We undertook a questionnaire feasibility study to determine patient acceptability and ability to self-screen for this service. A total of 267 respondents completed questionnaires regarding acceptability of a future NTT service; 227 agreed to comparison of their self-screen with clinician risk-assessment. Overall, patient acceptability for a future NTT service was high, with an average of 7.8/10 awarded for opinion. Seventy-three percent of patients agreed they would consider utilizing such a service in the future. Sixty-one percent of respondents suggested at least one benefit to a future NTT service; principally, prospects for increased speed, efficiency, capacity and reduced waiting times. Comparing STI risk self-assessment with clinician assessment, discrepancies were identified for 37% of individuals. However, a majority (70%) of the discrepancies identified were due to a risk being noted in the self-screen alone, and missed from clinician notes. In summary, the study demonstrated NTT as acceptable and feasible. Based on these results, we have now successfully introduced such a service within our department.

Limitations to the identification of HIV‐associated neurocognitive disorders in clinical practice

The objective of this study was to establish the level of awareness of HAND among healthcare providers, the screening tools that are currently used in its detection and factors that limit cognitive assessments. We distributed a 12-item questionnaire to doctors and nurses who work in the Department of Genitourinary Medicine and Infectious Disease (GUIDE) service and also to doctors who work in the emergency department (ED) at St James Hospital. 35 surveys were collected, 54% (n = 19) from the GUIDE service and 46% (n = 16) from the ED. 82% (n = 29) of participants were doctors from interns to consultants. There was reasonable appreciation among participants with regards the prevalence of neurocognitive impairment (estimated at 29.1% among patients on HAART, and 39.3% among patients not on HAART). Screening tools were rarely used by GUIDE and ED clinicians (25% vs. 15% of the time). The Mini Mental State Examination (MMSE) was previously used by 37% (n = 13) of the group. Very few people had used the HIV Dementia Scale (HIVDS) 6% (n = 2). 34% of respondents felt that 'Orientation in Person, Place and Time was a sufficient screening tool for cognitive assessment'. Lack of time, exposed environment and lack of availability of screening tool were cited as limitations to cognitive screening in the ED environment. This study examines awareness of HAND among healthcare providers and also reasons for inadequate assessment. There is a need for consensus on screening guidelines. A quick, easy to use and readily available screening tool may have a role in the acute setting in identifying high-risk patients.

Editorial introductions

Editorial introductions

P77 Colposcopy of cervical warts

BackgroundBASHH guidelines for the management of genital warts do not recommend colposcopy for women with cervical warts unless there is diagnostic uncertainty or clinical concern. Our local cervical cytology guidelines...

P142 Evaluating the vulval service within our genitourinary (GU) medicine department

BackgroundVulval disorders with their psychosocial and psychosexual impact are frequently encountered within GU clinics. Dedicated specialist clinics should ideally be multidisciplinary with input from dermatology, GU and gynaecology; however this is not always feasible. A need for this service was recognised at our urban clinic—thus in 2005, a monthly vulval dermatoses clinic was set up and led by a GU physician with training in genital skin disease. In 2009 a monthly vulvodynia clinic was set up, staffed by a trained GU physician and psychosexual counsellor.AimsTo review our service provision over a 1-year period.MethodsRetrospective notes review of monthly vulval dermatoses and vulvodynia clinics were performed from November 2010–2011.ResultsThere were 145 vulval clinic appts; patients were only counted once—94 notes were reviewed. Vulval dermatoses clinic (n=40; 20 new, 20 f/u): median age 36 (IQR 29–44); referred by GUM 85%, derm/gynae 10%, GP 5%. Referral symptoms: itching (23), burning (8), dyspareunia (6), vulval pain (5), other (12); median length of symptoms 2 yrs (IQR 1–3). Predominant conditions were: psoriasis 28% (11) and lichen sclerosis 28% (11). Vulvodynia clinic (n=54; 24 new, 30 f/u): median age 28 (IQR 25–32); referred by GUM 67%, GP 26%, gynae/derm 7%. Referral symptoms: superficial dyspareunia (42), vulval pain (11), itching (2); median length of symptoms 2 yrs (IQR 1–5). Diagnosis of vulvodynia made in 74% (40/54). 22/40 were seen for f/u, 73% (16/22) reported at least 50% improvement in their symptoms with treatment.ConclusionOur vulval service meets the needs of a significant number of symptomatic women allowing timely diagnosis, management and f/u. Recognising the multifactorial nature of vulval disorders means patients receive a thorough assessment in one clinic visit with a GU screen, dermatology review and psychosexual input, thus providing a service tailored to the patient.

Cervical cytology screening in HIV-positive women: do samples from genitourinary medicine departments have high inadequacy rates?

Cervical cytology screening in HIV-positive women: do samples from genitourinary medicine departments have high inadequacy rates?

Sexual assault and coincident alcohol use in attendees at a genitourinary medicine clinic in the south of England

To investigate the relationship between alcohol consumption and the experience of sexual assault, either as victim or perpetrator, among genitourinary (GU) medicine department attendees in Portsmouth, UK, we carried out a cross-sectional survey of consecutive patients attending the walk-in service when a researcher was available. Self-completed questionnaires were used and anonymized data were collected from 1186 participants (response rate 34%). Responses showed that 15.6% of female and 3.7% of male participants had ever being sexually assaulted. Women who reported sexual assault drank more on a heavy night out than those who did not report sexual assault (mean 21.3 versus 17.0 units, P = 0.041). Over half of the victims had been drinking prior to the relevant assault. Twenty-seven participants (2.3%) admitted to having sex with a person who was not fully willing. Of these, 59% had been drinking prior to the assault, and the majority believed alcohol had contributed to the assault. Any strategies aiming to reduce the incidence of sexual assault must address hazardous drinking as a high priority.

Cutaneous human papillomavirus-related immune reconstitution-associated disease in human immunodeficiency virus: an under-recognized phenomenon

British Journal of DermatologyVolume 164, Issue 2 p. 458-459 Cutaneous human papillomavirus-related immune reconstitution-associated disease in human immunodeficiency virus: an under-recognized phenomenon Correction(s) for this article Erratum Volume 165Issue 1British Journal of Dermatology pages: 228-228 First Published online: June 24, 2011 R. Meys, R. Meys Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorC. Macedo, C. Macedo Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorR. Jones, R. Jones Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorS. Day, S. Day Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorJ. Weir, J. Weir Department of Histopathology,Charing Cross Hospital,London W6 8RF, U.K.Search for more papers by this authorF.M. Gotch, F.M. Gotch Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorC.B. Bunker, C.B. Bunker Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this author R. Meys, R. Meys Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorC. Macedo, C. Macedo Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorR. Jones, R. Jones Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorS. Day, S. Day Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorJ. Weir, J. Weir Department of Histopathology,Charing Cross Hospital,London W6 8RF, U.K.Search for more papers by this authorF.M. Gotch, F.M. Gotch Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorC.B. Bunker, C.B. Bunker Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this author First published: 29 October 2010 https://doi.org/10.1111/j.1365-2133.2010.10109.xCitations: 5 Christopher Bunker.E-mail: cbb@hamderm.demon.co.uk Funding sources: The Chelsea and Westminster Health Charity, the Westminster Medical School Research Trust and START (the Skin Treatment and Research Trust) generously provided funding that assisted in the generation of this item of correspondence. Conflicts of interest: none declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume164, Issue2February 2011Pages 458-459 RelatedInformation

A review of HIV postexposure prophylaxis provision at a genitourinary medicine department

We undertook a retrospective case-note audit of all patients who presented to the Edinburgh genitourinary (GU) medicine department following a potential exposure to HIV infection during the period 1 January 2006 to 31 December 2008. Over the audit period, 81 individuals attended the department, in relation to 85 exposure events. Twenty-three (27%) exposures had occurred in a health-care occupational setting and 50 (59%) in a sexual context. Baseline HIV testing was only performed in 38 (45%) of the 85 exposures. Postexposure prophylaxis (PEP) was initiated in 65 (76%) cases: 61 (94%) received the first dose within the recommended 72 hours. In 68 (80%) of the 85 exposures, the PEP initiation decision tallied with guideline recommendations. Fifty-six of the 65 individuals started on PEP continued beyond 72 hours; 53 of them were reviewed at least once during the course of PEP and had routine blood monitoring performed. Documentation regarding adherence was poor, with only 31 having this recorded in notes. Thirty-seven (66%) individuals who continued on PEP attended for follow-up HIV testing at three months. In summary, the department performed well in some aspects of PEP provision. However, baseline HIV testing and documentation regarding adherence are unsatisfactory and we suggest recommendations to improve this.

Post-coital bleeding in young women: the role of genitourinary medicine

Recently published Department of Health (DoH) guidelines and National Health Service Cervical Screening Programme guidelines recommend referral to a genitourinary (GU) medicine or sexual health clinic as part of the management pathway for young women with post-coital bleeding (PCB). The objectives of this questionnaire study were to ascertain whether GU medicine practitioners agreed with these recommendations and to assess which skills were considered necessary regarding the diagnosis and management of cervical pathology in departments of GU medicine and sexual health and also, therefore, in training in the specialty. The majority of respondents considered it important to check for cervical infection in determining the cause of PCB, but few GU medicine practitioners now perform colposcopy and many consider themselves insufficiently trained to assess the cervix in more detail. Since the colposcope is the optimal tool for examining the anogenital tract, we suggest that colposcopy, in its broadest sense, should be reconsidered as an essential part of GU medicine training.

Genitourinary medicine at the frontline: postcard from Basra

This is a personal account of a genitourinary medicine (GUM) physician deployed in the field hospital during the Iraq conflict in Basra. Historically sexually transmitted infections (STIs) have posed major threats to military operations as they can have significant impact on the fighting capacity of the soldiers. The GUM department was one of the busiest departments in the field hospital. Most of the STIs seen among the soldiers were acquired in the UK prior to deployment and while away on rest and recuperation leave. The most common infection seen was genital warts.

Prevalence and Immunization Status of Hepatitis B Virus in the HIV Cohort in Fife, Scotland

BackgroundRoutes of transmission of hepatitis B virus (HBV)/HIV infections are similar and there is a significant rate of co-infection in patients. A study was recently carried out in NHS Fife, Scotland from February 2007 - February 2008 to estimate the prevalence of HBV/HIV co-infection, occult HBV infection and immunisation status against HBV in a cohort of patients with HIV attending the departments of infectious diseases and genitourinary medicine.MethodsCase notes were reviewed retrospectively (n = 70). Details on patient demographics, risk category, nadir/current CD4 count, HIV viral load and vaccination history were analysed. HBV markers (HBsAg/anti-HBs/anti-HBc/HBV DNA) and alanine transaminase (ALT) levels were tested prospectively if these tests had not been carried out in the previous 12 months.Results and ConclusionPrevalence of HBV/HIV co-infection was 5.6% of which 2.8% of patients had occult infection and 22.9% had evidence of previous exposure. Although HBV is preventable by vaccination, only 24.2% of patients had been vaccinated against it. Improvements could therefore be made in the field of prevention with vaccination and monitoring the immune response in this cohort.KeywordsPrevalence; Immunization status; Hepatitis B Virus; HIV

A review of cervical cytology in genitourinary medicine clinics in England between 1997 and 2008

The current cervical screening guidelines lay the duty of care of women under 25 years of age on genitourinary (GU) medicine clinics. To date there has not been an extensive review of cervical cytology results sourced from GU medicine departments. We reviewed the annual reports of the cervical screening programme, with their extensive and comparative data, including records of cervical cytology from GU medicine. There is a clear and progressive trend of rising percentages of 'severe dyskaryosis' in laboratory reported GU medicine cervical smears. The trend and observations indicate that GU medicine physicians should take young women's concern on cervical cancer seriously. The programme of opportunistic cervical screening in GU medicine should not be discouraged.

Contraceptive use among women attending an open access genitourinary medicine department

Termination of pregnancy rates among young women are rising in the UK and are associated with poor use of reliable contraceptive methods. Many women attending the genitourinary (GU) department for sexually transmitted infection screening do so because of poor or no condom use and are at ongoing risk of unwanted pregnancy. Few of these women attend a contraception clinic, where a full range of contraceptive methods, including long-acting reversible contraception, are available. In this study of 152 women of reproductive age, half stated that they needed further contraceptive advice. In total four-fifths of the women without a reliable method of contraception wanted contraceptive advice and/or future contraceptive provision in the GU medicine clinic.

Cervical surveillance in HIV-positive women: a genitourinary medicine clinic experience

BackgroundThe prevalence of cervical intraepithelial neoplasia (CIN) is increased in HIV infection. The UK National Health Service Cervical Screening Programme (NHSCSP) guidelines therefore provide specific recommendations for HIV-positive women. An...